AccountId: 011433970860
ContactId: f4d12e03-8e56-4c11-be9b-5b035ddb4824
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373429 ms
Total Talk Time (AGENT): 127655 ms
Total Talk Time (CUSTOMER): 191953 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/f4d12e03-8e56-4c11-be9b-5b035ddb4824_20250107T20:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi um I am calling from a provider's office. I had a question about a claim.
[AGENT][NEUTRAL] OK, yeah, I can look at a claim for you. Uh, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number or the claim number?
[CUSTOMER][NEUTRAL] Um, probably have a claim number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Looking at the EOB just a second.
[CUSTOMER][NEUTRAL] Oh, I see a reference number that nothing says claim number.
[CUSTOMER][NEUTRAL] Do you want me to give you that? Oh wait, no sorry, I said number uh it is 354-418-6.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] In the mean, did he?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, and it
[CUSTOMER][NEUTRAL] It rears.
[AGENT][NEUTRAL] OK, and [PII], really quick, can you verify the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, the insured is [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just call us if it because sometimes.
[AGENT][NEUTRAL] And who was the patient?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Got it. OK, I did get this claim looks like we paid a benefit of $110. Uh, what kinds of questions did you have for me?
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][NEUTRAL] Um, I was calling because I noticed there's two codes on there, um, the D0274 and the D1110. Those are showing up as fee. The fee is a fee that I did not submit the claim with um, the bite wing fee that we submitted with the claim is $65 on the EOB it says $24.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the pro fee we submitted $90 and it says $21 on the EOB.
[AGENT][NEUTRAL] OK, OK. Give me just a moment, and we'll take a look at that.
[CUSTOMER][NEUTRAL] Sorry, it's
[CUSTOMER][NEUTRAL] One second, I
[AGENT][NEUTRAL] Alright [PII], if you don't mind I'm gonna put you on a brief hold and reach out to our claims specialist and see um you said it was for the 0274 and I'm sorry, what was the other one?
[CUSTOMER][NEUTRAL] The other one is D1110.
[AGENT][POSITIVE] Got it. OK, thank you. Yes, one moment please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And is the Delta dental for you? You are on hold.
[CUSTOMER][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[CUSTOMER][POSITIVE] Good, how are you?
[AGENT][NEUTRAL] Doing alright thank you actually have a provider on the line uh calling regarding a claim. Uh, she's stating that for two procedure codes that the information doesn't match what they have submitted. I think she just wants to take a look at that.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] It is 02410980.
[CUSTOMER][NEUTRAL] The patient's name?
[AGENT][NEUTRAL] The patient is, uh, yes.
[CUSTOMER][NEUTRAL] Is this dental?
[CUSTOMER][NEUTRAL] I don't. OK, what's the claim number?
[AGENT][NEUTRAL] Oh, OK, um, it's uh 354-418-6.
[CUSTOMER][NEUTRAL] 3544186 0 Lord, I have no idea.
[CUSTOMER][NEUTRAL] Uh, 3, OK, um, which one is it? 3544 for which patient? 254-4186, OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And she's saying, uh, two of the procedures don't match?
[AGENT][NEUTRAL] So yeah, the top two the 0274 and 1110 she's talking about that it doesn't match, she's looking at the EOB we sent versus what she sent um and she's saying that the information and the amounts are different.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm, yeah, it looks like they mixed it up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, OK, so it's the 27, let me highlight it.
[CUSTOMER][NEUTRAL] Uh, I don't do dental, so I can't even say 274 and 220.
[AGENT][NEUTRAL] Uh, 274 and the 1110.
[CUSTOMER][NEUTRAL] 1110.
[CUSTOMER][NEUTRAL] OK, so 274 should be.
[AGENT][NEUTRAL] I keep looking back. I called dental key, right?
[CUSTOMER][NEUTRAL] 65. Yeah, they've mixed it, um.
[AGENT][POSITIVE] Oh, no, oh, no, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, they, that's OK. No, that's I'm just like, I don't know how to answer these questions, but I mean, I'll just, it looks like.
[CUSTOMER][NEUTRAL] 111 0 21. Yeah, it looks like they put the wrong.
[CUSTOMER][NEGATIVE] Amounts which is weird.
[AGENT][NEUTRAL] OK, so it might just need to be reprocessed.
[CUSTOMER][NEUTRAL] Yeah, I'm just gonna send it to dental and have them reprocess it, take a look and reprocess it, but you can send them over. I'll just let him know that.
[AGENT][NEUTRAL] Got you. OK.
[AGENT][NEUTRAL] OK, um, the provider we're talking to, her name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, and you have a callback number?
[AGENT][NEUTRAL] Yes, uh, [PII].
[CUSTOMER][NEUTRAL] OK, you can send her over.
[AGENT][POSITIVE] All right I appreciate your help thank you bye bye.
[CUSTOMER][NEUTRAL] You too. Bye.