AccountId: 011433970860
ContactId: ffe58fd6-d1fe-4186-9e09-c6d84ef02d3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 946340 ms
Total Talk Time (AGENT): 304209 ms
Total Talk Time (CUSTOMER): 217360 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/ffe58fd6-d1fe-4186-9e09-c6d84ef02d3b_20250417T15:55_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], this is [PII] calling from our provider's office. I am looking for a claim.
[AGENT][NEUTRAL] OK, well, I can help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, yes, I have, um.
[CUSTOMER][NEUTRAL] 00613879.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [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 bill for the claim you like me to look for?
[CUSTOMER][NEUTRAL] [PII] for the billed amount of 1,952.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, this is for Doctor uh [PII].
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Some shall received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 6210.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim, a total of $42.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you need the check information or anything?
[CUSTOMER][POSITIVE] Yes, I think I'm getting the information that I need from you so that I can ask you all the questions um.
[CUSTOMER][NEUTRAL] So I basically need
[CUSTOMER][NEUTRAL] Uh, claim number you already gave it to me check date.
[CUSTOMER][NEUTRAL] Was that the same date the [PII]?
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] OK, and then do you have that check number?
[AGENT][NEUTRAL] Yes, it's 203.
[AGENT][NEUTRAL] 761 2.
[CUSTOMER][NEUTRAL] OK, and then the claim payment was for $42. Was that a single or a bulk?
[AGENT][NEUTRAL] It was a single check.
[CUSTOMER][NEUTRAL] Single check. And was that check, um, do you have the address for that check?
[AGENT][NEUTRAL] Mhm. It was sent to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect um and then do you have a clear date for that?
[AGENT][NEUTRAL] Um, the check hasn't cleared yet. It's coming from [PII], so I don't know how long it will take to get to you all, but if you have not received the check by [PII], um, just give us a call back and we'll check on the check. If it has been cleared, we'll provide you with a copy of the clear check. If not, we'll void this and reissue a check to you all.
[CUSTOMER][NEUTRAL] OK perfect and then you said it was a check.
[CUSTOMER][POSITIVE] OK, perfect. I think that's all I need. Oh, were there, were there any denied codes on this?
[AGENT][NEUTRAL] Let me see, hold on one moment.
[AGENT][NEUTRAL] Hold on one moment, it's coming up now.
[AGENT][NEUTRAL] OK, code 02740.
[AGENT][NEUTRAL] And 02950 were denied because crowns are payable once every five years.
[CUSTOMER][NEUTRAL] 02 uh hold on so this was for [PII].
[AGENT][NEUTRAL] [PII] is the date of service. Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, so I'm just trying to look.
[CUSTOMER][NEGATIVE] Oh sorry, I'm gonna uh I was completely in the wrong picture. I'm like why we don't have a crowd.
[CUSTOMER][NEUTRAL] But that makes sense why I didn't have a crown in here because this is for [PII], this is for [PII].
[CUSTOMER][NEUTRAL] Uh, and I was on Stacy American Public Life. Give me one second. Let me go in here for [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, so many pop-ups. OK. Uh, 3:18. OK, so this was the the.
[CUSTOMER][NEGATIVE] 2740 on uh was denied because it's once every 5 years and you show that she had that done.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Hold on one moment, let me get the codes.
[CUSTOMER][NEUTRAL] Before the 5 years?
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][POSITIVE] Yeah, you're good.
[AGENT][NEUTRAL] Let me check on these.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][POSITIVE] Mhm you're good.
[AGENT][NEUTRAL] So for those, for that part of the claim, I'm going to send that back to the claims department.
[AGENT][NEUTRAL] When I search in our screen for those two codes, I don't see a data service or like history on file. So I have them research and if there in fact is no history on file, then we can reprocess this and let you, let you know of the outcome. If it is correct, then they will reach out to you and let you know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was the code 2740 and the 2950?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] Is it alright if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Of course, thank you so much.
[AGENT][NEUTRAL] OK, hold on one moment. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Why didn't that come up before? And I tried it both ways. OK, don't matter as long as it came up now, 274.
[AGENT][NEUTRAL] OK, wait a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So I um tried it again and they came up. Um, so for 02740, that last day of service was [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] On [PII], right?
[AGENT][NEUTRAL] For who? I'm sorry, say that one more time. [PII].
[CUSTOMER][NEUTRAL] Uh, number [PII].
[AGENT][NEUTRAL] Like [PII]?
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Um, let me.
[CUSTOMER][NEUTRAL] I'm so sorry, on [PII] number [PII].
[AGENT][NEUTRAL] OK, hold on one moment let me.
[CUSTOMER][NEUTRAL] Can you hear me OK?
[AGENT][NEUTRAL] Yes, I can hear you. Hold on one moment.
[AGENT][NEUTRAL] For the 2740, are you doing it for the crown?
[AGENT][NEUTRAL] Hold on one second, because when I put [PII] and then there's a 2740.
[CUSTOMER][NEUTRAL] Yeah, the [PII].
[CUSTOMER][NEUTRAL] The 2740 would be the crown.
[AGENT][NEUTRAL] And that one, the last day I see is this is [PII].
[CUSTOMER][NEUTRAL] Yeah, so that makes sense. [PII].
[AGENT][NEUTRAL] Along with the 02950.
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] [PII], ah.
[AGENT][NEUTRAL] No, the first time I put it in, nothing came up and then I just kept doing it and stuff started popping up. So I apologize for the back and forth, but yes, it was for [PII]:14.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] You're good.
[CUSTOMER][NEUTRAL] It happens. OK, so last day of service for 27,402,940 was 20 [PII]. That makes sense. OK, because that's less than 5 years. OK. And then, um, [PII], let's see, I think I have everything that I need. If I could, um, have a an EOB faxed to me, do you think that's possible?
[AGENT][NEUTRAL] EOB4, yes, I can send it to you. What's a good fax number?
[CUSTOMER][NEUTRAL] 3, I'm so sorry, [PII].
[AGENT][NEUTRAL] And what attention should I put?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and that was 80.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I, OK.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, so I will go ahead and send the um
[AGENT][NEUTRAL] Explanation of benefits over for the claim we just went over 358-6210. And was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yes, if I can have a call reference number for this please.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII] The first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] Hello, oh, you know what, I forgot to ask you what's the patient responsibility on this?
[AGENT][NEUTRAL] So we don't determine pay, well, hold on, this is dental. Hold on one second, let me pull up the EOB.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] 02740 was billed 1498.
[AGENT][NEUTRAL] And 02950 is 342, so 1840.
[CUSTOMER][NEUTRAL] For patient responsibility.
[AGENT][NEUTRAL] And hold on one second of this, well, let me see what adjusted schedule.
[AGENT][NEUTRAL] The patient responsibility for 03110 was $70 and we paid $42. So hold on one moment.
[AGENT][NEUTRAL] So the.
[AGENT][NEUTRAL] Let me close out of this.
[AGENT][NEUTRAL] So altogether it's $1,868 which was the $1498 the $342 and then the difference between the $70 that was the patient responsibility for 3110 and the $42 that we paid.
[CUSTOMER][POSITIVE] Awesome, 1860, right?
[AGENT][NEUTRAL] 1868.
[CUSTOMER][POSITIVE] 0, 68. I'm so sorry. OK, perfect. Thank you so much, [PII]. Have a great day.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.