AccountId: 011433970860
ContactId: 5602beee-c03a-4df8-9950-adfbcbb11995
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332239 ms
Total Talk Time (AGENT): 101422 ms
Total Talk Time (CUSTOMER): 140608 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/5602beee-c03a-4df8-9950-adfbcbb11995_20250401T22:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII]. Um, yes, this is [PII] from Ko Autism Therapy.
[AGENT][NEUTRAL] Yes, sir. You said your name was [PII]?
[CUSTOMER][POSITIVE] Yes correct VIN.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][POSITIVE] How can I help you today?
[CUSTOMER][NEUTRAL] Um, yes, sorry, we actually submitted a separate authorization request with a different cover letter.
[CUSTOMER][NEUTRAL] Uh, in hoping that we would get a denial letter for a member.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a way you can check it for us?
[AGENT][NEUTRAL] OK, then, and what was the name of the facility you're calling from again?
[CUSTOMER][NEUTRAL] Um, Kyo, K Y O Autism.
[AGENT][NEUTRAL] OK and then can you please give me your callback number in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Um, policy number one moment.
[CUSTOMER][NEUTRAL] Insurance card.
[CUSTOMER][NEUTRAL] Is it the Medicaid ID?
[AGENT][NEUTRAL] No, it's not Medicaid. It'll be APL.
[CUSTOMER][NEUTRAL] APL
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] This is American Public Life.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Oops.
[CUSTOMER][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] 024.
[CUSTOMER][NEUTRAL] 581-69.
[AGENT][NEUTRAL] There
[AGENT][NEUTRAL] OK, 0258169?
[CUSTOMER][NEUTRAL] I'm sorry, 02458169.
[AGENT][NEUTRAL] 69. OK, let me pull up that policy real quick.
[AGENT][NEUTRAL] OK, Camden. Part 3.
[AGENT][NEUTRAL] OK, and when did you send it in?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] One moment. [PII]?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's actually a cover letter that we're submitting this request with the understanding that we may get a denial.
[AGENT][NEUTRAL] OK, so did you send in a claim with it?
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] Did you send in a claim with it?
[CUSTOMER][NEUTRAL] Um, I don't think so because we have been.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Request or started the service yet?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] What we what we just want is a formal denial letter.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] In order for us to take the next step with the family.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, you, well you would have to send in a claim and the claim would have to be denied and then you'd get the EOB of the denial.
[CUSTOMER][NEUTRAL] And for us to submit claims.
[AGENT][NEUTRAL] We don't
[CUSTOMER][NEUTRAL] Um, we should send it to IMA, right?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Because for that member I may address the claim.
[AGENT][NEUTRAL] OK, let me transfer you to IMA and maybe they have a different procedure than what we have that way they can help you, OK, as, as far as what to do, OK? It's gonna be a brief hold. I'm gonna transfer you on over. Thank you, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I'm sorry, sorry. I just wanna confirm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So we can only submit claims through IMA and not with APL right for this member.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and in order for us to get the denial, we need to submit the claim first to IMA.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] OK, it's gonna be a brief hold. I'm gonna transfer you.
[CUSTOMER][NEUTRAL] Um, did you get?
[CUSTOMER][NEUTRAL] I'm sorry, did you get the fax or the fax that we sent last [PII]? Just wanna confirm before you transfer me.
[AGENT][NEUTRAL] I don't see faxes. I don't see faxes. I do see that we have something submitted by the insured, but I don't see anything from you. And if you send it to IMA it would not come to us.
[CUSTOMER][NEUTRAL] Mm, OK, let me see.
[CUSTOMER][NEUTRAL] Uh let me see one moment let me see.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] OK, go ahead and transfer me to IA. Thank you so much, sir. I appreciate that.
[AGENT][POSITIVE] You're very welcome. You have a great night and thank you for calling APL. Bye-bye, sir.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Thank you for