AccountId: 011433970860
ContactId: 31e41dc1-0b74-4a0d-b73c-fd213c9c82a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354359 ms
Total Talk Time (AGENT): 159204 ms
Total Talk Time (CUSTOMER): 76962 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/31e41dc1-0b74-4a0d-b73c-fd213c9c82a9_20250220T16:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I need help on claims.
[AGENT][POSITIVE] OK, sure, I can assist you with claims Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] and that is correct.
[AGENT][NEUTRAL] Thank you, Miss [PII]. And you're calling from which facility or provider what's the name?
[CUSTOMER][NEUTRAL] Oh, Cora Physical therapy or rehab services?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you. And uh may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] It is 02304088 ML 8.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][POSITIVE] Perfect. Thank you, Mrs. [PII]. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] for $680.
[AGENT][NEUTRAL] All right. OK, let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII] and that's just optional. And let's see.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me pull this explanation of benefits, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it consecutive days all in one claim or is it separate claims?
[CUSTOMER][NEUTRAL] No, all consecutive dates on the same claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm on your portal, the APL or provider.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And it asked me for my tax ID and the patient's account number, but then it tells me it doesn't recognize it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The, the patient's account number you're putting in, what, what's the number that you're using for that?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] That's, that's not um the the ID number. That's gonna be your ID number, so the one in box 26.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] I'm waiting on the documents on this claim.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. It is gonna be this one. All right. Um, I did find a claim on this claim was processed on [PII].
[AGENT][NEUTRAL] And let me see, um.
[AGENT][NEUTRAL] The claim was denied. Let me see what's the reason.
[AGENT][NEUTRAL] OK, so kineology, speech or occupational therapy are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, so she has no coverage for physical therapy?
[AGENT][NEUTRAL] OK, let me check. I see, I am, so was this is occupational therapy or physical therapy?
[CUSTOMER][NEUTRAL] And we do both physical and occupational and speech.
[AGENT][NEUTRAL] OK. I know that um we probably do cover physical, but we do not cover speech or occupational. Um let me check and see just to make sure that that's correct. Um, let me pull her benefits. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] All right, so he's outpatient inpatient. Yes, we do cover physical therapy. We do not cover speech or occupational therapy or kinetology.
[CUSTOMER][NEUTRAL] Ah, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Let see and speech. OK, and may I have a reference number for our call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information, Ms. [PII]?
[CUSTOMER][POSITIVE] Just the spelling of your name would be great.
[AGENT][NEUTRAL] Yeah, sure. That's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] Awesome. I appreciate your time and help with this. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Goodbye.
[AGENT][POSITIVE] Thank you. Bye