AccountId: 011433970860
ContactId: d37743e2-28c7-4f8f-b4eb-8bec9ae7af4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 549809 ms
Total Talk Time (AGENT): 208313 ms
Total Talk Time (CUSTOMER): 253283 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/d37743e2-28c7-4f8f-b4eb-8bec9ae7af4d_20250124T20:11_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I was hoping that you could help me with the patient's claim.
[AGENT][POSITIVE] Well it would be my pleasure to assist you with that claim information. May I ask your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, [PII], and a good callback number, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Uh, policy number is 02512405.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] All right, thank you, [PII] and this is for dental claim?
[CUSTOMER][NEUTRAL] Yeah, I tried to register on the portal and I guess I don't know what the patient's account number is like.
[AGENT][NEUTRAL] Sure, I can help you with that. Do you happen to have the claim number or data service so I can pull up that specific claim?
[CUSTOMER][NEUTRAL] I tried
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Uh, the data service is going to be [PII].
[AGENT][NEUTRAL] OK, let me get that claim pulled up.
[AGENT][NEUTRAL] What's the dental provider name?
[CUSTOMER][NEUTRAL] Uh, Doctor [PII].
[AGENT][NEUTRAL] Is she with a group?
[CUSTOMER][NEUTRAL] Uh, it's at Sherman Western Dental.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Let me just check something real quick.
[AGENT][NEUTRAL] So his patient account number is 566.
[AGENT][NEUTRAL] 255.
[AGENT][NEUTRAL] 566.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's always gonna be on the ADA form.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And I'll tell you exactly where that's gonna be.
[CUSTOMER][NEGATIVE] Uh, yeah, I don't see where that is at anywhere like that's nowhere on his account when I print his claim it doesn't come up so I don't know like where you even find that number.
[AGENT][NEUTRAL] It should be, let me.
[CUSTOMER][NEUTRAL] Cause I've looked at the EOBs, I've looked at his Prios, I've looked at his fax backs. I don't find that number anywhere.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] It's like, where do I find this magical number?
[AGENT][NEUTRAL] I'm gonna, I'm gonna, I'm gonna, I'm trying to get that claim pulled up so I can give you that information so it's always in box 23 on the ADA form.
[AGENT][NEUTRAL] So it where it says patient ID account number assigned by dentist?
[CUSTOMER][NEUTRAL] I'm, I'm trying to print preview it here.
[AGENT][POSITIVE] Take your time because it's always easier if you know where to go next time too.
[CUSTOMER][NEUTRAL] Right. So, um, when I send my ADA claim, box 23 is blank. Like, where do I find that number? Where would I find that number to put it in there?
[AGENT][NEUTRAL] Was this electronically um submitted?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that may be they may be the one putting that in there.
[CUSTOMER][NEUTRAL] Oh, so I need to check with my clearing house.
[AGENT][NEUTRAL] Yeah, I bet you anything. If you didn't put that number, the 566-255-566, that's gotta be through the clearing.
[CUSTOMER][NEUTRAL] Uh, I didn't do that. So maybe that is my clearing house. OK, that makes more sense though, cause I thought I was losing my marbles. So,
[AGENT][NEGATIVE] You know losing it. If you're losing it, I've already lost mine.
[CUSTOMER][POSITIVE] That's so funny. So anyhow, I can get on the portal now. Now, so you can only use the portal per patient?
[AGENT][NEUTRAL] Make sure first though.
[AGENT][NEUTRAL] Per tax ID number.
[CUSTOMER][NEUTRAL] Like you can't just register like your office?
[AGENT][NEUTRAL] Yeah, the tax ID number.
[CUSTOMER][NEUTRAL] Right, it has a tax ID number, but then it wants that patient account number. So once I register, will it let me look up all patients or is it just that one?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It should.
[AGENT][NEUTRAL] No, uh, you should be able to look them up.
[CUSTOMER][NEUTRAL] OK perfect alright I'm gonna go try it then is there any way that you can fax me a copy of the claim just in case I can't find it?
[AGENT][NEUTRAL] Yeah, and what was that total bill amount on that claim just to make sure.
[CUSTOMER][NEGATIVE] Uh, I got $582. It looks like it was denied because of her reaching her or him, sorry, my bad, him reaching his max, but I need the denial to send to his secondary.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] I'm working on that right now if you don't mind holding just one second.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][POSITIVE] My pleasure. If you want to try to create that account while I got you on the line.
[CUSTOMER][POSITIVE] Yeah, I'm, I'm, I'm trying right now actually.
[AGENT][POSITIVE] I would just get you all set up.
[AGENT][POSITIVE] And I can give you the claim number too to make it easier.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Whenever you're ready to give me the fax number I can go ahead and get it on the way.
[CUSTOMER][NEUTRAL] It's 563.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Just to verify, [PII].
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK, that's on the way for you.
[CUSTOMER][NEUTRAL] 31
[AGENT][POSITIVE] I love your background noise.
[CUSTOMER][NEGATIVE] Yeah, he is obnoxious. He does that all day long. Like I've just given up trying to make him stop.
[AGENT][POSITIVE] That is so funny.
[CUSTOMER][NEGATIVE] He is so naughty. I just don't, have you, have you ever had an orange cat? That's, this is what it's like.
[AGENT][NEUTRAL] Oh yeah, yeah, yeah, I have, but I have a black cat and she wants to get right where my mouse is and I keep
[CUSTOMER][NEUTRAL] Yeah, that
[AGENT][NEUTRAL] Throwing her off the table and finally, I've got a pillow, but she'll jump up to that section for me to put her on the pillow now. I'm like, come on here, I gotta work.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] Oh, that's funny. They're just characters, I tell you.
[AGENT][NEUTRAL] They are.
[CUSTOMER][NEUTRAL] He is so, he's probably the loudest cat I've ever had in my life. He is um, I mean, he talks all the time.
[AGENT][NEUTRAL] Really
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] So I'm in. Thank you so much for your help. I really appreciate it.
[AGENT][NEUTRAL] You want me to give you that claim number real quick and make sure you get you can get it pulled up. It's coming to you by fax anyway, but just so you kind of have the navigation. So if you'll go to option one for the claim status.
[CUSTOMER][NEUTRAL] Sure. Yup.
[CUSTOMER][NEUTRAL] Um, option one, where do I see that? Oh, why am I on?
[CUSTOMER][NEUTRAL] Need a claim status.
[AGENT][NEUTRAL] To go under the
[CUSTOMER][NEUTRAL] I'm under
[AGENT][NEUTRAL] Claims.
[CUSTOMER][NEUTRAL] And then I just go to the APL claim number?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did I give you that claim number yet?
[CUSTOMER][NEUTRAL] Not yet.
[AGENT][NEUTRAL] Well, the claim number is 35499973.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Search.
[CUSTOMER][NEUTRAL] Oh, you must have to put the patient's name in. Hold on.
[AGENT][POSITIVE] You too. Sorry about that.
[CUSTOMER][NEUTRAL] Nope, that's fine. I just was like, it's not letting me search. [PII] search.
[CUSTOMER][NEGATIVE] It says 0 claim found.
[AGENT][NEUTRAL] Oh my
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] What is going on?
[CUSTOMER][NEUTRAL] It was 354-99973, right?
[AGENT][NEUTRAL] 3544, yeah, 354.
[CUSTOMER][NEUTRAL] Did I type it in wrong?
[CUSTOMER][NEUTRAL] 354.
[AGENT][NEUTRAL] 4973.
[CUSTOMER][NEUTRAL] 4. So do I have too many 9s? I have 3 549973. Do I have too many 9s?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, you do. It's 354.
[AGENT][NEUTRAL] 4973.
[CUSTOMER][NEUTRAL] 4973. That makes a difference now.
[AGENT][NEUTRAL] And I might have said it incorrectly and if I apologize if I did.
[CUSTOMER][NEUTRAL] No, I, I'm sure it was me cause it's
[CUSTOMER][NEUTRAL] It looks like, so then do I just click on the blue claim number EOB I think.
[AGENT][NEUTRAL] That's it. Mhm.
[CUSTOMER][POSITIVE] Have fun. Thank you so much for helping me. I appreciate it.
[AGENT][POSITIVE] It's my pleasure. Anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] Nope, that'll be it. You have a great weekend.
[AGENT][POSITIVE] You too, [PII], and thank you for calling APL. You take care.
[CUSTOMER][NEUTRAL] You too bye now.
[AGENT][NEUTRAL] Bye-bye.