AccountId: 011433970860
ContactId: 9823ef9e-586f-4dc2-b8f5-8df4a56d0530
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354040 ms
Total Talk Time (AGENT): 130074 ms
Total Talk Time (CUSTOMER): 168956 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/9823ef9e-586f-4dc2-b8f5-8df4a56d0530_20250529T20:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am calling from Grand Family Dentistry about one of our patients' claims, and I, I had a question about the frequency limitation and, uh, um, a possibility of a resubmitting this claim. Is that something you might be able to help me with?
[AGENT][NEUTRAL] OK, let's take a look. Um, do you have [PII] in their policy number?
[CUSTOMER][NEUTRAL] I do, yes, um, uh, the ID I have is 00614247.
[AGENT][NEUTRAL] Thank you. And then if I can get the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, uh, [PII], date of birth is [PII].
[AGENT][NEUTRAL] Perfect and then what is the date of service that we're looking at?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then do we have a build amount?
[CUSTOMER][NEUTRAL] We do $331.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright and then [PII], do you have a good call back number just in case anything happens on the call just for documentation?
[CUSTOMER][NEUTRAL] Yeah it's gonna be [PII] no extension.
[AGENT][POSITIVE] Thank you. OK.
[AGENT][NEUTRAL] All right, so I've got this pulled up and it looks like.
[AGENT][NEUTRAL] A benefit payment was made. It looks like a portion of it, the benefits were applied towards the deductible.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] And then it looks like one of the denials stated policy does not provide benefits for any procedure or service not listed in the schedule.
[CUSTOMER][NEUTRAL] So for that one I think it was for that um a D 0210.
[CUSTOMER][NEUTRAL] If uh we were to is there a way that we could resubmit this for like bite wings and PAs instead of the intraoral?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, it looks like it, the procedure code, yeah, I see on our side for that one was I think 1206.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, that one I'm showing that 1206 was for the fluoride. um I was looking at 0210.
[AGENT][NEUTRAL] So that one shows it was applied towards the deductible.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] What was this guy talking about then let's see.
[CUSTOMER][POSITIVE] I love when they think they know everything um.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] No, it's totally fine. I was going back and forth because making sure I'm reading the right line, but yeah, so.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Because it's showing that on I guess the the EOB we got the full mouth X-ray series was showing that um a deductible 45 would apply and then patient responsibility is still 125.
[AGENT][NEUTRAL] Uh, so.
[CUSTOMER][NEUTRAL] So I'm guess I'm wondering if we had submitted this as like bite wings and PAs if it would have uh.
[CUSTOMER][NEUTRAL] Paid out on that.
[CUSTOMER][NEUTRAL] Still like minus the deductible but.
[CUSTOMER][NEUTRAL] Um, uh, if there's a way that we could resubmit it as that instead to get more payment from it because the patient is refusing to pay.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I mean, you guys can definitely resubmit, um, a corrected claim. I mean there's no time.
[CUSTOMER][NEUTRAL] Is that going to mess up like um uh if uh we'd already like filed that he had like the full mouth uh do we need, is there a way to like undo that so it doesn't like say that he got um a full mouth X-ray series it's only if all we did was like bite wings and 2 PAs. What I don't want that to affect his future frequencies if uh we're resubmitting something, uh.
[CUSTOMER][NEUTRAL] And I don't wanna, I don't wanna double things up, you know what I'm saying.
[AGENT][NEUTRAL] Right. I mean, it would definitely show as far, so it wouldn't mess with this particular claim itself in in any way, shape or form, um, you know, it may come back as a duplicate and just be denied straight out. Um, if it was approved under the different procedure code, I mean, it definitely would show as far as frequencies go and then if in the future any other provider called to ask us on frequency, we would advise on that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you, mm there's no way to.
[CUSTOMER][NEUTRAL] Unsubmit that claim now that we've sent it through already for the [PII].
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, no, I mean that makes sense, um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] trying to figure out all my options here before I call the station back um.
[AGENT][NEUTRAL] No, it's OK.
[CUSTOMER][NEUTRAL] Yeah, let me see what else, um, uh, OK, let me, uh, talk to, uh, Senatorgenistson and see how she'd like to move forward. [PII], is there a reference number for this call?
[AGENT][NEUTRAL] Yeah, absolutely. So call reference is my name with today's date. Uh so my name again is [PII] and then my last initial to my name is [PII].
[CUSTOMER][POSITIVE] Oh perfect.
[CUSTOMER][POSITIVE] Perfect alright well thank you so much for your help I appreciate it.
[AGENT][POSITIVE] You're welcome. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.