AccountId: 011433970860
ContactId: aba74c50-0326-49d4-a780-47cc5c1d3982
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 209399 ms
Total Talk Time (AGENT): 68770 ms
Total Talk Time (CUSTOMER): 122381 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/aba74c50-0326-49d4-a780-47cc5c1d3982_20250107T14:06_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Health Texas provider network to check on a claim status. How's your day going today?
[AGENT][NEUTRAL] I'm fine, [PII], thank you. And could you provide the policy number, please?
[CUSTOMER][NEUTRAL] Sure, it's 02261851.
[AGENT][NEUTRAL] OK. And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] Thank you for that and what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, you said you're checking a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we can provide information for you. What's the date of service in charge?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Data service is 8-15-2024. The amount is $728.97.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm, and I would appreciate if you can spell out your name for me for my documentation.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] First initial last name is [PII].
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][NEUTRAL] Uh, you're welcome. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I show the claim was received [PII].
[AGENT][NEUTRAL] Process [PII]. Uh we denied the claim for a copy of the major medical explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, could you please repeat it again?
[AGENT][NEUTRAL] We need a copy of the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so do you have any idea which insurance is acting as the primary?
[AGENT][NEUTRAL] Our records indicate Well Net Healthcare, but you also want to check with the patient as well.
[CUSTOMER][NEUTRAL] Well net or WellCare.
[AGENT][NEUTRAL] Well Net Healthcare.
[AGENT][NEUTRAL] And you can also check your status online at [PII].
[CUSTOMER][NEUTRAL] OK, so I could.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, so, uh, could you please uh confirm since when are you guys acting as a secondary?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] No, I'm asking since when are you guys acting as a secondary?
[AGENT][NEUTRAL] My response was yes.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Could you please confirm the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 352-7310.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you so much. Also, uh, may I have the reference number for this call?
[AGENT][NEUTRAL] My name in today's date?
[AGENT][NEUTRAL] And any other questions, [PII]?
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] No, that is all for the day. Thank you so much. You've been extremely helpful for me and I really appreciate your assistance. Have a wonderful day ahead. Be safe. Yeah, take care.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You too, [PII] thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye