AccountId: 011433970860
ContactId: e5125429-513b-4802-a445-6c2e5ca3c161
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 3415250 ms
Total Talk Time (AGENT): 1060613 ms
Total Talk Time (CUSTOMER): 914100 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/e5125429-513b-4802-a445-6c2e5ca3c161_20250617T18:10_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I'm calling on behalf of the dental office to check claim status of number of patients on a recorded line. Can you please help me with that?
[AGENT][NEUTRAL] Uh, you said that we're needing to check on claim status, is that correct?
[CUSTOMER][NEUTRAL] Correct, claim status.
[AGENT][NEUTRAL] Yes, yes, I can check on claims for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Policy number is 0 I'm sorry, 02559646.
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] This is for [PII]'s [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] Data services [PII] but amount $562 even.
[AGENT][NEUTRAL] OK, that was [PII] for $562?
[CUSTOMER][NEUTRAL] May I know
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] That's right, for procedure code 11:10.
[AGENT][POSITIVE] OK thanks
[AGENT][NEUTRAL] It was just the one procedure code?
[CUSTOMER][NEUTRAL] May I know how do you spell your name?
[CUSTOMER][NEUTRAL] Yes, we can send on one procedure code on this claim.
[AGENT][NEUTRAL] OK. Um, my name is spelled [PII]
[CUSTOMER][POSITIVE] Thank you for that, [PII].
[AGENT][NEUTRAL] Of course, uh, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, what was the name of this provider, [PII]?
[CUSTOMER][NEGATIVE] A Korean lame.
[AGENT][NEUTRAL] OK, so I did find this claim. It looks like uh that was the only code we, excuse me, the only procedure we did pay a benefit on, uh, we paid a benefit of $69 even.
[CUSTOMER][NEUTRAL] 69. And what is the date when the payment was issued?
[AGENT][NEUTRAL] Uh, one moment, let me get that for you.
[AGENT][NEUTRAL] I'll also get that check number. Did you need that claim number first?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, uh, that's on a different page, so I need to take a note of the payment information first. But then, mm, sure, let's proceed with the payment information.
[AGENT][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this check was issued [PII].
[AGENT][NEUTRAL] And I am showing that it is still uh has not yet cleared so yes it was a paper check, um, if you have not received the check after 30 days of the from the issue date uh then you can give us a call back and we will get this voided and reissued.
[CUSTOMER][NEUTRAL] It's, right?
[CUSTOMER][NEUTRAL] OK. What is the checking number for this one?
[AGENT][NEUTRAL] That is 20.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is this a single check or bulk check card?
[AGENT][NEUTRAL] Single check.
[CUSTOMER][NEUTRAL] Is it cash or still outstanding? You mentioned this is still outstanding, right?
[AGENT][NEUTRAL] Yes, that's correct. It has not yet cleared.
[CUSTOMER][NEUTRAL] Let me take a note of it.
[CUSTOMER][NEUTRAL] Was this check sent to the address of [PII]?
[CUSTOMER][NEUTRAL] [PII] or to the address of [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Um, I have the address that we sent it to was [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, that's the address. Take a note.
[CUSTOMER][NEUTRAL] What is the total patient responsible in this claim?
[AGENT][NEUTRAL] Uh, we don't say what is patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK. What's the claim number for this car?
[AGENT][NEUTRAL] That is 3603617.
[CUSTOMER][NEUTRAL] I would like to request your be with fax, please.
[AGENT][NEUTRAL] Of course, absolutely what was that fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, uh, I'm going to read that back to make sure I heard that correctly. That was [PII].
[AGENT][NEUTRAL] 5261475.
[CUSTOMER][POSITIVE] Perfect, [PII].
[AGENT][NEUTRAL] OK, alright, I will get that sent to you now. I should get it within about 10 minutes or so. Uh, did you need any other information regarding this claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This patient has another claim that is also for May 925. And that is in the billed amount of $872 even.
[CUSTOMER][NEGATIVE] I hope this is also paid.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] Was this for multiple procedures or were we looking at one specific procedure code again?
[CUSTOMER][NEUTRAL] Well this is a multiple procedure code and the claim includes 01200220023045 and 0274. These are concern codes on that claim.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Oh was this this was for the same provider or was this a different provider?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I see this is provider Roderick Ari.
[AGENT][NEUTRAL] I see. OK.
[AGENT][NEUTRAL] OK, bear with me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, yes, so for this claim we did pay a benefit of $135.80.
[CUSTOMER][POSITIVE] Perfect. And what is the date when the payment was issued?
[AGENT][NEUTRAL] Yes, one moment, let me get that.
[AGENT][NEUTRAL] OK, so this check was also issued, uh, [PII]. Uh, it is also still outstanding, has not yet cleared, and I am showing it sent to that same address in uh [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. And [PII] is the issue date, right? Perfect. And what is the check number?
[AGENT][NEUTRAL] Uh, [PII]. Sorry.
[CUSTOMER][NEUTRAL] Oh, [PII]. All right. And yes, I'm ready for the check number.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh yes, it is 204-589-8.
[CUSTOMER][POSITIVE] Perfect. And this is also outstanding taking a note over here and sent to the same address.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] For this one, the claim number is?
[AGENT][NEUTRAL] Oh, that claim number is 3,603,730.
[CUSTOMER][POSITIVE] Perfect. I've saved this one. And I would like to request you be on the same fax number. And just want to confirm all the four quotes we mentioned, uh, I mentioned to you are paid, right?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] What was I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] All the 4 codes are paid, right?
[AGENT][NEUTRAL] Um, for this claim, give me just a moment, let me see which codes we did pay on. Let's see.
[AGENT][NEUTRAL] That was 01200274.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And then several instances of uh 0230.
[AGENT][NEUTRAL] Yes, so that, no, no, no, those are the ones that we did pay on this claim.
[CUSTOMER][NEUTRAL] Oh, they are not paid?
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Yes, sorry about the confusion.
[CUSTOMER][NEUTRAL] So 01200274.
[CUSTOMER][NEUTRAL] Uh huh, no worries, uh, 012002740.
[AGENT][NEUTRAL] 0274.
[CUSTOMER][NEUTRAL] Uh, and 0220 and 0230. These are paid, right?
[AGENT][NEUTRAL] Let's see, we did not pay on 0220.
[CUSTOMER][NEUTRAL] What's the reason for that?
[AGENT][NEUTRAL] Give me just a moment, let me get that for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh, the benefit, um, that benefit had been applied to their, uh, deductible, their calendar year deductible.
[CUSTOMER][NEUTRAL] Deductible. OK. And what is the deductible amount on this?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Per calendar year it is $50.
[CUSTOMER][NEUTRAL] So $50 is applied for this procedure code, right, on this claim.
[AGENT][NEUTRAL] Let's see, so it looks like there were a few procedures that went towards the deductible. Give me just a moment. I can get all of those for you. Hold on.
[CUSTOMER][NEUTRAL] Um, so, I, I don't need all the procedures. My concern is what is the amount applied for this particular claim? You can provide the total amount applied for deductible.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, towards the deductible.
[CUSTOMER][NEUTRAL] On deductible on this claim.
[AGENT][NEUTRAL] Sure, I, I do believe that with this claim it did meet their $50 deductible.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so the entire $50 and you have already taken a request for EOB and we have taken a note for claim number and we're ready to go for the new patient. Before that, I would like to know what is the call reference number, please?
[AGENT][NEUTRAL] Reference number would be the same for any claim that we look at today. It would be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[AGENT][NEUTRAL] And if you'll give me one moment I'm going to finish uh sending these EOBs to you. I'll let you know when I'm ready to proceed with that next policy number.
[CUSTOMER][POSITIVE] Oh sure, great.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][POSITIVE] OK, I appreciate your patience. You can go ahead uh with that next policy number.
[CUSTOMER][NEUTRAL] OK great this is 020.
[CUSTOMER][NEUTRAL] 336-44.
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for this member please?
[CUSTOMER][NEUTRAL] This is a patient.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Perfect, thank you for that and then what was the date of service please?
[CUSTOMER][NEUTRAL] [PII] bill amount $550.
[CUSTOMER][POSITIVE] And whenever you're ready, I can share the codes.
[AGENT][NEUTRAL] Sure, OK, and that was [PII] for $550?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, yes, uh, go ahead with those codes please.
[CUSTOMER][NEUTRAL] Uh, that is [PII] for tooth number 21 and 2330 for tooth number 22.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And what was the name of this provider, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, got it thank you. OK, so for this claim we were unable to pay a benefit as their calendar year maximum has been exhausted the benefit maximum.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I see. Taking uh what is the date when the claim was processed in the system, [PII]?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] So this claim was processed on [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What is the claim number for this one car?
[AGENT][NEUTRAL] That is 3599.
[AGENT][NEUTRAL] 931.
[AGENT][NEUTRAL] Uh, would you like me to send you a copy of this EOB as well?
[CUSTOMER][POSITIVE] Perfect. And
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll go ahead and get that sent now.
[CUSTOMER][NEUTRAL] May I know what is the annual maximum for the patient policy meanwhile? Sure.
[AGENT][NEUTRAL] Sure, give me just a moment I'll get that pulled up.
[AGENT][NEUTRAL] OK, uh, so the calendar year maximum for this plan is uh $500.
[CUSTOMER][NEUTRAL] $500 perfect. What is the date when the claim was last processed and got paid, where the patient met the annual max amount?
[AGENT][NEUTRAL] Uh, give me just a moment, let me find that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said the date that it was processed?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, that was also on [PII].
[CUSTOMER][NEUTRAL] So, uh, let, let me repeat my question, sorry. Uh, I would like to know what is the last date of service?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh OK I got you, yes, and it does look like, sure, uh, yes, yes, this, um, and it does look like it was for the same provider, uh, the [PII] that was [PII]. It was a single claim um that did pay the benefit amount maximum of $500.
[CUSTOMER][NEUTRAL] Which is speed and the patient max out. Uh-huh.
[CUSTOMER][POSITIVE] Perfect. I'll take a note of it and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did we have any other claims to check for this member?
[CUSTOMER][NEUTRAL] And it's with the same provider.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, for this patient, that's it, and you have already taken a request for the EOB. So I'll save this one and then yes, we can now move to the other patient's policy.
[AGENT][NEUTRAL] I did, I did go ahead and send that.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and then, uh, you can go ahead with that next policy number.
[CUSTOMER][NEUTRAL] 0013615999.
[AGENT][NEUTRAL] OK, um, that's going to be a bit too long to be one of our policy numbers, [PII].
[CUSTOMER][NEUTRAL] Can you just take out 10 in the beginning.
[AGENT][NEUTRAL] Um, I did, um, after the zeros you did say 136159999.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEGATIVE] OK, yeah, that's going to be a bit too long.
[CUSTOMER][NEUTRAL] Um, let's just try with removing 19 at the end. Maybe they are, you know,
[AGENT][NEUTRAL] I'll give it a try. Give me just a moment, sure.
[CUSTOMER][NEUTRAL] Typing or or something.
[AGENT][NEUTRAL] Maybe, um, no.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] No, I got a very old accident policy with that.
[CUSTOMER][NEUTRAL] Um, can you tell me the first name?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, do you have the members uh social? I could search for them that way.
[CUSTOMER][NEUTRAL] Mm, well, I don't see that, but uh I'm trying to pull that on the other page. But meanwhile, if you can try with the patient name and date of birth.
[AGENT][NEUTRAL] Um, I wouldn't be able to search for the date of birth, but if you wouldn't mind spelling out the first and last name, I can try that way.
[CUSTOMER][NEUTRAL] Sure. The patient name is [PII], spelled as [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I write the last name.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] As for November
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Got it. OK, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, um, I do not have anyone with that name in our system, [PII].
[CUSTOMER][NEUTRAL] Mm, let me try in case on the other page.
[CUSTOMER][NEUTRAL] Uh I see that with the social.
[CUSTOMER][NEUTRAL] Mm, no, I don't see that. I don't see uh uh uh I don't see a group number.
[CUSTOMER][NEUTRAL] Can you try with the group number?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Sure, what was that group number?
[CUSTOMER][NEUTRAL] 52 Z as in Zulu.
[CUSTOMER][NEUTRAL] 151413 L as in Lima.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that is not one of our group numbers, [PII], um, that is too long and our group numbers also don't have letters in them so that doesn't appear to be a policy with us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let's skip this one. Just a moment. Let me create a note with that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what is the?
[CUSTOMER][NEUTRAL] No, I, I did, I just have, uh, for the other patient ID so we can move to the other one.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient named [PII].
[CUSTOMER][NEUTRAL] [PII] with the date of birth, [PII].
[AGENT][NEUTRAL] Got it. OK, thank you for that. um, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] This is for the date of service.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Build on on this one is.
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], the amount $1,031 even.
[AGENT][NEUTRAL] Got it.
[AGENT][NEUTRAL] 1,031. OK, so I will say this policy did terminate [PII]. If you'll give me one moment, I'll see if she had one that was active during that time. Bear with me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so she did not, this was the only policy she had with us. Did you still want me to check to see if we received this claim?
[CUSTOMER][NEUTRAL] Oh yes, I would like to check whether you have received the claim. If not, I can take a note accordingly if you have received the claim, I can take a note accordingly whether it's denied.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course, absolutely, uh, what was the name of that provider?
[CUSTOMER][NEUTRAL] Sure. This policy provider is [PII].
[AGENT][NEUTRAL] OK, got it. OK, so yes, we did receive this claim, um, and of course it did deny as the services were rendered after coverage was terminated. Um, did you want me to go ahead and send you this EOB as well?
[CUSTOMER][NEUTRAL] I'll take a note of it.
[CUSTOMER][POSITIVE] I would like to, yes.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] And what is the date?
[CUSTOMER][POSITIVE] Sure, no worries. Take your time.
[AGENT][NEUTRAL] Uh, the process date? No, you're fine. I can go ahead and give you that. Uh, process date was [PII].
[CUSTOMER][POSITIVE] I appreciate that.
[CUSTOMER][NEUTRAL] And once you're done, I would like to know what is the effective date of the policy.
[AGENT][NEUTRAL] Oh sure, this policy's effective date was [PII].
[CUSTOMER][NEUTRAL] [PII]. Perfect. And the termination you mentioned was on [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, uh, [PII].
[CUSTOMER][NEUTRAL] Thank you for that. Is that an individual termination or group termination?
[AGENT][NEUTRAL] Um, I can see. Give me just a moment. Let me see if there are any notes regarding that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, no, I guess this policy just simply lapsed outside of the group.
[CUSTOMER][NEUTRAL] So it's an individual termination? OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What is the claim number for this one?
[AGENT][NEUTRAL] Yes, that is 36.
[AGENT][NEUTRAL] 00
[AGENT][NEUTRAL] 808.
[CUSTOMER][POSITIVE] Perfect. I have saved this one. And now I'm ready for the next patient's policy, [PII].
[AGENT][NEUTRAL] OK, we are completed with this, uh, this policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me just a moment I'll let you know and I'm ready to proceed.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][POSITIVE] OK, I appreciate your patience. You can go ahead with that next policy number.
[CUSTOMER][NEUTRAL] 021-7335.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for this number please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, got it and then uh what was that date of service please?
[CUSTOMER][NEUTRAL] [PII] $1,063 even.
[AGENT][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] And we were looking at multiple procedures again?
[CUSTOMER][NEUTRAL] Um, this is for correct, multiple codes including 0140.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 0220.
[CUSTOMER][NEUTRAL] 0230.
[CUSTOMER][NEUTRAL] 03300270 2392 for surface A and B.
[AGENT][NEUTRAL] Got it. OK, um, was this with the provider is that, uh, Colleen Dental Services?
[CUSTOMER][POSITIVE] Correct. Clean dental services.
[AGENT][NEUTRAL] Got it. OK, uh, so for this claim we paid a benefit of $603.20.
[CUSTOMER][NEUTRAL] 603 26.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And just to confirm,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The procedure codes I mentioned to you are paid, right?
[AGENT][NEUTRAL] So we paid on procedure code 0140 and then both of the uh 0 excuse me 2392 we did pay on both of those as well we did not pay on 0270 or 0330 uh let's see, give me just a moment let me get clarification as to why.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Um, uh, we can take a note for clarification later. I just want to discuss, um, all our paid.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, as you mentioned, all the other are paid. 0330 and 0270 are not paid. Are they pending for any additional information?
[AGENT][NEUTRAL] No, um, so apparently they had already met their maximum for these specific procedures, uh, so it does state they're limited to one X-ray procedure per 5 year period, and then the bite wings limited to one bite wing X-ray procedure per 12 month period. So those benefits had already been met, uh, prior.
[CUSTOMER][NEUTRAL] Um, oh, OK.
[CUSTOMER][NEUTRAL] Uh-huh. And 0220 and 0230, they paid, right?
[AGENT][POSITIVE] Oh yes, yes, I apologize. Yes, those two are.
[CUSTOMER][NEUTRAL] And what is the date when the claim was paid?
[AGENT][NEUTRAL] Uh, give me just a moment, I'll get that.
[AGENT][NEUTRAL] That was
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Looks like it processed [PII]. Let me look at that actual uh check issue date. Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, yes, so this one, the check was issued [PII], and again I am showing this one has not yet cleared, so I can go ahead and get this one, voided and reissued. Let me know when you're ready and I'll, um, go over the address that we have.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, no, let it take its time because as per our system, we have 2 months, 60 days' time, so that's fine. So, what is the check number? Mhm.
[AGENT][NEUTRAL] Oh, I see. OK.
[AGENT][NEUTRAL] Sure, I, yes, that is uh 204-404-7.
[CUSTOMER][POSITIVE] Perfect. Is that a single check or a bulk check?
[AGENT][POSITIVE] Yes sir single track.
[CUSTOMER][POSITIVE] Perfect. And this is still outstanding, saving that one.
[AGENT][NEUTRAL] And you did want a copy of this EOB as well, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this was sent to the address of [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Perfect, taking note.
[CUSTOMER][NEUTRAL] Just to confirm, um, well, I would like to know the history for procedure code 0270 as it is once every 12 months.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was for 0270?
[CUSTOMER][NEUTRAL] Correct, 0270. What is the history?
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] Sure, give me just a moment let me find that.
[AGENT][NEUTRAL] OK, looks like the last the excuse me 027 that was uh.
[AGENT][NEUTRAL] [PII] was the last time we paid for a bite wing X-ray.
[CUSTOMER][NEUTRAL] Is that with the provider what, let me see.
[AGENT][NEUTRAL] Um, let me check that provider. Let's see.
[AGENT][NEUTRAL] Uh, repeat the provider's name. I'm sorry.
[CUSTOMER][NEUTRAL] Mm, that is, uh, I would like to spell it instead. That is spelled as S as in Sam, Uniform Hotel Romeo Uniform Delta.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Whiskey Alpha Mike Sam India.
[AGENT][NEUTRAL] OK, uh, no, so I do have this as a, I have this as a diff, well, I don't have the provider's, um, the doctor's name. I have the name of a facility. Do you maybe have the tax ID? I could, uh, confirm that way.
[CUSTOMER][NEUTRAL] Last name is
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] No sir, OK, this is a different, uh, tax ID, different provider.
[CUSTOMER][NEUTRAL] A different provider, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And now for procedure code um 0330 it's once every 6 months or 36 months, sorry.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, uh, once every 5 years that was uh FMX and Pao correct?
[CUSTOMER][NEUTRAL] OK. Yes, FMX.
[AGENT][NEUTRAL] Yes, give me just a moment, let me see.
[CUSTOMER][NEUTRAL] And the history for that one is?
[AGENT][NEUTRAL] Yes, bear with me just a moment let me try to find that.
[AGENT][NEUTRAL] OK, so it does look like that was [PII].
[CUSTOMER][NEUTRAL] [PII]. Is that with the same tax ID with different tax ID ending with [PII]?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Uh, give me just a moment, I'll get that pulled up and check.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I apologize my system just decided to freeze on me. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, no, so this provider.
[AGENT][NEUTRAL] Is different um it looks like it was the same provider that was that also had did the by wings as well.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The provider, taking note. Now, coming back to the claim for [PII], um do you have a patient responsibility on this one?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Uh, again, we don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. And the claim number for that claim for [PII] is?
[AGENT][NEUTRAL] Yes, that is 36.
[AGENT][NEUTRAL] 00.
[AGENT][NEUTRAL] 938.
[CUSTOMER][POSITIVE] Perfect. And I would like to request new be fax on the same one, please.
[AGENT][NEUTRAL] Uh, yes, I do believe I already sent it. Hang on, let me see. Yes, I did already send that.
[CUSTOMER][POSITIVE] Oh great. I'll take a note of it. Uh-huh.
[AGENT][POSITIVE] No worries.
[CUSTOMER][POSITIVE] I appreciate that.
[CUSTOMER][POSITIVE] And now I'm ready for the next patient's policy whenever you are ready.
[AGENT][POSITIVE] OK thank you give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Thanks for your patience, [PII]. Uh, you can go ahead with that next, uh, policy number.
[CUSTOMER][NEUTRAL] OK. The next policy number is 02612909.
[AGENT][NEUTRAL] OK and then uh the name and date of birth for this number please?
[CUSTOMER][NEUTRAL] This is for [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright and then uh what was that uh date of service please?
[CUSTOMER][NEUTRAL] This patient have
[CUSTOMER][NEUTRAL] Two claims for the same date of service. The first one, that is for May [PII], which is the, the bill amount of $366 for procedure code 1206 and 1110.
[AGENT][NEUTRAL] OK, and I'm sorry, you did say that was [PII]?
[CUSTOMER][NEUTRAL] [PII], right.
[AGENT][NEUTRAL] OK, OK thank you one moment.
[AGENT][NEUTRAL] OK and then what was the name of this provider please?
[CUSTOMER][NEUTRAL] The provider is [PII].
[AGENT][NEUTRAL] OK, thank you for that. Alrighty, so for this claim we paid a benefit of $127 even and that was only for a procedure code 1110.
[AGENT][NEUTRAL] If you'll give me one moment, I will take a look at why we did not pay. There is also a 12:06 and 13:30.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we we're unable to pay on either of those as uh those are not covered procedures under this policy.
[CUSTOMER][NEUTRAL] 0, um, 1110 is paid 126 is denied as not covered benefit, right? Taking note.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the date when the payment was issued?
[AGENT][NEUTRAL] Uh, let me get that check information one moment.
[AGENT][POSITIVE] OK, so this check was issued [PII], and I am also showing this one is outstanding.
[CUSTOMER][NEUTRAL] And the check number is?
[AGENT][NEUTRAL] 204571-0.
[CUSTOMER][POSITIVE] OK single check, right? Still outstanding.
[AGENT][POSITIVE] Single check that's correct and yes it is still outstanding.
[CUSTOMER][POSITIVE] Perfect. Taking a note.
[CUSTOMER][NEUTRAL] And is sent to the address of [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Perfect. Taking a note.
[CUSTOMER][NEGATIVE] And no patient responsibility information available.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And just to confirm, the procedure code as you mentioned, 1206 is denied as uh not covered benefit. Just wanna confirm, is it denied the age limit?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, so it's just not a covered procedure, uh, under this policy as that policy is not listed, um, then it's not going to be covered.
[CUSTOMER][NEUTRAL] And what's the age limit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] What is the claim number for this one?
[AGENT][NEUTRAL] That is 36.
[AGENT][NEUTRAL] 03.
[AGENT][NEUTRAL] 859.
[CUSTOMER][POSITIVE] Perfect, taking a note.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And this patient, as I mentioned, I have one more claim.
[AGENT][NEUTRAL] Yes, you said that was for the same date of service?
[CUSTOMER][NEUTRAL] Correct, that is in the bill amount of $1,736 even.
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] OK, was this, uh, the same provider [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for this claim we paid a benefit of $372 even.
[CUSTOMER][NEUTRAL] 372 even, perfect. And what is the date when the payment is issued?
[AGENT][NEUTRAL] Let me get that one moment.
[AGENT][NEUTRAL] So this check was issued [PII].
[CUSTOMER][NEUTRAL] [PII], perfect. And the check number is?
[AGENT][NEUTRAL] That is 20.
[AGENT][NEUTRAL] 44.
[AGENT][NEUTRAL] 554.
[CUSTOMER][NEUTRAL] I see that.
[CUSTOMER][NEGATIVE] Still outstanding and sent to the same mailing address. And any of the code on this claim denied?
[AGENT][NEUTRAL] Uh, I believe several have. Give me just a moment. Let me go back to that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so we did not pay a benefit for procedure code 1999.
[AGENT][NEUTRAL] Uh, we also did not pay on 0367.
[AGENT][NEUTRAL] 0220.
[AGENT][NEUTRAL] Oh, OK, those are the only claims we did not make a payment on those 3.
[CUSTOMER][NEUTRAL] So, um, 0220 is denied for what reason?
[AGENT][NEUTRAL] Give me just a moment, I'll get that.
[AGENT][NEUTRAL] Oh excuse me, the that benefit had been applied to their deductible.
[AGENT][NEUTRAL] The other two that denied were not covered procedures.
[CUSTOMER][NEUTRAL] Oh, not covered benefit for procedure 0220.
[AGENT][NEUTRAL] No, no, no, uh, 0220 was that one went to their deductible. The other two, that denied were not covered. Sorry about that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, sure, OK. And what's the, what are the other codes you mentioned?
[AGENT][NEUTRAL] Uh, sure, let me go right back to that.
[AGENT][NEUTRAL] So that was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] And the other one?
[CUSTOMER][NEUTRAL] OK, noted that. And what is the deductible applied towards this claim?
[AGENT][NEUTRAL] Uh, the amount applied to their deductible?
[CUSTOMER][NEUTRAL] Yes, on this claim.
[AGENT][NEUTRAL] Sure, give me just a moment, let me get that.
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm so sorry it's running pretty slow give me just a moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, uh, that amount was $45.
[CUSTOMER][POSITIVE] Perfect. What is the claim number for this?
[AGENT][NEUTRAL] Yes, that is 3602.
[AGENT][NEUTRAL] 244.
[CUSTOMER][POSITIVE] Perfect and I would like to request you be on the same.
[AGENT][NEUTRAL] Yes sir, right, I'm getting that sent now, um, you did just so that I know you do want all of these EOBs sent to you, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK yeah so I'll just go ahead and send them as I get them pulled up.
[CUSTOMER][POSITIVE] No worries. You can send it all together because I see the other patients are from the same family. So you can send all together, that's fine.
[AGENT][NEUTRAL] OK, um, did we have another, uh, date of service for this member?
[CUSTOMER][NEUTRAL] Uh, not for this patient. I see.
[CUSTOMER][NEUTRAL] That's it for this patient and under the same family, we have another patient, a sibling to Ivan.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] What patient was that?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is [PII] Yee, [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And did we have multiple claims to check for this number?
[CUSTOMER][NEUTRAL] Two claims for this patient. That's right.
[AGENT][NEUTRAL] Got it. OK, what was that uh date of service?
[CUSTOMER][NEUTRAL] May 725 $1,368.
[AGENT][NEUTRAL] [PII] for 360.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] May 725 $1,368.
[AGENT][NEUTRAL] Got it. OK, one moment, uh, what was that, um, what were the procedure codes for this claim?
[CUSTOMER][NEUTRAL] So, the procedure codes we can see are.
[CUSTOMER][NEUTRAL] 01500220
[CUSTOMER][NEUTRAL] 5 units of 0230.
[CUSTOMER][NEUTRAL] And 0272.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so I did fund a claim with uh those procedure codes listed, however, it does appear to be more than $360.
[AGENT][NEUTRAL] Are we just looking at specific procedures?
[CUSTOMER][NEUTRAL] So, uh, just to confirm, the paid amount you mentioned is $360 right?
[AGENT][NEUTRAL] Uh, no, I'm showing this claim, uh, does include multiple procedure codes. Um, we paid a benefit of $373.
[CUSTOMER][NEUTRAL] But then the procedure codes I mentioned to are on file, right?
[AGENT][NEUTRAL] Let's see uh 0150.
[AGENT][NEUTRAL] 02200330 and let's see.
[CUSTOMER][NEUTRAL] 0272
[AGENT][NEUTRAL] 0272 yes.
[AGENT][NEUTRAL] So this does include those procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh. $370 is the paid amount, right?
[AGENT][NEUTRAL] 373.
[CUSTOMER][POSITIVE] Oh thank you for correction 373.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what is the date?
[AGENT][NEUTRAL] Let me get that one moment. Mhm.
[CUSTOMER][NEUTRAL] When the payment was issued?
[AGENT][NEUTRAL] Uh, that was [PII].
[CUSTOMER][NEUTRAL] [PII]. And the check number is?
[AGENT][NEUTRAL] 20
[AGENT][NEUTRAL] 44.
[AGENT][NEUTRAL] 507.
[CUSTOMER][NEUTRAL] Uh, I'm sorry, I missed the first digit. It's 2044 and then?
[AGENT][NEUTRAL] Oh, sorry.
[AGENT][NEUTRAL] 50 507.
[CUSTOMER][NEUTRAL] If I'm not, uh-huh.
[CUSTOMER][POSITIVE] Perfect. 204450-7.
[CUSTOMER][NEUTRAL] Taking a note.
[CUSTOMER][POSITIVE] Perfect. And this is also sent to the same address, the [PII]. Perfect. And
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All the courses are paid, so is there any deductible applied on this claim?
[AGENT][NEUTRAL] Oh, let me check that. Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, uh, there has, and if you'll give me one moment I'll get that total amount for you.
[AGENT][NEUTRAL] OK, excuse me, um, so it does look like that there are.
[AGENT][NEUTRAL] 2 and then it has with this claim it did meet that um.
[AGENT][NEUTRAL] $50 deductible.
[CUSTOMER][NEUTRAL] $50 noted that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Claim number for this one is.
[AGENT][NEUTRAL] That is 36.
[AGENT][NEUTRAL] 02
[AGENT][NEUTRAL] 232.
[CUSTOMER][POSITIVE] Perfect. And I would like to request a new be on the same.
[AGENT][POSITIVE] Yes, I'm getting that sent to you right now.
[CUSTOMER][NEUTRAL] Fax number
[CUSTOMER][NEGATIVE] OK, great, save this one.
[CUSTOMER][NEUTRAL] And Cora, this patient have one more claim.
[AGENT][NEUTRAL] OK, give me just a moment. Let me go ahead and send this EOB to you.
[AGENT][NEUTRAL] OK, uh, what was that date of service?
[AGENT][NEUTRAL] The next state of service.
[CUSTOMER][NEUTRAL] This is for
[CUSTOMER][NEUTRAL] May 725 $366 even.
[AGENT][NEUTRAL] OK, uh, those procedure codes please.
[CUSTOMER][NEUTRAL] Uh, the codes, uh, it's 1206 and 11:10.
[AGENT][NEUTRAL] OK, got it one moment.
[AGENT][NEUTRAL] OK, so for this claim we paid a benefit of $127. Uh, we did pay that on procedure code 1110.
[AGENT][NEUTRAL] Uh, 12:06 and 13:30 were also on this claim, um, and they are not covered procedures.
[CUSTOMER][NEUTRAL] Taking note
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And any deductible applied on this claim?
[AGENT][NEGATIVE] No, not on this one.
[CUSTOMER][POSITIVE] Perfect. And what is the date when the payment is issued?
[AGENT][NEUTRAL] Uh, one moment, let me get that.
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][POSITIVE] Perfect and the check number on this one is?
[AGENT][NEUTRAL] 2044.
[AGENT][NEUTRAL] 555.
[CUSTOMER][POSITIVE] Perfect. Taking a note.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And this is also outstanding. What is the claim number for this one?
[AGENT][NEUTRAL] That is 36.
[AGENT][NEUTRAL] 02
[AGENT][NEUTRAL] 230.
[CUSTOMER][POSITIVE] Perfect. And I hope you have already taken the request for the EOB.
[AGENT][NEUTRAL] Yes, I have already sent that.
[CUSTOMER][NEUTRAL] OK. See this one.
[CUSTOMER][POSITIVE] And I'm ready for the next patient under the same policy.
[AGENT][NEUTRAL] OK, different member but the same policy number correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, uh, which member are we looking at now?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did we have multiple claims for this member as well?
[CUSTOMER][NEUTRAL] Yes, 2 claims.
[AGENT][NEUTRAL] OK, what was that date of service, please?
[CUSTOMER][NEUTRAL] [PII] bill on $366 even.
[CUSTOMER][NEUTRAL] The codes on this claim are
[CUSTOMER][NEUTRAL] [PII] and [PII].
[CUSTOMER][NEUTRAL] Hello, we're connected, right?
[CUSTOMER][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Hello, [PII]. I'm I audible to you?
[CUSTOMER][NEUTRAL] I'm sorry, I can't hear you.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] OK, I'll give a call back. Thank you.