AccountId: 011433970860
ContactId: 34402a98-badb-4f5b-aabd-12e06027cab5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 751539 ms
Total Talk Time (AGENT): 179803 ms
Total Talk Time (CUSTOMER): 316348 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/34402a98-badb-4f5b-aabd-12e06027cab5_20250421T20:14_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] Uh, my headset was cutting you. Can you hear me OK?
[AGENT][NEUTRAL] Yes I can hear you fine can you hear me OK?
[CUSTOMER][NEGATIVE] No, you're cutting out. I think it's my headset. Let me fix something real. Hang on a second. Oh my goodness, I'm so, so sorry, uh.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] OK, I think this is better now, OK.
[CUSTOMER][NEGATIVE] 00 wait, wait, wait, wait, wait, oh my gosh, OK, yeah, it sounds like you're, you're under water. Oh my gosh, I've gotta get a new headset. This is driving me nuts. Um, it works and then it doesn't and then I can't tell, uh, because the music plays great, you know, the whole music, and then I get somebody on the phone and then it's like bubbly. uh, OK, so is this better? Can you, uh, can you, can, can you, um, hear me right?
[AGENT][NEUTRAL] Can hear you, can you hear me?
[CUSTOMER][POSITIVE] Much better, thank you so much.
[AGENT][POSITIVE] OK good
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, good. All right. OK, and what is your name?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Oh, I'm so sorry, yes.
[AGENT][POSITIVE] Oh yes, we did it.
[CUSTOMER][NEUTRAL] Uh oh wait a minute. OK, I should just call on my cell phone. I'm not supposed to though, um, my, uh, so my name is [PII], um, what was your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII], OK. I think um uh hopefully this gets better because this is gonna drive me insane. Hi, [PII], how are you?
[AGENT][POSITIVE] Hi, I'm good, Miss [PII].
[CUSTOMER][POSITIVE] OK, good, um, I was just trying to get you to talk, see if I could hear. I'm like my headset is like playing tricks on me.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, OK, and [PII], would you mind helping me out with a, yeah, um, can you help me, um, research a claim, please?
[AGENT][POSITIVE] Oh goodness.
[AGENT][NEUTRAL] Yes, ma'am, I can hear with claim status is [PII] uh
[AGENT][NEUTRAL] Number callback number in case the call is dropped I can call you right back.
[CUSTOMER][NEGATIVE] Yeah, um, I'm trying to, mm, uh, you're still really cutting out pretty bad. OK, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and number?
[CUSTOMER][NEUTRAL] Um, so, OK, I'm, I'm trying to get, um.
[CUSTOMER][NEUTRAL] I'm getting bits and pieces, but I'm trying to understand. I think you said the patient's name and date of birth. Um, the patient's name is gonna be [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII], um, [PII] is her date of birth.
[AGENT][NEUTRAL] OK, and then what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, I'm sorry, yes, it's gonna be 02132359.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright and then may I have um the date service and the charge amount?
[CUSTOMER][NEUTRAL] OK, this is gonna be, bear with me now this is all this is [PII], um, the uh bill amount is um $173 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what charges after the primary insurance pay part?
[CUSTOMER][NEUTRAL] I'm trying
[CUSTOMER][NEUTRAL] Yeah, OK, uh, the primary, I, I'm not sure what you said, um, I, I, I apologize, my, the connection is really bad, but, um, were you asking me what the primary, how the primary process the claim?
[AGENT][NEUTRAL] The the um charged after the primary paid.
[CUSTOMER][NEUTRAL] 00000, OK, OK, so, um, the the $40 is the co-payment that the, uh, United Healthcare apparently is the primary. It looks like they applied, uh huh, it looks like on the EOB they applied $40 to the co-payment of the um this claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] OK, um, it is Integris Urgent Care Plus.
[CUSTOMER][NEUTRAL] And we are, it looks like Enid, Oklahoma.
[AGENT][NEUTRAL] OK, alright, thank you so much. I'm going to put you on hold while I look up this claim right back to you.
[CUSTOMER][POSITIVE] OK sounds good thank you [PII].
[AGENT][NEUTRAL] You're welcome. brief hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's look up this patient.
[AGENT][NEUTRAL] It's gonna be
[AGENT][NEUTRAL] Number 5.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi there, Ms. [PII]. This is [PII] back with you again.
[CUSTOMER][NEUTRAL] Hi, [PII].
[AGENT][NEUTRAL] Hi, OK, so I have a claim for you. The claim number is 334.
[AGENT][NEUTRAL] 4106.
[CUSTOMER][NEUTRAL] Uh, I, I'm sorry, can you repeat that? I apologize. I'm sorry.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, it's 34-4106.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered on the patient's policy.
[CUSTOMER][NEUTRAL] Office visits are not covered. OK, office visits not covered.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and um, so what kind of policy is this for? Is it just for, um, like it really is it really sounds like it's really basic.
[AGENT][NEUTRAL] It's um uh and this is just to verify the benefits. It's not a guarantee of paying supplemental policy that is a gap insurance that helps with deductible, co-pay and co-insurance, but under the patient's plan offices are not covered under the policy for outpatient.
[CUSTOMER][NEUTRAL] Oh, OK, um.
[CUSTOMER][NEUTRAL] OK, so because it's just, it's just an office visit that's um that's unfortunate that that is not covered under the plan. Like what kind of plan, uh, like what, what, what are the only things that would be covered?
[AGENT][NEUTRAL] Uh, there's several different things that can be covered, but um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] According to the claim that was sent to in and the code that was sent in on the claims are not covered.
[CUSTOMER][NEUTRAL] OK, OK, um, OK.
[AGENT][NEUTRAL] Under the patients that they chose.
[CUSTOMER][NEUTRAL] Right, OK, well, I, that I can just, I, yeah, of course I'll note that on the on the account and then that would if the patient calls then, um, we'll just say yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And well it's fine we'll just let them know that it's not a, a uncovered um benefit under the policy and then um if they if they have questions about their policies, um I'll just have them reach out to you so that they can get um you know um clarification of exactly what their um benefits will cover so I'll just note that on the um on the AR for them.
[AGENT][POSITIVE] Correct
[AGENT][POSITIVE] OK, OK, and they are more than welcome to call and we'll go over their benefits um.
[CUSTOMER][NEUTRAL] And it's yeah.
[CUSTOMER][NEUTRAL] OK, OK, sounds great, sounds great, but I mean, even if they are, you know, I mean they, they not actually even know that and they might just pay the 40 bucks, but if they don't know, I will not on here to reach out to you so that they can get, yeah, um, they might, they might verification.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of exactly what their policy covers and then they can, you know, they can dispute that with you guys um but as a provider, um, I that's all we can do. I'll, I'll note it on the, on the AR but thanks Miss [PII]. Do you have a, um, call reference for me?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Sounds great. Got it. Alright, well I appreciate you so much for researching that, um, and, and yeah, thank you so much. That means a lot that, that helps me knock this out of my work here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're welcome, Ms. [PII].
[CUSTOMER][POSITIVE] Thanks, [PII], you have a great day.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] I'm glad I was able to help you. OK, you have a wonderful week and thanks for calling APL.
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Alright, bye bye.