AccountId: 011433970860
ContactId: 77e9314a-f004-4392-a7a2-2c344382b7ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345149 ms
Total Talk Time (AGENT): 121358 ms
Total Talk Time (CUSTOMER): 173868 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/77e9314a-f004-4392-a7a2-2c344382b7ff_20250107T20:11_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I am calling for Statesboro Pathology Associates. How are you doing today?
[AGENT][POSITIVE] I'm doing good. How are you?
[CUSTOMER][NEUTRAL] I'm doing all right. uh, we received an explanation of benefits, um, and it's saying that uh it's a non-coverage service, so there's no payment or anything, but it also doesn't say whether it's the patient's responsibility or not. Is this something you can help me with?
[AGENT][NEUTRAL] Well, yes, um, I can, and may I have a good contact number just in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] That would be [PII] option 3 for insurance.
[CUSTOMER][NEUTRAL] And the policy number is 02138649.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and I'm sorry, what was your name again?
[AGENT][NEUTRAL] My name is [PII] and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you [PII].
[AGENT][NEUTRAL] You're welcome. And then, do you have um that claim number?
[CUSTOMER][NEUTRAL] The claim number is 351-063-5.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Uh looks like the insured ID number we have isn't the same as the policy number on the explanation of benefits.
[AGENT][NEUTRAL] I was just literally about to say, I was just getting ready to say it looks like this was filed under another policy. I literally just pulled that up. Hold on one moment. I'm sorry, let me pull that policy up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And 351.
[AGENT][NEUTRAL] course
[CUSTOMER][NEUTRAL] 0635.
[CUSTOMER][NEUTRAL] Is the claim number.
[AGENT][NEUTRAL] OK, so there's two parts. 4, so APL doesn't give patient responsibility because we're not the major medical insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, if there is an outstanding balance, um, that would just, it would be between primary and the provider to determine patient responsibility or write off or however the um procedures are at that point, but we can't give a patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK well we.
[CUSTOMER][NEUTRAL] When I say we we build the primary.
[CUSTOMER][NEUTRAL] And what we submitted to American public is what the primary had applied to the patient.
[CUSTOMER][NEUTRAL] And APL is saying it's non covered service because.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, charges incurred in an independent lab which are not covered.
[AGENT][NEUTRAL] Yes, so that's why on the explanation of benefits you don't see a, because usually like our dental policies, there will be a column that says patient responsibility, but for our medical policies because we're not the major, we can't determine patient responsibility. So that's why it's not on the explanation of benefits. So I'm not sure whatever your protocol is for outstanding balances. I can't really help on that part.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, we usually, I mean, hm, well, from my understanding the way it usually goes unless we're told otherwise by the secondary insurance it stays as patient responsibility.
[CUSTOMER][NEGATIVE] Now, uh, the client may call up and say hey this doesn't show I'm responsible for anything so why am I still getting billed so see.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] That's, you know, I mean that.
[AGENT][NEUTRAL] Um, the, so if that's your protocol, then the, the only other option would be to bill the patient for that balance.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, and so if they call us saying hey you know I don't see where I'm responsible for this, then we have to say, well, according to your American public, uh, they're not responsible for it so it's up to our discretion as to the what the primary says and the primary says you're responsible that's pretty much how it goes, right?
[AGENT][NEUTRAL] I mean, yes, it is.
[CUSTOMER][NEUTRAL] OK, alright, I just want to make sure in it, so, uh, be prepared if they call y'all and so.
[CUSTOMER][NEUTRAL] If, if you get out to them and they're gonna say, well, I'm sorry, you need to redo your policy then and make it a little bit more fair, so.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] No, I'm just joking. Um, I, I don't know. They may call and say, why aren't y'all covering this? Why is this that? No, but OK, so alright, so we will leave it as patient responsibility. You got a reference number for me, [PII]?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. Um, so that's [PII] to my last name [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you so much I hope you have a great day.
[AGENT][POSITIVE] You also and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.