AccountId: 011433970860
ContactId: 7530199e-2c9d-4896-84c5-542789a005e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 541419 ms
Total Talk Time (AGENT): 290688 ms
Total Talk Time (CUSTOMER): 92363 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/7530199e-2c9d-4896-84c5-542789a005e3_20250129T19:09_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEGATIVE] My name is [PII] and I was calling about my account. For some reason I'm going to physical therapy, but it's not paying. They said that.
[CUSTOMER][NEGATIVE] Um, my, this doesn't pay for my physical therapy as a supplemental.
[AGENT][NEUTRAL] OK, let me take a look at your benefits and I can let you know, um, for sure. And [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] The Contact number is [PII]. The policy number is 01631918.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] My date of birth is [PII]. My mailing address is [PII], and my email is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Let me take a look at your benefits. Hold on one second. You said physical therapy.
[AGENT][NEUTRAL] OK, let me ask you this. Is it being done in a physical therapy facility or in like an office?
[CUSTOMER][NEUTRAL] Um, it's uh.
[CUSTOMER][NEUTRAL] I guess it's the doctor's office is on one side and the physical therapy is on the other side.
[AGENT][NEUTRAL] OK, let me look at this. Hold on. The reason I ask is because um the your policy does have physical therapy coverage, um, so it's under outpatient, up to $500 per calendar year, um, and that's for physical, that does include physical therapy in a physical therapy facility. What's the name of your physical therapy, uh, what's the name of the facility?
[CUSTOMER][NEUTRAL] Uh, the, I don't know.
[CUSTOMER][NEUTRAL] It it's.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] It's it, it has the initial of [PII]. It's [PII] and that's
[AGENT][NEUTRAL] Oh, this is it.
[CUSTOMER][NEUTRAL] OK. Now, it was saying at one.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Now what she, what were you saying?
[CUSTOMER][NEGATIVE] It was planned, but when the [PII] came in, it stopped paying, cause I didn't have to pay, but now I'm having to pay every visit.
[AGENT][NEUTRAL] But you had the same plan the whole time?
[CUSTOMER][NEUTRAL] The same plan the whole time, but they're, they're saying that it doesn't cover.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Calendar year max. Alright, so let me do this. Let me look at these claims and the reasons for the denial and then um see what I, what we need to do. Do you mind if I place you on just a brief hold while I look through the claims?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, what now calendar year policy maximum of 4 doctor visits. This is the [PII].
[AGENT][NEUTRAL] Has been met there I know for the payable. Wait a minute. So was it paid as the physi? Hold on, hold on, hold up.
[AGENT][NEUTRAL] Oh, so it was using this.
[AGENT][NEUTRAL] It was using that
[AGENT][NEUTRAL] No, this isn't the same thing. Wait a minute.
[AGENT][NEUTRAL] Have any of the
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Have any, uh, she said she was paying, she wasn't paying.
[AGENT][NEUTRAL] And now she is.
[AGENT][NEUTRAL] But that's not the same thing. OK, so I need to look for.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What's the name of it?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, wait a minute.
[AGENT][NEUTRAL] Oh you pay [PII].
[AGENT][NEUTRAL] Uh, oh, so these are the only ones from [PII]. Wait a minute.
[AGENT][NEUTRAL] Because that's back in [PII].
[AGENT][NEUTRAL] So, let's try this one.
[AGENT][NEUTRAL] Nope.
[AGENT][NEUTRAL] That ain't them though. The only ones that's them are these, but are they 424?
[AGENT][NEUTRAL] Oh, they are for 24.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Laboratory, that ain't it. So we only received the one claim?
[AGENT][NEUTRAL] It looks like we only received that one claim.
[AGENT][NEUTRAL] And that was the, uh, let me see if it's more.
[AGENT][NEUTRAL] Yeah, that's the only one.
[AGENT][NEUTRAL] And even this is for November of [PII].
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I was just going through your claims. So there's a few things. So for one,
[AGENT][NEGATIVE] Do you know if they've billed to us before, because I went through all the claims, but I only saw this one from January, but that one was denied because by the time it came in, you had already used the four visits for the year. It was from [PII], but they just filed it.
[AGENT][NEUTRAL] Um, January.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] And I went through each claim, but I didn't see any others from this [PII], um, or [PII], but I went through each one and it's just this one, so I don't think that they, I don't see where they filed with us before, but
[AGENT][NEUTRAL] Had they filed for this earlier in the year because it's, they filed it in [PII], but it's for [PII] though, but you use you use your benefits, so by the time they filed it, you had already used, you know, the four
[AGENT][NEUTRAL] for office visits. Yeah, so they filed it in January, but it was for November and then you had already used your benefits for the year.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I went through each claim. I went back to [PII] or 223. Hold on, it might have been before then.
[AGENT][NEUTRAL] This, um, I just went back to [PII], but you have more claims for [PII] and [PII], but it's not from them, and I only saw that one claim from them.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But now you don't have a timely filing so if now I don't know because like this one they filed it late and you use the you had used your benefits already, but if they want to file for other claims, they still have time, we don't have like a deadline, but it'll have to be for [PII] because you definitely use your benefits, which is good, a lot of people don't.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEGATIVE] But yeah, that's what's happening here. That's the only reason it was denied. If you had that benefit, it would, it would have paid towards it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am. I'm gonna call them back.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] You too, thank you so much.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye bye. Hey, how you doing?