AccountId: 011433970860
ContactId: d412d43d-7db6-49c4-9e02-9508f58192e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282619 ms
Total Talk Time (AGENT): 118630 ms
Total Talk Time (CUSTOMER): 97377 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/d412d43d-7db6-49c4-9e02-9508f58192e6_20250205T18:59_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh hi, good morning. This is [PII] calling from Texas Health Physician Group to check on a claim status.
[AGENT][NEUTRAL] OK, I can assist you. And you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, that's right. And could you please spell out your name for me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And if I can get the policy number, [PII]?
[CUSTOMER][NEUTRAL] Oh yeah, sure. Policy number is 02449815. And could you please tell me what's your last name is, sir?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's go back to the policy number. You gave me 02449815.
[CUSTOMER][NEUTRAL] Yeah, that's right. It's uh it's American public, public health, uh health insurance for variety.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. The first initial of my last name is [PII].
[AGENT][NEUTRAL] And if I can get a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh yeah, sure. The callback number is [PII].
[AGENT][POSITIVE] Thank you, give me one moment to pull up the file.
[CUSTOMER][NEUTRAL] Oh yes, sure.
[AGENT][NEUTRAL] Mhm, you can verify the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Oh yeah, sure. Patience's first name was spelled as [PII] and patient's last name was spelled as [PII] Sorry, it's [PII] Date of birth was [PII].
[AGENT][NEUTRAL] OK, thank you. And we're checking claim status?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] All right, we can help you with that information. [PII], what is the date of service and the total charge?
[CUSTOMER][NEUTRAL] Oh yeah, the data service was [PII] and the bill amount was $277.95.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You show the claim was received [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there was no payment made on this claim. The maximum outpatient benefit is exhausted.
[AGENT][NEUTRAL] Let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yes, could you please provide me that?
[AGENT][NEUTRAL] 355.
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] 90.
[AGENT][NEUTRAL] And [PII], you can also check claim status online at [PII].
[AGENT][NEUTRAL] And any other questions I can assist with today?
[CUSTOMER][NEUTRAL] Uh yeah. Uh, could you please help me with that, uh, [PII]?
[AGENT][NEUTRAL] The maximum outpatient benefit is exhausted.
[CUSTOMER][NEUTRAL] Which means the maximum benefits has been existed.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But however, upon checking here, can found that tailing like.
[CUSTOMER][NEUTRAL] Uh, provider was out of, but that was not correct, and, uh, could you please fax it, uh, correct GOP to us.
[AGENT][NEUTRAL] Um, it was actually mailed when the claim was processed to the address that's on your claim. Um, it is now available to download online, uh, to the address provided, and I can help you set that account up if you would like.
[CUSTOMER][POSITIVE] Oh yeah, could you please help me with that one.
[AGENT][POSITIVE] It's secured.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] This one.
[CUSTOMER][NEUTRAL] Could you spell out that?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Letter [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, OK. Thank you so much. To get the card you be, uh, we need to, uh, go with the portal, the self-register portal.
[AGENT][NEUTRAL] Correct, it's gonna ask you for the provider's tax identification number.
[AGENT][NEUTRAL] And the patient account number that's on your claim in box number 26.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, OK, thank you so much. Could you please provide me the call reference number?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][POSITIVE] Oh yeah, thank you so much for assisting today with me. Have a wonderful day. Enjoy the rest of your day. Bye-bye.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day.