AccountId: 011433970860
ContactId: dc9ff3ae-499c-4ae8-b628-752d9a473645
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 645690 ms
Total Talk Time (AGENT): 155490 ms
Total Talk Time (CUSTOMER): 198125 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/dc9ff3ae-499c-4ae8-b628-752d9a473645_20250411T16:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII], um, I was calling for a couple claim status updates.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII], and may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, it's um [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And their subscriber ID is 02042180.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, and then can you please give me the data service and the amount of the charge?
[CUSTOMER][NEUTRAL] Uh, yes, let's see.
[CUSTOMER][NEUTRAL] It's for data service 312.
[CUSTOMER][NEUTRAL] Uh, we actually have two data services. Let's start with 33.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And that's 2024?
[AGENT][NEUTRAL] Or 2025, 25, OK, and then what is the charge amount please?
[CUSTOMER][NEUTRAL] Of 2025.
[CUSTOMER][NEUTRAL] Uh, let me see
[CUSTOMER][NEUTRAL] 338.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] Oh, you know what, actually let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on, I might have 2.
[CUSTOMER][POSITIVE] Oh, you know what, this actually, never mind, I think I answered my own question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, is it, is it showing that the patient is maxed out?
[AGENT][NEUTRAL] Well, um,
[CUSTOMER][NEUTRAL] Um, for the two data services I have, I guess they were denied because they were maxed out for 3325 and 326 25.
[AGENT][NEUTRAL] Let me check for you real quick.
[AGENT][NEUTRAL] Let me look this one up first, the 33.
[AGENT][NEUTRAL] 58
[AGENT][NEUTRAL] And the facility that you're calling from please is.
[CUSTOMER][NEUTRAL] Boss Dental.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, um, the, the calendar year maximum for the dental benefits has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I just didn't cross reference on my end. OK, alrighty well thank you so much. I appreciate your help today, [PII]. Thank you.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is that all I can help you with before we go?
[CUSTOMER][NEUTRAL] Uh yes ma'am.
[AGENT][POSITIVE] OK, well, you have a wonderful weekend and thank you for calling APL.
[CUSTOMER][NEUTRAL] Or actually ma'am, can you hold on one second? Let me make sure I have the EOB for those data services.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3, could you maybe are you able to fax those um EOBs?
[AGENT][NEUTRAL] Yes, I can fax the EOB. What is your fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and then this you gave me one day of service. What is the second date of service and the charge amount?
[CUSTOMER][NEUTRAL] Uh, for 33 and for um.
[CUSTOMER][NEUTRAL] And for 312.
[AGENT][NEUTRAL] OK. OK. I'm gonna put you on a brief hold while I get those EOBs ready for you and I will be right back.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, Ms. [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Miss [PII], just wanna let you know I haven't forgot about you. It's in the process of loading so that I can go ahead and send them, but I just wanted to get back and let you know.
[CUSTOMER][NEUTRAL] OK, um, while, while you were doing that, I, I not sure if we have one claim submitted, um, mainly, uh, I don't know if you have an endo claim for, uh, code 3330.
[CUSTOMER][NEUTRAL] Uh, if you can let me know because I know we, we probably have a couple different claims, uh, for 312 because of the different providers, um, so if you could just keep that in mind, please, because that's the one I'm looking for specifically.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am. I will
[AGENT][NEUTRAL] Yes, I will check that um as soon as I get that claim pulled up to send you the EOB and I will check it for that code on the EOB for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, because I'm not positive if any of those.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That date of service went out actually so.
[AGENT][NEUTRAL] OK, let me check. You're very welcome and it's on the [PII] is that you're checking on now, right?
[CUSTOMER][POSITIVE] OK thank you ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am, yeah, because they had, they had work done, uh, for, uh, they had crown build up and and the work on [PII].
[AGENT][NEUTRAL] Yes, um, and you're right looking on data service of [PII], I do not find a claim on file.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] No? OK.
[CUSTOMER][NEUTRAL] And then that's I'm like maybe if it's.
[CUSTOMER][NEUTRAL] Seat date or something.
[AGENT][NEUTRAL] And I'm gonna look the procedure code up.
[CUSTOMER][NEUTRAL] Let's see, OK, so.
[AGENT][NEUTRAL] And see if we have any that procedure code anywhere.
[AGENT][NEUTRAL] For this insured.
[CUSTOMER][NEUTRAL] Yeah, we have 2740 and we have 3330.
[AGENT][NEUTRAL] Yeah, the 3330 is not pulling up, so it doesn't look like it's been filed yet.
[CUSTOMER][NEUTRAL] OK, that might be, uh, do y'all pay by seat date?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, that might be why because we might not have seen that they got it delivered. OK, so we'll probably have to just resubmit those.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 412.
[AGENT][NEUTRAL] But I do have the other EOB on its way to you.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] For the data service of 33.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] OK, alright, perfect, thank you so much ma'am.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is that everything I can help you with?
[CUSTOMER][NEUTRAL] Yes ma'am, that's all.
[AGENT][POSITIVE] OK, have a good weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.