AccountId: 011433970860
ContactId: a0a44085-731f-4f7a-8741-0a1d3d5ec877
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 741650 ms
Total Talk Time (AGENT): 189279 ms
Total Talk Time (CUSTOMER): 191471 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/a0a44085-731f-4f7a-8741-0a1d3d5ec877_20250520T15:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from provider's office to check on our claim status. Can you please help me with that?
[AGENT][NEUTRAL] Sure, I can verify claim status for you. And your name is again?
[CUSTOMER][NEUTRAL] [PII], spelled as [PII].
[AGENT][NEUTRAL] OK, and what is the policy number, Turl?
[CUSTOMER][NEUTRAL] So the member ID number is 162-0299.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] OK. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yeah, patient name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, I don't show that patient's name on this policy number, and what's their uh spell the first and last name for me, please?
[CUSTOMER][NEUTRAL] Um, uh, I'm sorry. Uh, I just gave you the wrong member ID. I'm sorry for that, ma'am. So the correct member ID is 01326525.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] So the date of service is uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $600.
[AGENT][NEUTRAL] And what was the balance after primary?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] What was the balance after, oh, this is for dental?
[CUSTOMER][NEUTRAL] Yeah, it's 12.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] The provider office is [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and what was the provider's name again?
[CUSTOMER][NEUTRAL] The provider name is [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Give me one moment I'm trying to pull up the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] I'm gonna have you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I do have the claim number here. Can you please check with that?
[AGENT][NEUTRAL] Sure, what's the claim number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's 359-2288.
[AGENT][NEUTRAL] OK, let's.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. I'm showing that claim process is the policy does not provide benefits for any procedure or service not listed in the schedule of covered dental services and procedures.
[AGENT][NEUTRAL] So it looks like those procedures are not covered per the policy.
[CUSTOMER][NEUTRAL] OK. Uh, and I just, uh,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, is it about the 11206 and 4910?
[AGENT][NEUTRAL] Was for all four of the codes, the 4910, the 1206, the 1330, and the, uh sorry, 4381. Those are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it. 330.
[CUSTOMER][NEUTRAL] And 4381, right?
[AGENT][NEUTRAL] Correct. It's not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Even 419 10.
[AGENT][NEUTRAL] Yes, 4910 is not covered.
[CUSTOMER][NEUTRAL] OK. Got it. One moment.
[CUSTOMER][NEGATIVE] So do you have an EOB that state it was uh tin is not good.
[AGENT][NEUTRAL] Yes, uh, do you have a copy of the EOB? Because you gave me the claim number, so I'm assuming that you have the claim, uh, the EOB. If not, we can send it out to you or we do have an online service center where providers can check claim status as well as print out the EOB.
[CUSTOMER][NEUTRAL] No, we don't have
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure, uh, but, uh, is there a web portal.
[AGENT][NEUTRAL] We do have an online service center where providers can check claim status. That site is at [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you will need your tax ID number and a patient account number assigned to the claim, and from there you'll be able to set up a username and password to where you'll be able to check claim status.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, can you please say the web portal name again? [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, thank you. And what uh can I get that in the
[CUSTOMER][NEUTRAL] Uh, fax. Can you please send that in the fax?
[AGENT][NEUTRAL] Sure, what's the fax number?
[CUSTOMER][NEUTRAL] So that we could
[CUSTOMER][NEUTRAL] Yeah, it is.
[CUSTOMER][NEUTRAL] 949289-9807.
[AGENT][NEUTRAL] OK, that's 4, I'm sorry, 949289-9807.
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] So, uh, can I get the base plan name?
[AGENT][NEUTRAL] It's just group dental.
[CUSTOMER][NEUTRAL] My name is Group Dental. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any alternative benefit available or any criteria have to be met for this treatment to be covered?
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] It's just not covered under the policy. Per the patient's policy with our company, these procedures are not covered.
[CUSTOMER][NEUTRAL] OK, one.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And can I get the claim uh receive it and process it?
[AGENT][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, the claim was received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Sorry to keep you wait, ma'am, one moment.
[CUSTOMER][NEUTRAL] Can I get your name again?
[AGENT][NEUTRAL] Sure, it's [PII] last initial [PII].
[CUSTOMER][NEUTRAL] OK, and can I get the reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name at today's date. And is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, no, uh, that's all on my end.
[AGENT][POSITIVE] OK, well thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yeah, uh, yes, and isn't the
[CUSTOMER][POSITIVE] Uh, you'll be right.
[AGENT][NEUTRAL] Yes, I will fax the EOB.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Mhm. Thank you for calling. Thanks for calling APL. Have a great day. Bye.
[CUSTOMER][NEUTRAL] Please do send us, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah mhm bye.