AccountId: 011433970860
ContactId: fda0627a-4e59-4211-a8b9-1fa1560fe43a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1181469 ms
Total Talk Time (AGENT): 256000 ms
Total Talk Time (CUSTOMER): 141793 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/fda0627a-4e59-4211-a8b9-1fa1560fe43a_20250430T18:56_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of provider's office to check on claim status. Could you please help me with that?
[AGENT][NEUTRAL] Oh sure, I can assist you with claim status, Miss [PII], and um may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, that'll be [PII].
[AGENT][NEUTRAL] OK. And may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] Sure, the policy number, that will be.
[CUSTOMER][NEUTRAL] 234 4896
[AGENT][NEUTRAL] OK, thank you. One moment, let me pull that policy.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Mm yeah.
[CUSTOMER][NEUTRAL] Patient that is uh
[CUSTOMER][NEUTRAL] That'll be [PII], [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, thank you. This is for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Um, may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is so was [PII]. The amount is $437.
[AGENT][NEUTRAL] OK, so [PII] for 4:[PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. For future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] And let's see uh.
[AGENT][NEUTRAL] 4:37.
[AGENT][NEUTRAL] Let me look at this claim, one moment.
[AGENT][NEUTRAL] Do you mind holding for me, I'm just gonna pull this document, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII].
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Miss [PII]? Can you hear me? OK. OK. OK. I have a
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] OK, I have pulled the explanation of benefits that we processed on [PII]. Uh, the claim was denied and the denial reason is because the service was rendered following the termination of the policy. This policy was terminated back in [PII].
[CUSTOMER][NEUTRAL] OK, then so can I have the claim number?
[AGENT][NEUTRAL] Yes, um,
[AGENT][NEUTRAL] Your claim number is 3583729.
[CUSTOMER][NEUTRAL] OK then, so can you please help me with the last patient? I have one more.
[AGENT][NEUTRAL] OK, um, let me go ahead and do a note on this one, OK?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, what's in its policy number?
[CUSTOMER][NEUTRAL] The next policy number that is?
[CUSTOMER][NEUTRAL] 02576415
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] for the amount of $1,123.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Let me pull this up for you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one more minute. I'm waiting on the system.
[AGENT][NEUTRAL] OK, it looks like we processed this claim on [PII] and we send a benefit amount of $372 to the provider.
[CUSTOMER][NEUTRAL] On which date again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, that is for $372. And can I have the check number?
[AGENT][NEUTRAL] It is um check number 2032727.
[CUSTOMER][NEUTRAL] It's just a single boxer?
[AGENT][NEUTRAL] It's a single trip.
[CUSTOMER][NEUTRAL] OK, can I have the address of the check with center?
[AGENT][NEUTRAL] It was sent to um dentist of you first.
[AGENT][NEUTRAL] Um, [PII] [PII].
[CUSTOMER][NEUTRAL] OK. Can I have the patient responsibility?
[AGENT][NEUTRAL] Sure. One moment.
[AGENT][NEUTRAL] Alright, it looks like um.
[AGENT][NEUTRAL] Yeah, I'll have to add this together, bear with me.
[AGENT][NEUTRAL] Moment
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] It looks like $751.
[CUSTOMER][NEUTRAL] $751. And how about the bike ranges? Was it paid or not on this claim, the 0274?
[AGENT][NEUTRAL] 0374.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] Yes, 0274, we pay $87.
[CUSTOMER][NEUTRAL] How about for the D 02304 5 unit?
[AGENT][NEUTRAL] 0230. OK, so that one let me see.
[AGENT][NEUTRAL] One of them was applied towards the deductible, which they applied like $41 to the deductible. The other three were paid at $32.80 each.
[CUSTOMER][NEUTRAL] The other one, so there's only 3 and then 4, right? Uh, but then we submitted 5.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me see 123 44 were paid at 32801 was applied towards the deductible.
[CUSTOMER][NEUTRAL] About the
[CUSTOMER][NEUTRAL] OK, sure. How about for the D0150, is it 3 or not?
[AGENT][NEUTRAL] We pay 125 on that one.
[CUSTOMER][NEUTRAL] 125 and how about the 0220?
[AGENT][NEUTRAL] 0220.
[AGENT][NEUTRAL] OK, we pay 28.80 on that one.
[CUSTOMER][NEUTRAL] OK, then so can you please help me verify on this claim how much deductible was applied?
[AGENT][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] 50. Uh, so what would be the yearly deductible?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 50s.
[CUSTOMER][NEUTRAL] Remaining 0. Can I have the
[CUSTOMER][NEUTRAL] Claim number.
[AGENT][NEUTRAL] Yes, uh, claim number is 3,573,780.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK, can I have that again? 3, just to confirm, 3,573,780.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you please send me the copy of EOB for this one through first?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] One moment, let me have that fax number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, I'm gonna place you on a brief hold so I can send this out to you right now. OK, one moment.
[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][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, can I have the spelling of your name?
[AGENT][NEUTRAL] Sure. That's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] So much for your time and your help.
[AGENT][POSITIVE] You're welcome. Thank you for calling APO. Have a good day, Miss [PII].