AccountId: 011433970860
ContactId: ef152dfe-d312-4b25-81b7-796497078b0b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402160 ms
Total Talk Time (AGENT): 68718 ms
Total Talk Time (CUSTOMER): 159444 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/ef152dfe-d312-4b25-81b7-796497078b0b_20250612T14:25_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] on the care team. How are you doing?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] I'm doing good. I have a provider on the other line. They, it's dental. Um, they submitted like the pre-estimate, but the pre-estimate was missing one of the codes. And so we, um, I guess whoever they spoke to in claims was gonna reprocess it, but nothing ever happened, but I see some notes here showing um what the missing code was and what the dollar amount would be. She's wanting to know.
[CUSTOMER][NEUTRAL] She's wanted to speak to somebody about when they'll get a copy and then when the amount shown is that what they have to pay or I'm sorry, what the insurer has to pay or what we're paying towards that code. Um, let me give you the policy number.
[CUSTOMER][NEUTRAL] It's 1603081.
[AGENT][NEUTRAL] And what code was missing from it?
[CUSTOMER][NEUTRAL] 0, hold on, let me go back to the notes. 2740 is missing.
[AGENT][NEUTRAL] And the data service was 21-2025.
[AGENT][NEUTRAL] And 2:30
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I see that claim in uh in history.
[AGENT][NEUTRAL] So she said they never got it.
[CUSTOMER][NEUTRAL] The pre the pre-estimate on on base only shows the 2740. They need the, oh, I said it backwards. They need the, hold on one moment.
[CUSTOMER][NEUTRAL] 02796.
[AGENT][NEUTRAL] OK, so that's on claim number 2260. It's not listed, so benefits will not be covered.
[AGENT][NEUTRAL] But you can send her over.
[CUSTOMER][NEUTRAL] So on a pre-estimate, just so I know moving forward, if it's not listed on the, on the facts back, then we're not gonna answer it on the estimate because it's not covered.
[CUSTOMER][NEUTRAL] Is that
[AGENT][NEUTRAL] It is on the it's on there it's under uh claim number 3,562,260.
[CUSTOMER][NEUTRAL] Just so I know.
[AGENT][NEUTRAL] And so it should be listed there.
[AGENT][NEUTRAL] you can send her over so I can see what she got because uh I don't know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We put the claim up.
[CUSTOMER][NEUTRAL] OK, hold on one second.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hello, Daddy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thanks again for holding. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][POSITIVE] OK, thank you so much have a happy happy Thursday. Thank you you also. Bye bye. Thank you.
[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII], and how can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I'm calling with Grand Avenue Dental Care in [PII]. I am just trying to get um some information on a pre-authorization we sent in um in February for the 2740 code, and I'm guessing that they'll pay about 40%. I just need to know kind of what your usual and customary fees are.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK 1 2nd to pull that information up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I go Pratosh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can I get your zip code please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and can I get the amount that you are usually charged for this procedure?
[CUSTOMER][NEUTRAL] 1435.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's just showing us that uh that is within the UCR for this zip code.
[AGENT][NEUTRAL] It does, it's not giving me a charge amount.
[CUSTOMER][NEUTRAL] That that that
[CUSTOMER][NEUTRAL] It's not giving you a charge amount?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Okey dokey.
[CUSTOMER][NEUTRAL] All right, and it um I'm showing the last time that we talked to somebody um.
[CUSTOMER][NEUTRAL] They said that um.
[CUSTOMER][NEUTRAL] It would be 40% and their out of pocket costs would be about 7574 so I'm gonna guess I mean 40% of our fee is about 574 so that's I mean I know that this is just an estimate. I know that like I can't, it's not guarantee of benefits so I think that that's what I'll just tell the patient and go from there.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright sounds good.
[CUSTOMER][NEUTRAL] OK, alright then that is all I needed.
[AGENT][POSITIVE] Alrighty well thank you for calling APL and have a great rest of your day.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][NEUTRAL] Alright bye bye.
[CUSTOMER][NEUTRAL] Bye bye.