AccountId: 011433970860
ContactId: 89e28891-0399-43ba-b122-3cae409b26c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395959 ms
Total Talk Time (AGENT): 256120 ms
Total Talk Time (CUSTOMER): 121787 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/89e28891-0399-43ba-b122-3cae409b26c0_20250220T13:16_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I just had a claim and um it got denied I guess because they said I was, I was doing OT for my physical therapy, but I'm doing PT so I was trying to figure out what was going on.
[AGENT][NEUTRAL] Yes, of course, we can look up your policy. What is that policy number, please?
[CUSTOMER][NEUTRAL] I, I don't know. I don't have it. I don't know what it is, to tell the truth.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] What else do you need? What else you need?
[AGENT][NEUTRAL] I could use your social security number to look up your policy, um.
[CUSTOMER][NEUTRAL] OK, yes ma'am. Mhm. [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And how do you spell your last name, sir?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your first name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] mhm.
[AGENT][NEUTRAL] Yeah, OK, thank you. And uh just need a date of birth and a phone number, sir.
[CUSTOMER][NEUTRAL] [PII] excuse me, [PII] and then [PII].
[AGENT][NEUTRAL] OK, thank you. So let's see what we.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there a particular date of service that we're looking at? Um.
[CUSTOMER][NEUTRAL] Yeah, there's, well, there's 3 of them, 3 different services, or there's really 44 different services, mhm.
[AGENT][NEUTRAL] OK, and what's
[CUSTOMER][NEUTRAL] OK, mhm.
[AGENT][NEUTRAL] Oh, I see. OK, I see. I'm here so.
[CUSTOMER][NEUTRAL] Yeah mhm.
[AGENT][NEUTRAL] Well, um,
[AGENT][NEUTRAL] Let's see what we have here. So, uh, [PII].
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And then we've got another, OK. Oh.
[CUSTOMER][NEUTRAL] The [PII] or something?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So let's look at the two ones in [PII]. Let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] For those two, for those two services.
[AGENT][NEUTRAL] We have, we showed that your policy was active from [PII] [PII].
[AGENT][NEUTRAL] Um, so in February, it just wasn't active. your, your policy lapsed first of [PII]. Um, the last, uh, we received several dates of service in, uh, this, this month, [PII], so those were denied because your policy was no longer active. Um, so it wouldn't have mattered what, whether it was physical therapy or, or, um, uh, or, uh, occupational therapy, it just, your, your policy was not active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Now, um, we also have.
[CUSTOMER][NEUTRAL] I don't how would the, uh huh, good mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] How was, how was what?
[CUSTOMER][NEUTRAL] No, no, no, because my job, my job, my job pays for that. So how would that be possible? Because I got my, I got, I went back to, to workers' comp. I'm on worker's comp, so my job is liable for that, that pays for that for for all my insurance, everything, so I don't get it. How would that be possible? Mhm.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] Yeah, um, so what we did was, uh, we, we don't, we don't just cancel your policy. What we did was we received uh in December from your employer. They, they have, um, it's an electronic, uh, spreadsheet that they send us and uh the electronic, uh, this is from your your company and.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They ask us to um.
[AGENT][NEUTRAL] Uh, they had a, a, uh, a group letter. Uh, it was a generated letter that, uh, as of [PII], uh, those policies are, are no longer active. So let me just see whether it's a policy for the for just you or whether it's just for the group. So that's, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Cause normally if it's a group letter and that's what it looks like, it means that the entire group has canceled, so let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, the only thing that we had was, uh, this is for Miller Electrical Services, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Then, in this case, what we received was something from uh Miller uh canceling your policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It it's, it's called the bookkeeper's request and as of [PII], uh, at their request, we canceled, canceled the policy. So if this is something that if you're, if you feel that the policy is still active, they're still if they're still supposed to be paying for it, you would need to contact uh Miller Electrical. You'd need to contact their HR department because they're the ones who who listed it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yeah, but I still lost, I lost all, all the money that I already paid for, that's what I'm saying, like that's done, right?
[AGENT][NEUTRAL] Well, it
[CUSTOMER][NEGATIVE] Because they didn't pay for it.
[AGENT][NEUTRAL] Well, if they don't, uh, let's just say that, um, that you contact them and they, they reinstate your policy. They, they, if they reinstate it retroactively, uh, to [PII], we would then uh review each one of those, um, claims, uh, with a view to being able to pay them. And then it would make a difference whether you were having occupational therapy as opposed to physical therapy, and we'd and we would look at the documents that you submitted.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and, and see what we could do at that point, but, uh.
[AGENT][NEUTRAL] It's it, what we, what we received from your employer was that, was that your, your policy lapsed. And so that's, that's December [PII], so you would need it, the very, the starting point here would be um to check with them and see why that was lapsed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because it, we would never have done that.
[CUSTOMER][NEUTRAL] Oh, it was less because, because I went.
[CUSTOMER][NEGATIVE] Cause I, they can't, they froze uh worker's comp because I had surgery on my neck. So when they froze that, so that stopped it, but I got it back [PII]. You know what I'm saying? Like I went back to workers' comp [PII]. Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, then they need to, then they need to uh supply us with something letting us know that. Because the, the last thing that I have is that it was that it was uh lapsed. And we've never received anything at all that it's, that's back, uh, it's being active. So that would be the starting point. We would need that from them and, and you would need to contact them for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] No, I'm gonna call him right now. Yes, ma'am. I appreciate you, man. Thank you very much. I'm gonna get on there right now.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, there's nothing else I can help with. Thanks for contacting ATL. Yeah, thank you. Have a good morning.
[CUSTOMER][NEUTRAL] No, ma'am.