AccountId: 011433970860
ContactId: 943b65ad-2798-42c1-9fa5-2a9514636622
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 532070 ms
Total Talk Time (AGENT): 213016 ms
Total Talk Time (CUSTOMER): 198099 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/943b65ad-2798-42c1-9fa5-2a9514636622_20250211T20:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm just calling to in regards to a patient, um, an EOB that we got back just trying to figure out um what it exactly means.
[AGENT][NEUTRAL] OK [PII], I can help you with your EOB um first can I get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name?
[CUSTOMER][NEUTRAL] First name is gonna be [PII]. Last name will be [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And [PII]'s policy number please?
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] 277-828-618
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK. You said it was 277-828-618?
[CUSTOMER][NEUTRAL] Um, 828, yeah, 277-828-618.
[AGENT][NEUTRAL] OK, what is the claim number?
[CUSTOMER][NEUTRAL] That is 355-9330.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I'm showing that the claim was paid.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And then there's two benefit uh two benefits uh policy or I'm sorry, procedure number 8 and 24.
[AGENT][NEUTRAL] Um, the benefits were applied towards the deductible.
[CUSTOMER][NEUTRAL] OK, um, let me, let me go back to this data.
[AGENT][NEUTRAL] And I'm doing a different policy number.
[AGENT][NEUTRAL] For that EOB 355-9330, I show it is for [PII] but the policy number is 2584425.
[CUSTOMER][NEUTRAL] OK, that's what I have on this EOB is the policy number.
[CUSTOMER][NEUTRAL] Is that what it should be, uh, when you say policy number, is that like their member ID number as well the same? OK.
[AGENT][NEUTRAL] Yes. Yes, ma'am.
[CUSTOMER][NEUTRAL] Cause
[CUSTOMER][NEUTRAL] OK, um, let me look.
[CUSTOMER][NEUTRAL] I'm totally confused I guess because this is the first time I believe maybe we've submitted to you guys so um how would that would that was that a check that was sent or?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, let me look it up for you.
[CUSTOMER][NEUTRAL] Well, I know it's out of network but they said that we would they would pay the provider. Do you think that the check could have been sent to the patient?
[AGENT][NEUTRAL] Let me look and see if it was.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] No, it was sent to the provider.
[CUSTOMER][POSITIVE] It was it was sent where I'm so sorry.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] It was sent to the provider?
[CUSTOMER][NEUTRAL] To the provider? OK, does it give you an address that it was sent to?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I can get the address for you. Can you provide for me the provider name that you're calling from?
[CUSTOMER][NEUTRAL] Sure, um, that's gonna be um Doctor [PII]
[CUSTOMER][NEUTRAL] Um, if you can't pull that up, I can give you uh NPI. She goes by two different last names, so I'm not sure how this is in your system.
[AGENT][NEUTRAL] Can you give me another name because that's not who it was paid to.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] No, it wasn't paid to them either.
[CUSTOMER][NEUTRAL] Doctor [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, yes, OK, he's the owner of our practice, he's not the treating dentist, um, so that's probably I could see, OK.
[AGENT][NEUTRAL] Let me look up.
[CUSTOMER][NEUTRAL] Yeah, I think I need this because he has, we have two other practices so it could have been mailed to one of those. I don't know if you're able to see that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm trying to find it now, find the check number, no, you're fine. I'm trying to find the check number for the claim.
[CUSTOMER][NEUTRAL] OK, oh, I'm sorry, I just.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 355-9330.
[AGENT][NEGATIVE] Why can't I see the check number? Hmm, that doesn't make sense to me.
[CUSTOMER][NEUTRAL] Because there was like a on the EOB um I can if there's like a remark description so I don't know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me look in the remarks and see.
[CUSTOMER][NEUTRAL] OK, I didn't know if that it kind of was confusing because I don't think we got a payment with it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Showing that $303.80 was paid.
[AGENT][NEUTRAL] But I don't see the check number which means that we're probably gonna have to go to the claims department.
[AGENT][NEGATIVE] And have them pull the check number up because it's not pulling up for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I can read the remarks and tell you what the remarks mean.
[CUSTOMER][POSITIVE] OK, that'd be great.
[AGENT][NEUTRAL] OK, so when this claim was sent in we're waiting for eligibility.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] For the insured.
[AGENT][NEUTRAL] Since the claim was sent in every day they check to make sure these patients are eligible through benefits in the card since the claim had been sent in, they had checked and the uh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Patient ended up being eligible and they processed the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it's not giving me the data process, which means that it's probably just been recently processed and they don't have the um.
[AGENT][NEUTRAL] Yeah, it looks like it's being processed now. That's why I can't find the check number.
[CUSTOMER][NEUTRAL] OK, so it's just being processed it hasn't been like actually mailed out yet, OK.
[AGENT][NEUTRAL] Right, it'll probably need to go um finish its processing overnight. If you wanna call back tomorrow we can give you a check number and verify the address but the um provider that it's being paid to looks like.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, yeah, that's probably how they sent the claim or I know his name's on the claim form, and that is pro that's how we process like our checks and stuff, so as long as it comes to um that that [PII] address um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because that that's our specific practice that um the patient was seen at then I I think that it should be OK, but I can definitely call back is there a um should I call like the claims department number or?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, the number that you called is the correct number to call. We should be able to put it up tomorrow like I said, let it process overnight and we should be able to pull it up tomorrow and give the check number and verify the address with you.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so at the time that they received the claim they were still like they confirmed like you said they make sure the patient's still eligible and so they were just waiting to process that. OK perfect well that makes sense um if I could just have a reference number for our call today.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII] in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Today's date. Alright, thank you for your help, [PII] that makes that is so helpful and I'll just give a call back.
[AGENT][POSITIVE] OK, you have a great day and thanks so much for calling APL.
[CUSTOMER][POSITIVE] You too take care bye bye.
[AGENT][NEUTRAL] You too. Bye-bye.