AccountId: 011433970860
ContactId: f32665fb-1180-45e5-b3c3-7c7ea5eab8c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 888200 ms
Total Talk Time (AGENT): 200608 ms
Total Talk Time (CUSTOMER): 172893 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/f32665fb-1180-45e5-b3c3-7c7ea5eab8c6_20250612T14:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling with Grand Avenue Dental Care and I am just following up on a pre-authorization that we were waiting for clarification on.
[AGENT][NEUTRAL] OK, um, and daddy, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Um, our contact phone number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Um, it is 01603081.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um so this was like for a pre-estimate.
[CUSTOMER][NEUTRAL] Yep, we sent a pre-estimate back in looks like January and somebody had um followed up in February and they said that they had processed the pre-authorization wrong and would send out updated information and we just have never received it and so I'm just kind of following up the patient was in the other day and was asking about that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] To see what happens.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold? I'm just looking at what was sent in and see if I can get an update. OK, hold on one moment. You're welcome.
[CUSTOMER][POSITIVE] Yep, yep, no problem.
[CUSTOMER][POSITIVE] OK sounds good thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, thank you so much for holding. I apologize for that wait. So, um, the part that you're missing is for code 2740?
[CUSTOMER][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, I don't see a generated like the estimate, I see something here in the notes, um, that for code 02740, the estimate is $574.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it and that would be because so this is in my note and maybe make sure that I'm reading this correctly so um eligible he's eligible for the crown the coverage would be at 40%.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That his portion would be 574?
[CUSTOMER][NEUTRAL] Is that how I'm reading that, or is it like?
[AGENT][NEGATIVE] No coverage charge.
[AGENT][NEUTRAL] Hold on. I'm all for procedure.
[AGENT][NEUTRAL] I'm not sure. Let me check with claims. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Because I know this is like you can you can you ask them another question too um because I'm, I'm guessing that they'll pay about 40% of usual and customary. I just don't know what the usual and customary fee is that's kind of what I'm what I'm looking for is the fee, uh, like what the what your usual and customary fee is on the on the [PII].
[CUSTOMER][NEUTRAL] And then I can estimate a little bit better.
[AGENT][NEUTRAL] And what's your zip code?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][POSITIVE] OK, thank you, yep, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh, this is annoying.
[AGENT][NEUTRAL] Let me go over there.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] We can't call anybody.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, what's the screening for it?
[AGENT][NEUTRAL] Why do they do stuff like this?
[AGENT][POSITIVE] Why not just put the screen that goes with it because it's right here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What's the UCI screen?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You can watch the show and then all of a sudden he'll come in and be like.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the wait. Um, so what I'm gonna do is go ahead and get you over to a claims examiner, so they, so that they can um discuss it with you further in detail, OK?
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect, sounds great.
[AGENT][NEUTRAL] All right, Daddy, hold on one moment while I get the rep for you. And was there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, you've been more than helpful thank you so much.
[AGENT][NEUTRAL] You're welcome. Well, thanks for calling APL. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][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 going to 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.
[AGENT][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.
[AGENT][NEUTRAL] It's 1603081.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And what code was missing from it?
[AGENT][NEUTRAL] 0, hold on, let me go back to the notes. 2740 is missing.
[CUSTOMER][NEUTRAL] And the data service was 21-2025.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And 2:30
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I see that claim in uh in history.
[CUSTOMER][NEUTRAL] So she said they never got it.
[AGENT][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.
[AGENT][NEUTRAL] 02796.
[CUSTOMER][NEUTRAL] OK, so that's on claim number 2260. It's not listed, so benefits will not be covered, but you can send her over.
[AGENT][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.
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] Just so I know.
[CUSTOMER][NEUTRAL] It is on the it's on there it's under uh claim number 3,562,260.
[CUSTOMER][NEUTRAL] And so it should be listed there.
[CUSTOMER][NEUTRAL] Yeah you can send her over so I can see what she got because uh I don't know me put the claim up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hello, Daddy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][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.
[AGENT][POSITIVE] Thank you, you also. Bye-bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Good morning thanks