AccountId: 011433970860
ContactId: c9843878-d9a3-4725-aeaa-9822218c60e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 807570 ms
Total Talk Time (AGENT): 365895 ms
Total Talk Time (CUSTOMER): 152750 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/c9843878-d9a3-4725-aeaa-9822218c60e1_20250102T18:56_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thanks for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, I am calling to check the status of payments on the claim or a few claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, let me help you with some claim status today. Can I have the policy number?
[CUSTOMER][NEUTRAL] Yes, 792-353.
[AGENT][POSITIVE] Perfect and then do you mind real quick if I also get a good first name and call back number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Call number is [PII].
[AGENT][POSITIVE] Wonderful. Thank you so much. And your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] All right, and there's a chance I put this number in wrong. Would you mind if I get that policy number one more time?
[CUSTOMER][NEUTRAL] 792353
[AGENT][NEUTRAL] All right, I do see Ms. [PII] here. And one more time that um date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Thank you I really appreciate that and.
[AGENT][NEUTRAL] Let's take a look at those claims.
[AGENT][NEUTRAL] Um, 2.
[AGENT][NEUTRAL] And what was the date of service on the claim we want to look at?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] All right. Wonderful. And
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] All right, I believe I have your claim here. Would you just be able to verify for me the name of the facility name on file?
[CUSTOMER][POSITIVE] Yes, it would be the winning smile dental group.
[AGENT][NEUTRAL] Perfect, thank you so much, and I show that we received your claim on [PII] and that we processed the claim on [PII], same day. It does look like this check was uh this check, this claim had benefits payable. I have your claim number listed as 353-5783.
[AGENT][NEUTRAL] And that the benefits on this claim was
[AGENT][NEUTRAL] In the amount of 18,780 and the check number was 2015926.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Let me see, is that there were several different claims on that.
[CUSTOMER][NEUTRAL] Date um.
[CUSTOMER][NEUTRAL] Is that do you know what the bill amount for that one is?
[AGENT][NEUTRAL] Um, let me pull that up.
[AGENT][NEUTRAL] So I actually, it does not look like I can view the original claim for whatever reason. I'm not sure why um I can see.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, I'm so sorry. I see like a lot of charges, um, but they all look like they have the same procedure code 02391.
[AGENT][NEUTRAL] And so I'm not sure.
[CUSTOMER][NEUTRAL] Yeah it was I think we had 4 claims or one was for um.
[CUSTOMER][NEUTRAL] A cleaning fluoride.
[CUSTOMER][NEUTRAL] Uh, X-ray and exams and then we had several fillings.
[CUSTOMER][NEUTRAL] Uh, I think those were broken into two different claims.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Because they were originally we, we were told back in October that the checks were sent out but we hadn't received them so we called on [PII] and they said they were gonna do a reissue of the checks.
[CUSTOMER][NEUTRAL] So I didn't know
[CUSTOMER][NEUTRAL] Where those were being sent to or how many checks there were.
[AGENT][NEUTRAL] OK, so that would probably explain what I'm seeing then, um.
[AGENT][NEUTRAL] Cause I am looking like.
[AGENT][NEUTRAL] I'm showing a few different checks. Hold on one second. I wish I could like see them all at once. One sec. I'm gonna.
[AGENT][NEUTRAL] Type these out.
[AGENT][NEUTRAL] All right, so it looks like I'm showing that it was split and that's probably why I couldn't view the original claim, um.
[AGENT][NEUTRAL] I'm showing it was split into 4 separate payments and checks, um, so I have 4 different check numbers.
[AGENT][NEUTRAL] On file and then the benefit totals um.
[AGENT][NEUTRAL] The first one is 18,780.
[AGENT][NEUTRAL] I'm, I am so I really wish I had written these down the first time I went into all of them.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] 31 for one of them and.
[AGENT][NEUTRAL] Let's see, the next one would have been for $16.
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] The very last one was gonna be for 100.
[AGENT][NEUTRAL] 9680, so the total amount between the four checks should have been $431.60.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And I show that they were reissued on.
[AGENT][NEUTRAL] [PII] [PII]. Um, they were sent to [PII].
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and how often does that typically take to actually be sent out? We haven't received those still.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] So, typically, if they're cut on the [PII], they're put in the mail on the [PII], like the very next day. So, I mean, I imagine you would have received them by now if you were going, you know what I mean, like,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It doesn't usually take longer than
[AGENT][NEUTRAL] 5 to 10 days in the mail.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But that's is that the correct address like uh the one I read off the [PII]?
[CUSTOMER][NEUTRAL] Um, well, that is the trading address you said [PII].
[AGENT][NEUTRAL] Um, yeah, so it actually.
[AGENT][NEUTRAL] It's um they have it in here as not [PII], it's like [PII], and I'm wondering if that is what is the problem.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] That could be um I could.
[CUSTOMER][NEUTRAL] Because we also have our like billing address that is different than the physical office address.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] As far as like what would we need to wait to see about getting those reissued again.
[AGENT][NEUTRAL] So we've actually, it's typically only like um 30 days, so we've already exceeded that so I can go ahead and get a request put in to get them void and reissued as long as they haven't, as long as they don't have.
[AGENT][NEGATIVE] Confirmation of it being cleared. Um, and on my side, I don't see that, but I also don't.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Go as far as they do into the systems like I don't have that much access so um I can go ahead and get that process started for you.
[AGENT][NEUTRAL] I am trying to see.
[AGENT][NEUTRAL] That's sorry, one second.
[AGENT][NEUTRAL] All right, I am, I'm going to look into this a little more and see.
[AGENT][NEUTRAL] Some things, but I'm not gonna make you hang out on the phone with me no matter what I'm gonna get that request put in. I will mention um the address making sure it goes to an I and not a one. I don't know if that was a typo or if we have information incorrect on our side, but I can't see the original claim form um and so that's what I'm gonna try to dig up and so that way I can.
[AGENT][NEUTRAL] Verify that we have it correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On that, um,
[CUSTOMER][NEUTRAL] Because we did receive um.
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] We received checks from other claims on the same family.
[CUSTOMER][NEUTRAL] Just not for this specific patient.
[CUSTOMER][NEUTRAL] So I, I would think that.
[CUSTOMER][NEUTRAL] The address would be correct.
[AGENT][POSITIVE] Yeah, I, I definitely like, I'm getting the feeling that it is a
[AGENT][NEUTRAL] Typo and not.
[AGENT][NEUTRAL] Let me see, so this is for the same patient that check was.
[AGENT][NEUTRAL] But that one went to a PO box, so I'm not.
[AGENT][NEUTRAL] I'm not sure, but is there, do you prefer it going to the PO box, the [PII]?
[CUSTOMER][NEUTRAL] Yes, if we could get that sent um to the [PII], that's where our billing offices, and that would be better.
[AGENT][POSITIVE] All right. I am gonna get working on getting that taken care of for you. Is there anything else I can do to help you?
[CUSTOMER][NEUTRAL] That is all I need if I could just have a reference number for the call please.
[AGENT][NEUTRAL] You bet you. It's gonna be my name, [PII], first initial, last name [PII], and today's date.
[CUSTOMER][POSITIVE] All right thank you so much for your help.
[AGENT][POSITIVE] Hey, it's my pleasure. Thank you so much. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye.