AccountId: 011433970860
ContactId: 864dd0fa-6fee-4c28-9b4f-a2e1fbb5f765
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 720789 ms
Total Talk Time (AGENT): 215557 ms
Total Talk Time (CUSTOMER): 220636 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/864dd0fa-6fee-4c28-9b4f-a2e1fbb5f765_20250303T17:07_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] Yeah, hi, [PII]. This is [PII] calling from the products office to check on a claim status.
[AGENT][POSITIVE] I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[AGENT][NEUTRAL] OK, phone number 5, I'm missing a number.
[CUSTOMER][NEGATIVE] And there is no extension so directly.
[AGENT][NEUTRAL] I'm missing a number. [PII]. What was the next one?
[CUSTOMER][NEUTRAL] No, that was [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Mm, I have 3 games today.
[AGENT][NEUTRAL] OK, and may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, that was D as in Delta 473-05915.
[AGENT][NEUTRAL] And do you have the member's ID card available?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm, yeah, I have the ID card.
[AGENT][NEUTRAL] On the ID card, do you see anywhere that says in hospitals or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Mm, one moment. Can you please start for a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Let me just
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, I'm sorry, [PII], I don't have this information.
[AGENT][NEUTRAL] OK, because that the number is the policy number for 90 Degree benefits. Um, I can also look up the policy with the social or the member's first and last name.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So since I have more policy number in the ID card, can I go with it?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, I have one more patient's number ID in the ID card. So can I go with the new number?
[AGENT][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] Yeah, it was.
[CUSTOMER][NEUTRAL] 02574226
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII] and the member's date of birth is [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] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and the date of service is [PII].
[AGENT][NEUTRAL] And the
[CUSTOMER][NEUTRAL] And the total charge amount was $670 670 dollars.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See another one.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, the prot health physician.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0411.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As the policy provides no benefits for charges made by a doctor for an inpatient visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the bill was patient responsibility, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][POSITIVE] Yeah, the outstanding balance for patient responsibility, right?
[AGENT][NEUTRAL] Oh, so we don't determine patient responsibility because we're not a major medical, um, that's why there's no patient responsibility on the explanation of benefits. It'll just be whatever your um policies are for outstanding balances.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that could be a write-off, that could be billing a patient, we just don't determine that.
[CUSTOMER][NEUTRAL] Yeah, it is true.
[CUSTOMER][NEUTRAL] Mhm. Yeah, since the patient policy won't cover the service made by the doctor, so that should come under the patient's plan only, right? I mean, the patient responsibility.
[AGENT][NEUTRAL] So again, we do not determine patient responsibility at APL. It would be whatever your company's policies are for outstanding balances. Whether you write it off, whether you bill the patient, we cannot determine that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I got it. So can I get a, you have to be on the phone?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, I need a copy of EOB explanation of benefit.
[AGENT][NEUTRAL] Sure. Um, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Mm, yeah, one moment.
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], and is that attention, [PII]?
[CUSTOMER][NEUTRAL] No, that's italic group.
[AGENT][NEUTRAL] What's the attention? Is it to the attention of your name?
[CUSTOMER][NEUTRAL] No, the extension is Texas Health Physician Group.
[AGENT][NEUTRAL] The attention is health. Can you repeat that again?
[CUSTOMER][NEUTRAL] Texas Health physician group.
[AGENT][NEUTRAL] OK, will you need an explanation of benefits for the other two claims that we go over as well?
[CUSTOMER][NEUTRAL] Mm, yup.
[AGENT][NEUTRAL] OK, I'll send them at the end of the call. And what's the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the call reference numbers same for the cost that you're gonna discuss.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mm, yeah, it's for the same patient. So can I go with the data service?
[AGENT][NEUTRAL] Oh, it is all the, all the um claims are for the next member?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] OK, um, and what's the next, I'm sorry, the next data service?
[CUSTOMER][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's the total bills?
[CUSTOMER][NEUTRAL] The total bill was $476 476 dollars.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] I don't have, so there's no claim with this range of [PII], but I do see two claims here.
[AGENT][NEUTRAL] But there's a different total bill. Hold on one moment.
[AGENT][NEUTRAL] And it's the same provider?
[CUSTOMER][NEUTRAL] Yeah, since I have the claim number, could you please.
[AGENT][NEUTRAL] Sure, what's the claim number?
[CUSTOMER][NEUTRAL] Uh it's for the same provider and I have the claim number too, yeah, it was 355-0408.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good
[AGENT][NEUTRAL] So you received that claim on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied um for the same reason. Policy provides no benefits for charges made by a doctor for inpatient visits.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you so much. So, I just need a copy of you before this one also.
[AGENT][NEUTRAL] All right, and the next day whenever you're ready.
[CUSTOMER][NEUTRAL] So, can you move to the next one?
[CUSTOMER][NEUTRAL] The next date of service is [PII]. So can I go with the claim number?
[AGENT][NEUTRAL] Is it 355-041-3?
[CUSTOMER][POSITIVE] Yeah, that's perfect.
[AGENT][NEGATIVE] Did you need the date received and denied? It was denied for the same reason.
[CUSTOMER][POSITIVE] Thank you so much. Uh, can I get a copy of you before these 3 claims that we discussed.
[AGENT][NEUTRAL] Sure, I'll be sending it to the fax number that you gave, the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Alrighty, and was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, I'm done for now. Can I get the reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for assisting me today. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you, [PII], you also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.