AccountId: 011433970860
ContactId: b69249bd-03b3-4612-b8bb-e963f41b0847
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 927780 ms
Total Talk Time (AGENT): 289863 ms
Total Talk Time (CUSTOMER): 338753 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/b69249bd-03b3-4612-b8bb-e963f41b0847_20250326T18:42_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] Yeah, this is [PII] and I was checking for the dental claim status on a recorded line. How are you doing today?
[AGENT][POSITIVE] I'm good, thank you. How about you?
[CUSTOMER][POSITIVE] I, I'm doing good. Thanks for asking. And sorry, I was not able to get your first name.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. And um you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah, ma'am. OK.
[AGENT][NEUTRAL] All right. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It will be [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, I got the ID.
[CUSTOMER][NEUTRAL] 20
[CUSTOMER][NEUTRAL] 33644.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, patient is uh [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] All right, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mm this is [PII].
[CUSTOMER][NEUTRAL] Uh, total charge amount $1,173.
[CUSTOMER][NEUTRAL] And uh they have paid $186.20 on this one.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] OK, one moment. I need to pull the explanation of benefits on this one.
[CUSTOMER][POSITIVE] No, no problem. Take your time and let me know because they do have some specific questions for a specific code on this one, so I can just ask that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I have it pulled up and go ahead with your questions.
[CUSTOMER][NEGATIVE] Uh yes, uh, for this claim, actually, they are only checking for the fluoride, D 1206. Uh, it was been not paid. So they are just confused, uh, with this one because they are saying as for them, it was a 100% covered. So is it like not covered or is it denied for some frequency?
[AGENT][NEUTRAL] The 12:06.
[CUSTOMER][NEUTRAL] Or age limit.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so the charge amount was 115 um.
[AGENT][NEUTRAL] Schedule 81.
[AGENT][NEUTRAL] I think that one is not listed on the schedule but let me double check, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, that one is not listed in the scheduled benefits, so it's not payable under this policy.
[CUSTOMER][NEGATIVE] Uh, so it's simply not covered by the plan.
[AGENT][NEUTRAL] Mm, no, no, we only cover 1208.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Not 12 or 6.
[CUSTOMER][NEUTRAL] 108. Got you. Not covered.
[CUSTOMER][NEUTRAL] Under the member plan.
[CUSTOMER][NEUTRAL] Updated that. And uh so is there going to be any reference number for this which, which I can update uh your name and date?
[AGENT][NEUTRAL] We don't my name in today state we don't have reference numbers.
[CUSTOMER][POSITIVE] OK, no problem. I'll update that.
[CUSTOMER][NEUTRAL] And done with this. Only have one last member if you can please help me out with that.
[AGENT][NEUTRAL] OK, let me go ahead and make a note on this one and you don't need any other information on this one?
[CUSTOMER][POSITIVE] No, no. Just uh checking for the fluoride which you already answered, so no issues.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] [PII], I have a more.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] A little.
[CUSTOMER][NEUTRAL] Uh, it's uh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] [PII] and I'm calling to the data.
[AGENT][NEUTRAL] All right. And what's the next policy number?
[CUSTOMER][NEUTRAL] Uh, this one.
[CUSTOMER][NEUTRAL] 246-611-5
[CUSTOMER][NEUTRAL] 288.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, patient is [PII]. Date of birth. I got is [PII].
[AGENT][NEUTRAL] OK. And what is the date of service?
[CUSTOMER][NEUTRAL] And uh for
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And this is actually different uh provider. So do you need the provider information or should I provide you the date of service?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Just the data of service and the amount of the claim.
[CUSTOMER][NEUTRAL] OK. It's [PII].
[CUSTOMER][NEUTRAL] And uh we have charged amount $1,973.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh for this one actually, uh do not have any information. Last only, one of my colleague has mentioned that we need to send this claim to the correct mailing address. So I don't know whether it was received, processed or denied.
[AGENT][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII], yeah, the claim is not on file for [PII].
[AGENT][NEUTRAL] Oh, well, yes, there is one. Bear with me just a second.
[AGENT][NEUTRAL] What are the costs that you're looking for?
[CUSTOMER][NEUTRAL] So, I need 20
[CUSTOMER][NEUTRAL] Uh, this, uh.
[CUSTOMER][NEUTRAL] Mm, actually they have built D0230 D0150, D 1110 D 0274.
[CUSTOMER][NEUTRAL] 900,220, but as I said, I do not have any information on this one.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, I was just asking so I can make sure I'm pulling the correct 11 moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And you said the total charge was?
[CUSTOMER][NEUTRAL] Mm 1973.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] 57
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Is it separated in two different um claims or is it just one claim?
[CUSTOMER][NEUTRAL] Uh, sorry, I didn't get your question.
[AGENT][NEUTRAL] Is this separated in two separate claims or is it one claim? Because I don't see that amount.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, as, uh, correct, correct. As per the uh information which I have, they are billed as in a single team. But yeah, sometime billing team is a different team, so they might uh divide in two parts.
[CUSTOMER][NEUTRAL] If the total comes to 1973 for both the claims, then that's the one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yeah, it looks like this is gonna be in two separate claims.
[AGENT][NEUTRAL] So let me go ahead and
[CUSTOMER][NEUTRAL] Mm, it could be possible.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me give you the one for $1,244 which it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for this one we send a benefit amount of $123.60.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] There are 4 charges that were denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the reason for these denials is let's see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, the policy does not provide benefits for procedure service not listed in the schedule of benefits.
[AGENT][NEUTRAL] And then um there's, mhm, and there's some that was applied towards the calendar year deductible, so there's two of them.
[CUSTOMER][NEUTRAL] So not uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can you just let me know which are like not covered if you can just quickly provide me that code also?
[AGENT][NEUTRAL] OK. It's gonna be um let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] 350 is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 367 is not covered.
[AGENT][NEUTRAL] And then for the uh amounts applied towards the deductible, we have 220 was applied towards the deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 230 was applied for the deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And yeah, and there's 23 0s applied towards the deductible.
[CUSTOMER][NEUTRAL] And uh any amount like uh how much deductible was applied for this one?
[AGENT][NEUTRAL] Um, for the 230, it was $15 which is the maximum benefit, um, for the, um, 15, yes.
[CUSTOMER][NEUTRAL] 15
[AGENT][NEUTRAL] For the 220 was $17 which is the maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, gotcha.
[AGENT][NEUTRAL] And yeah and then there's another $230 that we applied um $3 towards the deductible to complete the $50 and we paid $540 on that one.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this one is you said for the uh bill amount you received was $1,244.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And also, uh, by any chance, is it possible you can provide me the payment information for the $120.23 dollars 60 cents? Like it was issued on [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what would be the check or EFT number? Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 1848192.
[CUSTOMER][NEUTRAL] 184.
[CUSTOMER][NEUTRAL] 8192.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] And uh this is like a paper check or EFT?
[AGENT][NEUTRAL] That's a paper check, paper checks, single checks.
[CUSTOMER][NEUTRAL] OK, got you. I updated that.
[CUSTOMER][NEUTRAL] And let me just confirm, OK, yeah, it shows in my system also. And for this one, can you help me out with the claim number for 10 sorry 11244?
[AGENT][NEUTRAL] And the claim number is 34473007.
[CUSTOMER][NEUTRAL] And what about the another amount which you received? Uh, anything was paid on that claim or it was completely denied?
[AGENT][NEUTRAL] Let me check one moment.
[AGENT][NEUTRAL] OK, for this one, there was a payment of $58.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and that was for code 1110?
[AGENT][NEGATIVE] And the rest of the codes were denied, not covered service.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] And this was issued on the same date, [PII] or different?
[AGENT][NEUTRAL] Yes, the same date, different check number. The check number is 184.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] 1,848,190.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1,848,190 single check, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what would be the claim number for this uh claim?
[AGENT][NEUTRAL] 344-731-0
[CUSTOMER][NEUTRAL] Oh, I think I'm done with this also, and only last request. So is it by any chance possible you can send this to [PII] to us on fax so I can just close this one.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I can provide you that quickly. The secure fax number will be 302.
[CUSTOMER][NEUTRAL] 526
[CUSTOMER][NEUTRAL] 1475
[AGENT][NEUTRAL] OK, let me repeat it back to you. That is [PII] to your attention.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, you can attention my name, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'll go ahead and send those out to you. Um, it's gonna be before the end of the day, OK?
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK. Is there anything else I can help you through?
[CUSTOMER][POSITIVE] Done. Thank you so much for that.
[CUSTOMER][POSITIVE] No, thank you so much. I really appreciate that. Take care, be safe and enjoy the rest of the day.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You as well thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] I