AccountId: 011433970860
ContactId: ff6e9c69-4ce1-400e-99e3-4ef6e9fea06b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 551989 ms
Total Talk Time (AGENT): 228978 ms
Total Talk Time (CUSTOMER): 155158 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/ff6e9c69-4ce1-400e-99e3-4ef6e9fea06b_20250416T20:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII] and I'm calling from a provider's office and I have a question about an age claim for one of our patients, please.
[AGENT][NEUTRAL] OK, you have a question, is it regarding claim status on one that has been filed?
[CUSTOMER][NEUTRAL] Yeah, clean te, yeah.
[AGENT][POSITIVE] Yes ma'am, I can help you out with that, [PII], and what is your callback number please?
[CUSTOMER][NEUTRAL] Uh, my direct line is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Uh, we have 02293914.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And what type of policy are you calling on today, [PII]?
[CUSTOMER][NEUTRAL] Uh, dental policy.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And send me any information that I provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] OK, thank
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] Uh, [PII] for a build out of 298.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] OK, so I show the claim was received on [PII] and it was processed on [PII].
[AGENT][NEUTRAL] The claim number is 3571391.
[AGENT][NEUTRAL] Give me just one second, [PII].
[AGENT][POSITIVE] OK, I do show that there was a benefit paid.
[AGENT][NEUTRAL] In the amount of $72.
[AGENT][NEUTRAL] And that was paid on single check 203.
[AGENT][NEUTRAL] 0989 and that was on the code 0120.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The other two codes were denied and the reason for the denial on those two codes states policy does not provide benefits for any procedure or service not listed in the schedule.
[CUSTOMER][NEUTRAL] Oh, I see. OK, um, so let me just read back some informa just to, sorry, just to make sure I haven't missed anything. So you said it was processed on [PII], um, and it was clean.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] No, yeah, mhm.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] No there's a little bit of a lag in our call. I can hear like a a short delay, so go ahead and then I'll come back with any information that's not accurate.
[CUSTOMER][NEUTRAL] OK, OK, um, claim number 3571391 paid $72 on uh payment number 2030989.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, was that payment a paper check, EFT virtual credit card?
[AGENT][NEUTRAL] Paper only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So paper check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you said that it paid $72 on the oral evaluation, but that was the only thing that it paid on correct?
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK, alright, and then let me.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, alright, we'll go ahead and reflect that um once we are you showing that that check cleared?
[AGENT][NEGATIVE] I'm having to reopen another window, um, the one I tried to just check that for it, something had happened to it and it didn't let me do it. So give me just a second, I'll try again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, we do still show that is open at the moment.
[AGENT][NEUTRAL] According to my, what I can see.
[CUSTOMER][NEUTRAL] So the check
[CUSTOMER][NEUTRAL] OK, so the check has not cleared.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And then can you, can you tell me um what was the mailing address for that check?
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] Bear with me just a second. It's just very slow and lighting.
[CUSTOMER][NEGATIVE] Sure, oh, it's almost [PII]. Even the computer wants to shut down.
[AGENT][NEUTRAL] OK, we have.
[AGENT][NEUTRAL] Right, so it was sent to [PII].
[CUSTOMER][NEUTRAL] So [PII] location.
[AGENT][NEUTRAL] Yes, and that is also what is on the claim form, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] All right, well, very good, um, and you're showing it hasn't cleared.
[AGENT][NEUTRAL] And if you need a copy.
[AGENT][NEUTRAL] Yeah, I'm showing that as of now it has not, no, ma'am.
[AGENT][NEUTRAL] And if you need a copy.
[CUSTOMER][NEUTRAL] Yes, I would, are you able to fax me a copy of the EOB?
[AGENT][NEUTRAL] Yes, actually you can just print it directly from our portal now that you have the claim number if you have access to the Internet, we have a portal that you can check claim status in.
[AGENT][NEUTRAL] Once we've processed the claim.
[CUSTOMER][NEUTRAL] OK, and what is.
[CUSTOMER][NEUTRAL] Sure, what is that portal address?
[AGENT][NEUTRAL] OK, you would go to [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] So again that is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you'll give me just a moment I'll go ahead and fax this one but just for future, you know, for future reference you should be able to go to that website. So [PII], what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, so give me just a moment. Will it need to be put to your attention?
[CUSTOMER][POSITIVE] Uh, yeah, that'd be great thank you.
[AGENT][NEUTRAL] OK. You're welcome. And do you spell [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and again that fax number is [PII].
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, well, I have just sent that to you so provided that there's not any technical mishap, you should be receiving that very soon.
[CUSTOMER][NEUTRAL] OK, very good and can you again, can you give me your name and just a reference number?
[AGENT][NEUTRAL] Again, my name is [PII], and my name in today's date would also be your call reference number.
[CUSTOMER][POSITIVE] OK, perfect, that's wonderful.
[AGENT][NEUTRAL] And if for any reason again that you don't receive the fax, but it has been sent, um, go to that website that I gave you and you should be able to print that EOB now that you have the claim number.
[CUSTOMER][POSITIVE] OK perfect thank you so much for all your help.
[AGENT][POSITIVE] You're certainly very welcome and can I help you with anything else today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, [PII]. Well, thank you again for calling APL. I hope you have a wonderful evening.