AccountId: 011433970860
ContactId: 0ea2b690-e0d7-4381-a827-935f4b184144
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 229860 ms
Total Talk Time (AGENT): 98141 ms
Total Talk Time (CUSTOMER): 90229 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/0ea2b690-e0d7-4381-a827-935f4b184144_20250226T15:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Um, hi, I'm calling to get some information on a claim denial.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] 02566198.
[AGENT][POSITIVE] OK, thank you so much. Give me a moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][POSITIVE] OK, thank you so much and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and you say you're calling about claim status. Uh, what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] [PII] and the total charge was.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Uh, yes, I am.
[CUSTOMER][NEUTRAL] $143.
[AGENT][NEUTRAL] 33.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, and while I look up claim information, just to let you know we do have an online service center where providers can check claim status as well as print out the EOB and that site is at [PII].
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Symbios Medical Services.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sure the claim process is the calendar maximum for this benefit has been exhausted for the um.
[CUSTOMER][NEUTRAL] And I see that, but it doesn't tell me whether it's patient responsibility or not.
[AGENT][NEUTRAL] No, ma'am, it's not gonna state that on our explanation of benefits. Uh, we don't give patient responsibility, we only just verify how the claim was processed.
[CUSTOMER][NEGATIVE] OK, so who do I get this information from? I'm looking at the EOB. It tells me there's no benefits paid. It tells told me why it doesn't tell me who's responsible for the pay for the charges. Does it go to patient responsibility or is it contractual? Who can I ask that question to?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Well, it's not contractual. We don't just claims. You have to contact the patient to verify if they have any other insurance, but we don't give patient responsibility.
[CUSTOMER][NEUTRAL] So the patient can have these services and because you don't want to pay it we get we just have to write it off.
[CUSTOMER][NEUTRAL] Is that what you're telling me?
[AGENT][NEUTRAL] No, ma'am. Like I said, we don't say about write-off or contractual adjustments. You will have to contact the patient to verify if they have any other insurance. We cannot give patient responsibility.
[CUSTOMER][NEUTRAL] And they don't, so.
[CUSTOMER][NEGATIVE] What do you mean you can't give patient responsibility? I'm questioning the EOB. I'm not, I'm not asking you.
[CUSTOMER][NEGATIVE] I'm not asking you if to put it to patient responsibility, the EOB yes tells me that you didn't pay on it but it doesn't tell me who's responsible for the charges.
[AGENT][NEUTRAL] Our EOBs do not show patient responsibility.
[CUSTOMER][NEGATIVE] And how am I supposed, how are we supposed to know who's supposed to pay it?
[AGENT][NEUTRAL] Well you have to contact the patient.
[CUSTOMER][NEUTRAL] If it doesn't put it to patient responsibility.
[AGENT][NEUTRAL] If there is a balance that you have to contact the patient. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] I, I don't, there is useless.