AccountId: 011433970860
ContactId: 4d7e0782-6043-416c-a1a8-c065bf06d7ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1115979 ms
Total Talk Time (AGENT): 236588 ms
Total Talk Time (CUSTOMER): 373593 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/4d7e0782-6043-416c-a1a8-c065bf06d7ef_20250211T14:29_UTC.wav
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[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Miss [PII], how are you doing this morning?
[AGENT][NEUTRAL] I'm fine. How are you doing?
[CUSTOMER][NEUTRAL] Yeah. This is [PII].
[AGENT][NEUTRAL] How are you doing this morning, [PII]?
[CUSTOMER][POSITIVE] Good enough, good enough.
[CUSTOMER][NEUTRAL] Uh, I've got, uh.
[CUSTOMER][NEUTRAL] Well, some, some time ago I had two different claims. One was for, uh, one of those sleeping.
[CUSTOMER][NEUTRAL] Uh, things that.
[AGENT][NEUTRAL] So a sleep study.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] They, they got the sleep study and then he had to get one of these CPAP machines, I think you call it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so our insurance paid for the CPAP machine.
[CUSTOMER][NEUTRAL] Now and then that was with River City. Now I've got a, a guy with uh home Co Enterprise.
[CUSTOMER][NEGATIVE] And he took a sleep study and they didn't pay for the, we didn't pay for the sleep study.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, we denied the claim.
[CUSTOMER][NEUTRAL] And then, so I need to find out what, what do we cover with the sleep studies and what do we cover as far as equipment.
[CUSTOMER][NEUTRAL] And then on another, uh, situation, 345 years ago, whatever it's been.
[CUSTOMER][NEUTRAL] I had a uh
[CUSTOMER][NEUTRAL] Employee for River City.
[CUSTOMER][NEUTRAL] His wife got ill and she had to go start taking physical speech and occupational therapy.
[CUSTOMER][NEUTRAL] And our insurance paid for the physical therapy.
[CUSTOMER][NEUTRAL] And, uh
[CUSTOMER][NEUTRAL] So I mean the gap insurance pay for physical therapy so I need to find out also do we cover for home comfort enterprises, physical therapy, uh but not speech and occupational, which I think the case is, but how do we bill it so they'll pay the speech therapy.
[AGENT][NEUTRAL] Let me look at their proposal first.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] I've been dreading doing this because it, it just, it just.
[CUSTOMER][NEGATIVE] Gets me confused.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I understand. So who at home comfort had the sleep study and the CPAP?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let me pull up this stuff.
[AGENT][NEUTRAL] OK, so he's on the 7900 plan.
[AGENT][NEUTRAL] I kinda wonder if the sleep study has to be done in an outpatient facility.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] It's not considered an outpatient facility. I bet that's why I didn't get paid.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Any
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] The sleep study had to be done in the outpatient facility.
[AGENT][NEUTRAL] Yeah, I'm thinking that's, you know, without seeing um the coding and everything now I can transfer you over to claims.
[CUSTOMER][NEUTRAL] I'm thinking
[AGENT][NEUTRAL] And they might be able to tell you why we didn't pay it, but that would be my just my guess.
[CUSTOMER][NEUTRAL] OK, uh, what about.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] And there's no equipment.
[CUSTOMER][NEUTRAL] The match.
[AGENT][NEUTRAL] Yeah, there's no equipment.
[AGENT][NEGATIVE] That would have been covered.
[CUSTOMER][NEUTRAL] There's
[CUSTOMER][NEGATIVE] No equipment for them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because we have equipment covered on River City, the other one account, OK.
[AGENT][NEUTRAL] Probably, but not on this one. Let me pull up River City and see.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] What is River City called now?
[AGENT][NEUTRAL] They have a name change.
[CUSTOMER][NEUTRAL] At
[CUSTOMER][NEUTRAL] Elite services.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] I think my computer's wanted to go on vacation, [PII].
[AGENT][POSITIVE] Yes, so that policy has durable, durable medical equipment.
[AGENT][NEGATIVE] It doesn't on home comfort.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] The other guy is [PII]. He's the general manager.
[CUSTOMER][NEUTRAL] He has a handicapped son.
[CUSTOMER][NEUTRAL] And the son gets physical speech and occupational therapy.
[AGENT][NEUTRAL] And he's at home comfort?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Flip back over to home comfort.
[AGENT][NEUTRAL] OK. It has to be physical therapy performed in a physical therapy facility.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] But it's in the it's in the outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I guess I need to go over and talk to billing then and find out how to build that because.
[CUSTOMER][NEGATIVE] When they send it in with all three of the codes for speech, physical, and occupational, they keep denying it.
[AGENT][NEUTRAL] Uh, you wouldn't need to talk it billing, our billing department.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, it wouldn't be the billing, um, it'd be claims.
[CUSTOMER][NEUTRAL] Claims I mean.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I was gonna ask you one other thing.
[CUSTOMER][NEUTRAL] Oh yeah, does is Home Comfort being sent a bill right now because I, I, I got that that lady, I forget her name, [PII] or something.
[CUSTOMER][NEUTRAL] I don't think it was [PII]. I don't know who was anyway, she was gonna send me a thing after uh.
[CUSTOMER][NEUTRAL] Anyway, can you check on that for me?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let's see.
[AGENT][POSITIVE] Well, it looks like they've got 2 outstanding invoices.
[AGENT][NEUTRAL] Um, looks like they usually pay them online.
[CUSTOMER][NEUTRAL] Could be
[AGENT][POSITIVE] Um, but they've got January and February both still outstanding.
[CUSTOMER][NEUTRAL] OK, when do we generate a note for them to pay it?
[AGENT][NEUTRAL] They'll get a past due notice here pretty soon if they don't pay, but.
[AGENT][NEUTRAL] I mean if you wanna let them know they've got outstanding notices or invoices.
[CUSTOMER][NEUTRAL] Are are we sending them a bill right now?
[AGENT][NEUTRAL] Uh, I don't know. Let me see.
[AGENT][NEUTRAL] I would imagine so because even if they pay online we still send invoices out.
[CUSTOMER][NEUTRAL] Well, what happened was I was a couple of days late with the report.
[CUSTOMER][NEUTRAL] You know, uh,
[AGENT][NEUTRAL] The renewal?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And, uh, the little sheet that you, you fill out how many people you've got all that, uh, and so they didn't send out a bill I guess to get my attention.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And, uh, so then I called down there, lady said she was gonna get it taken care of. She was gonna send me a notice telling me that she got it taken care of. I never got the notice and, and.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] So the bill still ain't paid.
[CUSTOMER][NEUTRAL] So I mean if they don't know that.
[CUSTOMER][NEUTRAL] The bill is due.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] No, it looks like they're just doing the online statements because I don't see a bill was generated. I can ask for a bill to be generated for January and February.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, I don't, I don't know. I mean, we don't normally send them a bill.
[AGENT][NEUTRAL] It looks like they've been paying online for a while, since [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah, they, they, so, so whenever you pay online they don't, you don't get a bill.
[AGENT][NEUTRAL] Typically not. Um, sometimes we'll generate a bill and sometimes we don't, and it does not look like we are generating bills for them.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, let's go ahead and generate one right now, see if we can get this thing paid well how does that come in a in a mail or email?
[AGENT][NEUTRAL] Yeah, it would be uh mailed out.
[CUSTOMER][NEUTRAL] OK, well, how can we send him an email?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me get with our billing department where I can see what they can do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Can I, uh, get over to claims to talk to him about.
[CUSTOMER][NEUTRAL] How to get this
[CUSTOMER][NEUTRAL] Physical therapy bill pay.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] And I just pulled something up we are mailing them invoices.
[CUSTOMER][NEUTRAL] OK, we are.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And so they, they got the bill for December and January or they got that bill for.
[AGENT][NEUTRAL] Uh, they've got in January and February.
[CUSTOMER][NEUTRAL] OK, they got January and February.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Looks like we sent him on the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last year, right.
[CUSTOMER][NEGATIVE] Well, can I, uh, trouble you to get me over to, uh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] What do you call it claims so I can find out about what I can do with this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure. And what was the name of the gentleman whose son needs physical therapy?
[CUSTOMER][NEUTRAL] Other stuff.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK dokey.
[AGENT][POSITIVE] Alright, let me get you over to claims and um if you need anything else just give me a shout, OK?
[CUSTOMER][POSITIVE] Alright thank you dear.
[AGENT][POSITIVE] All right, we'll talk to you soon, [PII].
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hi, this is [PII]. I'm transferring [PII], who is the broker for Home Comfort Enterprises. He's calling in reference to customer number.
[AGENT][NEUTRAL] 259-573-1.
[AGENT][NEUTRAL] Should be for [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, um, I don't know the date of service for [PII]. It's for his son, uh, for his physical therapy, evidently we denied the claim.
[CUSTOMER][NEUTRAL] What is the son's name?
[AGENT][NEUTRAL] Uh, just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Probably [PII].
[CUSTOMER][NEUTRAL] Are you under the right policy?
[AGENT][NEUTRAL] Uh, [PII]. Yeah, I'm under [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm, no, I know I get that you're under the correct policy with the names, but are you under the right policy that he's calling in regards with the questions about the claim? It was the question.
[CUSTOMER][NEUTRAL] But you can send him over. I'll be able to assist him, but it wasn't the right policy.
[AGENT][NEUTRAL] Um, it's me, isn't it?
[CUSTOMER][NEUTRAL] Yes, that's correct. However, if you go to CUINQ there's multiple policies. One that expired [PII].
[CUSTOMER][NEUTRAL] That's the one that he may be calling about the claim status of that one of those claims.
[AGENT][NEUTRAL] Oh, it didn't
[AGENT][NEUTRAL] OK, I bet let's look atlas.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Yep. Here's his other policy, I bet this is one.
[CUSTOMER][NEUTRAL] I have the policy. I pulled it up. You can transfer him.
[AGENT][POSITIVE] All right, well thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bye.