AccountId: 011433970860
ContactId: 08153f31-93e8-41ed-a950-696ac5b4080a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327500 ms
Total Talk Time (AGENT): 179669 ms
Total Talk Time (CUSTOMER): 123243 ms
Interruptions: 6
Overall Sentiment: AGENT=1.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/08153f31-93e8-41ed-a950-696ac5b4080a_20250317T14:32_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Mr. [PII], how are you? This is [PII].
[AGENT][POSITIVE] I'm great, [PII]. How about you?
[CUSTOMER][NEUTRAL] I, I am.
[CUSTOMER][POSITIVE] Yeah, pretty good. I'm actually returning a call because one of your representatives left a voicemail Friday. Uh, I have some questions about uh um some physical therapy that I had received.
[AGENT][NEUTRAL] OK, do you know who called you?
[CUSTOMER][NEUTRAL] Oh [PII], did she leave a name?
[CUSTOMER][NEUTRAL] I do not.
[AGENT][NEUTRAL] OK, well, I'm not sure what's going on, but go ahead and give me your policy number and I'll see if I can help you.
[CUSTOMER][POSITIVE] Oh, that's a beautiful question. Let me run upstairs and get it.
[AGENT][POSITIVE] All righty, [PII], no problem.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me a second. Uh, don't come up these stairs, no, ma'am.
[CUSTOMER][NEUTRAL] I'm sorry, I'm, I'm painting at the same time. Dogs trying to follow me.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Alright, let's see.
[CUSTOMER][NEUTRAL] It is, I don't know if that ain't it.
[CUSTOMER][NEUTRAL] See if I turn some light up here.
[CUSTOMER][NEUTRAL] OK, uh, 024.
[CUSTOMER][NEUTRAL] 55082
[AGENT][POSITIVE] Alright, [PII], thank you for all that information. Now while I'm pulling your policy up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, got that pulled up. OK, and what is your address and date of birth today, please, ma'am?
[CUSTOMER][NEUTRAL] Uh, uh, [PII] [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. Alright, let me get the notes and see if I can figure out who's calling you and why. Alright, let's see, I see [PII] had tried to call you. Second attempt, uh, call member, no answer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On your physical therapy claims. Looks like maybe she was calling to tell you that they went back and processed, processed your claims because that's what it looks like.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I know she, the voicemail she left, she said she was uh trying to figure out if my physical therapy was occupational therapy or
[AGENT][NEUTRAL] Physical therapy, yeah.
[CUSTOMER][NEUTRAL] Or physical therapy, yeah.
[AGENT][NEUTRAL] Yeah, cause it looks like um.
[AGENT][NEUTRAL] It says, however, claim in order for us to further consider your claim, we need, yeah, we need documentation. Yep, that is what we have to clarify um because physical therapy would be covered, but occupational therapy is not covered. So, uh, what you would need to do is get uh from your provider's office that you're going to, um, tell him that you need a copy of your bill with procedure codes on it.
[AGENT][NEUTRAL] And submit that to yeah.
[CUSTOMER][NEUTRAL] Oh yeah, see, so when I called them, they were supposed to be sending you guys something called a CMS 1500.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yep, yes, ma'am, that's what it's called.
[CUSTOMER][NEUTRAL] Cause, cause the last person I talked to asked me for that, and they told me they were gonna send it. So you're saying they have not sent it as of as of date?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's correct. I have not sent it.
[AGENT][POSITIVE] But that is what we need. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, yeah, cause he wouldn't send.
[CUSTOMER][NEUTRAL] Yeah, so obviously, yeah, I've obviously been on this, uh, and he wouldn't send it to me directly, so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh, OK. Well, I tell you what, if he's not mailed, I'll tell you what, I'll give you our fax number and see if you can call them, yeah, and see if they'll fax it over to us, OK?
[CUSTOMER][NEUTRAL] Which is
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, let me, yeah, yep.
[CUSTOMER][NEUTRAL] Uh, OK, let me get back to the pencil again.
[AGENT][POSITIVE] So we can get it. Yes, ma'am, no problem. Take your time.
[CUSTOMER][NEUTRAL] Trying to multitask you.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] And it's a Monday, so.
[CUSTOMER][NEUTRAL] And, and it's Monday, yes.
[AGENT][NEUTRAL] That is Monday.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, you tell that provider to fax a copy of the claim and the ELB to fax number [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942-3 and tell them to put attention claims department.
[CUSTOMER][NEUTRAL] Claims department. OK. And you need to, so you need the CMS and an EOB, is that what I'm understanding?
[AGENT][POSITIVE] We'll see if we can get this taken care of.
[AGENT][NEUTRAL] Yes ma'am, because we're just a supplemental plan, so yeah, we need your primary be, yeah, and they have that information so yeah they can go ahead and submit both of them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, will do. Well, let me call them now, get this, get this over with.
[AGENT][NEUTRAL] OK. That's right, Ms. [PII]. Was that all I can help you with today?
[CUSTOMER][POSITIVE] Oh no, that'll do it. Thank you.
[AGENT][POSITIVE] OK, yes, ma'am, and thanks for calling APona. You have a great rest of your Monday.
[CUSTOMER][NEUTRAL] All right, you too.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.
[CUSTOMER][NEUTRAL] All right, bye bye.