AccountId: 011433970860
ContactId: 869c346c-19b1-4531-8c77-3e95dfd907e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344820 ms
Total Talk Time (AGENT): 150151 ms
Total Talk Time (CUSTOMER): 79930 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/869c346c-19b1-4531-8c77-3e95dfd907e4_20250224T13:50_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] Hi, [PII]. My name is [PII]. I'm calling from Health Texas access provider network office to check on the claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well [PII] how are you?
[CUSTOMER][NEUTRAL] Same
[CUSTOMER][POSITIVE] I'm doing good thank you so much for asking [PII].
[AGENT][NEUTRAL] You're welcome. And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Policy number is 024250001.
[CUSTOMER][NEUTRAL] Hi this is calling from.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] And can you verify, thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name [PII] and date of birth [PII].
[AGENT][NEUTRAL] Thank you, 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 and the total bills?
[CUSTOMER][NEUTRAL] Data service [PII] total charge amount $540.33.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $40.
[AGENT][NEUTRAL] OK, and do you mind if I place you on just a brief hold while I locate the claim for you?
[CUSTOMER][POSITIVE] Sure, take your time, [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 7735212973536664.
[AGENT][NEGATIVE] I said how long this was a dupe.
[AGENT][NEUTRAL] 773. What's that?
[AGENT][NEUTRAL] Did I get everything? 69. Wait, what? What's that one? Oh, that's a Duke too.
[AGENT][NEUTRAL] Lord
[AGENT][NEUTRAL] 3492429.
[AGENT][NEUTRAL] 88 0 my goodness.
[AGENT][NEUTRAL] Well, we know it's not that one.
[AGENT][NEUTRAL] On the first try.
[AGENT][NEUTRAL] And what is it for?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm here I know.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait, and I do have the claim here. Um, I'm sure we received it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 09
[AGENT][NEUTRAL] 77
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So codes 82306.
[AGENT][NEUTRAL] And 83036?
[AGENT][NEGATIVE] were denied because the policy provides no benefits other than defined, other than what's defined in the policy, so it's not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All the other codes were denied requesting the explanation of benefits from primary insurance?
[CUSTOMER][NEUTRAL] Primary insurance AUB, OK.
[AGENT][NEUTRAL] Let me see if there's any other codes on here.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, there is one more.
[AGENT][NEUTRAL] And then code 3061 F as in Frank was denied um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Because the benefit, we cannot, I'm sorry, the policy does not provide a benefit for services in which no charges were incurred, so there was no charge for that code.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so for the rest of the CPTs you want the explanation of benefits.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, how can we submit the EOB? Is there any fax number or?
[AGENT][NEUTRAL] Yes, you can fax it to us, um, both. Our fax number is [PII].
[CUSTOMER][NEUTRAL] Mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK attention too.
[AGENT][NEUTRAL] APL claims department.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you so much [PII] and the lastly the call reference number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[AGENT][NEUTRAL] And just for the call again, all the information provided was a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] Was there anything else I could assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] No, thank you so much and you have been extremely helpful. I appreciate your assistance. Have a great day. Take care.
[AGENT][POSITIVE] You also, thanks for calling APR. Have a great week.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.