AccountId: 011433970860
ContactId: a22003b3-84f6-4ce9-81d0-32f8658c4d1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 721590 ms
Total Talk Time (AGENT): 249880 ms
Total Talk Time (CUSTOMER): 186237 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/a22003b3-84f6-4ce9-81d0-32f8658c4d1d_20250430T15:30_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on behalf of the private office to check on the claim status of the patient. How are you doing today?
[AGENT][POSITIVE] I'm doing well [PII] how are you?
[CUSTOMER][POSITIVE] I'm doing great too. Thank you so much for asking.
[AGENT][POSITIVE] That's good and I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, in total I have only 2.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, the callback number that will be [PII].
[CUSTOMER][NEUTRAL] And the policy number whenever you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] 01979122.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] Thank you. Can you verify?
[CUSTOMER][NEUTRAL] Just to let you know, it's uh same, oh sure, sure, go ahead.
[AGENT][NEUTRAL] No, no, you can finish.
[CUSTOMER][NEUTRAL] Uh, just wanna let you know that it's uh same member for two claims.
[AGENT][NEUTRAL] Alrighty, and I have the um policy here. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] That'll be [PII]. The is on [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the um dates of service and the total bill for both claims?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure. It's on the same date, [PII]. The first charge amount is $870.
[CUSTOMER][NEUTRAL] Event and the other charge amount, $687 event. Same date of service.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, and [PII], is it OK if I place you on just a brief hold while I locate the claims?
[CUSTOMER][NEUTRAL] That's fine. That's fine, take your time.
[AGENT][NEUTRAL] All right. Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, so I see 356-073-1.
[AGENT][NEUTRAL] 60728. Is there any more?
[AGENT][NEUTRAL] So these are probably.
[AGENT][NEUTRAL] Both of the ones that he's looking for so let's see.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, I do. Uh, yes, [PII].
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So both of the claims were received on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they were both processed on [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For the $870 claim, um, that claim number is 356-0731.
[AGENT][NEUTRAL] And we paid out on that claim a total of $557.80.
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, could you repeat the amount paid again?
[AGENT][NEUTRAL] Yes, $557.80.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All calls were paid with the exception of 00274, which was bite wings and it's limited to one procedure per 12 months, so it just hasn't been that 12 months yet.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So, when was the last date of service that was not this school?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] Good time.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Is it done with the provider's name, [PII]?
[AGENT][NEUTRAL] Um, hold on one moment, let me locate that claim.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What's the name of the provider?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, that means the same provider. OK. And for the, that amount paid, I may, can I have the issue date?
[AGENT][NEUTRAL] Hold on one moment, let me go back to that claim.
[CUSTOMER][POSITIVE] Sure, sure, sure. Sure, sure. Any time.
[AGENT][NEUTRAL] The process date for both is [PII]. That's also the issue date. Did you need the check information?
[CUSTOMER][NEUTRAL] Uh yes. Is it a book check or a single check?
[AGENT][NEUTRAL] Um, these are both single checks. Um, let me get that check number. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] OK, so the check was issued on [PII].
[AGENT][NEUTRAL] Check number 202.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] 6569.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And it cleared on [PII].
[CUSTOMER][NEUTRAL] So are these? And may I know the check was sent to which address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Bear with me a moment.
[CUSTOMER][NEUTRAL] OK, 662 medium it is OK.
[CUSTOMER][POSITIVE] All the course, uh, paid, uh, with this one.
[AGENT][NEUTRAL] Except for the bite wing code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] And the rest are paid. Uh, could you help me with the patient responsibility?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The patient responsibility.
[AGENT][NEUTRAL] Um, hold on one moment, let me pull up the explanation of benefits.
[CUSTOMER][NEUTRAL] Uh, is there any patient responsibility?
[AGENT][NEUTRAL] So I'm just waiting for the explanation of benefits to populate. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure, sure, sure.
[AGENT][NEUTRAL] So what's the difference? If the total bill, hold on one moment.
[CUSTOMER][POSITIVE] It's nice.
[AGENT][NEUTRAL] The remaining balance is $312.20.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. And how about for the other one?
[AGENT][NEUTRAL] Alright, hold on one moment let me go back to that.
[CUSTOMER][NEUTRAL] Sure. 252-614-75. And
[AGENT][NEUTRAL] Alright, so that policy number for the $687 is 356.
[AGENT][NEUTRAL] 0728.
[AGENT][NEUTRAL] And we paid out on that claim a total of $70.80.
[CUSTOMER][NEUTRAL] OK. Right.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] Um, that was applied to
[CUSTOMER][NEUTRAL] Take number?
[AGENT][NEUTRAL] The check number is 2,026,570.
[CUSTOMER][NEUTRAL] 831 is that?
[AGENT][NEUTRAL] Did you need the checking information for this as well?
[CUSTOMER][NEUTRAL] with the same address, right? Same address and check cash on.
[AGENT][NEUTRAL] Yes, the same, yes, same, same um address and it was cleared on the same day, [PII].
[CUSTOMER][NEUTRAL] OK. All the codes are paid in here or is there any service codes that are not paid?
[AGENT][NEUTRAL] Hold on, let me go back to that.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Specially for the 4th, 9, 10th.
[AGENT][NEUTRAL] So the $70.80 was applied to 4910?
[AGENT][NEUTRAL] The other codes were denied. Let me see why. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy does not provide benefits for any procedure or service not listed in the schedule. So the other three codes are not covered by the patient's policy.
[CUSTOMER][NEUTRAL] OK, can I have the patient responsibility?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] So the total bill is $687. We applied $70.80. The difference is $616.20.
[CUSTOMER][NEUTRAL] Um, could you fax me the copy of you for those, this, uh, all this information?
[AGENT][NEUTRAL] And what's a good fax number for you?
[CUSTOMER][NEUTRAL] These two claims?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's attention, [PII]?
[CUSTOMER][POSITIVE] Yes, you're right, [PII].
[AGENT][NEUTRAL] OK, that was [PII]?
[CUSTOMER][POSITIVE] You got that right.
[AGENT][POSITIVE] All right, so I'm sending this to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, the call reference number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, which is [PII], [PII] to my last name is [PII].
[CUSTOMER][POSITIVE] And then [PII]. OK. OK, then, uh, thank you so much for your help then this is only information needed for today and have a nice day. Bye-bye.
[AGENT][POSITIVE] Thank you, [PII] you also and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.