AccountId: 011433970860
ContactId: bc3698e3-8b17-4545-8421-3196b4b87fd6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514020 ms
Total Talk Time (AGENT): 213818 ms
Total Talk Time (CUSTOMER): 161612 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/bc3698e3-8b17-4545-8421-3196b4b87fd6_20250619T13:23_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, this is [PII] calling from provider's office to check up on the claim status.
[AGENT][NEUTRAL] OK, did you say your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, [PII], and you
[CUSTOMER][NEUTRAL] No, my name is [PII].
[AGENT][NEUTRAL] [PII], oh, I'm so sorry. OK, and [PII], you're wanting to check claim status?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII].
[AGENT][NEUTRAL] Thank you. And the members, do you only have one claim, [PII], to check status on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, which is 5 consecutive zeros.
[CUSTOMER][NEUTRAL] 23 5 6315.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][NEUTRAL] And do you mind to spell out your name please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], is it correct?
[AGENT][NEGATIVE] No, sir, it is not.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII], any information that I provide is a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what type of policy is this that you're checking claim status on?
[CUSTOMER][NEUTRAL] Yeah, I need a claim status for the rate of service of 724-2023.
[AGENT][NEUTRAL] OK, well, is this medical or dental?
[CUSTOMER][NEUTRAL] Dental.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And again, the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the date of services, uh,
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $466 and events.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And the name of the provider? Practice?
[CUSTOMER][NEUTRAL] Yeah, provide the name is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is the name of the group that she's with?
[CUSTOMER][NEUTRAL] Yeah, the group name is uh
[CUSTOMER][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] No, sir, that's who I'm with. What's the tax ID number?
[AGENT][NEUTRAL] For the provider.
[CUSTOMER][NEUTRAL] Tax ID is [PII].
[CUSTOMER][NEUTRAL] Yeah, tax ID for the provider is [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, and you said the total billed amount on this claim is 466. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so for that data service, there is no claim on file for that bill amount.
[CUSTOMER][NEUTRAL] Just a second. It is for the date of service of [PII].
[AGENT][NEUTRAL] Uh-huh, for
[AGENT][NEUTRAL] Correct, for 466. Is that correct?
[CUSTOMER][NEUTRAL] And it was already.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Actually, uh, for this claim, it was already paid also. If you want, I can provide you the claim number for this.
[AGENT][NEUTRAL] Yes, sir, but that's not.
[AGENT][NEUTRAL] I need for you to provide for me the correct bill amount that's on the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I get the, OK, I'll just confirm the procedure codes for this, which is 0150022002300270 and 0330. This is what the procedure codes and the bill amount is 466.
[AGENT][NEUTRAL] No, so that's
[AGENT][NEUTRAL] Yes, sir, that's not what this claim is showing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this and this page is for a different claim number different claim, right?
[AGENT][NEUTRAL] I do not have a claim for that billed amount 466 for data service.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would you mind to confirm me your payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And your plan mailing address is [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] No, that is not correct. The claim's mailing address is [PII].
[AGENT][NEUTRAL] Are you ready? I'm sorry. Are you ready for me to give that to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So the client's mailing box is [PII].
[CUSTOMER][POSITIVE] Yes, yes, go on, please.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, this is what I said.
[AGENT][NEUTRAL] That's, that's not what you said to me, but that may be what you have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And what will be the fee schedule?
[AGENT][NEUTRAL] This point, this is uh based on the Carringtonee schedule.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what would be the timely filing limit?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the provider is in network or out of network?
[AGENT][NEUTRAL] You would have to check with Carrington. Again, as I explained, this is, this is a Carrington.
[AGENT][NEUTRAL] PPO plan, however, they were not required to use the Carrington provider, but if you have questions regarding if the provider participates with Carrington, you would need to speak to Carrington and I can provide you their phone number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. I'll just confirm those patient demographic details. Patient name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Subscriber will be the same and patient address is [PII] with the zip code of [PII]. Is it correct?
[AGENT][NEUTRAL] That is what we show on file for her. I don't know if that is still valid because this policy is no longer active, but that is the address that we had on the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For her at the time that her plan was active with us.
[CUSTOMER][NEUTRAL] OK, and can I get the call reference number for this one?
[AGENT][NEUTRAL] Yes sir, you would use my name in today's date and then [PII], once the claim has been received and processed by APL, we would, um, excuse me, we have a portal that you should also be able to check claim status in for our members by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK and thank you so much for helping me out. That's it from my end.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Well, you're very welcome, and [PII]. So if that's all I can help you with, thank you again for calling APL and I hope you have a nice day.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][NEUTRAL] Uh-huh