AccountId: 011433970860
ContactId: ed5f592c-9560-4aed-8873-4cd8fcf17e73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 956159 ms
Total Talk Time (AGENT): 466344 ms
Total Talk Time (CUSTOMER): 152611 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/ed5f592c-9560-4aed-8873-4cd8fcf17e73_20250220T20:50_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. How are you doing?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] I'm doing good thank you. I have a dental provider on the line on policy number 160.
[CUSTOMER][NEUTRAL] 3081.
[CUSTOMER][NEUTRAL] She's calling on part one for [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she's calling regard that um pre-treat estimate on claim number 3,562,260.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEGATIVE] I cannot get that pre-treat to come up at in on base I.
[AGENT][NEUTRAL] I don't even know. What, what is she just trying to see what the decision is?
[CUSTOMER][NEUTRAL] Yeah, she's asking why the crown is not listed on here it just says one cent.
[AGENT][NEGATIVE] Oh, I don't know anything about dental. I don't know why they put us all in the queue.
[AGENT][NEUTRAL] Have these questions we don't.
[AGENT][NEUTRAL] We don't know. Uh, let me, hm.
[AGENT][NEUTRAL] OK. What is her name?
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] And her call back?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. I'm gonna have to transfer her again.
[CUSTOMER][NEGATIVE] And I just cannot locate the.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The pre-treat EOB.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So it goes out like a ELB. I'm sorry, I'm asking you that. Is that how it works? I don't know anything about this.
[CUSTOMER][NEUTRAL] Well, it, it has, so I'm not sure.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Crown.
[AGENT][NEUTRAL] So the crown is the.
[AGENT][NEUTRAL] 2796 is the, is that what she's asking about? The seat crown, 2796?
[CUSTOMER][NEUTRAL] Um, 279-6 yeah.
[AGENT][NEGATIVE] Well, there's a 0.
[AGENT][NEUTRAL] See on the.
[AGENT][NEUTRAL] The image
[CUSTOMER][NEUTRAL] You see the retreat EOB?
[AGENT][NEUTRAL] Well, not the EOB what they actually sent in the claim. Yeah. So that code is, the fee is only, it, there's no fee for it.
[CUSTOMER][NEUTRAL] Oh, the claim, yeah.
[CUSTOMER][NEUTRAL] And then for the other one is alternate procedure not applicable?
[AGENT][NEUTRAL] The 1435.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm, OK, wait, wait, wait.
[AGENT][NEUTRAL] So additional actions.
[AGENT][NEUTRAL] I don't know. I don't know anything. OK. I, I mean, I'll just have to transfer to someone in dental.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] This is on the the 2740, yeah, I see it shows as a listed benefit.
[AGENT][NEUTRAL] OK. Yeah, I don't, I don't process dental, so I, I have no clue. I'll just have to turn around and transfer to uh someone in dental.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] You want to just hang up and let me do it that way she doesn't seem, look like she's getting bounced around.
[AGENT][MIXED] I think that's best, but I, you know, I don't know how, what you guys are taught for it, you know.
[CUSTOMER][POSITIVE] Let's do that. Let's do that. I think that's best instead of.
[AGENT][NEUTRAL] Let me look here because I normally ask, let's see if she's available.
[AGENT][NEUTRAL] OK, she's not.
[AGENT][NEUTRAL] OK. Yeah, um, I, but I don't know, did you, what, what queue did you go in because we're all in the queue.
[CUSTOMER][NEUTRAL] Dental, dental.
[AGENT][NEUTRAL] Yeah, they've put us all in the queue to answer the phones, but
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I don't have the answers or Vicky's not here.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Before you go back, let me see.
[AGENT][NEUTRAL] Let me see who processes dental.
[CUSTOMER][NEUTRAL] [PII], maybe?
[AGENT][NEUTRAL] She does. Now, if I have any questions, I, I do reach out to her. She's the only person that I know. Oh, no, no, no, I don't know. I, I, I reach out to [PII]. I've never reached out to [PII], but she's available.
[AGENT][NEUTRAL] Yeah, see, [PII] said [PII]. That's the only person I know.
[AGENT][NEUTRAL] Let me, let me see what [PII].
[CUSTOMER][NEUTRAL] Is [PII] available?
[AGENT][NEUTRAL] She's available.
[AGENT][NEUTRAL] Yeah, I would say reach out to her, her.
[AGENT][NEUTRAL] She's at [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, I only know [PII]. I reached out to her and she's not showing available right now.
[AGENT][NEUTRAL] If nothing else, I would say take her number down and, and let her know that someone will call her back.
[AGENT][NEUTRAL] If [PII] doesn't know. Well, now [PII]'s not available.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Or you can send her over and I'll just tell her I'll have to have someone call her back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I see that, OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, thank you [PII], let me get her on the line.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] [PII], thank you for your patience. I have patient in our claims department. She's gonna try to assist you and thank you for calling APL. Hope you have a great afternoon.
[CUSTOMER][POSITIVE] You too thank you. Thank you bye bye.
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][POSITIVE] Hi, thank you for holding. I do apologize for the wait. I was trying to um get a dental examiner.
[CUSTOMER][NEUTRAL] Oh, it's OK.
[AGENT][NEUTRAL] Uh, someone that can explain because I see here, let me take a look at something really quick.
[AGENT][NEUTRAL] So your question is about the crown, correct?
[AGENT][NEUTRAL] Are, are both procedures.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, mostly just the crown. The only code that's listed on what we received back was the crown seat, which is at 2796, but that's it's a no charge code anyway. We were really just looking at the crown.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look here D27.
[AGENT][NEUTRAL] OK, alternate procedure not applicable. Let me check their fee schedule [PII]ybe this.
[AGENT][NEUTRAL] Let me make sure this procedure.
[AGENT][NEUTRAL] It's on their fee schedule.
[AGENT][NEUTRAL] That may be
[CUSTOMER][NEUTRAL] Yeah, and from what I
[CUSTOMER][NEUTRAL] Yeah, one we had from June had the 2740 listed on there.
[AGENT][NEUTRAL] OK, let me see frequencies and everything to make sure if it's there.
[AGENT][NEUTRAL] Yeah, let me look at let me see if I can look at it that way.
[AGENT][NEUTRAL] OK, so that is the.
[AGENT][NEUTRAL] 2740.
[AGENT][NEUTRAL] So they looks like they.
[AGENT][NEUTRAL] Maximum one per.
[AGENT][NEUTRAL] 6 months 1 person, let me see if it's been.
[AGENT][NEUTRAL] If we receive a.
[AGENT][NEUTRAL] OK, so it looks like uh.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, let me see if someone oh hold one moment.
[AGENT][NEUTRAL] Let me call. Hold one moment for me. I'll get that uh answer for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, [PII], this is [PII]. I had a question. I, I'm good. How are you?
[AGENT][NEUTRAL] I'm good. I have a question. Um, I have a, a provider on the call on the phone, and they're asking about a pre-treatment they sent in.
[AGENT][NEGATIVE] And they're confused about the uh remark code that they received back on one of the procedures.
[AGENT][NEUTRAL] Uh, the policy number is 160.
[AGENT][NEUTRAL] 3081.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm. For [PII].
[AGENT][NEUTRAL] Uh, long girl.
[AGENT][NEUTRAL] I know, it's probably gonna be the last, uh, longest 1.5 hours I have.
[AGENT][NEUTRAL] So that C crown is a, a zero charge. So she's not concerned about that one. It's the crown.
[AGENT][NEUTRAL] The 14th. Mhm.
[AGENT][NEUTRAL] OK, did you do this one?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Are you just the only person I know to ask questions about these dental clients?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, so they wouldn't receive that information back on the EOB after it's been. How does that work? I guess she was I guess she got documentation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me go cause I have the image up.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII] cause it was, she, she was transferred to me. [PII] was saying she couldn't pull the ELB, so that's why I was, I went to the image. Let me see.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, maybe that's.
[AGENT][NEUTRAL] OK, I, I see it here. I see it here.
[AGENT][NEUTRAL] OK, let me see, so I wonder what her question is, why is she?
[AGENT][NEUTRAL] OK, that's the 96 chart. I mean procedure. Let me go.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I think that's what she's saying. She only got the 01.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] OK, and so on, on this one, so would I tell her that what we, what we'll pay is the 574 or or percentage of the 570?
[AGENT][NEUTRAL] OK, we paid them. OK.
[AGENT][NEUTRAL] Estimated. OK.
[AGENT][NEUTRAL] Oh, OK. OK, good. OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] OK, I'll let her know. OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Same, you just help me here, so I'm glad I know where to look now if I get a a question back. OK.
[AGENT][POSITIVE] All right, have a good one, [PII].
[AGENT][POSITIVE] You too. We're gonna get it together, girl. OK.
[AGENT][POSITIVE] OK, thank you. Same to you.
[AGENT][NEUTRAL] OK, [PII], thank you for holding. I do apologize for the wait. So I was able to figure out what the issue was. Um, so for some reason it did not, uh, populate the procedure 2740.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, which is why you got the explanation of benefits with just the 01, the 0.01 charge. Um, uh, they will send out another, so it shows the procedure, but I do have the information, uh, so it shows for this procedure, the estimated amount paid would be 574.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But she's going to uh resubmit it so you get the explanation of benefits that shows uh what they uh estimated for the procedure.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK perfect that makes a lot more sense. I thought I was going crazy.
[AGENT][NEUTRAL] Oh OK
[AGENT][POSITIVE] OK, well, is there anything else I can help you with? I do apologize for that.
[CUSTOMER][POSITIVE] No, it's OK that's all I needed.
[AGENT][POSITIVE] OK. You have a wonderful day, [PII]. Thank you for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] You too thanks bye bye.