AccountId: 011433970860
ContactId: a8ed98fc-78e4-4920-a305-6f6adc249c3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 580400 ms
Total Talk Time (AGENT): 174946 ms
Total Talk Time (CUSTOMER): 179328 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/a8ed98fc-78e4-4920-a305-6f6adc249c3f_20250521T19:09_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yeah. Hi, this is [PII] calling from the provider office, and I just need the claim status for a date of service, ma'am.
[AGENT][NEUTRAL] OK, sure. I can assist you with the claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, yeah, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The uh callback number is
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yeah. So the patient policy number is 412915797.
[AGENT][NEUTRAL] That's too many numbers to be one of our policy numbers. Is that a social?
[CUSTOMER][NEUTRAL] Uh, I think so. Yeah, it's on social.
[AGENT][NEUTRAL] OK, let me have that one more time.
[CUSTOMER][NEUTRAL] Yeah, it's 412.
[CUSTOMER][NEUTRAL] 9157997.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK. What's the name of the patient?
[CUSTOMER][NEUTRAL] Uh yeah. It's [PII], with the date of birth, [PII].
[AGENT][NEUTRAL] Thank you. And this is a claim for dental?
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] OK. I just have uh two total charges for uh that is uh $576 and $325 as well.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] They're both for the same day.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII], and that's just optional.
[AGENT][NEGATIVE] OK, so the one for the uh anesthesia, that one is not covered under this policy. It's not a covered service, so it was denied.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Uh, uh, your, uh,
[AGENT][NEUTRAL] So that mhm.
[CUSTOMER][NEUTRAL] Uh, is it for the charge amount of, uh,
[AGENT][NEUTRAL] 325.
[CUSTOMER][NEUTRAL] 576.
[CUSTOMER][NEUTRAL] OK, right, right.
[AGENT][NEUTRAL] 325. Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, for the other claim, do you need the claim number on that one that was denied?
[CUSTOMER][NEUTRAL] Uh, yeah, right.
[AGENT][NEUTRAL] OK, that is 3600555.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And um yeah, and how much is the paid amount?
[AGENT][NEUTRAL] OK, um, we did not pay nothing for the anesthesia. We did pay for code 2391. Now, the payment for the code 2391 went in a separate claim. Um, it's a different claim, so I can give you this claim number.
[AGENT][NEUTRAL] The claim number is 3600554.
[AGENT][NEUTRAL] And we send $100 for code 2391.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And, uh, and what is the uh receipt it and process it for the claim?
[AGENT][NEUTRAL] For the one that we paid, let me get that for you.
[AGENT][NEUTRAL] It was received on [PII] process [PII].
[CUSTOMER][NEUTRAL] OK. And the payment is uh done through the check or the EFT?
[AGENT][NEUTRAL] Is a check, single check, paper check?
[CUSTOMER][NEUTRAL] OK. And the claim number and the issue date for it?
[AGENT][NEUTRAL] The claim number is 3600554. The issue date is the same as the process date [PII].
[CUSTOMER][NEUTRAL] OK. Um
[CUSTOMER][NEUTRAL] And it's a patient responsibility for this place?
[AGENT][NEUTRAL] For which one? For the anesthesia?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement.
[CUSTOMER][NEUTRAL] OK. Right. So this is the claim for the uh charge amount 325, right? And what about the uh charge of, yeah, what about the charge of 576?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct. Mhm.
[AGENT][NEUTRAL] OK, for the 576 we also received that claim on [PII] process [PII], and we send a benefit amount of $260.80.
[CUSTOMER][NEUTRAL] OK. And for this, the, uh, what will be the claim number?
[AGENT][NEUTRAL] The claim number on this one is 3600465.
[CUSTOMER][NEUTRAL] And the uh check number, uh,
[CUSTOMER][NEUTRAL] Um, yeah, just to check number.
[AGENT][NEUTRAL] 2044027.
[CUSTOMER][NEUTRAL] OK. And it showed on uh [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Single check.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, and for this claim, uh, as well, the anesthesia has been denied, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. And yeah, thank you so much, ma'am, for the information. And uh can you just uh send me the EOB by the fax?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] What is, what is the fax number?
[CUSTOMER][NEUTRAL] Yeah, it's 281.
[CUSTOMER][NEUTRAL] 499
[CUSTOMER][NEUTRAL] 3197.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] For holding and being patient for me. I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, no, thank you so much. Uh, I just need, need your name to be spelled out and the reference number for the call.
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII].
[AGENT][NEUTRAL] And we don't have reference numbers you can use my name in the state.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you so much, ma'am, and have a great day.
[AGENT][POSITIVE] Yes sir and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah. Bye-bye.