AccountId: 011433970860
ContactId: d7d4cbfb-d050-4f33-9eef-655410e94d4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293269 ms
Total Talk Time (AGENT): 124211 ms
Total Talk Time (CUSTOMER): 57612 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/d7d4cbfb-d050-4f33-9eef-655410e94d4b_20250226T16:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] with Baylor Scott and White. Um, I was speaking with the rep there and then she told me that um.
[CUSTOMER][NEGATIVE] It was the wrong, uh, I had to call 90 degrees.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Uh 9 degrees trash me back.
[AGENT][NEUTRAL] Gosh.
[CUSTOMER][NEGATIVE] And and said that the you're not supposed to look up the member ID you're supposed to look up the name or something because they didn't select 90 degrees.
[AGENT][NEUTRAL] Hmm, OK. Let's take a look, [PII]. What information are you needing to just check benefits and eligibility or on a claim?
[CUSTOMER][POSITIVE] Clean.
[AGENT][NEUTRAL] OK, um, do we have a claim number or anything like that? What do we have?
[CUSTOMER][NEUTRAL] Uh, let me see if I have a claim.
[CUSTOMER][NEUTRAL] Uh yes, I have a claim number 3552611.
[AGENT][NEUTRAL] OK, let me.
[AGENT][NEUTRAL] Hold this because I should be able to get the members info from this.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Right. And then if I could just verify, please [PII] patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, I said I think [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you so much. OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so it looks like on this particular claim [PII], it looks like showing not eligible, but let me.
[AGENT][NEUTRAL] If if they're waiting eligibility, one second.
[AGENT][NEUTRAL] OK, so looks like we're just awaiting eligibility um it looks like the insured has this plan through like a staffing agency a temp staffing agency and so right now um we're just awaiting to see if they were eligible for services at that time.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Because it looks like we didn't get premium for the date of service.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, do you know how long that takes, or?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] One this client receipt.
[AGENT][NEUTRAL] Yeah, it looks like all their claims right now have been denied for the same reason.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] So they're all being denied.
[AGENT][NEGATIVE] Yeah, it looks like they're all being denied for the same reason, saying not eligible for benefits and we didn't receive premiums. So at this point it looks like they weren't eligible for any benefits. We haven't received anything different at this time, [PII].
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] That it'll make it seem like it was patient responsibility then.
[AGENT][NEUTRAL] Yeah, I mean that's up to the facility or provider to build them, but yeah, we don't show that they were eligible at this time.
[CUSTOMER][NEUTRAL] And that's because they didn't make the premium payments?
[AGENT][NEGATIVE] Yeah, it's showing a premium not received.
[CUSTOMER][NEUTRAL] OK, what was your name? Sorry, I didn't catch your name.
[AGENT][NEUTRAL] That's OK. My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] And you go by reference numbers?
[AGENT][NEUTRAL] Yeah, so call reference is my name with my last initial than today's date. My last initial is [PII].
[CUSTOMER][POSITIVE] OK, alright, and that's all I have thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Have a good one.
[CUSTOMER][NEUTRAL] You too bye bye.