AccountId: 011433970860
ContactId: f9516d39-55de-4f40-8e4a-9b91eb11e401
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2173270 ms
Total Talk Time (AGENT): 480589 ms
Total Talk Time (CUSTOMER): 355785 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/f9516d39-55de-4f40-8e4a-9b91eb11e401_20250617T19:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII] and I'm calling on behalf of the dental office to check claim status of number of patients on a recorded line. Can you please help me with that?
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] 0619, I'm sorry, 02612909.
[AGENT][NEUTRAL] And are all the claims for this member or there are multiple members?
[CUSTOMER][NEUTRAL] Well, all the patients are on the same member ID.
[AGENT][NEUTRAL] OK. And um may I have the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] This is a patient, um [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Um, the bill, uh, data services [PII], but I'm on $366 even.
[AGENT][NEUTRAL] [PII] $366.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] I think it's that. Oh no.
[AGENT][NEUTRAL] I'm just gonna start from the bottom cause Lord.
[AGENT][NEUTRAL] 37.
[AGENT][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] 3606238.
[AGENT][NEUTRAL] And this one.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Well, to be sure.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So we received a few claims on that date of service, um, but your claim, can you verify the name of the provider on the file?
[CUSTOMER][NEUTRAL] The provider is [PII].
[AGENT][NEUTRAL] Yes. OK, so your claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 223 8.
[AGENT][NEUTRAL] And also on [PII], the claim was processed.
[AGENT][NEUTRAL] And we paid out to the provider a total of $127.
[AGENT][NEUTRAL] And did you need the check information or anything?
[CUSTOMER][NEUTRAL] Is that a paper check?
[CUSTOMER][NEUTRAL] Yes, I would like to know what is the check number?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So it was a single check?
[AGENT][NEUTRAL] Check number 2044556.
[CUSTOMER][POSITIVE] Perfect. Is it cash or still outstanding?
[AGENT][POSITIVE] I was still outstanding.
[CUSTOMER][NEUTRAL] Was the check sent to the address of?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Perfect. And what is the total patient responsible in this claim?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility because we're not the major medical.
[CUSTOMER][NEUTRAL] Just to confirm, uh, we are concerned about two procedure codes on this claim. That is 1110, and 1206. Both of them are paid?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] No, both of them are not paid. 1110 was paid $127.
[CUSTOMER][NEUTRAL] Only 1, I mean 11 1 is paid. Why 1206 is denied? Is it denied due to the age limit?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Um, um, 1206 was denied because the policy does not provide benefits for any procedure not listed in the schedule of benefits, so it's not a covered code.
[CUSTOMER][NEUTRAL] So it's not a card benefit denied as not.
[CUSTOMER][POSITIVE] Perfect. And I would like to request EOB via fax, please.
[AGENT][NEUTRAL] OK, well you need EOBs for all of the claims that we go over?
[CUSTOMER][NEUTRAL] It depends on the situation, whether it's paid, denied, or if it is in process, it won't.
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's attention, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, save that one and I'm ready for the next claim for the same patient, Liam.
[AGENT][NEUTRAL] OK, data service.
[CUSTOMER][NEUTRAL] [PII] but about $1,368 even.
[CUSTOMER][NEUTRAL] And I would like to know if it is paid, I would like to know the paid amount first, please.
[AGENT][NEUTRAL] OK, hold on. Can you repeat the date of service, please?
[CUSTOMER][NEUTRAL] It's same date, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Unless I missed one. Hold on one moment.
[AGENT][NEUTRAL] There's no claim on file with that total. Hold on one moment.
[AGENT][NEUTRAL] But I'm just going through them again.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Do you have a claim number for your claim?
[CUSTOMER][NEUTRAL] No, I don't see a claim number.
[AGENT][NEUTRAL] The reason I'm asking um is because I went through all of the claims for that data service and wrote the totals down um for the first claim, but we don't, there was no claim with that total of $1,368.
[CUSTOMER][NEUTRAL] So, can you try with the procedure codes?
[AGENT][NEUTRAL] On file.
[AGENT][NEUTRAL] So, I went through all of the claims that were received for date of service [PII] and I wrote down the total bill for each claim on that date of service, and we do not have a claim on file with your total bill.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] But then, um, you can't check with the procedure codes. They might be split it or might be billed with any other claim.
[AGENT][NEUTRAL] But it would still be the same date of service, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] So when I searched for all the claims for that date of service, every claim came up for [PII], and I wrote the total bill down for each one, for the first claim that we went over. I wrote the total bill down for each of the claims for that day.
[AGENT][NEUTRAL] There is no claim on file with your total bills. So the procedure codes wouldn't matter because I went through each claim for that date of service.
[CUSTOMER][NEUTRAL] So, um, that's what I said, it might be split it.
[CUSTOMER][NEUTRAL] So you can't take the total if it is split it, right?
[AGENT][NEUTRAL] So what would be the other date of service?
[CUSTOMER][NEUTRAL] Uh, there's no other date of service, but then, uh, I see the code we can send on on this date of service that's [PII] or [PII] and [PII].
[AGENT][NEUTRAL] OK, so there's
[AGENT][NEUTRAL] So there's 3 claims on file.
[AGENT][NEUTRAL] The total of all 3 claims is more than your total bills.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The two claims that are left outside of the claim that we went over is less than your total bills. We do not have your claim on file, but there is no timely filing. So if you
[CUSTOMER][NEGATIVE] Not even the course.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] Not even the codes on the file?
[AGENT][NEUTRAL] The codes won't matter, sir. I went through every claim we received from [PII] and I wrote down the total of each claim.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So all I need to do is sign a claim on [PII] with the total bills of 1368. We don't have that on file.
[AGENT][NEUTRAL] There's no claim here with that total.
[AGENT][NEUTRAL] If it's split, I added them together and it doesn't equal your total bills.
[CUSTOMER][NEUTRAL] So, um, a total, uh, how does the total matter, but the procedure matters, right? They might split it.
[AGENT][NEUTRAL] Sir, there is no claim on file. If you'd like to file the claim, I can give you the fax number, the payer ID, or our mailing address.
[AGENT][NEUTRAL] But we do not have a claim on file with your total bills.
[CUSTOMER][NEUTRAL] Uh, let's just forget about the total. That's what I'm saying, and, uh, uh, the codes matter, right?
[CUSTOMER][NEUTRAL] You have, uh, have you checked the codes on that claim?
[AGENT][NEUTRAL] Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, what are the codes that you'd like to look for?
[CUSTOMER][NEUTRAL] 01500220.
[CUSTOMER][NEUTRAL] 0230 and 0272 0330. That's it.
[AGENT][NEUTRAL] 0272 and 0230.
[AGENT][NEUTRAL] What was the last code?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] 03300230
[CUSTOMER][NEUTRAL] 0272
[CUSTOMER][NEUTRAL] 0220 and 0150.
[AGENT][NEUTRAL] OK, wait.
[AGENT][NEUTRAL] Because then I'm missing 2. 0150022002300272 and what was the last one?
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] Thank you, and then you added another one or that's the last one?
[CUSTOMER][NEUTRAL] So I see 01500220023002720330 5 quotes.
[AGENT][NEUTRAL] OK, hold on one moment for me, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] All right, thank you for holding. And what is your tax ID for this provider?
[CUSTOMER][NEUTRAL] Sure, the tax ID is [PII].
[AGENT][NEUTRAL] Thank you for that. So I am showing a claim on file with these codes.
[AGENT][NEUTRAL] The claim
[CUSTOMER][NEUTRAL] I found it right?
[AGENT][NEUTRAL] Yes, it was a total bill of $730.
[CUSTOMER][POSITIVE] Oh great.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3,602,240.
[AGENT][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] Digit speed
[CUSTOMER][NEUTRAL] Uh, sorry.
[AGENT][NEUTRAL] Yes, [PII] is paid $474.20.
[CUSTOMER][POSITIVE] Perfect. And [PII] you mentioned this is paid. What is the check number?
[AGENT][NEUTRAL] 2044508.
[CUSTOMER][NEUTRAL] Single check, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Still outstanding or cash?
[AGENT][POSITIVE] Outstanding.
[CUSTOMER][NEUTRAL] Saving that
[CUSTOMER][NEUTRAL] Mm, any of the procedure codes on this claim denied?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Let me go back to the claim.
[AGENT][NEGATIVE] Code 00350 was denied.
[CUSTOMER][NEUTRAL] 350. And the other codes are paid, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Any patient responsible in this claim?
[AGENT][NEUTRAL] Hold on one moment, let me get the EOB for you.
[AGENT][NEUTRAL] Hold on one moment. I have to pull the EOB for the patient responsibility.
[AGENT][NEUTRAL] Hold on one moment, [PII]. I have to go through each claim for that day to get to the EOB. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], I'm gonna place you on a brief hold, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Why is there no total for the patient responsibility on here?
[AGENT][NEUTRAL] Can we make it a little easy for care to like come on and the and the provider.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So what's the patient responsibility this is crazy. I can't bel[PII] this. OK. [PII].
[AGENT][NEUTRAL] Why not just put a call with patient responsibility and you know that's what they asked for. I don't know.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. I had to use one of my team leads because the um explanation of benefits wasn't clear. So the total um patient responsibility is $530.80.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect. And you have uh already sent the EOB, right?
[AGENT][NEUTRAL] No, I haven't. I'll be sending that at the end of the call.
[AGENT][NEUTRAL] All of them.
[CUSTOMER][NEUTRAL] OK, I would like to request via fax, please.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you've already given the fax number. I'm just gonna send them all together. It was all the same policy number, right?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, did you have another total bill or codes that you wanted to go over?
[CUSTOMER][NEUTRAL] Uh, for this patient, that's it, and I'm ready for the next patient's policy, uh, I mean, next patient on the same policy.
[AGENT][NEUTRAL] OK, and um what's that? Who's that patient?
[CUSTOMER][NEUTRAL] This is a patient named [PII] with the date of birth, [PII].
[AGENT][NEUTRAL] OK, the date of service and total bills?
[CUSTOMER][NEUTRAL] The data service is May 725 but amount $960 and the procedure code is 1206.
[AGENT][NEUTRAL] OK, hold on one moment. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[AGENT][NEUTRAL] Alright, so there is a um a claim for that code, or you just wanting the outcome?
[CUSTOMER][NEUTRAL] Um, well, this is a procedure 1206 for the date of service [PII].
[AGENT][NEUTRAL] Right. Are you needing the date, are you needing the date we received it and processed, or you just wanting to know what happened with [PII]?
[CUSTOMER][NEUTRAL] Only one code.
[CUSTOMER][NEUTRAL] Uh, uh, first of all, I would like to know, is it paid?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So it's denied for what reason?
[AGENT][NEUTRAL] It's not a covered code.
[CUSTOMER][NEUTRAL] OK. Then, now, I would like to know what is the denial date? Just the denial date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Just to confirm, is it denied to the age limit or this is not a covered benefit at all?
[AGENT][NEUTRAL] It's not a covered code on the fax back.
[CUSTOMER][NEUTRAL] OK. What's the total patient responsible for this code?
[CUSTOMER][NEUTRAL] I believe the bill on.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] I'm pulling the EOB. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The patient responsibility is $960.
[CUSTOMER][NEUTRAL] $960 perfect. What is the claim number for this one?
[AGENT][NEUTRAL] 360-1513.
[CUSTOMER][NEUTRAL] I would like to request the new BBX, please.
[AGENT][POSITIVE] Yes, I'll be sending you an EOB to the fax number you provided.
[CUSTOMER][POSITIVE] OK, great. And
[CUSTOMER][NEUTRAL] That's it. I have this many claims. Well, I do have one more patient on the same policy where I've not received the EOB. So if you can uh send the EOB for that claim also, please.
[AGENT][NEUTRAL] OK, what's the number and the date of service?
[CUSTOMER][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[CUSTOMER][POSITIVE] Date of service, [PII]. Now, this is in a huge, uh this is paid in the amount of $373. I can provide you the claim number for that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number is 3602232.
[CUSTOMER][NEUTRAL] I would like to request be fax for this one, please.
[AGENT][NEUTRAL] All right. And was there anything else I could assist you with today, [PII]?
[CUSTOMER][NEUTRAL] That's it thank you very much, [PII] and what is the car reference number by the way?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you for that, [PII], and have a good one. Be safe. Bye-bye.
[AGENT][POSITIVE] Thank you, you also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.