AccountId: 011433970860
ContactId: f5072184-81b1-42a8-8126-c7f5364b38b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269839 ms
Total Talk Time (AGENT): 100878 ms
Total Talk Time (CUSTOMER): 104164 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/f5072184-81b1-42a8-8126-c7f5364b38b2_20250529T17:35_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling about the EOB that I received and our posting team would like to know if the patient has a responsibility. It doesn't say on the EOB.
[AGENT][NEUTRAL] OK. Well, I can assist you with the explanation of benefits and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, um, [PII].
[CUSTOMER][NEUTRAL] Policy number 02567400.
[CUSTOMER][NEUTRAL] So your name is [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the first initial to my last.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The initials is what?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So APL doesn't provide patient responsibility because we're not a major medical insurance company, um, so that's why it's not listed there on the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is there, let me see what they're asking for. I need to know if there is a patient responsibility to do or adjustment need to be made or there's any adjustments that need to be made?
[AGENT][NEUTRAL] Yeah, so that that all goes into patient responsibility. So since we don't determine that, it'll just be whatever you, you as a provider, whatever your processes are on remaining or outstanding balances.
[CUSTOMER][NEUTRAL] So the remaining balance.
[CUSTOMER][NEUTRAL] It's up to us.
[AGENT][NEUTRAL] Right, or if the insured has another insurance, yes, that's what I'm saying, because we don't, we can't provide patient responsibility. We're not a major medical insurance company. So that's usually it will be on the explanation of benefits, but because we can't give that, that's why it's not on there.
[CUSTOMER][NEUTRAL] It's up to the company?
[CUSTOMER][NEUTRAL] OK, so the remaining balance is up to [PII].
[AGENT][NEUTRAL] Right, the provider or primary insurance if they have other insurance.
[CUSTOMER][NEUTRAL] Uh, provide our other insurance.
[CUSTOMER][NEUTRAL] OK, I'm just trying to write this down. OK, so y'all don't provide patient patient responsibility.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK provider, OK, let me make sure that I have this written down correct. OK, you have, you said the APL doesn't provide patient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Responsibility.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] For the remaining balance is up to the provider or other insurance.
[AGENT][NEUTRAL] Yes, because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] It's not a major.
[CUSTOMER][NEUTRAL] Insurance.
[CUSTOMER][NEUTRAL] Company.
[CUSTOMER][NEUTRAL] OK, so as far as the balance is up to them what they decide to do with it.
[CUSTOMER][NEUTRAL] Because the patient doesn't have no other insurance, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I get your name is [PII]. Can I have a call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's not a major insurance. So you're not a major insurance company. What type of company are you guys?
[AGENT][NEUTRAL] So for this particular policy, it's a hospital indemnity policy, so we provide a limited medical.
[AGENT][NEUTRAL] Policy, um, some of them could be a mailing policy, which is a secondary like a gap insurance, so it depends on what type of policy they enroll in.
[CUSTOMER][NEUTRAL] OK, so this is a limited medical policy?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, limited limited medical policy. OK, thank you, ma'am.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that'll be it.
[AGENT][POSITIVE] All right. Well, thank you so much for calling [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] OK, do the same thanks.
[AGENT][POSITIVE] Thank you.