AccountId: 011433970860
ContactId: aeeaf9cf-8a29-469a-8057-ee7025e71b44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407880 ms
Total Talk Time (AGENT): 160744 ms
Total Talk Time (CUSTOMER): 113888 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/aeeaf9cf-8a29-469a-8057-ee7025e71b44_20250113T17:49_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] calling from provider's office. I would like to check on a claim status, [PII].
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Uh, at 02295286.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Um, OK, just one moment please, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], again, any information that is provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient's name is
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII], which is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And this is for a dental claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service place and total bill amount?
[CUSTOMER][NEUTRAL] Yeah, it is in [PII] and the total bill amount is 1 $1,285 even.
[AGENT][NEUTRAL] OK, so you said the date of service is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you said the total bill amount is $131,284. Is that also correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so we do not have a claim on file for this number for that data service and that total bill amount.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] Uh, but I just received uh the EOP and all. I do have a specific question.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I have a specific question regarding the billed amount. You said it was $131,284.
[CUSTOMER][NEUTRAL] No, it is 1285.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, so that's not the amount you gave me. You gave me 134284.
[CUSTOMER][POSITIVE] Oh, I'm so sorry. Please pardon me.
[AGENT][NEUTRAL] 100
[AGENT][NEUTRAL] Mhm. So what is the total bill amount that you're inquiring on?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] 1285.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you do have the claim number, is that correct?
[CUSTOMER][NEGATIVE] Mm no.
[AGENT][NEUTRAL] I'm sorry, I thought you just said that you had a claim number.
[CUSTOMER][NEUTRAL] Oh, yes.
[CUSTOMER][NEUTRAL] Let me just check for that.
[AGENT][NEUTRAL] So you do or do not?
[CUSTOMER][NEUTRAL] No, I don't see any check number in the COP.
[AGENT][NEUTRAL] No, sir. I'm asking you, do you have a claim number?
[CUSTOMER][NEUTRAL] Yeah, the claim number is 353-937-9.
[AGENT][NEUTRAL] OK, and how can I help you with that claim today?
[CUSTOMER][NEUTRAL] Uh, I do see that D 0929 was denied.
[CUSTOMER][NEUTRAL] Um, but the EOB does not, and the DOB does not have any valid reason for that. It does not prescribe, so I would like to know the denial reason for D020929.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, and page 2 of our explanation of benefits, just so you're aware, [PII] has the denial remarks.
[AGENT][NEUTRAL] But the denial for this code states this policy.
[AGENT][NEUTRAL] does not
[AGENT][NEUTRAL] Provide benefits for any procedure or service not listed in the schedule.
[AGENT][NEUTRAL] This is not a covered benefit under this member's policy.
[CUSTOMER][NEUTRAL] All right. So,
[CUSTOMER][NEUTRAL] That is not a covered benefit, right? So what about the patient responsibility?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] We do not determine.
[CUSTOMER][NEUTRAL] Patient responsibility.
[AGENT][NEUTRAL] Yes sir, [PII], we do not determine patient responsibility that would be up to the provider.
[AGENT][NEUTRAL] And you may also obtain a copy of this explanation of benefits, [PII], from our portal by going to [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, what about the payment that you have made, is that you provider or to the patient?
[AGENT][NEUTRAL] This was to the provider.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So may I know the call difference for this one?
[AGENT][NEUTRAL] Yes, sir. It would be my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Uh, so that is [PII].
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, my name and today's date.
[CUSTOMER][POSITIVE] All right. So thank you so much, [PII]. That's all the information that I need. Have a great day. Bye.
[AGENT][POSITIVE] OK. Well, I hope you have a great day too, [PII] and if that's all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] Oh