AccountId: 011433970860
ContactId: 0192ce75-329b-4eee-b5b7-ebea2d36511f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325429 ms
Total Talk Time (AGENT): 111864 ms
Total Talk Time (CUSTOMER): 108171 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/0192ce75-329b-4eee-b5b7-ebea2d36511f_20250219T21:19_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] Hi [PII], my name is [PII]. I'm calling to checking on claim status today. I hope, hopefully you can assist.
[AGENT][NEUTRAL] I sure can help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and the member's policy number?
[CUSTOMER][NEUTRAL] Uh, showing to be 00 I'm sorry 01653959.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Should pull up a [PII] jury.
[AGENT][NEUTRAL] OK, can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] [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 for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Yes, I have two for this patient 26-2024. The bill amount is $183.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] UTMB faculty group practice.
[AGENT][NEUTRAL] 342.
[AGENT][NEUTRAL] 45. Hold on one moment. OK, here it is. So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 3452113.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on this policy?
[CUSTOMER][NEGATIVE] Office visits are not covered.
[AGENT][NEUTRAL] Yes, on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then showing full balance patient responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not the major medical, um.
[CUSTOMER][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Yes, so that would be between primary and provider.
[CUSTOMER][POSITIVE] OK, sure, no worries, I will get this one taken care of. Uh, let me see you have a, do you have time for one more?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The next claim, it's gonna be the same thing because it's an office visit. I just need to confirm a claim number. The next date of service is [PII]. bill amount is $705.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, wait a minute, this is duplicate where's the original.
[AGENT][NEUTRAL] It is all one claim, hold on one moment.
[CUSTOMER][NEUTRAL] You know what? Let me look.
[CUSTOMER][NEUTRAL] 75 and I have split the charges. Uh, I'm seeing the original is $715.79.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You said 7:15 79?
[CUSTOMER][NEUTRAL] So let me, let me double check that. Let me go back, uh, let's see where to go, where to go.
[CUSTOMER][NEUTRAL] 7:15 79, yes.
[AGENT][NEUTRAL] OK, it's this one.
[AGENT][NEUTRAL] OK, so the claim number that I'm showing is 344-9108.
[AGENT][NEUTRAL] And did you need the date received and processed?
[CUSTOMER][NEUTRAL] What was the date process?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and same issue?
[AGENT][NEUTRAL] This one, let me make sure, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, office visits, uh, well, not this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I will get this one worked out. Do you have a reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date and um the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] What was your first name again? I'm sorry.
[AGENT][NEUTRAL] Oh, it's OK. My name is [PII]
[CUSTOMER][NEUTRAL] And then oh, OK.
[CUSTOMER][POSITIVE] All right well thank you so much for your help today. I do appreciate it.
[AGENT][POSITIVE] You're very welcome, [PII]. Thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thanks, you're welcome bye bye.