AccountId: 011433970860
ContactId: bd87f0e9-acaf-4ed9-9163-90e1a8b99060
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502390 ms
Total Talk Time (AGENT): 115182 ms
Total Talk Time (CUSTOMER): 259032 ms
Interruptions: 3
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/bd87f0e9-acaf-4ed9-9163-90e1a8b99060_20250304T18:33_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII] calling from dental office taking for claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status. Can you repeat your first name please?
[CUSTOMER][NEUTRAL] Sure. Can this.
[AGENT][POSITIVE] And [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] OK, sure. I have [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] OK. I have 02565683.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The number will be [PII] [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And what's the the other one?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] And what is the date of service for the claim?
[CUSTOMER][NEUTRAL] I have [PII] with the amount of $2,39594.
[AGENT][NEUTRAL] And this is for dental?
[CUSTOMER][NEUTRAL] Yes, for 10,000.
[AGENT][NEUTRAL] OK, um, I'm not showing they have a dental policy with us, so the claim denied because there was no dental coverage.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, you said the payment was to, uh, the patient has, does not have dental coverage.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, there's no dental coverage on the policy, so the claim denied.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. I'm in a second. Just wait a moment for me.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, can you please wait a moment for me?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK. Thank you so much for that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] you
[CUSTOMER][NEUTRAL] Uh hello, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Thank you so much for that. And just for to confirm you said, the uh this patient does not have any coverage. So can you please provide me the term terminated for this.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, they never had dental coverage so I can't give you a termination date.
[CUSTOMER][NEUTRAL] OK. Um, can you please provide me the effective date then?
[AGENT][NEUTRAL] Effective date for their medical policy is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what will be the reference number for this one?
[AGENT][NEUTRAL] Reference is just my name and today's date and time.
[CUSTOMER][NEUTRAL] [PII]. OK. And [PII], I have 2 more patients left. Can you please help me with that one?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That will be 02565683, same patient.
[CUSTOMER][NEUTRAL] We set of service will be.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] That will be the same, but the bill amount is different.
[CUSTOMER][NEUTRAL] $2,717.
[AGENT][NEUTRAL] For the same data service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that claim denied as well because there was no dental coverage.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. And when was the claim of the one?
[AGENT][NEUTRAL] Claim was denied on.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Both claim was denied on [PII].
[CUSTOMER][NEUTRAL] So what
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um, uh, can you please provide me the claim number for this one?
[AGENT][NEUTRAL] 3549588
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just for the confirm, 354-598-8.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I have the.
[CUSTOMER][NEUTRAL] What about for the other one?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, for that.
[CUSTOMER][NEUTRAL] First patient, for the first patient, can you please provide me the claim number?
[CUSTOMER][NEUTRAL] 70837.
[AGENT][NEUTRAL] 3, it's the same patient, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, 3549634.
[CUSTOMER][NEUTRAL] OK, I got it. Thank you so much. And can you please provide me the reference number or that will be your name and uh today's date? OK, I got it. And the effective date will be the same, right? [PII].
[AGENT][NEUTRAL] It's the same my name.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can we proceed to the last one patient?
[AGENT][NEUTRAL] Is it the same patient or a different patient?
[CUSTOMER][NEUTRAL] Different.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] I have 025647774.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name will be [PII] and the last name will be [PII] [PII]. That service I have generally a 225 suitable amount of $1,671.
[AGENT][NEUTRAL] And what's the date of service?
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm showing the claim was denied because the.
[AGENT][NEUTRAL] Um, procedure is not covered.
[CUSTOMER][NEUTRAL] Uh, due to the age limit, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, for the age limit or for uh not covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] None of the CPT codes that you, that were um billed are covered.
[CUSTOMER][NEUTRAL] Uh, I mean, 41206.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] It did not for not covered.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, not for HM, right?
[CUSTOMER][NEUTRAL] 1,0001.
[AGENT][NEGATIVE] No, it did not, it's not covered.
[CUSTOMER][NEUTRAL] OK. What will be, uh, when was the claim was the one?
[CUSTOMER][NEUTRAL] I just for me.
[AGENT][NEUTRAL] Claim was denied on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], I mean [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, with the procedure code of 1206.
[CUSTOMER][NEUTRAL] Patient responsibility.
[AGENT][NEUTRAL] We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Claim number?
[AGENT][NEUTRAL] Claim number is 3551605.
[CUSTOMER][NEUTRAL] Just for the confirm, 3551605. Is that correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And can you please send me a fax you pay for these claims?
[AGENT][NEUTRAL] OK, and what's that fax number?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Sure, I have
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And to whose attention?
[CUSTOMER][NEUTRAL] Uh, that will be [PII].
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Uh, no, thank you so much, [PII], for this.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] OK, you too.