AccountId: 011433970860
ContactId: 317f951e-200d-4969-b0ce-2b637fcdb4b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273679 ms
Total Talk Time (AGENT): 89789 ms
Total Talk Time (CUSTOMER): 116779 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/317f951e-200d-4969-b0ce-2b637fcdb4b0_20250304T15:20_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Doing all right thank you um I've got a member on the line uh calling regarding the um uh several uh claims they have for their medlink um, they were supposed to be for physical therapy and from what I see it denied as, um.
[CUSTOMER][NEUTRAL] You know, uh, speech occupational therapy, um, but she's insistent that it was in fact physical therapy, um, so she wanted us to take a look at that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's that policy number?
[CUSTOMER][NEUTRAL] OK, that is 02304088.
[CUSTOMER][NEUTRAL] And it is for uh part two.
[AGENT][NEUTRAL] Part two, alrighty, you can put it through.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hi, this is [PII] with APL claims department. How are you?
[CUSTOMER][POSITIVE] Yes, good. How are you? How are you?
[AGENT][NEUTRAL] I'm, I'm good um I understand that you were calling in regards to some deny claims and that they were supposed to be for.
[CUSTOMER][NEUTRAL] Yes, it's for physical therapy, uh, I had um surgery on my hand.
[AGENT][NEUTRAL] Physical therapy.
[AGENT][NEUTRAL] OK, let me just make sure um we.
[AGENT][NEUTRAL] Didn't process it wrong. Let me, I'm pulling up the claim form.
[AGENT][NEUTRAL] That they submitted.
[AGENT][NEUTRAL] OK, thank you so much for your patience. So they submitted this as occupational therapy. And so that's why you received that denial which states um it bunches it all together, but it does say on there, um.
[AGENT][NEGATIVE] Kinesiology, speech, and occupational therapy are not covered, so that's why you received that denial.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So you don't cover for hand for hand therapy?
[AGENT][NEUTRAL] You have coverage for physical.
[CUSTOMER][NEUTRAL] Or is it just the way
[AGENT][NEUTRAL] They billed it as, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Well, that is part of
[CUSTOMER][NEUTRAL] I'm sorry, but I mean, um, I was told that part of physical therapy was the hand surgery, that uh the uh the the therapy afterwards.
[CUSTOMER][NEUTRAL] Cause it's so, I had.
[AGENT][POSITIVE] They built, I'm sorry.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm sorry, no, I'm sorry. I'm, I'm the one who's interrupting you. I know what they, they build, but my question is, would hand therapy because it wasn't speech, it wasn't any of that, it was the hand, so they're considering that occupational therapy?
[AGENT][NEGATIVE] They billed it as occupational therapy. So if they were supposed to bill it as physical therapy, then you would need to call and talk to them. But they send in the claim stating that you had occupational therapy and that's why it's not covered. Don't, don't pay attention to, we, we bunch all three of them together when we deny. So you're more focused on the speech. We denied yours for occupational, which is also listed in that denial.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I understand, I understand. OK, then I'll call them back cause they're the ones I originally called, and um, and every time I went, they told me, oh, you're covered and you don't owe anything.
[CUSTOMER][NEUTRAL] And that was months ago. That was since July, so.
[CUSTOMER][NEUTRAL] That's why, um, then when I called them now, they told me it was that you guys didn't wanna, uh, that you guys wanted me to pay a co-payment. I said, wait a minute, my husband has used it before and we've never had a problem. OK, so now I know what to tell them.
[AGENT][NEUTRAL] Alright, was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No, thank you, [PII]. I really appreciate your help. I'll call them and see if they can bill you in another way. OK, thank you so much.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day. You too.
[CUSTOMER][POSITIVE] Have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][NEUTRAL] All right.