AccountId: 011433970860
ContactId: 99a200e1-e781-418e-990a-001b2415742d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362230 ms
Total Talk Time (AGENT): 114111 ms
Total Talk Time (CUSTOMER): 148356 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/99a200e1-e781-418e-990a-001b2415742d_20250509T15:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hello [PII], my name is [PII]. I'm calling from Memorial Herman Hospital. I'm calling to get status of a claim for one of your members. Are you able to assist me?
[AGENT][NEUTRAL] OK, I can help you with claim status, Ms. [PII]. May I please get your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh, and [PII], I need to mention to you, I'm having some problems with staying connected to the internet, and um I'm saying this because usually it takes me like a couple of moments to get back on, so you may hear just silence and thinking that I may have disconnected the line, which is not the case. It's just that the internet knocked me off. So, if you would just give me a couple of moments to get back on again. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Of course, Ms. [PII], and I totally understand because I have issues sometimes myself with my phone when I'm working, so please don't feel like you have to rush or anything. I understand.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're very welcome. And Ms. [PII], what is the patient's name, um, date of birth and policy number?
[CUSTOMER][NEUTRAL] Uh, [PII] 331 63 and his ID number is uh [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][NEUTRAL] OK, and then can I please have [PII]'s date of service and charge amount?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII] for the bill amount of $97,830.54.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, um, and who is the primary insurance?
[AGENT][NEUTRAL] We're the secondary insurance.
[CUSTOMER][NEUTRAL] Yes ma'am, do you show, uh, on file who the primary insurance is?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Because we only have you guys, OK.
[AGENT][NEUTRAL] OK, that's OK. I can still look up the claim and see if there's any remarks on it. If you don't mind, I'm gonna put you on a quick hold and search that claim and I'll be right back, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, Ms. [PII]. So looking on data service of 3325 through 37 of 25, I do not find a claim on file for this member.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And maybe we said we submitted on 323 uh 25 is made of.
[CUSTOMER][NEUTRAL] Um, you may not have received it as of yet.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][NEUTRAL] Uh, so,
[CUSTOMER][NEUTRAL] We have a United Healthcare as a secondary pair, but you guys, are you a uh supplement or?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] How this members plan OK.
[CUSTOMER][NEUTRAL] So are you guys paying the car insurance and the deductible or?
[AGENT][NEUTRAL] Yes, and this is just to verify benefits. It's not a guarantee of payment. This policy does help with deductible copay and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great. Uh, we'll go ahead and send it to United Healthcare so that they can review it. Thank you so much for your help. Is there a reference number for the call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], in today's date.
[CUSTOMER][NEUTRAL] OK, and [PII], uh, when we do get the information from United Healthcare, uh, can we fax this claim back to you guys? Oh well, you don't have it, so can we fax it?
[AGENT][NEUTRAL] Yes, you can, and you'll need to include the EOB from the primary insurance carrier.
[AGENT][NEUTRAL] Um, the fax number if you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am, go ahead.
[AGENT][NEUTRAL] 1877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, we'll go ahead and submit it to United Healthcare. Thank you so much for your help. I really appreciate it. Have a great day, OK? Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. Yes, Ms. [PII], you have a wonderful weekend and thanks for calling APL. Bye-bye, ma'am.