AccountId: 011433970860
ContactId: a95fedeb-f5ed-4f64-bfd3-500348df584c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 665039 ms
Total Talk Time (AGENT): 204030 ms
Total Talk Time (CUSTOMER): 165630 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/a95fedeb-f5ed-4f64-bfd3-500348df584c_20250219T14:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling for prior office and how are you doing today?
[AGENT][NEUTRAL] Mm good I'm good and I'm sorry, what is your name again?
[CUSTOMER][NEUTRAL] It's [PII] spelled as [PII]
[AGENT][NEUTRAL] Thank you and what is your callback number if we were disconnected?
[CUSTOMER][NEUTRAL] Uh, just hold on, let me pull that for you, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's going to be [PII].
[AGENT][NEUTRAL] Thank you alright and what is your policy number?
[CUSTOMER][NEUTRAL] Uh yeah, sure, it's going to be 02408611.
[AGENT][NEUTRAL] OK, let me repeat that because you went kind of fast there for me that is 02408611. Is that correct?
[CUSTOMER][POSITIVE] Perfect. You got it. Sorry for that. So you have lost it.
[AGENT][POSITIVE] Thank you. Thank you.
[AGENT][NEUTRAL] OK, no problem, and if you would verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Absolutely it's going to be [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And are you calling for benefits for the member?
[CUSTOMER][NEUTRAL] No, it's actually regarding a claim.
[AGENT][NEUTRAL] Claim status, is that for dental or medical?
[CUSTOMER][NEUTRAL] It's for dental?
[AGENT][POSITIVE] Dental thank you one moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, let me provide you with the correct policy number. The policy number is 02408546.
[CUSTOMER][NEUTRAL] It's 02408546.
[AGENT][NEUTRAL] That is correct, thank you. And again, you call for claim status. I can assist you. What is that date of service and the total charges, please?
[CUSTOMER][NEUTRAL] Uh, it's for [PII], and it has charged amount of $22,796.
[CUSTOMER][NEUTRAL] And it's for a multiple services.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that was, that was, I'm sorry, one moment please, one moment, just wanna verify again that's [PII] total charges $22,796. Is that correct?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yes, exactly.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And when was this claim submitted?
[CUSTOMER][NEUTRAL] Uh, it was submitted on [PII], uh, electronically.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] Is this one claim or is this broken down to two claims?
[CUSTOMER][NEUTRAL] Mm, maybe it should be broken down into two claims because that's a huge amount and also there are many treatment procedures.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm this claim is mostly for crown or core build up on with number 89, 1011.
[CUSTOMER][NEUTRAL] Retainers D 67404 take porcelain D62 45 etc.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, may I place you on hold please? Thank you.
[CUSTOMER][POSITIVE] take your time, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, 12,000.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thank you so much for your patience. I was able to find both claims. It was two separate claims that shows that we did make a payment on one of the claims. Um, give me one second here.
[AGENT][NEUTRAL] And that payment was $1,238.60.
[AGENT][NEGATIVE] Now the claim that was billed for $12,894 nothing was paid on that. It shows that the maximum for the calendar year had been met.
[CUSTOMER][POSITIVE] Mm, thank you so much for that. Uh, could you please uh repeat the charge amount for the claim you guys paid?
[AGENT][NEUTRAL] OK, of course. One moment for the claim that was total charge of $9,902 a payment was made in the amount of $1,238.60.
[CUSTOMER][POSITIVE] Thank you so much for that. And the other claim, uh, has what charge amount? Can you repeat that one too?
[AGENT][NEUTRAL] $12,894.
[CUSTOMER][POSITIVE] Thank you so much for repeating that for me and for the great claim, may I have the claim number?
[AGENT][NEUTRAL] Of course the pay claim shows claim number 3562903.
[CUSTOMER][NEUTRAL] It's uh 356-209-23, correct me if I'm wrong?
[AGENT][NEGATIVE] That is incorrect. It is 3562903.
[CUSTOMER][NEUTRAL] 29033562903, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I also know the receive and process date of this claim.
[AGENT][NEUTRAL] Of course one moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, the claim was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] for that and when this payment was issued?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Check was issued on [PII] and that check number single paper check, check number shows 2027316.
[CUSTOMER][NEUTRAL] That's it. And 202-7316, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much for that. And uh is this a check clear stillal training?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK check currently shows outstanding.
[CUSTOMER][POSITIVE] Thank you so much for confirming that. And is it possible for you to send me a copy of UB over the checks?
[AGENT][NEUTRAL] You can actually receive the ELBs on our website and check claim status that is secured. [PII]. I will send this over via fax for you. What is your fax number?
[CUSTOMER][POSITIVE] Thank you so much and it's going to be.
[CUSTOMER][NEUTRAL] [PII]. I'm repeating the fax number again it's [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, is there anything else I can assist you with, please? Yes.
[CUSTOMER][NEUTRAL] And in.
[CUSTOMER][NEUTRAL] And you could you please uh send the fax twice because sometimes our fax system didn't catch the fax.
[AGENT][NEUTRAL] I will fax over the EOBs to [PII], but you're more than welcome to try to receive the EOBs on that website as well, [PII].
[CUSTOMER][POSITIVE] Sure we will thank you so much for that and [PII], uh, in the end, if, if, if you can provide me that reference number for this call.
[AGENT][NEUTRAL] We do not provide reference numbers. However, you can use my name. Last initials [PII] and today's date. Is there anything else I can assist you with, please, [PII]?
[CUSTOMER][POSITIVE] No, that's all. Thank you so much, and for your kind assistance. Have a great rest of the day.
[AGENT][POSITIVE] And thank you for calling APL. Have a good day as well. Mm bye.
[CUSTOMER][NEUTRAL] Bye.