AccountId: 011433970860
ContactId: b4380d0b-83e6-4d49-8200-f47ae7ce406b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 620099 ms
Total Talk Time (AGENT): 162941 ms
Total Talk Time (CUSTOMER): 242658 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/b4380d0b-83e6-4d49-8200-f47ae7ce406b_20250313T18:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from Northern Oral Surgeons. I am trying to follow up on a pre-estimate that I received on a mutual patient.
[AGENT][NEUTRAL] OK. May I have
[AGENT][NEUTRAL] The spelling of your name and a callback number?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] and a good phone number is [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Yes, like the ID, the patient's ID number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, it's 1580719.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII] date of birth is [PII].
[AGENT][POSITIVE] Thank you. And you were saying that you have received an estimate?
[CUSTOMER][NEUTRAL] Yeah, we had sent out a pre-estimate on this patient. Um, the total that it was submitted for, uh, should have been $8,137. I received two estimates back that have services that were on that the full preestimate that was submitted. I just don't have the full one for some reason, and I was just following up with that to see if it was on its way. It just looked like it was like separated.
[AGENT][NEUTRAL] OK, do you have a claim number for the one that you received?
[CUSTOMER][NEUTRAL] Yes, so there's two of them that I've received. I can give you a claim number it's 35632002.
[AGENT][NEUTRAL] You said one is for 8000?
[CUSTOMER][NEUTRAL] Yeah, so the, the whole total of it should be $8,137.
[CUSTOMER][NEGATIVE] But I never got.
[CUSTOMER][NEUTRAL] An estimate with.
[CUSTOMER][NEGATIVE] All like the codes on there. There's two paper estimates that I've received back, but they each just have 1.
[CUSTOMER][NEUTRAL] One like line of service for.
[CUSTOMER][NEUTRAL] That is like on the whole estimate that was sent out and it looks like.
[CUSTOMER][NEUTRAL] That was sent.
[CUSTOMER][NEUTRAL] Like um that was sent on the [PII] or [PII].
[AGENT][NEUTRAL] So I'm gonna pull that image up of the claim number that you just gave me. Now is.
[AGENT][NEUTRAL] Do you have a specific date of service?
[CUSTOMER][NEUTRAL] Well, this is just the pre-estimate, so he was in for his evaluation on [PII]. Um, he hasn't followed up with any um surgery yet. He wanted to know what his insurance is estimating to pay before like scheduling anything.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have the other like I have both forms so I have another claim number if you wanted to try looking it up on that one.
[AGENT][NEUTRAL] So the image that we received for the data for the claim number that you have is 32 ending in 3202.
[AGENT][NEUTRAL] I'm pulling that image up.
[AGENT][NEUTRAL] And that claim is only showing the $65.
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] We have another claim.
[AGENT][NEUTRAL] And that's ending in 3206.
[CUSTOMER][NEUTRAL] Yes, I have that one here.
[AGENT][NEUTRAL] Here's another one.
[AGENT][NEUTRAL] Now this one is for.
[AGENT][NEUTRAL] For this data service, this is the 1025 24 data of service.
[CUSTOMER][NEUTRAL] Right, yeah, that was, that's when we send out the pre-estimate from the evaluation.
[AGENT][NEUTRAL] OK, and then I'm looking at the last one.
[CUSTOMER][NEUTRAL] And it should have been
[CUSTOMER][NEUTRAL] I think there's like a total bill charges is 8,072 on that one, but it only has an extraction fee.
[AGENT][NEGATIVE] See, the only thing that we received in was the two claims.
[AGENT][NEUTRAL] That was processed. That is showing the $65.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] Sorry my system froze. It is showing the $65 and then.
[CUSTOMER][NEUTRAL] No, that's
[AGENT][NEUTRAL] There's this other claim, let me, let me total this one up.
[AGENT][NEUTRAL] Because it's showing the total fee is $8,137 and that is that second claim that you received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4 ending in 3206.
[CUSTOMER][NEUTRAL] Right, so I do have that. However, the only thing listed on it is like it's like code 09222. It's like this, um, that's just our IV coding, but that's the only thing listed on there for some reason like none of the other services are on there to like show what patient pays and what if you guys are paying anything.
[AGENT][NEUTRAL] Let me see what this code meaning because what I'm looking at it the codes are listed on there.
[CUSTOMER][NEUTRAL] OK, yeah, for some reason the only code that I have is just the one so if, yeah, because if I had all of them listed on there, then it would have made sense that's $65 on that um one claim ending in 3202 um plus that $8,0072 that equals the whole total that we had submitted over to you guys, but we don't have all of the like services on there.
[AGENT][NEUTRAL] I'm pulling the EOB out.
[CUSTOMER][NEUTRAL] Is that something
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that code was the 7472.
[AGENT][NEGATIVE] So there's a description listed on that EOB you should have should have received 4 pages. That one, the first page would have been.
[AGENT][NEUTRAL] That coding that you're saying is the non.
[AGENT][NEUTRAL] 2222
[AGENT][NEUTRAL] But then right below that, it is a listing that shows the APL at the top and it's giving you the pre-treatment estimate worksheet.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEGATIVE] So I don't have that. I only have 2 of the 4 pages.
[AGENT][POSITIVE] Yes. All the 4 pages was submitted at the same time.
[CUSTOMER][NEGATIVE] Yeah, we sent it all around the same time, but I only received 2 pages back.
[CUSTOMER][NEUTRAL] And there's nothing like on the back of them that has any like like further information so that's kind of why.
[AGENT][NEUTRAL] May I have a fax number and I can submit this duplicate EOB back over to you?
[CUSTOMER][NEUTRAL] Yeah, absolutely it is 715.
[CUSTOMER][NEUTRAL] 564.
[CUSTOMER][NEUTRAL] 4081
[AGENT][NEUTRAL] And that's to the attention of [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] OK, I will get that submitted over to you. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Uh, no, I think that is it. Can I get a reference number for this call?
[AGENT][NEUTRAL] Yes, the call reference would be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][POSITIVE] All right perfect thank you so much I appreciate your help.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye.