AccountId: 011433970860
ContactId: f73d52e4-d26f-4590-bc52-be645d5101fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369589 ms
Total Talk Time (AGENT): 172278 ms
Total Talk Time (CUSTOMER): 182934 ms
Interruptions: 4
Overall Sentiment: AGENT=1.4, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/f73d52e4-d26f-4590-bc52-be645d5101fc_20250324T19:36_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]. I'm calling from a provider's office. I'll be honest, I'm calling the status of claim. I'm not sure if I'm, if I chose the right department or not.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] It would be my pleasure to assist you with that claim status. Do you, what is a good callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] I have 2, I'm sorry, 02069359.
[AGENT][NEUTRAL] Thank you, [PII] and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, the patient is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you, and I can help you with that claim status for [PII]. What is the data service?
[CUSTOMER][NEUTRAL] Oh, that
[CUSTOMER][NEUTRAL] Sure, it is [PII] and the claim amount was $271.
[AGENT][NEUTRAL] And what is the facility name please ma'am?
[CUSTOMER][NEUTRAL] Uh, the group is Grady Health Systems.
[AGENT][POSITIVE] Perfect. Thank you, and I can help you with the claim status. And see we did receive that claim on 12-11-24.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] The claim was processed on [PII].
[AGENT][NEUTRAL] And the claim was denied.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] As
[AGENT][NEUTRAL] Uh, let's see. Treatment in uh uh.
[AGENT][NEUTRAL] Treatment in an outpatient hospital less than 18 hours is not covered by this policy.
[CUSTOMER][NEUTRAL] Oh, OK, treatment.
[CUSTOMER][NEUTRAL] Oh, less than OK, treatment and out of, I'm sorry, outpatient department.
[AGENT][NEUTRAL] Outpatient hospital. Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's not less than 18 hours is not covered by this policy.
[CUSTOMER][NEUTRAL] Uh, oh, also, if the time span for the patients there at the facility is less than 18 hours is not covered.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] I got you uh.
[AGENT][NEUTRAL] And it's only covered if it's in an emergency emergency room or urgent care physician's office.
[AGENT][NEUTRAL] Or physical therapy facility. So they don't have benefits for an outpatient facility.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] OK, OK, dokey, let me ask you a question, um, was the ELB issued?
[AGENT][NEUTRAL] It was, um, it would have gone out on.
[CUSTOMER][NEUTRAL] For the denial?
[AGENT][NEUTRAL] 12:14 if that was a weekday.
[AGENT][NEUTRAL] 24 now we do have a portal if you would like I can provide that information to access EOBs claim status and even claim submission.
[CUSTOMER][NEUTRAL] Uh, I think I is that APL I because I was while you were talking I was trying to, while I was on hold I was trying to see if I was able to access because the first thing I don't know what they had. They had the patient coverage loaded as IMA because I wanted to ask to the correct name that should have been submitted on the claim. I'm, I'm, I'm happy the claim made it to you guys. We did mail it. Look.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am, so it does go to IMA they reprice it through multi plan if if you're a multi plan provider and then they forward the medical claims to us, but for medical it is through APL.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, and let me get the because see it's asking for the claim number. Can I get the claim number for this one?
[AGENT][NEUTRAL] Absolutely. The claim number is 3541018.
[CUSTOMER][NEUTRAL] 3541018. OK, so then hopefully I can.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because that at least it was better than most plans with trying to uh sign in and have to wait on all that information so.
[AGENT][POSITIVE] No, this is fairly easy.
[CUSTOMER][POSITIVE] Yeah, it, it was that's what I'm hoping this is.
[CUSTOMER][POSITIVE] I'm able to get what I need here.
[CUSTOMER][NEUTRAL] I think I got it. OK, and then I can pull the EOB from here.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Uh, let's see, I think I'm getting lucky here today. OK, alright, [PII]. Well, thank you.
[AGENT][POSITIVE] Oh, it's gonna be a lucky day.
[CUSTOMER][NEUTRAL] I, I, I need it to be. Can I get a reference number for the call?
[AGENT][NEUTRAL] I understand. The reference is, it's Monday and we need it to be successful and easy, don't we?
[CUSTOMER][POSITIVE] Yes, we do.
[CUSTOMER][POSITIVE] Yes, we do, I tell you.
[AGENT][NEUTRAL] Well, a reference number would be my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] OK, cool. Well, thank you. You have a wonderful day.
[AGENT][POSITIVE] It's been a pleasure to assist you with that claim status today, [PII], and before you go, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, let me make sure I don't have any more of this APL.
[CUSTOMER][NEGATIVE] Well like I said, they don't exactly have them loaded correctly.
[CUSTOMER][POSITIVE] So that I know the phone number they had attached was to [PII] compliance so I am gonna go and uh yes, I called and I was like [PII]. I was like how did we get there? So I definitely gotta go in and update the yes please because I didn't have that, yes please.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Would you like our direct
[AGENT][NEUTRAL] Would you like our direct phone number?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII] and that does come straight to um APL claims.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK cool thank you you have a great day.
[AGENT][POSITIVE] I hope you do too. Thank you for calling APL and hope the rest of your Monday goes very easy.
[CUSTOMER][POSITIVE] Yes you too you too thanks bye bye.
[AGENT][POSITIVE] Thank you, Dee. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.