AccountId: 011433970860
ContactId: 9c5db2c6-85b4-4198-88ed-cf55a0d28bda
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409200 ms
Total Talk Time (AGENT): 126769 ms
Total Talk Time (CUSTOMER): 151610 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/9c5db2c6-85b4-4198-88ed-cf55a0d28bda_20250425T14:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, sir. My name is [PII] and I'm from Providence's office, checking on the claim status.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim for you today. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] So that's going to be 2,103,620.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull this up here one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yeah, so.
[CUSTOMER][NEUTRAL] And that's going to be.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you and may I please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] That's [PII], date of [PII].
[AGENT][NEUTRAL] Thank you. And are we looking for dental or medical coverage?
[CUSTOMER][NEUTRAL] Uh, it's uh dental coverage.
[AGENT][NEUTRAL] So, patient is active. Effective date is [PII].
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] Still active?
[AGENT][NEUTRAL] Patient is still active, yes.
[CUSTOMER][NEUTRAL] Uh, should I see the date of service?
[AGENT][NEUTRAL] Uh, what was the date of service?
[CUSTOMER][NEUTRAL] That's [PII] for the total charge amount $512.41.
[AGENT][NEUTRAL] $520.41.
[CUSTOMER][NEUTRAL] Go right.
[CUSTOMER][NEUTRAL] $512.41 sir. 512.41.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you for your patience on that, [PII]. So it looks like we did receive a claim for the state of service on [PII]. Claim was processed on [PII]. There was a benefit payment sent in the amount of $377.51.
[CUSTOMER][NEUTRAL] Uh, is there any?
[AGENT][NEUTRAL] I'm not showing any denials on the claim, no.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So the claim got paid, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I have a loan amount?
[AGENT][NEUTRAL] The benefit payment was 37751.
[CUSTOMER][NEUTRAL] But the total, OK, 377.
[CUSTOMER][NEUTRAL] What is the uh is that the allowed and paid or same?
[AGENT][NEUTRAL] So it looks like a portion of it was applied towards the deductible, and that was the max benefit payable for the date of service.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What is the deductible amount?
[AGENT][NEUTRAL] The patient's deductible is $50 for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, do you have the payment details like EFT or check?
[AGENT][NEUTRAL] It was a single check. Check number is 2,037,140.
[AGENT][POSITIVE] The check still shows outstanding.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And do you have any reason for still it's outstanding?
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][POSITIVE] A reason for still outstanding.
[AGENT][POSITIVE] Yes, it's still outstanding.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, I have a still one doubt, uh, actually, uh, I just need the allowed amount and the paid amount. Is it the allowed amount and the paid amount the same?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's 377 51, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And there is a deductible amount that is $50.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And there is no patient responsibility coinsurance copy, right?
[AGENT][NEUTRAL] We're not able to advise on the patient responsibility. Uh, there is no co-pay or co-insurance on it, no.
[CUSTOMER][NEUTRAL] And it's a single check. And can I have a claim number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 358-528-2.
[CUSTOMER][POSITIVE] I can help you
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] 358-5282. Do you have the check issue date with you?
[AGENT][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] A check again was issued on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] And it's still outstanding.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have a good call reference number, sir?
[AGENT][NEUTRAL] Call reference is my name with my last initials and today's date. My name again is [PII], that's [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Last initial is [PII], and today's date.
[CUSTOMER][NEUTRAL] And you.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][POSITIVE] Thank you so much, sir. I appreciate that. Have a wonderful day. Stay safe. Take care and bye for now.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] I