AccountId: 011433970860
ContactId: b9ce0331-2f9c-46a0-95d7-869a831c91d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1710180 ms
Total Talk Time (AGENT): 314464 ms
Total Talk Time (CUSTOMER): 361075 ms
Interruptions: 8
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/b9ce0331-2f9c-46a0-95d7-869a831c91d8_20250417T17:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Take another
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] from our dental Health Services. And I would like to check on some claims status, please.
[AGENT][NEUTRAL] OK, I can help you with claim status, and can you please spell your first name for me?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] OK, and you pronounce that [PII]?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] OK, thank you, thank you for helping me and what is your callback number, sir? Just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][NEUTRAL] Thank you. And then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm. It is [PII].
[CUSTOMER][NEUTRAL] Walling
[CUSTOMER][NEUTRAL] Date of birth [PII] and member's ID is 02273691.
[AGENT][NEUTRAL] OK, let me pull up the member real quick.
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You need to have an appeal, right?
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] It is [PII], build the amount 344.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, let me just double check.
[CUSTOMER][NEGATIVE] But they cannot feel there is a feeling of white.
[CUSTOMER][NEUTRAL] It is $30.
[AGENT][NEUTRAL] OK, and then you said you were calling from Arbent Health?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a.
[CUSTOMER][NEUTRAL] On behalf of HSAS.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] On behalf of what was that again, please, sir?
[CUSTOMER][NEUTRAL] A yes, AHS Oklahoma physician Group.
[AGENT][POSITIVE] OK, thank you. I appreciate you giving me that information. I'm gonna put you on a quick hold while I look this claim up for Cyber, and I'll be right with at the moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sure, no worries.
[AGENT][NEUTRAL] You.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Yeah one.
[AGENT][POSITIVE] Thank you Ir for holding for me. I have the claim pulled up for you now.
[AGENT][NEUTRAL] The claim number is.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] I R
[AGENT][NEUTRAL] You're welcome. The claim number is 3502048.
[CUSTOMER][NEUTRAL] 594.
[CUSTOMER][NEUTRAL] 88726, right?
[AGENT][NEUTRAL] Uh, the claim was denied. There's two reasons. One, office visits are not covered under the patient's policy, and two, the policy does not provide a benefit for service in which no charges were incurred.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] X.
[CUSTOMER][NEUTRAL] 867-560. 0, OK.
[CUSTOMER][POSITIVE] OK, so well thank you so much for the information. Let me just make some notes here and in the meantime I give you the other data service.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, is it for the same patient?
[CUSTOMER][POSITIVE] Yes, actually I have 5 claims for the same patient.
[AGENT][NEUTRAL] OK, and what's the next day the service?
[CUSTOMER][NEUTRAL] It is [PII], build amount 165.
[AGENT][NEUTRAL] OK, and then the amount after the primary?
[CUSTOMER][NEUTRAL] Oh sure, let me see.
[CUSTOMER][NEUTRAL] Hold on a second. There um 36, OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It is $37.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look this one up and I'll be right back with you, sir.
[CUSTOMER][NEUTRAL] Thanks. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] No
[AGENT][POSITIVE] Thank you so much, [PII], for holding for me. I um have found this the claim for you. The claim number is 3521759, and the claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. OK, so you need the copy of the primary UV and what's, yes, and what's the best way we can send it over to you via fax?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] You, you can send it fax or you can send it by uh payer ID number electronically either way or you can um even mail it in, which would you prefer?
[CUSTOMER][NEUTRAL] Oh, OK, so it would be great if we can start with the fax number.
[AGENT][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] Like even the.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The first number is the area, the area, right?
[AGENT][NEUTRAL] Yes, [PII] is the area code.
[CUSTOMER][POSITIVE] Oh, OK. Thank you.
[CUSTOMER][POSITIVE] OK, perfect. Well, thank you so much and do I need to put attention to anyone?
[AGENT][NEUTRAL] You can put claims department.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] Claims department. OK, perfect.
[CUSTOMER][NEUTRAL] And let me just make some notes, claims department, OK. And when this claim was processed, do you have the date?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Yes, let me check for you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And I know on the number of the train.
[AGENT][NEUTRAL] I am looking.
[AGENT][NEUTRAL] The claim was received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Perfect. OK. And before we can continue with the other ones, could you please send us via fax as well? Well, if you can email it, it would be great. If not, you can fax them the EOBs to us.
[AGENT][NEUTRAL] Yes, I can fax the EOB to you. Can I please get your fax number?
[CUSTOMER][NEUTRAL] Yes, it is 513.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me repeat it.
[CUSTOMER][NEUTRAL] So what
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] Exactly you can put attention to my name, please.
[AGENT][NEUTRAL] OK, I, I will do that. I'm gonna put you on a quick hold while I get this EOB ready to fax to you. I'll be right back, sir.
[CUSTOMER][POSITIVE] Thank you. And the previous one as well, please. Sorry.
[AGENT][POSITIVE] OK. All right. I will do both. I'll be right back, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me. I've got those faxes on the way to you now.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] Oh, OK, I appreciate it. Sorry. And well, the next date of service is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] build amount.
[CUSTOMER][NEUTRAL] 158 and let me see.
[CUSTOMER][NEUTRAL] The remaining balance.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] 158 and the remaining balance is $30.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, quick hold again. I'm gonna look this one up. I'll be right back, sir.
[CUSTOMER][POSITIVE] Sure, no worries. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] 85467681. Sure.
[AGENT][NEUTRAL] OK, thank you, [PII] for holding for me. So I have the claim pulled up for this one. It's 354-884-9.
[AGENT][NEGATIVE] And this one was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Yeah, you can see oh so like.
[CUSTOMER][NEUTRAL] So I will say.
[AGENT][NEUTRAL] And I have already sent that fax to you for this one.
[CUSTOMER][POSITIVE] Oh thank you I appreciate it, OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And when was it processed?
[AGENT][NEUTRAL] Uh, let me look for you.
[AGENT][NEUTRAL] We received it on [PII] and processed it on [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. And uh let me see the next date of service. Hold on a second.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. The next one is [PII].
[CUSTOMER][NEUTRAL] Bill amount 134.
[CUSTOMER][NEUTRAL] And the remaining balance.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] It is $40.44.
[AGENT][NEUTRAL] OK, alright, I'm gonna put you on hold again. I'll be right back sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, of course I am.
[AGENT][NEUTRAL] Mm 134.
[AGENT][NEUTRAL] Uh-huh, there you are.
[AGENT][NEUTRAL] 3559657
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Thank you very much for holding for me again, Iver. I've got this claim ready for you. The claim number is 3559657.
[CUSTOMER][NEUTRAL] I cannot repeat it again. A A H.
[AGENT][NEUTRAL] The claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Yes I
[CUSTOMER][NEUTRAL] OK. And uh
[AGENT][NEUTRAL] And the claim was received.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was received on [PII] and processed on [PII] and I do have the fax on its way to you.
[CUSTOMER][POSITIVE] OK, thank you. OK, perfect. So, you will be.
[CUSTOMER][POSITIVE] Got it. And well, finally,
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let me see something here.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So the last claim data service is
[CUSTOMER][NEUTRAL] Actually it is the same date of service that is [PII], and the bill amount for this one is 224 and the remaining balance, let me take a look.
[CUSTOMER][NEUTRAL] Hold on a second. OK. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It is $55.
[AGENT][NEUTRAL] OK, one more brief hold and I'll be right back with you.
[CUSTOMER][POSITIVE] Sure, no worries.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] OK, [PII], I've got this claim for you. The claim number is 3561863.
[CUSTOMER][NEUTRAL] It now
[AGENT][NEUTRAL] This claim was also denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] how much
[AGENT][NEUTRAL] The claim was received on [PII] and processed on [PII] and I have sent the fax of the EOB to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] What
[CUSTOMER][POSITIVE] OK, perfect. So, well, thank you so much. I appreciate it in this case. Well, that's what I needed to know, and well, I will be looking forward to the facts and that's it for today.
[AGENT][POSITIVE] OK, well, thank you very much, [PII]. I hope you have a wonderful [PII] weekend and we thank you for calling APL.
[CUSTOMER][NEUTRAL] but here we have denied just like it's nice. OK, thank you and you too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][NEUTRAL] 7, like a.