AccountId: 011433970860
ContactId: 11235dd9-8c9f-42e3-8e0c-bda0a824e91d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1256579 ms
Total Talk Time (AGENT): 309175 ms
Total Talk Time (CUSTOMER): 514469 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/11235dd9-8c9f-42e3-8e0c-bda0a824e91d_20250417T13:26_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] it.
[AGENT][NEUTRAL] APL, this is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hey, how you doing? I got a question about my medical benefits.
[AGENT][NEUTRAL] Can't be because
[CUSTOMER][NEUTRAL] They, I called last.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I called last week and they keep showing that I had a bill that you guys never paid out two bills and then the lady told me to have my the insurance people, I mean my um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] The medical people just rerun it, uh, she said they ran it twice and they still ain't paying ain't paid the bill.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, go ahead and give me your name and your policy number. Let me do some checking.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] And I can give you my social because I don't have a problem I'm driving. I'm sorry.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 71
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please, sir.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, thank you for all that information. Alright, let's see, now you, are you calling on your medical which plan are you calling on?
[CUSTOMER][NEUTRAL] On my medical.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] They're telling me I owe $1000.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Oh, I think I found your plan. Oh, OK. Uh, go ahead and verify your date of birth and your address for me.
[CUSTOMER][NEUTRAL] [PII]. Address [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh right.
[AGENT][NEUTRAL] Thank you for all that information. All right, let's see. I'm going to try to help you. OK, give me a data service to check on. What am I looking for?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] OK. On [PII], it was a bill that wasn't paid and on [PII]. It's a bill that wasn't paid.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Uh, let me pull up 12:16.
[AGENT][POSITIVE] Yeah, see you have a $50 per per day benefit, yeah, that was paid.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Out on the X-ray. OK, so let me see. Bear with me just a moment while I look up this code. Let's see.
[AGENT][NEUTRAL] OK, yeah, you have a maximum of $50 per day benefit which was paid out. So the other dates on 12/16 is not gonna be anything payable for that date.
[CUSTOMER][NEUTRAL] So, my visit, they said I owe $500. Why is that?
[AGENT][NEGATIVE] That would be between you and the doctor as to what you owe, but it's not, not going to be covered here because that $50 benefit was paid out on an X-ray, which is your max.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To be per calendar day.
[CUSTOMER][NEUTRAL] Oh, that's, and what date is that for, ma'am?
[AGENT][NEUTRAL] That's for [PII] date.
[CUSTOMER][NEGATIVE] OK, well, what she's telling me is the the visit wasn't paid for. I paid my copay, but the whole visit wasn't paid for.
[AGENT][NEUTRAL] Right, there's nothing gonna be payable because you only have $50 payable for each data service, so the $50 on the X-ray was paid because that bill came in before your office visit.
[AGENT][NEUTRAL] So there's nothing gonna be paid on that, right, and there's nothing gonna be paid on that office visit at all. So if you pay the X-ray out of pocket, then they should refund you your money back.
[CUSTOMER][NEUTRAL] Yeah, I paid that out of pocket.
[AGENT][NEUTRAL] Because we paid the doctor's office.
[CUSTOMER][NEGATIVE] Well, that's what I'm saying. The doctor's office say they didn't get paid. That's why I got a $500 bill.
[AGENT][NEUTRAL] Yeah, that's from your doctor. The X-ray came from a, from a different, no, it didn't. It came from the same provider. Yeah, they got a $50 they got a $50 check. Let me go and see if it's look up that check number. Hang on just a second for me.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 3.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Uh, the $50 check has been cashed.
[AGENT][NEUTRAL] It's dated [PII]. The provider cashed it on [PII].
[CUSTOMER][NEUTRAL] I'm confused now because
[CUSTOMER][NEUTRAL] This is more than $50 right?
[AGENT][NEUTRAL] Yes sir, but you only have a $50 benefit payable here. That's all we're gonna pay no matter what the doctor charges.
[CUSTOMER][NEUTRAL] I don't get it. So y'all pay all the other benefits, but it was more than. Can I, I'm OK. Can I get them on the phone and
[CUSTOMER][NEGATIVE] And um cause I don't still don't get how this works.
[CUSTOMER][NEUTRAL] Cause then all other visits, you know, OK, you gonna hold for me?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] I sure will.
[CUSTOMER][NEUTRAL] Yes ma'am. I just don't understand how it works and then on, I got one for [PII]. I mean [PII]. I don't know how that works either.
[AGENT][NEUTRAL] Let's see, yep, same thing, we pay $50 and that's the max benefit payable.
[CUSTOMER][NEUTRAL] See that, I guess that's my thing. I go to the doctor every 36 months, and it's my first time, um, going through this and I don't.
[AGENT][NEUTRAL] Oh, OK. Yes, sir, because no matter where you go, you only have $50 payable per calendar day, no matter, no matter how many bills come in.
[AGENT][NEUTRAL] You only have that $150 benefit payable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna call them that way they can kind of explain to me because I don't really know how this insurance stuff work because why would they uh the other visits, I don't know why would it.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah, because I'm looking at the thing where it says.
[CUSTOMER][NEUTRAL] OK, hold on, I'm gonna make a phone call.
[CUSTOMER][NEUTRAL] Yeah, so I understand how that works. I'm looking at it right now.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I'm just looking for the number and I'll make a phone call.
[CUSTOMER][POSITIVE] I appreciate your pace.
[AGENT][NEUTRAL] Oh, that's fine, no problem, sir.
[CUSTOMER][NEUTRAL] OK I'm gonna call right now.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Can you hear me OK?
[CUSTOMER][NEUTRAL] Yes ma'am, I'm driving but I also trying to search through here and get this number what.
[AGENT][NEUTRAL] OK, I just hear a lot of, yeah, I just hear a lot of wind, like I'm hanging out a window.
[CUSTOMER][POSITIVE] But I think I found it.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, let me turn this up.
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] That's better. Thank you so much.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, I'm, I'm right here now. I'm just signing up to.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] To help us continuously improve our service to you, this call may be recorded. Please listen carefully as our menu options have changed. For appointments, clinic locations, and fax numbers, please press one.
[CUSTOMER][NEUTRAL] If you need the prescription refill, please contact your pharmacy directly or send your physician a MyChart prescription refill request.
[CUSTOMER][NEUTRAL] If you have a clinical question or need to speak with your physician's office, please press 2.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] If you're calling about an inpatient or an emergency room consult and are needing to speak with the physician, please press 3.
[CUSTOMER][NEUTRAL] If you have questions regarding your bill, please press 4. to request a copy. If there are ever any changes to your insurance coverage or your contact information, please be sure to let us know so we can keep your records up to date.
[CUSTOMER][NEUTRAL] Thank you for calling Baylor Medicine customer service department. For customer service or billing related concerns, please press [PII]. If you for.
[CUSTOMER][NEUTRAL] For billing related customer service, press [PII].
[CUSTOMER][NEUTRAL] Paying now. To help us continuously improve our service to you, this call may be recorded.
[CUSTOMER][POSITIVE] We appreciate your patience. Your call will be answered in the order it was received.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Service, my name is [PII]. How can I assist you today? Hey, I had a question with my bill. I called last week about a question with my bill and I called my insurance, but now, um, I still haven't got it resolved and I got my insurance company on the phone.
[CUSTOMER][NEUTRAL] Sure, what's your first and last name? The one Ain.
[CUSTOMER][NEUTRAL] Date of birth and address? [PII] address [PII].
[CUSTOMER][NEUTRAL] Alright, and what date of service are you calling in regards to? Uh.
[CUSTOMER][NEUTRAL] It showed that I got a bill from hold on I got the.
[CUSTOMER][NEUTRAL] [PII]. In [PII].
[CUSTOMER][NEUTRAL] 10 what? I'm sorry? I say and also [PII].
[CUSTOMER][NEUTRAL] OK, so the one for 1216 2024.
[CUSTOMER][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] And you said your insurance is on the line? Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, and who is on the line?
[AGENT][POSITIVE] My name is [PII] and I work with American Public Life. I'm great. How about you today?
[CUSTOMER][NEUTRAL] Hi there how are you?
[CUSTOMER][POSITIVE] Doing wonderful thank you.
[CUSTOMER][NEUTRAL] So it looks like on [PII] this was sent over to insurance follow up um the patient called regarding the claim trying to find out why the patient has a balance if insurance states that this should be covered, so this particular one for [PII] is being reviewed. Did y'all receive the claim?
[AGENT][NEUTRAL] Yes ma'am, we have received a claim and he has a $50 benefit payable per calendar day here and I do show that the $50 was paid out on an X-ray.
[AGENT][NEUTRAL] For that same date.
[AGENT][NEUTRAL] Do you see
[CUSTOMER][NEUTRAL] And I paid for the X-ray out of pocket.
[AGENT][NEUTRAL] You see that $50 because I am showing it's been cashed.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Hang on one second, let me take a look.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Are you talking about the one that we billed $200 for on the same day?
[AGENT][NEUTRAL] Yes, ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] Bear with me.
[AGENT][POSITIVE] Mhm, no problem.
[CUSTOMER][NEUTRAL] OK, so it looks like we billed $200.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you paid 50, so it left a balance of 150.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The patients paid $100 so there's a $50 balance for that one.
[AGENT][NEUTRAL] Yes, ma'am, because he has, like I said that, yeah, 1216. Mhm.
[CUSTOMER][NEUTRAL] The one on [PII].
[CUSTOMER][NEUTRAL] So the one on [PII] that we built $848 are y'all not gonna pay anything for that day?
[AGENT][NEGATIVE] Correct, there's nothing covered. He has 50 what he has $50 payable per calendar day no matter where the bills from, so he's already met that max $50 per calendar day. So nothing else for that date's gonna be paid.
[CUSTOMER][NEUTRAL] I mean for that particular one.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the one on [PII].
[CUSTOMER][NEUTRAL] We billed $838.
[CUSTOMER][NEUTRAL] And y'all said that they were noncovered charges.
[AGENT][NEGATIVE] You should have got a $50 check.
[AGENT][NEUTRAL] Let me see if it's been cash. Let's see.
[CUSTOMER][NEUTRAL] Yes, yes, you did. You paid $50 so the rest is patient responsibility.
[AGENT][POSITIVE] Yeah, that's, that is right, that's the max payable, mhm, that is correct. That's the max payable per calendar day benefit here.
[CUSTOMER][NEUTRAL] OK, so sir, the balance is correct. So I don't understand how this insurance, this, this is what I'm saying, this is what I don't get.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] You know, when I come to y'all, I'll, I thought I'll pay, I'll only pay the copay, so I don't know where the other balance come from. But your insurance, your insurance doesn't have a copay, sir. What she's trying to tell you is that your insurance only has a $50 payable per day. That's not a copay. That's just what they're gonna allow for all the services on that particular day, so your insurance doesn't follow the copay rule.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So when I come into your office and I pay that $50 what does that go towards?
[CUSTOMER][NEUTRAL] That goes towards the services that are gonna be performed because your insurance doesn't follow a co-pay rule, am I correct, ma'am?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So I guess I'm still confused cause even when I come to multiple visits, you say they the insurance only cover $50. So what about, I mean every time I came I said have a balance then.
[CUSTOMER][POSITIVE] Correct, and you do.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right now your account balance is $1,207. I did not never knew that, so.
[CUSTOMER][NEUTRAL] How many times I came to you guys, like, oh like 6 times.
[CUSTOMER][NEUTRAL] And that's what the bill is about.
[CUSTOMER][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] So that 1000 for all all them bills that when I come to you guys.
[CUSTOMER][POSITIVE] That is correct, yes sir.
[CUSTOMER][NEGATIVE] I never knew that work like that. I don't even.
[CUSTOMER][NEGATIVE] I don't even need the insurance if they only gonna pay $50.50 dollars.
[AGENT][POSITIVE] Yes, sir. That is what your benefit is. Yes, sir.
[CUSTOMER][POSITIVE] Alright, I'm so sorry. I
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm so sorry you're breaking up.
[CUSTOMER][NEUTRAL] I come out.
[CUSTOMER][NEUTRAL] Ma'am, can you hear him?
[AGENT][NEGATIVE] No, ma'am, he's breaking up bad. I think we've actually lost him.
[CUSTOMER][NEUTRAL] No, I'm on the phone.
[AGENT][NEUTRAL] OK, there you are.
[CUSTOMER][NEUTRAL] OK, now we can hear you. OK, perfect. So what I said was all the time that I come to the visit, I pay my $50 co-pay and I thought insurance cover the doctor. I didn't know they just cover only $50.
[AGENT][NEUTRAL] Yes, sir. There's only $50 that's covered, right.
[CUSTOMER][NEUTRAL] Well we're just finding this out right now, yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] OK, so I'm gonna have it on a payment arrangement with you guys and
[CUSTOMER][NEUTRAL] OK whenever you're ready to set that up you can call us, we'll need the first payment when you set it up and then we can go ahead and do it on a monthly basis where it's just deducted from your account.
[CUSTOMER][NEUTRAL] And that and that $1000 that $1000 is for multiple business, right?
[CUSTOMER][POSITIVE] It's for all of them correct it's for all of them together.
[CUSTOMER][NEGATIVE] I don't understand that went like that.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Is there anything else that I can help answer for you, [PII]?
[CUSTOMER][POSITIVE] No ma'am, I appreciate you.
[AGENT][POSITIVE] Oh, yes sir, yes sir.
[CUSTOMER][NEUTRAL] And ma'am, can I get your name one more time?
[AGENT][NEUTRAL] Yes, ma'am. My name is [PII] and that's [PII]
[AGENT][NEUTRAL] And thank you very much then, Mr. [PII] and no we don't give call reference numbers, but you can use my name in today's date if you need to do so, OK?
[CUSTOMER][NEUTRAL] And do you have a call reference number?
[CUSTOMER][POSITIVE] Perfect thank you so much and Mr. [PII] do you have any other questions for me? No, I just need to call back and set up a um uh uh.
[AGENT][NEUTRAL] All right.