AccountId: 011433970860
ContactId: 5c1f7399-f975-4630-a365-3938a9d8e390
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389459 ms
Total Talk Time (AGENT): 116863 ms
Total Talk Time (CUSTOMER): 112903 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/5c1f7399-f975-4630-a365-3938a9d8e390_20250521T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], this is [PII]. I'm calling from Texas Health Family Care, and I'm trying to verify benefits on a patient and find out if we're in network with with their plans.
[AGENT][POSITIVE] All right. Happy to check benefits, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] I have 02449815.
[AGENT][NEUTRAL] Thank you. And then if I could get their name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, first name is [PII]. I'm sorry, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And last name is [PII]
[AGENT][NEUTRAL] Thank you and then just date of birth.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you so much. So patient is active. The effective date on here is [PII].
[AGENT][NEUTRAL] This is the member's secondary policy, so this will cover deductible co-pay, co-insurance. The primary does not.
[AGENT][POSITIVE] And there's no network needed for usage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty and what would it um normally um go under? Is it like a.
[CUSTOMER][NEUTRAL] Uh, private health care systems or is this like a Medicare plan, limited benefit or?
[AGENT][NEUTRAL] It's a supplemental plan.
[CUSTOMER][NEUTRAL] I'm just
[CUSTOMER][NEUTRAL] Um, I'm sorry, I sales what again? I'm sorry.
[AGENT][NEUTRAL] It's a supplemental plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I'm not not finding it in our system or recognizing it this one we're in network with.
[CUSTOMER][NEUTRAL] Um, so is it, is it like a, like a Medishare type?
[CUSTOMER][NEUTRAL] Or is it a a limited benefit, um, secondary?
[AGENT][NEUTRAL] Yeah, so it is their secondary. I don't know who their primary would be. You would have to check with the insured.
[CUSTOMER][NEUTRAL] Yeah, I have, I have that information, but he's telling us we're in network, but I'm not finding it so that's why I'm trying to.
[CUSTOMER][NEUTRAL] Trying to verify everything.
[AGENT][NEUTRAL] Yeah, there shouldn't, so it, there shouldn't be a network required for usage. I mean it is a secondary plan. Do you need like the payer ID? Would any of that help you?
[CUSTOMER][NEUTRAL] OK, I can can go ahead and add that too.
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] And what is the payer, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what do we need to to send the claims to?
[AGENT][NEUTRAL] Uh, they can be mailed and faxed as well. The mailing address would be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK, is there any way you can look up our tax ID just to see if we, we can be accepted or not or?
[AGENT][NEUTRAL] I think we can look to see if there's anything on file let me check.
[CUSTOMER][NEUTRAL] We haven't seen seen the patients since like [PII] so.
[CUSTOMER][NEUTRAL] Um, this is all, all the information he's providing.
[AGENT][NEUTRAL] OK, what's your uh taxpayer ID?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] All right, for Texas Health Physicians Group?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Yeah I mean it looks like we have your guys' information on file.
[AGENT][NEUTRAL] So it looks like claims have been submitted with us before, so I don't see why it would be an issue going forward, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, and is there a reference number for today's call?
[AGENT][NEUTRAL] Mhm. Call reference is my name with my last initial and then today's date. My name again is [PII], that's [PII] My last initial is [PII].
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] Thank you, you too. Mm.
[AGENT][NEUTRAL] Bye bye.