AccountId: 011433970860
ContactId: ca567a1c-3a35-43bf-808d-df7ad5f89d2f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 433890 ms
Total Talk Time (AGENT): 125218 ms
Total Talk Time (CUSTOMER): 151611 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/ca567a1c-3a35-43bf-808d-df7ad5f89d2f_20250417T14:02_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, my name is [PII] and I'm calling with, um, West Atlanta OBGYN. We received payment, however, I'm trying to access the EOB to see the patient responsibility and.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I click on the the thing for a new user and when I put in our tax ID and the account number that we build on our claim, it keeps telling me there's no user identified. Well yeah, I, I'm trying to register for a new one and I can't get past that point.
[AGENT][NEUTRAL] OK. All right. So let me um look in.
[AGENT][NEUTRAL] The online service center.
[CUSTOMER][NEUTRAL] Or can you tell me how this payments to be it's a one it's like a set payment it says for $75 but it doesn't tell me what if there was a PPO reduction or anything it was or is that just what American public you pay per visit or something? I, I don't know.
[AGENT][NEUTRAL] Right, right, OK, Ms. [PII], I can actually look up the claim for you and send you a copy of the EOB. Can you please give me your callback number, ma'am, just in case the call is disconnected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, my number is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, the patient's name is [PII]. Her date of birth is [PII], and then the policy number is.
[CUSTOMER][NEUTRAL] It's um 02517646.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[AGENT][NEUTRAL] OK and then what is the claim number that you have?
[CUSTOMER][NEUTRAL] Um, the claim number that is showing here is
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Um, 358-285-7.
[AGENT][NEUTRAL] OK, let me look up the claim real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK on the claim itself, it is stating on the EOB with this check the maximum benefit payable for this date of service has been met, so that's the maximum payable um we, we don't ever give patient responsibility because we let the provider determine that but if you can give me your fax number I can send you a fax with this EOB.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, my fax number is [PII].
[AGENT][NEUTRAL] OK, and I'm Miss [PII] I'm gonna put you on a brief hold while I get that fax ready so I can send it while we're on the phone together.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Thank you so much for holding for me, Ms. [PII]. I've got that EOB on its way to you now.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Is there any other questions you may have before we go?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Nope, that is it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will um
[CUSTOMER][NEUTRAL] So for this there's there's actually what you're telling me is there's no you all don't use any sort of like PPO contract for any sort of write off it's based you issue the maximum amount allowable for the type of visit that was billed and it's the provider's discretion to either balance bill the patient for the difference that was billed to you all.
[AGENT][NEUTRAL] No, uh, it's up to the provider to decide after we make our payment to decide how they want to get the, the rest of the money if the um payment was not paid in full for the amount of the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] We just never give patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, if you don't give, you all don't give a patient responsibility, it's up to the provider to give the difference for the patient responsibility.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, all right, you're OK, so.
[CUSTOMER][NEUTRAL] We, we, we will balance bill the patient for the difference then.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] All right. You're very welcome, Ms. [PII]. I hope you have a wonderful Easter and thank you for calling APL.
[CUSTOMER][POSITIVE] All right, thank you so much have a good day.
[AGENT][NEUTRAL] Bye-bye, ma'am. You too.