AccountId: 011433970860
ContactId: 91b95e85-47b8-4ea3-aa9f-306ba3f5bf37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 908500 ms
Total Talk Time (AGENT): 132603 ms
Total Talk Time (CUSTOMER): 165639 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/91b95e85-47b8-4ea3-aa9f-306ba3f5bf37_20250310T15:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. This is [PII] calling from I Smile Dental Clinic. I just want to check if the patient's plan is active, and I also have here another question to ask regarding his PD. Can you help me with that?
[AGENT][NEUTRAL] Yeah, I can check eligibility. What's the patient's policy number, JD?
[CUSTOMER][NEUTRAL] Sure. That would be 2259801.
[AGENT][NEUTRAL] All right, let me pull this up one moment.
[AGENT][NEUTRAL] Patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure. For [PII], date of birth would be [PII].
[AGENT][POSITIVE] All right, thank you so much. So the patient plan is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Thank you for that and yeah I just have your one last question to ask regarding his prey regarding the payment.
[AGENT][NEUTRAL] OK, what questions did you have in regards to payment?
[CUSTOMER][NEUTRAL] Yeah, because we already have here the copy of the EOB and it shows here that for the four line items for code D4341, that's for SRP the previous rep told me that the insurance will pay $128.40 for SRP. I just want to double check if is this per line item or for all the codes for SRP?
[AGENT][NEUTRAL] Do you have a specific claim that you need me to check?
[CUSTOMER][NEUTRAL] Yes, that's correct. I have here, let me just check the claim number.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] Sure. That would be 357-1338.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I do see this claim and let me see here.
[AGENT][NEUTRAL] 4341.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Insured?
[CUSTOMER][NEUTRAL] Because the previous rep already gave me the paid amount, but I just want to double check if that is per line item or for the whole pretty for SRP.
[AGENT][NEUTRAL] Yeah, I mean based off of the fax back I'm not showing a dollar amount. It falls under Pao expenses, so it's paid at 40% of UCR.
[CUSTOMER][NEUTRAL] Yes, because the previous rep gave me that the night guard is paid for $180 and then for SRP it's paid for $12.40.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I just want to make sure if is this per line item because we have here 4 line items for SRP or this is the total paid amount for all these SRPs.
[AGENT][NEUTRAL] It should be per line item, per procedure code.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] If this one is going to be paid $428.40 so that should be a total of $513.06 for all this SRP.
[AGENT][NEUTRAL] The claim number 35.
[CUSTOMER][NEUTRAL] If you can just please double check.
[AGENT][NEGATIVE] The 357-1338. I'm not even showing a payment on.
[CUSTOMER][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] Yes, because that's what the previous rep also told me that the payment is not showing on the EOB, so she just gave me the payment amount.
[AGENT][NEUTRAL] I can't know that.
[AGENT][NEUTRAL] The date of service was [PII].
[CUSTOMER][NEUTRAL] This is just a pre-estimate, so the service has not been rendered yet.
[AGENT][NEUTRAL] Let me pull it up and see exactly.
[AGENT][NEUTRAL] Give me just one moment please, JD.
[CUSTOMER][NEUTRAL] I'm sure.
[AGENT][NEUTRAL] I'm not seeing where that.
[AGENT][NEUTRAL] The 12,840, like I see the pre-treat that was sent through, but I'm not seeing.
[AGENT][NEUTRAL] Oh where that amount's coming from.
[AGENT][NEUTRAL] So ultimately, JD you just need to know if it's per line item or for the entire treatment, correct?
[CUSTOMER][NEUTRAL] Yes, that $128.40. If it is per line item or for all the SRPs.
[AGENT][NEUTRAL] OK. I'll double check on that. I'm gonna place you on a brief hold. One moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for your patience and waiting on that JD. So I was able to confirm that it would be per line, so it would be 12,840 for each procedure code. So the total would be that uh 51,360 if it's paying based off of 40%.
[CUSTOMER][NEUTRAL] Thank you for that. So yeah, I think that's it for me today. So that's per line item and patient plan is active today. And if I can just get a reference number, please?
[AGENT][NEUTRAL] That would be my name with my last initial in today's date. My name again is [PII], which is [PII] [PII].
[CUSTOMER][NEUTRAL] And day to day, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] Thank you for that. So thank you so much for your help, [PII]. Have a great day and bye for now.
[AGENT][NEUTRAL] Bye bye.