AccountId: 011433970860
ContactId: c6e5ff83-b723-457e-8ab8-d2af635c88d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424309 ms
Total Talk Time (AGENT): 124917 ms
Total Talk Time (CUSTOMER): 94737 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/c6e5ff83-b723-457e-8ab8-d2af635c88d1_20250206T15:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling on behalf of the provider's office to check on the claim status on a recorded line. Could you please help me with that?
[AGENT][POSITIVE] Yeah, I'm happy to check on a claim for you today, [PII]. What is the patient's policy number?
[CUSTOMER][NEUTRAL] For the patient's policy number, just be a moment to note it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02536557.
[AGENT][POSITIVE] All right, thank you so much. Let me pull that up here one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] For the patient's name for this one here, it is [PII], [PII].
[AGENT][POSITIVE] Thank you. Data service.
[CUSTOMER][NEUTRAL] There a service for this one that is on December, I'm so sorry, it is [PII].
[AGENT][POSITIVE] Thank you. And the bill amount?
[CUSTOMER][NEUTRAL] And the bill amount is $999.
[AGENT][NEUTRAL] All right, thank you. One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Alright, thank you for your patience and waiting on that. So it looks like we did receive a claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit payment that looks like sent in the amount of $256.40.
[CUSTOMER][NEUTRAL] So the um the 1206, is it paid or not here, [PII]?
[AGENT][NEUTRAL] Uh, the claim was paid in the amount of 25,640.
[CUSTOMER][NEUTRAL] OK, so the 120 as well was paid right under this claim?
[AGENT][NEUTRAL] I'm sorry, what was your question again?
[CUSTOMER][NEUTRAL] Uh, I'm just confirming that for the postal code 1206 was paid as well on the discount.
[AGENT][NEUTRAL] 1206.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I don't even see that as a procedure code. Was this for, this was for a dental claim, yes?
[CUSTOMER][NEUTRAL] Yes, it is for fluoride. I'll just, it's for fluoride.
[AGENT][NEUTRAL] Yeah, I don't see 1206 under this claim.
[CUSTOMER][NEUTRAL] No, 1206 of the discount.
[AGENT][NEUTRAL] Mm mm, not that I see.
[CUSTOMER][NEUTRAL] For [PII], right?
[AGENT][NEUTRAL] Correct. I can go back.
[CUSTOMER][NEUTRAL] The amount of 99. Yes, sir.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we did get a claim for data service 11624 with a procedure code 1206. That claim was denied as it looks like there were no benefits for that um on the patient's policy.
[CUSTOMER][NEUTRAL] OK, so the 1206 was not covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So can I have the processed date?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, so it looks like this particular claim was processed [PII].
[CUSTOMER][NEUTRAL] OK. [PII]. And can I have the claim number?
[AGENT][NEUTRAL] Claim number is 3531528.
[CUSTOMER][NEUTRAL] 531-528. And what will be the patient responsibility on this claim?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility, that's up to the facility or the provider.
[CUSTOMER][NEUTRAL] OK. So are you able to send me the copy of EOB?
[AGENT][POSITIVE] Absolutely. What's a good fax number?
[CUSTOMER][NEUTRAL] That'll be [PII].
[CUSTOMER][NEUTRAL] 709
[CUSTOMER][NEUTRAL] 2408.
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, I am sending that now. It should be there in about 5 minutes. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Uh, I think that will be all. Can you just help me with the reference number?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial in today's date. My name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] So that's all and thank you so much for your time and your help. I really appreciate it. I hope you have a good day.
[AGENT][NEUTRAL] You too, [PII] bye bye.