AccountId: 011433970860
ContactId: 16efb5bb-50b4-4590-b061-3232322cff6d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347809 ms
Total Talk Time (AGENT): 152071 ms
Total Talk Time (CUSTOMER): 116559 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/16efb5bb-50b4-4590-b061-3232322cff6d_20250314T16:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I really.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Mo
[CUSTOMER][NEUTRAL] [PII] from the charm.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I'm getting my.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from Grady Memorial Hospital to check on the claim status.
[AGENT][POSITIVE] Well, [PII], it would be my pleasure to assist you with claim status today. What is a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And [PII], what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02069359.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Thank you, [PII], and the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Alright thank you and it would be a pleasure to assist you with that claim status. Do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Yeah, the date of service is uh December [PII] of 2024.
[AGENT][NEUTRAL] December [PII], 2024.
[CUSTOMER][NEUTRAL] And the bill amount is
[CUSTOMER][NEUTRAL] And the bill amount is $326 even.
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And [PII], what is the name of the facility please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's Grady Memorial Hospital uh Gray Health System.
[AGENT][NEUTRAL] All right, thank you. I can help you with that claim status. I'm showing that this claim we've received on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And [PII], this claim was denied.
[AGENT][NEUTRAL] I'm checking the denial reason for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, treatment in the hos.
[CUSTOMER][NEUTRAL] Could you please spell your name for the accommodation?
[AGENT][NEUTRAL] Sure, my name is [PII]
[AGENT][NEUTRAL] First initial and my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, it was denied because um treatment in an outpatient hospital is not covered by this policy.
[AGENT][NEUTRAL] And this policy does not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] So it's the dinner, the render service is not covered on the patient's plan, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Uh, and, uh, Grady Memorial Hospital is also not covered, right?
[AGENT][NEUTRAL] It's not covered uh for outpatient services.
[CUSTOMER][NEUTRAL] So, uh, may I know the patient state?
[AGENT][NEUTRAL] I'm sorry, can you repeat that question?
[CUSTOMER][NEUTRAL] The, so the patient belongs to [PII], right?
[AGENT][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] So the render service is not covered under the patient plan. So it's denied. OK, fine. I can get you. Can I apply for this?
[AGENT][NEUTRAL] You do have a right to an appeal.
[AGENT][NEUTRAL] At the time the filing for an appeal is 180 days from the date of denial.
[AGENT][NEUTRAL] And also the sandwich.
[CUSTOMER][NEUTRAL] OK, fine. Uh.
[AGENT][NEUTRAL] Yeah, would you like that claim number?
[CUSTOMER][NEUTRAL] May I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 4305.
[CUSTOMER][NEUTRAL] OK, fine. Uh, uh, may I know how I can appeal?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Is there any fax number for our bill?
[AGENT][NEUTRAL] We'll need
[AGENT][NEUTRAL] You can fax an appeals directly to our claims department at [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] and we will need an formal appeal letter stating the reason you are appealing the claim decision.
[CUSTOMER][NEUTRAL] OK, fine. Could you please fax me the copy of EOB?
[AGENT][NEUTRAL] EOBs are obtainable on our provider portal at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, fine. So,
[CUSTOMER][NEUTRAL] Uh, the render service that is, uh, ophthalmoscopy, right? OK, fine. I can get you. Could you please provide me the call reference number?
[AGENT][NEUTRAL] The reference number is my name and today's date.
[CUSTOMER][POSITIVE] OK, fine. Uh thanks for the information. Have a wonderful day, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] It was my pleasure to help you with that claim status, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Can I build the, can I build the, can I build the patient for this service?
[AGENT][NEUTRAL] So we're not major medical. We don't determine if you bill the patient or not. That would be determined by the provider.
[CUSTOMER][POSITIVE] OK, fine. Thanks for the information.
[AGENT][POSITIVE] You're very welcome, [PII]. It was a pleasure to help you with that claim status and thank you for calling APL. Hope you have a wonderful day.
[CUSTOMER][NEUTRAL] OK, fine.
[AGENT][NEUTRAL] Bye bye.