AccountId: 011433970860
ContactId: ebf25faf-fba3-48c2-bfab-d66585ec3d59
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 247520 ms
Total Talk Time (AGENT): 88680 ms
Total Talk Time (CUSTOMER): 141732 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/ebf25faf-fba3-48c2-bfab-d66585ec3d59_20250114T14:06_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hold on one second. I, um, so sorry, uh, my name is [PII] calling on behalf of Holly Tree Pediatric Dentistry. Had, um, some questions on, uh, claim and the explanation of benefits that was just received.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can help you, [PII]. What's the policy number and the claim number?
[CUSTOMER][NEUTRAL] Um, policy number is
[CUSTOMER][NEUTRAL] 02557398
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim number is 35 wrong one OK 354-7754. I actually have to dependent.
[AGENT][NEUTRAL] And what's the
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[AGENT][NEUTRAL] OK, did you have more than one claim number?
[CUSTOMER][NEUTRAL] Uh yes, the other one is 354-775-0. They're both on the same policy.
[AGENT][NEUTRAL] OK, and um what's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what's the patient's uh name and dates of her date of birth?
[CUSTOMER][NEUTRAL] So first one being [PII] and his date of birth is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and then the second one is [PII], uh, [PII].
[AGENT][NEUTRAL] OK, thanks for that, [PII], and we're going just over these two claims.
[AGENT][NEUTRAL] Yeah, questions regarding mhm.
[CUSTOMER][NEUTRAL] Yeah, so I received, yeah, that for Hunter, um, his data service [PII] received the explanation of benefits stating we are uh we are awaiting information to confirm eligibility for benefits and a card upon receipt of this information, we will continue processing your claim. If you have any questions, please call. So that's why I was calling if this needs to be a subscriber situation where they call and reach out to verify or.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that's in that's what we do. We'll do that we're corresponding so they don't have to do anything, but we've since went in and reprocessed those claims and so for Hunter, I'm showing a benefit of $204 was processed on [PII], so you should be receiving that shortly and then for Lucas, um, his was reprocessed on the [PII] as well, issuing a payment of $173.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because our the explanation of benefits I received on him, total charges, um.
[CUSTOMER][NEUTRAL] It looks like they were gonna remit payment of $103.
[AGENT][NEUTRAL] For Lucas?
[CUSTOMER][NEUTRAL] So it, yes, so what I'm looking at, we build out for um periodicam, adult prophy, and then fluoride treatment. Um, and it said it was gonna remit payment.
[CUSTOMER][NEUTRAL] Oh, maybe that was the 2:17. OK, sorry, uh, my eyes are playing tricks on me today. No, the total charges were 217. There was zero payments, so total patient responsibility for 217, but I was just wanting to ensure that this is just null and void at this point. A check should be coming soon.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, and so we were, it was kind of pendent status that EOB that you had it was it the claims were in pendent status and so we received the information needed, um, and then we went back in and reprocessed the claim. It's nothing that the patient needed to do anyway, it's, it's yeah.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just, we haven't received anything like this, so I haven't really received a lot of payments from APL, so I just wanted to to check on that but thank you so much for your help and can I get a reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll use my name in today's date as your reference, [PII], first initial last name is [PII], and you'll be receiving the checks along with the ELB attached to the ELB here shortly.
[CUSTOMER][POSITIVE] OK perfect thank you so much [PII] for your time have a good rest of your day.
[AGENT][POSITIVE] You're welcome, [PII], thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Uh huh bye bye.