AccountId: 011433970860
ContactId: 582ab8ae-f472-4435-b29f-ae606d73e952
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 459899 ms
Total Talk Time (AGENT): 159133 ms
Total Talk Time (CUSTOMER): 219263 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/582ab8ae-f472-4435-b29f-ae606d73e952_20250605T16:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII]. I'm a broker in [PII]. How are you?
[AGENT][POSITIVE] I'm great how are you?
[CUSTOMER][NEUTRAL] I'm good. Are you in, uh, [PII] or [PII] or somewhere else?
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEGATIVE] OK, I was gonna say you didn't sound like you're from you didn't sound like you're in [PII] because I'm from [PII] and you don't sound like my people. I can, I can understand your words. You're, you're enunciating. Um, hey, I've got a, I, I've put tons of business with ATL in the past, uh, oh, with, uh, specifically [PII]. This is the first time I've ever had to call because the doctor's office is making things miserable. Um, I've got a client who tried to use their APL today and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The doctor's office looked at them sideways, didn't understand how to do it. Uh, evidently they called APL and somebody APL told them they would just have to pay for it and then get reimbursed from APL. But can't we file like a manual claim or can we reach out to this doctor's office and tell them how to file the claim themselves?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I don't know why they would tell them that. Give me just a moment. Um, can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Alright, give me just a moment.
[AGENT][NEUTRAL] And you said are you reaching out on behalf of.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] A, uh, a group or a member, OK?
[CUSTOMER][NEUTRAL] It's, it's the member, it's, it's.
[CUSTOMER][NEUTRAL] Um, really, we, we can keep it. I don't because I don't have their member number, we can keep it generic enough as I just need to know.
[CUSTOMER][NEUTRAL] What to tell this doctor's office to to how to handle this claim.
[AGENT][NEUTRAL] Right, um.
[CUSTOMER][NEUTRAL] They have it they they didn't get the procedure because they were told they'd have to pay for it so I just need to call the doctor's office back and give them instruction on what to do.
[AGENT][NEUTRAL] And what to do. OK, um, real quick, I need to verify you, uh, do you have the group number?
[CUSTOMER][NEUTRAL] That's what I'm looking for um.
[CUSTOMER][NEUTRAL] While I'm looking
[CUSTOMER][NEUTRAL] It's uh Buford Pediatrics is the group I'm gonna try to find the group number.
[CUSTOMER][NEUTRAL] The approval, I don't have anything, um.
[AGENT][NEUTRAL] Uh, you said Buford?
[CUSTOMER][NEUTRAL] Yeah, B E A U F O R T.
[CUSTOMER][NEUTRAL] Oh yeah, it's uh 269-04.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can you verify your email for me please?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Alright, give me one moment and I will transfer you to broker resources um and they'll be able to help you with next steps, OK?
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi [PII], I have uh [PII] on the line. He has a question about group number 26904.
[CUSTOMER][NEUTRAL] OK, um, and, um, I guess I'm so sorry, are you, are you the broker?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] I'm with the APL care. I'm with the care team at APL sorry I.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] No, you're good.
[AGENT][NEUTRAL] He said I sounded like I'm from [PII], so I was like it threw me off.
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][NEUTRAL] OK, so, um, he, he's calling about that group and is he the broker or is he the group or who, who is he?
[AGENT][NEUTRAL] He is the broker for that group. He's wanting information uh he doesn't have the, the patients, uh.
[AGENT][NEUTRAL] Account number, um, but I guess a hospital denied a patient services saying that we won't pay for it, and he, he told me that I guess a member of someone from APL told him or told the insured or the the medical group that we won't pay for services, but he's unable to find that that patient's um policy number.
[AGENT][NEUTRAL] Uh, but I was told for a broker to, to transfer to broker resources because he's needing next steps on how to handle this situation.
[CUSTOMER][NEUTRAL] Yeah, I might ask if you can take into claims because I have no idea about how claims are paid or or anything like that. I don't know why uh uh anything would be declined.
[AGENT][NEUTRAL] OK, so you don't want me to send them to you, you want me to send them to claims?
[CUSTOMER][NEUTRAL] Here I'll if you wanna send them to me and then I can send them the claims that works too.
[AGENT][NEUTRAL] OK, and then maybe he'll be able to to give you more information that might be more helpful. I was just told send brokers to broker resources for issues um regarding this. Mhm.
[CUSTOMER][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] Yeah, if it, yeah, a lot of times if it's like claim stuff I have, I have no idea on that. So, um, we just send them to claims just because a lot of times they're they're asking a specific thing and I'm not very helpful with that.
[AGENT][NEUTRAL] OK, OK, um, I will transfer him over to you, um, and if you need to transfer him to claims, uh, we'll get it done somehow.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][POSITIVE] Alright, thank you so much. And your name is [PII]?
[CUSTOMER][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll introduce you just give me a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hey, [PII], are you still there?
[CUSTOMER][NEUTRAL] I am still here.
[AGENT][NEUTRAL] OK, I have [PII] from our broker resources who may be able to help you. If not, um, we might end up having to transfer you to claims. They might have more information for you, um, but if you could go ahead and let her know I gave her a brief synopsis of what you had mentioned to me first. I just wanna make sure we get you to the right person, OK?
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you. Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi [PII], how are you?
[CUSTOMER][POSITIVE] I'm good [PII], um.
[CUSTOMER][NEUTRAL] So I've got a client who tried to go to get a procedure done this morning, outpatient procedure, ended up not getting it because the doctor's office wasn't understanding, uh, [PII], and then she, she called ATL and she kind of got an odd response that she was told she would have to pay for it ahead of time.
[CUSTOMER][NEUTRAL] Which I don't think that's true. Um, for a doctor who doesn't understand how to process this.
[CUSTOMER][NEUTRAL] Do they, what should they do if they.
[CUSTOMER][NEUTRAL] Obviously, it's probably the newest employee they have and they put them up front to take information. Um, they've got their APL card and everything like that. What, what should we get them to do? Just give them a number to call or just direct them on how to do that or what?
[CUSTOMER][NEUTRAL] Yeah absolutely let me put you on a brief hold, OK? And then I'm, I'm just gonna do some research on this, OK?
[CUSTOMER][POSITIVE] OK, thank you.