AccountId: 011433970860
ContactId: 60aa3d3e-5a61-4f67-8180-0c56f93b3d51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495589 ms
Total Talk Time (AGENT): 142279 ms
Total Talk Time (CUSTOMER): 166785 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/60aa3d3e-5a61-4f67-8180-0c56f93b3d51_20250606T17:43_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] What was your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] In this issue your loss, [PII].
[AGENT][NEUTRAL] [PII]. Can I have your name and a callback number and could you spell your name, please?
[CUSTOMER][NEUTRAL] Sure. The callback number [PII].
[CUSTOMER][NEUTRAL] And my name will be spelled as [PII]. It's [PII], it's [PII] calling from Cora Health Services.
[AGENT][NEUTRAL] Can you provide me with that spelling again?
[CUSTOMER][NEUTRAL] That's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the first initial of your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and can I have the policy number of the member that you're calling to verify eligibility for today?
[CUSTOMER][NEUTRAL] That's 1452947 M. like Mike, L Lima, number 8.
[AGENT][NEUTRAL] Thank you, [PII]. Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name [PII] [PII].
[AGENT][NEUTRAL] And I apologize, were you calling to check the status of a claim or to verify benefits?
[CUSTOMER][NEUTRAL] Check on claim status.
[AGENT][NEUTRAL] What's the date of service that you're calling about?
[CUSTOMER][NEUTRAL] I have a claim number. It's 344.
[CUSTOMER][NEUTRAL] 2740
[CUSTOMER][NEGATIVE] And this client could denied as services are not covered under the patient benefits plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Could you provide me with a procedure code?
[CUSTOMER][NEUTRAL] 9,711,097,530.
[AGENT][NEUTRAL] So it looks like mm, occupational therapy is not covered under the policy?
[CUSTOMER][NEUTRAL] This is not an occupational therapy. You can Google it if you like. That's not falls in occupational. This is a physical therapy.
[AGENT][NEUTRAL] With a modifier of GO is occupational therapy.
[AGENT][NEUTRAL] GP is physical therapy, but GO is occupational therapy.
[CUSTOMER][NEUTRAL] This is submit to be GO?
[AGENT][NEUTRAL] Yes, the modifier is G as in Greg, O as in orange is the modifier on the claim. Do you have the claim before you?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me double check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if any claims that was processed and paid with the GP modifier, that's valid, right? GO is not covered.
[AGENT][NEUTRAL] Right, it'll be considered as physical therapy. But GO is not covered. It's considered as occupational therapy and the policy does not offer services for occupational therapy.
[CUSTOMER][NEUTRAL] OK, let me let me check.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 12
[CUSTOMER][NEUTRAL] 33
[CUSTOMER][NEUTRAL] 2353488.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number is 3,442,740.
[AGENT][POSITIVE] Yes, that is correct, that's the claim number that you provided me, yes, that is correct.
[CUSTOMER][NEUTRAL] That's the one I provided to you, OK.
[CUSTOMER][NEUTRAL] Yeah, you're right. And shall we move on to the next claim number?
[AGENT][NEUTRAL] For the same member?
[CUSTOMER][POSITIVE] You're right.
[AGENT][NEUTRAL] And what is that the what is the claim number?
[CUSTOMER][NEUTRAL] 343-375-8.
[AGENT][NEUTRAL] Deni is the same reason.
[AGENT][NEUTRAL] Modify your GO as well.
[CUSTOMER][NEUTRAL] Do we use the same modifier GO.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Next claim number will be
[CUSTOMER][NEUTRAL] 3442749
[AGENT][NEGATIVE] Denied for the same reason, same modifier used.
[CUSTOMER][NEUTRAL] OK. And then 343-888-85.
[AGENT][NEUTRAL] Could you give me a moment? I would have to go back to the claims in order to look up the claims. So could you give it to me now?
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] OK, that's 343.
[CUSTOMER][NEUTRAL] 3 consecutive 8, number 5.
[AGENT][NEGATIVE] Denied for the same reason with the same modifiers being used.
[CUSTOMER][NEUTRAL] OK, one more time.
[AGENT][NEUTRAL] What is that claim number?
[CUSTOMER][NEUTRAL] Last claim number would be
[CUSTOMER][NEUTRAL] 3442743.
[AGENT][NEGATIVE] The not for the same reason, same modifier being used.
[CUSTOMER][NEUTRAL] OK. Will that be fine to fax me the 5 UB copies to my fax number?
[AGENT][NEUTRAL] OK, so you will have to give me those claim numbers again so that I can do it one by one because I can only do it one at a time. What is your fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. What is the, so you got claim of 3,442,740. What was the next claim?
[CUSTOMER][NEUTRAL] 343-375-8.
[AGENT][NEUTRAL] The next claim?
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] 3442749
[AGENT][NEUTRAL] And what's the next, the 4th claim number?
[CUSTOMER][NEUTRAL] 343-3 consecutive 8 number 5.
[AGENT][NEUTRAL] And what was the last one?
[CUSTOMER][NEUTRAL] And then the last one would be
[CUSTOMER][NEUTRAL] 3442743.
[AGENT][NEUTRAL] Alright, and you want it to be sent over to [PII], correct?
[CUSTOMER][NEUTRAL] You're right, [PII].
[AGENT][POSITIVE] Alright, is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] When I can expect that you will be called this? How much is the time it will take?
[AGENT][NEUTRAL] I'm sending these over for you. I'm not sure how long it's gonna take, but I'm gonna send them over. I'm sending them over to you now as we speak.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] Bye-bye.