AccountId: 011433970860
ContactId: d47a91d8-7357-498c-a990-1d290320251b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2163449 ms
Total Talk Time (AGENT): 785007 ms
Total Talk Time (CUSTOMER): 674883 ms
Interruptions: 7
Overall Sentiment: AGENT=0, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/d47a91d8-7357-498c-a990-1d290320251b_20250428T12:54_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
[CUSTOMER][NEUTRAL] What's your last name. Got you. I'll let him know you're here, OK.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, I, I'm so sorry. Yes, I'm here, um, I'm, I'm calling to see if I can have a claim looked at.
[AGENT][NEUTRAL] Oh, are you needing claim status?
[CUSTOMER][NEUTRAL] Well, yes, looks like you guys did a maybe a partial payment on something. I'm just trying to see if I could get um an idea of of what happened.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can check that for you. And who am I speaking with?
[CUSTOMER][NEUTRAL] To the rest
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] And in nature, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Sure it is [PII].
[CUSTOMER][NEUTRAL] 274.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, yes, um, hold on there.
[CUSTOMER][NEUTRAL] I have 02568319.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get the information all pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the nature any information that I do provide verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK, so yes ma'am, uh.
[CUSTOMER][NEUTRAL] It's uh date of birth is [PII]. May I put you on a brief hold?
[AGENT][NEUTRAL] Uh, yes, I am.
[CUSTOMER][NEUTRAL] OK, hold on one second
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Good. I'm here inquiring about my wife. Her name is she was [PII]. She has an [PII] appointment today. OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Have you ever missed a dental appointment? Guess what? You're not alone. With a hectic schedule, it's hard to remember everything, and a timely reminder would make a big difference. So we're excited to introduce smile Reminder for people who would like to receive emails and text messages.
[CUSTOMER][NEUTRAL] to remind them of scheduled dental appointments, we can even let you know when it's time to schedule your next checkup. Never miss another dental appointment again with smile reminder from your hometown dental office. Ask for details when we return to your call.
[CUSTOMER][POSITIVE] We have the pleasure of serving patients of all ages, and we want to see our patients keep and enjoy their teeth for a lifetime. We call it lifetime care. Instead of the usual patch and repair approach, Lifetime care helps you keep your teeth in excellent shape throughout your lifetime while lowering the cost of dental care. For more information or to enroll in lifetime care, simply ask for details when we return to your call.
[CUSTOMER][NEUTRAL] Nearly all of our patients, young and old, enjoy the latest gadgets, mobile phones, and handheld gaming devices. Technology has changed our world and your hometown dental office. Be sure to look around during your visit and you'll notice that we use digital X-rays which provide.
[CUSTOMER][POSITIVE] Instant images while reducing exposure to radiation by up to 90%. Plus these X-rays can be enlarged to show more specific images for informed decisions about better oral health. It's just one way that your hometown dental office is putting cutting edge technology to work for you.
[CUSTOMER][POSITIVE] Did you know that our staff receives the latest continuing education to ensure that you receive the very best dental care? It's true. And as new technologies and treatments emerge, we're committed to making them available to our patients. Combined with our state of the art facilities and equipment, our team of professionals offers excellence in everything we do. We're proud to be your hometown dental office.
[CUSTOMER][POSITIVE] We're committed to serving entire families from the youngest grin to the most experienced smile and every age in between. We realize that people have unique dental needs at different points throughout their lifetimes, so we provide a spectrum of dental.
[CUSTOMER][NEUTRAL] from routine checkups, cleanings, and oral cancer screenings to more advanced dental procedures such as root canal therapy, dentures, and more, you can count on your hometown dental office for comprehensive care for the whole family.
[CUSTOMER][POSITIVE] Have you ever missed a dental appointment? Guess what? You're not alone. With a hectic schedule, it's hard to remember everything, and a timely reminder would make a big difference. So we're excited to introduce smile Reminder for people who would like to receive emails and text messages.
[CUSTOMER][NEUTRAL] to remind them of scheduled dental appointments, we can even let you know when it's time to schedule your next checkup. Never miss another dental appointment again with smile reminder from your hometown dental office. Ask for details when we return to your call.
[CUSTOMER][POSITIVE] We have the pleasure of serving patients of all ages, and we want to see our patients keep and enjoy their teeth for a lifetime. We call it lifetime care. Instead of the usual patch and repair approach, Lifetime care helps you keep your teeth in excellent shape throughout your lifetime while lowering the cost of dental care. For more information or to enroll in lifetime care, simply ask for details when we return to your call.
[CUSTOMER][POSITIVE] Nearly all of our patients, young and old, enjoy the latest gadgets, mobile phones, and handheld gaming devices. Technology has changed our world and your hometown dental office. Be sure to look around during your visit and you'll notice that we use digital X-rays which provide instant images while reducing exposure.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Oh, I'm so sorry thank you so much for waiting. I apologize for that.
[CUSTOMER][NEUTRAL] OK, um, let me hop back on.
[AGENT][NEUTRAL] OK, so what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it's gonna be [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And again, any information that's provided would be a verification of benefits and not a guarantee of payment. What is the data service and total bill amount and nature that you're calling about?
[CUSTOMER][NEUTRAL] Sure, date of service is [PII].
[AGENT][NEUTRAL] Mhm. And total bill amount.
[CUSTOMER][NEUTRAL] Total bill amount is $395.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, now the total, well, give me just one moment.
[AGENT][NEUTRAL] Let me look at this time because.
[AGENT][NEUTRAL] It wasn't for that bill amount.
[AGENT][NEUTRAL] I do not have a claim for 395 for him.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] It was for a comprehensive exam.
[CUSTOMER][NEUTRAL] And FMX.
[CUSTOMER][NEUTRAL] And a a prophylaxis cleaning.
[CUSTOMER][NEUTRAL] Does yours say 36,220?
[AGENT][NEUTRAL] Mhm. Who's the provider?
[CUSTOMER][NEUTRAL] Um, so it's gonna be Victor Key. Last name is [PII]
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] Mhm. What's the name of the group, the dental group?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh Wagner services solution.
[AGENT][NEUTRAL] OK, now I, I don't have a claim that matches any of that information.
[AGENT][NEGATIVE] For a for APL haven't been received.
[AGENT][NEUTRAL] For that data service. Do you have an explanation of benefits from us?
[CUSTOMER][NEUTRAL] Hm, because it
[CUSTOMER][NEUTRAL] Well, looks like you guys sent a check to maybe one of uh one of the other offices. It was uh check number. uh are you able to look up check numbers?
[AGENT][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So it was check number 2022727.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, now,
[AGENT][NEUTRAL] OK, so yes, but that.
[CUSTOMER][NEUTRAL] And I have a reference number.
[AGENT][NEUTRAL] Yes, but I'm showing that claim amount is 3.
[AGENT][NEUTRAL] 302.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 7
[AGENT][NEUTRAL] Just a moment to pull up some additional information but.
[AGENT][NEUTRAL] That's the number that I'm seeing.
[AGENT][NEUTRAL] So give me, uh, well, give me just a moment because I'm gonna have to open another window that has closed on me, so bear with me just a second please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's just taking a moment, [PII].
[CUSTOMER][POSITIVE] It's OK, no worries.
[AGENT][NEUTRAL] Alright, so let me try this again.
[AGENT][NEUTRAL] I thought it was opening and then it.
[AGENT][NEGATIVE] It froze on me, so.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK. Now, so this claim, the, it appears that the amount as I stated before, is different than what you're giving me.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] For that check number.
[AGENT][NEUTRAL] The billed amount is showing different.
[AGENT][NEUTRAL] Uh, let me see if I can look at it another way.
[CUSTOMER][NEUTRAL] Alright and the bill amount for you is.
[AGENT][NEUTRAL] Um, let me, let me look one more place.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Can you tell me what our um fee schedule is with you for these codes?
[CUSTOMER][NEUTRAL] I wonder if we have that wrong.
[AGENT][NEUTRAL] Uh, they use Carrington.
[CUSTOMER][NEUTRAL] Carrington, OK.
[AGENT][NEUTRAL] OK, so the claim that goes with that show.
[AGENT][NEUTRAL] Uh, what's the tax ID number?
[AGENT][NEUTRAL] Well, give me a second to get back to that, yeah.
[CUSTOMER][NEUTRAL] Uh, 2
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK, you ready for it? It's 200.
[CUSTOMER][NEUTRAL] 185918
[AGENT][NEUTRAL] OK, so that's not what's on this claim for him for that data service that would go with that check.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I wonder if he went somewhere else and then came here.
[CUSTOMER][POSITIVE] Interesting.
[AGENT][NEUTRAL] What's the mailing address?
[AGENT][NEUTRAL] For the name of the group.
[CUSTOMER][NEUTRAL] Um, and
[CUSTOMER][NEUTRAL] Uh, but for the, not us, but for his company.
[AGENT][NEUTRAL] For the treating and treatment location.
[CUSTOMER][NEUTRAL] OK, ours, I'm sorry, for Kathleen Dental care.
[CUSTOMER][NEUTRAL] And our address is [PII].
[CUSTOMER][NEUTRAL] Kathleen Road.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Again, no, that information is not what's matching the claim form that was received for him for that data service.
[AGENT][NEUTRAL] And how did you come to have the check number?
[CUSTOMER][NEUTRAL] So maybe
[CUSTOMER][NEUTRAL] Mm it was given by I have a reference number um Evi E E V I E.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] Um, 2, so [PII], but backslashes.
[CUSTOMER][NEUTRAL] So that's the reference number EV.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And she said it was uh it was paid with the check number for $57. A single check was mailed.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] [PII] um and it gave the address of [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and are you affiliated with that address at all?
[CUSTOMER][NEGATIVE] Um, I don't believe so.
[AGENT][NEUTRAL] OK, so what I need to do is transfer you over to another department to look at this because the claims information that she gave you has a completely different provider name, address, tax ID and bill amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm not sure on that.
[CUSTOMER][NEUTRAL] Yeah, so we would if we were in the same.
[AGENT][NEUTRAL] If she gave that information to you.
[CUSTOMER][NEUTRAL] Yeah, if we were in the same group we'd have the same tax ID number and you're saying that it's a different tax ID number so I'm thinking we're not affiliated with that one at all.
[AGENT][NEUTRAL] Yes, so let me transfer you over to given the circumstances on this one.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And I will let them know what you have been told.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When I transfer you and nature because I would normally send a request to have them research it and to call you back, but since you've already been given all that information.
[AGENT][NEUTRAL] Uh, I think you need to speak to someone.
[AGENT][NEUTRAL] Because I'm not seeing a a claim on file for your billed amount that you're giving me.
[CUSTOMER][POSITIVE] OK, that would be great.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, so before I do that though.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] Is there anything else that I could help you with?
[CUSTOMER][NEUTRAL] Um, no, I'm just trying to figure out what's happening with this claim.
[AGENT][NEUTRAL] Sure, I understand. um, now if you all do end up having to file this claim with us.
[AGENT][NEUTRAL] Then
[AGENT][NEUTRAL] Um, because.
[AGENT][NEUTRAL] Let me just look because that, OK.
[AGENT][NEUTRAL] Let me just look at a few more things because uh just go.
[AGENT][NEUTRAL] Just because, OK, just a second.
[CUSTOMER][NEUTRAL] OK, and then maybe I should make sure we've got.
[AGENT][NEGATIVE] Because that claim number is definitely not for you all, mm mm.
[CUSTOMER][NEUTRAL] OK, and your payer ID number is 6081 I'm sorry 60801.
[AGENT][NEUTRAL] Yes, and what again was your tax ID number?
[CUSTOMER][NEUTRAL] Sure [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so I, I don't know, I may not have to transfer you, but this claim.
[AGENT][NEGATIVE] That matches that tax ID number is still not for the bill amount that you're giving me.
[CUSTOMER][POSITIVE] Interesting
[AGENT][NEUTRAL] I have another claim for that same data service under that tax ID number.
[AGENT][NEGATIVE] But it's not for that, for the billed amount of 395.
[CUSTOMER][NEUTRAL] What's the amount?
[AGENT][NEUTRAL] I can't, I can't disclose that. Um.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Let me see what this looks like right here.
[CUSTOMER][NEUTRAL] So you're not are you.
[AGENT][NEUTRAL] It appears he may have gone to different places on the same data service.
[CUSTOMER][NEUTRAL] Let me see [PII].
[AGENT][NEUTRAL] According to what I can see.
[CUSTOMER][NEUTRAL] That has to be.
[AGENT][NEGATIVE] And she just mistakenly gave you that other information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, on that claim. Let me.
[AGENT][NEUTRAL] Bear with me again. I'm just trying to see what happened here.
[AGENT][NEUTRAL] If I can determine that without having to.
[AGENT][NEUTRAL] Because that claim has not, so you can scratch that claim number and that information.
[AGENT][NEUTRAL] Off. Cause that's is definitely not your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I think that may be just what happened is that she looked at the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] That's the wrong thing.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Should I should I resend the claim?
[AGENT][NEUTRAL] You may need to, but I just wanna look at this other claim for this other build amount, the one that does match your tax ID number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To look at the actual claim document.
[AGENT][NEUTRAL] And again, what was the provider name?
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] Sure, uh, [PII] and last name is spelled [PII]
[AGENT][NEUTRAL] OK. All right. So,
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] And what was the address again?
[CUSTOMER][NEUTRAL] Sure [PII].
[CUSTOMER][NEUTRAL] Kathleen Road.
[CUSTOMER][NEUTRAL] And it's Lakeland, Florida.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so this other claim that I'm looking at matches that, but can you double check your billing because the total again is not what you're giving me. The claim, I mean the provider matches, the address matches, tax ID matches what I'm looking at now, but the billed amount on this claim does not. There's 3 line items on this bill on this claim.
[CUSTOMER][NEUTRAL] OK, um, so total bill is 395.
[CUSTOMER][NEUTRAL] And then the estimate portion um that we're expecting from insurance is 36,220.
[AGENT][NEUTRAL] Uh.
[AGENT][NEGATIVE] Yeah, but again, um, what is typed on this claim form that we received is not for 395.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] It's weird because I I see that we're hard.
[AGENT][NEUTRAL] It's for more.
[CUSTOMER][NEUTRAL] It's for more.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm let me see if I can get a calculator maybe it didn't add it up for you.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Electronic there's one.
[CUSTOMER][NEUTRAL] Alright, so I've got 107.
[AGENT][NEUTRAL] Because what
[AGENT][NEUTRAL] See, I don't see that. That's not on, oh, sorry. Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, 395 yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No we did no we did do.
[CUSTOMER][NEGATIVE] And acula guard, but that was only for 350 but I got, I think it got denied or something.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Uh, because of what you're giving, what are the code numbers, what are the codes that you all filed?
[CUSTOMER][NEUTRAL] But that's just then just a one.
[CUSTOMER][NEUTRAL] OK, so it is um 0150.
[CUSTOMER][NEUTRAL] 0210.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then 1110.
[AGENT][NEUTRAL] OK, so those 3 are on this claim form.
[AGENT][NEUTRAL] For the 0150, the fee is 121.
[AGENT][NEUTRAL] For 02 10, it's 190.
[AGENT][NEUTRAL] And 1110, 124. So that's 4:35.
[CUSTOMER][NEUTRAL] Huh, I wonder if we.
[AGENT][NEUTRAL] I'm looking at the claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm wondering if those fees.
[CUSTOMER][NEUTRAL] We're not the correct fees and then we corrected it.
[CUSTOMER][NEUTRAL] Maybe?
[AGENT][NEUTRAL] We didn't see.
[CUSTOMER][NEGATIVE] And we sent the wrong fee schedule or?
[AGENT][NEUTRAL] I mean, I can't say on that. I mean, that's the only reason I'm giving you the, the value is because the codes, everything else matches other than the amounts.
[CUSTOMER][NEUTRAL] Yeah, maybe I should resend this one.
[AGENT][NEUTRAL] But this claim that I'm looking at that shows $435 for those three codes which I added it up as well and it's $435.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and so what was the.
[AGENT][NEUTRAL] Now that claim
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I was gonna say go ahead and give me those numbers again, but I don't know if it would make a difference.
[CUSTOMER][NEUTRAL] So maybe I should just resend this one and put corrective claim on it.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You can because this claim was denied and this claim was denied because it's, it says it's a duplicate of a previous submitted claim. Please check your records for the data services and charges submitted.
[CUSTOMER][NEUTRAL] With correct fees?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] But I
[CUSTOMER][NEGATIVE] Maybe I maybe we had the wrong fee schedule attached and then we resent it and resent it and then.
[CUSTOMER][NEUTRAL] Now they've got the correct fees since those were denied maybe that's what it is.
[AGENT][NEUTRAL] I, I, I don't know. I, I, honestly, at this point, I'm not sure. So what I am gonna do, I'm just gonna transfer you because I don't want you to submit it again and then get denied as another duplicate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, to have them go over this with you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, could you tell me the numbers again for the 0150 and then the other two?
[CUSTOMER][NEUTRAL] What what that claim state states it was.
[AGENT][NEUTRAL] On the claim form it.
[AGENT][NEUTRAL] 150 is 121, 0210 was 190 and 1 and excuse me, 1110, 124.
[CUSTOMER][NEUTRAL] OK, well we got one right?
[AGENT][NEUTRAL] Uh, so, I mean, I don't, yeah, I'm not I'm not sure. Um.
[AGENT][POSITIVE] So yes, at this point, I've exhausted everything that I can do. So I'm gonna try to get you connected with someone who could look at this a little more with you and tell you exactly what you do need to do.
[CUSTOMER][POSITIVE] OK, that sounds good I appreciate your time.
[AGENT][NEUTRAL] OK, alright and nature, well, you're welcome and um I don't know we talked about so much. Did I tell you about our portal where you should be able to get a copy of your explanation of benefits once we've processed the claim?
[CUSTOMER][NEUTRAL] Um, no, ma'am, I, I don't, I don't recall.
[AGENT][NEUTRAL] OK. OK. I don't think that I did. I usually wait till the end to do that, but we do have a portal which you should be able to have access to the explanation of benefits once I oh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] The nature of my phone just transferred you right in the middle of what I was saying. Ah, this is still [PII]. So the website for the portal is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] AMpublic.com.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] Uh-huh. OK. Well, um, again, is there anything else that I could try and help you with before I connect you?
[CUSTOMER][POSITIVE] Uh, no, ma'am, that was it thank you I appreciate your help.
[AGENT][POSITIVE] OK. Well, then, then you're welcome. Yes, ma'am. And thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][NEUTRAL] Uh-huh, thank you. One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Oh, hey, [PII], it's [PII]. Good morning. How are you?
[CUSTOMER][POSITIVE] Good morning. I'm good thanks how are you?
[AGENT][POSITIVE] I'm all right, thank you. I have a dental provider's office on the line.
[AGENT][NEUTRAL] That I need um for you to speak with. I've tried to decipher this claim the best that I can.
[AGENT][NEUTRAL] The policy number, [PII] is 256.
[AGENT][NEUTRAL] 831 9.
[AGENT][NEUTRAL] And the lady's name that I have on the on the line is [PII].
[AGENT][NEUTRAL] She's calling about date of service [PII].
[AGENT][NEUTRAL] OK, so for this data service there's two claims on file. Well, the they had called in January and EV gave them the information on the claim number ending in 358.
[AGENT][NEUTRAL] But that's
[AGENT][NEUTRAL] That's a totally different provider.
[AGENT][NEUTRAL] The tax ID.
[CUSTOMER][NEUTRAL] OK, I'm sorry, you said what's the data service?
[AGENT][NEUTRAL] 1217 of 24.
[CUSTOMER][NEUTRAL] Hm, I'm not getting, finding that date. Let's see.
[AGENT][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] What was the claim number?
[CUSTOMER][NEUTRAL] Is it under part one?
[AGENT][NEUTRAL] Yeah, there's only one part on this, [PII].
[CUSTOMER][NEUTRAL] OK, and what was the claim number?
[AGENT][NEUTRAL] Well, I, OK, the two that are on file for this data service is 354.
[AGENT][NEUTRAL] 5358.
[AGENT][NEUTRAL] And 354-6599.
[AGENT][NEUTRAL] OK, so the claims information that they have been given when they called for status was the one ending in 58.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] However,
[AGENT][NEUTRAL] That's not their claim.
[AGENT][NEGATIVE] ED just mistakenly gave them that claims information.
[AGENT][NEUTRAL] Is what I'm, I'm gathering from what she's saying.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then the other claim ending in 99.
[AGENT][NEUTRAL] The provider name matches, the tax ID matches the address matches for the provider, but.
[AGENT][NEUTRAL] The billed amount on the claim we received is more than what she initially gave me so because everything else matched, I did tell her in the same codes. I mean the codes that are on the claim are the ones that she gave me as well so she thinks that what happened was they used the wrong fee amounts initially and which is why the claims is for 435 instead of.
[AGENT][NEUTRAL] 395.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Their claim ending in 99 was denied as a duplicate of previously submitted expenses.
[AGENT][NEGATIVE] Very confusing.
[AGENT][NEUTRAL] Or for me it is.
[AGENT][NEUTRAL] I don't know why we denied their claim as a duplicate when they had only submitted one claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me just a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I mean, it's, it's just odd.
[AGENT][NEUTRAL] And that first claim number?
[CUSTOMER][NEGATIVE] So they're saying that they should have gotten paid more?
[AGENT][NEGATIVE] Well, they didn't get paid at all. They haven't been paid at all because their claim was denied as a duplicate and it looks like we paid.
[AGENT][NEUTRAL] The claims information that EV gave her, it was to a different provider under a different tax ID number.
[AGENT][NEUTRAL] And all of that.
[AGENT][NEUTRAL] I don't really know what happened.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, we denied all three of the codes on claim number 99 ending in 99 as duplicates.
[AGENT][NEUTRAL] But I don't even see the 0110.
[AGENT][NEUTRAL] It's almost like he went to two providers the same day, 2 different providers.
[CUSTOMER][NEUTRAL] So the provider you have on the other line is from the comfortable care dental.
[AGENT][NEUTRAL] Let's see, [PII], the one matching the 99 information so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Provider [PII], yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'm ready to transfer them over and what was their um callback number?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And again her name is [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All right, [PII]. Well, thank you for your help. Have a great day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you. Bye bye.