AccountId: 011433970860
ContactId: a4e9d4a8-c73f-4ed1-8081-8695b040103c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197059 ms
Total Talk Time (AGENT): 98158 ms
Total Talk Time (CUSTOMER): 55511 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/a4e9d4a8-c73f-4ed1-8081-8695b040103c_20250212T19:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, Ms. [PII]. My name is [PII] and I'm calling from UT Physicians, and I need to get some clarification on the patient's claim, please.
[AGENT][NEUTRAL] Sure we could take a look at that claim. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] is a direct line.
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] I am showing 02442567.
[AGENT][NEUTRAL] OK, thank you. And then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date, date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Now did you have a claim number?
[CUSTOMER][NEUTRAL] I do. It's 350-065-8.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Is that uh UT physicians?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See
[AGENT][NEGATIVE] OK, so yes, um, we were unable to pay a benefit. It does state the policy provides no benefits for charges made by a doctor for inpatient visits.
[CUSTOMER][NEUTRAL] OK, so that means I just wanna make sure before I build this to patient that this full balance is patient responsibility.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we don't say what is patient responsibility that would be up to the provider we were unable to pay a benefit though.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, and what is timely filing to get a clean claim to you all?
[AGENT][NEUTRAL] Um, there is no timely filing limit. I will say that this policy, I can see if they have one that's active, um, but this one did terminate [PII].
[AGENT][NEUTRAL] Let me see if they have no, OK, so this was the only policy they had with us so it was effective from [PII]. So anything within that time you can absolutely file those claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So you said there's no timely phone there, is there any type of appeal deadline or anything?
[AGENT][NEUTRAL] Yes, now for appeals that would be within 180 days. Uh, let me see when this one was processed. Give me just a moment.
[AGENT][NEUTRAL] 658
[AGENT][NEUTRAL] So this claim process uh [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It looks like all I need is a call reference number and that's it.
[AGENT][NEUTRAL] OK, so that would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with [PII]?
[CUSTOMER][POSITIVE] That was it, thank you so much.
[AGENT][POSITIVE] Alrighty, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.