AccountId: 011433970860
ContactId: 944e7204-1a73-44de-9016-1e94a8fb895f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 481790 ms
Total Talk Time (AGENT): 138791 ms
Total Talk Time (CUSTOMER): 150047 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/944e7204-1a73-44de-9016-1e94a8fb895f_20250512T14:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, I'm [PII].
[CUSTOMER][NEUTRAL] Yeah, hi, I'm [PII] calling the provider service for checking claim status. And for your kind information, this call may be recorded for training and quality purposes. Could you please once again repeat your name?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII], first initial last name is [PII], and if I can get you to spell your first name for me, please?
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] Sure, sure. It's [PII].
[AGENT][NEUTRAL] OK, and [PII], you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Can you give me the policy number?
[CUSTOMER][NEUTRAL] Sure. The ID number is 013.
[CUSTOMER][NEUTRAL] 26525
[AGENT][NEUTRAL] And a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] How much
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and what's the date of service and the total charge?
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Uh, the service of the patient is uh [PII], and the bill amount is
[CUSTOMER][NEUTRAL] $600 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 917
[CUSTOMER][NEUTRAL] 45
[CUSTOMER][NEUTRAL] 9848.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] At the
[CUSTOMER][NEUTRAL] 96191.
[AGENT][NEUTRAL] All right, let's see. This is a medical claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh no, dental.
[AGENT][NEUTRAL] A dental claim, OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], what's the name of the dental office?
[CUSTOMER][NEUTRAL] Uh, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] It's a reunion smiled dentistry.
[CUSTOMER][NEUTRAL] um.
[AGENT][NEUTRAL] And what's the dentist's name?
[CUSTOMER][NEUTRAL] Then this is [PII].
[AGENT][NEUTRAL] OK, what are those procedure codes on your claim?
[CUSTOMER][NEUTRAL] So I'm checking for the CDTs for uh it's for 4910 and 1206 for fluoride and uh period maintenance.
[AGENT][NEUTRAL] So you gave me 049 10, and did you say 01330?
[CUSTOMER][NEUTRAL] Uh, no, no. For 4910 and 1206.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh yeah, only for these two codes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, claim received [PII], processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for those codes.
[AGENT][NEUTRAL] Uh, the remark code sides that this policy does not provide benefits for any procedure or service that's not listed on the schedule, so these particular codes are not covered by the patient's policy.
[CUSTOMER][POSITIVE] Yeah, you are right.
[AGENT][NEUTRAL] No payment was made and let me know when you're ready for the claim number.
[CUSTOMER][POSITIVE] Yeah, one second, it's right.
[CUSTOMER][NEUTRAL] Please confirm me the, the patient's plan name.
[AGENT][NEUTRAL] It's just a dental plan.
[CUSTOMER][NEUTRAL] OK. And yeah, what's the claim number?
[AGENT][NEUTRAL] That number is 359-228-8 and did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] Uh, could you please confirm me the, uh, patients started responsibility?
[AGENT][NEUTRAL] We do, well, the the claim is denied it's not covered, and then of course we do not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please confirm me the claim received date?
[AGENT][NEUTRAL] [PII] process [PII].
[CUSTOMER][NEUTRAL] And would you please send me an year before this claim?
[AGENT][NEUTRAL] It's it was actually mailed to the address on your claim, so you can now download it online. It was mailed out to see it processed on the [PII], so the EOB was mailed out the next business day and it's now available to download on our online web center and let me know when you're ready and I can give you that address to create an account.
[CUSTOMER][NEUTRAL] Actually, uh, we have checked that, but we didn't receive any UB, so do you have any option to send through fax?
[AGENT][NEUTRAL] OK, so let's verify why you're not able to see it if you don't mind logging on to the online service center, let's verify that the information that you're using to create the account matches what we have in our system.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because I'm looking at the ELB so it is available.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. No, so do you, uh, you don't have any option to send through fax?
[AGENT][NEUTRAL] We do but you stated that you tried to download it but you were not able to so I wanna verify what the the problem is as to why you cannot, so if you don't mind logging on to.
[CUSTOMER][NEUTRAL] Actually, we have some uh
[CUSTOMER][NEUTRAL] Uh, we have some system issue that's why.
[AGENT][NEUTRAL] OK, and your fax number?
[CUSTOMER][NEUTRAL] So, can I please send to, sure, it's [PII].
[AGENT][NEUTRAL] OK, anything else I can help out with today?
[CUSTOMER][NEUTRAL] And finally, could you please confirm your call reference number?
[AGENT][NEUTRAL] My name and today's date?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, right. So then you're gonna assist me for this claim and thank you for your time and have a great wonderful day.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] Have a good day, bye.