AccountId: 011433970860
ContactId: c364a864-3895-42e2-aa68-04c70c38695d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 324600 ms
Total Talk Time (AGENT): 132640 ms
Total Talk Time (CUSTOMER): 185139 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/c364a864-3895-42e2-aa68-04c70c38695d_20250307T20:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Oh hi [PII]. My name is [PII]. I'm calling uh from Houston Methodist Willowbrook Hospital and um I needed to get some information like if this patient has coverage and if you received a claim that was submitted.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course, of course, and [PII], what is your callback number if we are disconnected please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It's secure and direct. It's uh [PII].
[AGENT][NEUTRAL] OK, I have that as [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you. What is the policy number please for the patient?
[CUSTOMER][NEUTRAL] OK, that's 01678926 ML 8.
[AGENT][POSITIVE] Thank you very much. One moment please, [PII].
[CUSTOMER][POSITIVE] You're welcome. OK.
[AGENT][NEUTRAL] Thank you and verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] OK, that's um [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you very much for that verification process and you're calling to check um eligibility.
[AGENT][NEUTRAL] And see if we receive the claim, OK.
[CUSTOMER][NEUTRAL] Ah yeah. Right.
[AGENT][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] It's a mystery.
[AGENT][NEUTRAL] It's OK, it's OK. Well this particular policy, yes ma'am, it showed effective for her as of [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And this policy termed as of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, when [PII]?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So this date of service is [PII]?
[AGENT][NEUTRAL] A this
[CUSTOMER][NEUTRAL] OK, so it would be covered.
[AGENT][NEUTRAL] I'm sorry, that was [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, thank you and what's the total charge amount?
[CUSTOMER][NEUTRAL] OK, it's $2,622.
[AGENT][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] And your primary, right? There's like no other coverage? No? OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, we were secondary for her when she had coverage with us. Let me just check to see if we received that claim first one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] We actually we did receive the claim and it denied because we were requesting for the explanation of benefits from the primary.
[CUSTOMER][NEUTRAL] OK. And do you show who the primary is?
[AGENT][NEUTRAL] Let me see if the information is available. Um, we do not coordinate benefits, but give me one moment please, [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. Yeah, I'm showing that the Blue Cross policy, the coverage terminated before.
[CUSTOMER][NEUTRAL] This day. So if we send the uh Blue Cross EOB that shows that sinces incurred after coverage terminated, would that suffice?
[AGENT][NEUTRAL] 12
[AGENT][NEUTRAL] I'm sorry, give me one second. I was looking for that information you were asking me who may have been the primary, um, it shows that the primary may have been United Healthcare.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Well, that's totally different, OK.
[AGENT][NEUTRAL] So, um, but of course you can confirm this with the, the patient, but we showed that it may have been United Healthcare.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, that's good to know. Um, then the Blue Cross then makes sense it was not in effect. They probably had the United Healthcare, and we need to bill it to them. Um, and I think that it's past the timely, yeah. What is the claim number for the one that denied?
[AGENT][NEUTRAL] I have a claim number.
[AGENT][NEUTRAL] OK, it is 3571478.
[CUSTOMER][NEUTRAL] OK. You wouldn't have to have the United Healthcare, um,
[CUSTOMER][NEUTRAL] Information like the address?
[AGENT][NEUTRAL] Um, no, ma'am, I wouldn't have the information now. We, we do not have any timely filing. I'm not sure what if you're not a healthcare does or not, but we do not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, they do they have a timely filing so if they, yeah.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So it's a predicament.
[AGENT][POSITIVE] OK. I'm sorry.
[CUSTOMER][POSITIVE] Well, well, hand, yeah, we, we need to verify that that was primary and then um go ahead and, you know, do what we need to do but uh it's good to know you don't have a timely filing that's nice. You sound like good insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes
[AGENT][POSITIVE] Well, thank you.
[CUSTOMER][NEUTRAL] Well, [PII], can I get a call reference number?
[AGENT][NEUTRAL] We do not use call reference numbers, Miss. [PII], but you can use my name and today's date, and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I ask you holy scripture questions? I'm kidding.
[CUSTOMER][NEUTRAL] You might have the answers.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Oh, Mr. [PII], thank you for making me laugh.
[CUSTOMER][POSITIVE] You're you're welcome. Thank you for protecting me, [PII]. I'm, I'm kidding.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] You have a blessed day.
[AGENT][POSITIVE] You as well. Thank you. Thank you so much.
[CUSTOMER][NEUTRAL] OK. Yes, ma'am. Bye-bye.
[AGENT][POSITIVE] Yes ma'am, take care bye bye.