AccountId: 011433970860
ContactId: ec071b83-329a-47e8-8ced-af08135997ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 733299 ms
Total Talk Time (AGENT): 191443 ms
Total Talk Time (CUSTOMER): 125833 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/ec071b83-329a-47e8-8ced-af08135997ef_20250319T15:44_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, uh, I'm [PII]. I had just signed. Uh, I have the policy number with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 025485554
[AGENT][NEUTRAL] OK, that was 025485554. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and verify your complete mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the last thing to verify is your email address.
[CUSTOMER][NEUTRAL] Uh, listing, uh.
[CUSTOMER][NEUTRAL] At this time [PII].
[AGENT][POSITIVE] OK, thank you very much for the information. I have your policy pulled up, [PII]. How can I help you?
[CUSTOMER][NEUTRAL] There is a claim number 357-097-9.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEGATIVE] And then I saw you don't pay anything.
[AGENT][NEUTRAL] OK, let me get that pulled up. That shows, OK, that was an office visit I sent her, yes, uh, it was denied as office visit.
[CUSTOMER][NEUTRAL] It's not office, no, that, it's not office visit. That uh procedure like surgery thingy, uh like um I get injection, uh, what's called, uh, basically it's like surgery, um, in the hospital, but why you not cover it?
[AGENT][NEUTRAL] OK, for claim number 357-0979, the one that you provided me, it shows it denied as an office visit not covered.
[CUSTOMER][NEUTRAL] What about the 757-7088?
[AGENT][NEUTRAL] OK, one moment, let me check that one for you as well.
[AGENT][NEUTRAL] 88 OK and that shows for [PII], those were procedures inside an office and those are also not covered by the policy.
[CUSTOMER][NEUTRAL] What office? I do, uh, what procedure? Uh this is procedure in the hospital. I went to the hospital. It's not in the office visit.
[AGENT][NEUTRAL] OK, um, it was submitted was the Doctor [PII].
[CUSTOMER][NEUTRAL] Yeah, that one in the hospital. I went to uh North Georgia hospital. It's not in the office.
[AGENT][NEUTRAL] OK, one moment, can I place you on hold?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Question.
[AGENT][POSITIVE] But you can laugh about it.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, where was the procedure performed, [PII]?
[CUSTOMER][NEUTRAL] In hospital, North, Northeast Hospital in [PII].
[AGENT][NEUTRAL] In [PII], OK, I will ask the adjuster to review the, the claim. Let's see.
[AGENT][NEUTRAL] 64993.
[AGENT][NEUTRAL] And that was NGPG intervention.
[CUSTOMER][NEUTRAL] NGPG yes NGPG, uh, not, not Georgia.
[CUSTOMER][NEUTRAL] North Georgia Hospital, whatever in [PII].
[CUSTOMER][NEUTRAL] Northeast Georgia Hospital.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] North Georgia, Northeast Georgia physicians group, is that it?
[CUSTOMER][NEUTRAL] No, no, no, Northeast Georgia Hospital in [PII].
[AGENT][NEUTRAL] Ok one.
[AGENT][NEUTRAL] OK, I will reach out to the adjuster to see if she can review the claim uh thing that you said it was not in off in a doctor's office. It was actually in a hospital.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In hospital setting.
[AGENT][NEUTRAL] In the hospital setting, OK, I will send that request to the adjuster who processed the claim, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, you can give us a call back to check.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] And then when, and then when you will let me know.
[AGENT][NEUTRAL] You can give us a call back to check the status of it and that's again that's 357-708-8 that claim number and that was the procedure inside you said that in a hospital setting.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, um, I will reach out to the adjuster and um.
[AGENT][NEUTRAL] And see what she says and I can give you a call back to let you know but again it may take some if you could hold the line for me actually if you could hold the line for me, continue to hold the line please.
[CUSTOMER][NEUTRAL] Yes, yes. You are on hold.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You never see one.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you so much for your patience. She is going to look at the claim.
[AGENT][NEUTRAL] And if you like I can see if she can give you a call back or I can give you a call back to see what she says to tell you what she says.
[CUSTOMER][NEUTRAL] OK, you can, you can contact, you can contact the doctor there uh because I went to the hospital. It's not in the doctor's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, she will do, uh, she will do some research on the claim, uh, she's going to review the claim, um, if she give me one second, she's, uh.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I'm communicating with her now if you would just bear with me please. OK, give me a moment here.
[AGENT][NEUTRAL] OK, she is going to reprocess the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, she's going to reprocess the claim and so again you can give us a call back just to check the status of it now will be it will be a different claim number, but you can provide the claim number that you provided me which was 357-7088, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] I think that's it. Thank you.
[AGENT][POSITIVE] Mm thank you for calling APL. Take care bye.
[CUSTOMER][NEUTRAL] Right.