AccountId: 011433970860
ContactId: 8a8ff497-51b8-4b07-90dd-255291836212
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 812729 ms
Total Talk Time (AGENT): 266297 ms
Total Talk Time (CUSTOMER): 467559 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/8a8ff497-51b8-4b07-90dd-255291836212_20250515T20:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This speaking. May I help you?
[AGENT][POSITIVE] Good
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, I'm sorry, my phone, I don't know, it's been weird. OK, listen, I have some questions about some claims that I have filed.
[AGENT][NEUTRAL] OK, and your name is?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] My name is [PII] OK, [PII] get out.
[CUSTOMER][NEUTRAL] I was talking to my daughter, sir.
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 183
[CUSTOMER][NEUTRAL] 6605
[CUSTOMER][NEUTRAL] I to get out, please.
[AGENT][NEUTRAL] Thank you. And do you have um a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][POSITIVE] Awesome thank you so much and let's see, verify your date of birth, mailing address and the email address for me please.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Yes ma'am. My date of birth is [PII]. Um, [PII], what else did you just ask me? Email address [PII] and um.
[AGENT][NEUTRAL] Mailing address.
[CUSTOMER][NEUTRAL] But, uh, OK, I'm sorry. Mailing address is um [PII].
[AGENT][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. And um you say you're calling about claim status, correct?
[CUSTOMER][NEUTRAL] Yes, ma'am. It was, well, they were for my daughter Ava Pro that I just recently had um submitted and um I was just trying to see.
[CUSTOMER][NEUTRAL] What was I guess the status of them since they
[CUSTOMER][NEUTRAL] I didn't know what else I needed to send because I had sent like 2 prior to prior to today or that date.
[CUSTOMER][NEUTRAL] Uh, the same method and I guess they were processed fine. So I was trying to see what, I don't know if anything changed if I did something wrong that um needed to sink out.
[AGENT][NEUTRAL] OK, well, I show some claims were received on the [PII] and processed on the [PII], um, and it the process as
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Uh, physical therapy is not covered under the policy.
[CUSTOMER][NEUTRAL] OK, so I, um, yeah, I know physical therapy wasn't, but we also had some office visits that was like the, the paper that they gave me, they include like, you know, the physical therapy as well as the office visit. So any of her visits from Doctor [PII].
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] They are not considered phys they're not physical therapy. He is their actual doctor.
[AGENT][NEUTRAL] Let's see, and there were, well, there are some data er well, there was a data service at 3:13.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, let me see.
[AGENT][NEUTRAL] And they're needing additional information like the itemized billing for this day because it looks like she had surgery on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Or 3
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Was it cause it, hold on, the procedure code is the 2988LT?
[AGENT][NEUTRAL] 29888 and 29881.
[CUSTOMER][NEUTRAL] Uh dash LT uh-huh and then dash 51 LT.
[CUSTOMER][NEUTRAL] Oh, you know what?
[CUSTOMER][NEUTRAL] I tell you what, I think, well, did I mess up on this because they gave me another print out with like the diagnosis, uh, the diagnosis code, I think, um, and so it was like S 83.512A, is that what y'all needed but no, that wasn't it.
[AGENT][NEUTRAL] What was that code?
[CUSTOMER][NEUTRAL] Um, the diagnosis code or the procedure code?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, diagnosis.
[CUSTOMER][NEUTRAL] The diagnosis,
[CUSTOMER][NEUTRAL] I'm sorry, um S then A3.
[CUSTOMER][NEUTRAL] Then, uh, or um 512A.
[CUSTOMER][POSITIVE] And there's another one that, I'm sorry.
[AGENT][NEUTRAL] Oh, I'm sorry. So you're saying like S as in Sam, 883, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That sounds like a.
[CUSTOMER][NEUTRAL] Yes, Sam 83.512 and Sam 83242A.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then, um,
[CUSTOMER][POSITIVE] The one for the 17th was Sam 83 512D. That's the best way I could.
[AGENT][NEUTRAL] No, you're fine. Um, and give me one moment. Um, and that's a bill you have that has that code, that diagnosis code or diagnosis codes?
[CUSTOMER][NEUTRAL] I get
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Oh yes,
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am, it has the account number, the type name, description, the procedure, procedure code, then, you know, like the, you know, the 3 blah blah blah, the reference date, diagnosis units amount. Yes ma'am.
[AGENT][NEUTRAL] OK, and what was the date of service for that one? For the 3:13?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, yes. If you can send that in to us, um.
[AGENT][NEUTRAL] Cause they were needing billing showing that diagnosis codes cause it looks like what we received was uh what is called a balance forward statement. And they usually don't have those diet codes need uh to process the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, I'm
[CUSTOMER][NEUTRAL] It was all my fault. I apologize about that.
[AGENT][NEUTRAL] No, no, you're fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, cause it says um.
[CUSTOMER][NEUTRAL] Yeah, I'm just looking at everything they gave.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, yes, I can um.
[CUSTOMER][NEUTRAL] It has it all there, but if I send it to you, you'll see the, the, the NO that stands for [PII]. I mean, I'm not asking you like you like you're dumb. I just need to know if I need you to like cover up uh the physical therapist's name so that you could just see see strictly um Doctor [PII]'s stuff that's all.
[AGENT][NEUTRAL] Um, you don't have to, not unless you want a mark beside him and put a note that you, this is what you're falling for.
[CUSTOMER][POSITIVE] Good by me.
[AGENT][NEUTRAL] They probably still process the arrest and if they already have that information, it probably just be processed as a duplicate though.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEGATIVE] OK, well, I mean, shoot, that case I'm just gonna look, I'm sorry, I'm a teacher. I'm frazzled and I could probably cry right now because it's been such a long year. you don't even understand, um.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so I'll do that and then do I have to refill out one of those, uh, oh, that you know that, that, that everyday benefit thing, yeah.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] The claim form
[AGENT][NEUTRAL] No, ma'am. No ma'am. And if you like, um,
[AGENT][NEUTRAL] You can submit it through our online service center and just do it as a new claim. What the examiners would do, they go by the data service see in our system we've received any claims previously and just kind of add that on to a previous claim received.
[CUSTOMER][NEUTRAL] OK, cause like I'm literally.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Doing it now as we speak.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Because I called yesterday about it, but you know what, it's OK cause uh life happens. I'm learning that bad boy.
[AGENT][POSITIVE] Life, that is the true statement. Life does happen. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, yeah, so I'm uploading it right now.
[CUSTOMER][NEUTRAL] Who you telling? I teach, teaching I.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Are you ready for summer break?
[CUSTOMER][NEUTRAL] Yeah, my, my, my student.
[CUSTOMER][NEUTRAL] You don't even understand. Uh, one of my students said, Are you finally gonna dress nice tomorrow? And I was just like, sweetie.
[AGENT][NEUTRAL] Uh uh.
[CUSTOMER][POSITIVE] I wanted, it took every god in me, and I only know one of them.
[CUSTOMER][NEUTRAL] I want to be like a day where you gonna pass tomorrow.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] What grade do you teach?
[CUSTOMER][NEUTRAL] It took hours 5.
[AGENT][POSITIVE] 00, yeah, I have a 4th grader over here and he's so ready for school to be over.
[CUSTOMER][NEGATIVE] Oh my, look, my, my 4th grader, like I, she said like self-proclaimed dropped out. She's like, I gotta go. She hates everybody in the class. She's like over it.
[AGENT][POSITIVE] Oh blessing. She is over it. She's been over it.
[CUSTOMER][NEGATIVE] Oh, she, since day about 3, she's like my teacher's snacks when she eats. She's one of those kids like everything annoys her. Yeah, so she's done.
[AGENT][NEUTRAL] Oh, wait.
[AGENT][NEUTRAL] Yeah, he sounds like my son. He's like that.
[CUSTOMER][NEUTRAL] And you know, at this point I'm with her.
[AGENT][NEUTRAL] He's
[CUSTOMER][NEGATIVE] Yeah, everything bothers them, annoys them, and they're fine by themselves, and when you start asking questions, then you're the problem. Mhm.
[AGENT][NEUTRAL] Everything.
[AGENT][NEGATIVE] Yeah, you're the problem. Why are you asking me questions?
[CUSTOMER][NEUTRAL] OK,
[AGENT][NEUTRAL] Why do you, what do you mean I have to go to bed? What do you mean? Uh, I mean, it's time for bed at school tomorrow. And he's so ready, so he don't, yeah, he wanna stay up all night. They only got one week left and he wants to stay up all night. He's like, why? I don't have any homework and like we do anything at school. I was like, I, I understand that, but still, bedtime.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I go to sleep.
[CUSTOMER][NEUTRAL] Oh, I got yours beat. Mine is ready for bed by [PII] and will cry. I'm talking about tears. If she has to leave the house for anything.
[AGENT][NEUTRAL] Oh wow, so she is a homebody.
[CUSTOMER][NEUTRAL] To, to, to, I mean, like, if she has a softball game, we can't go to the house. We just have to stay out in the streets.
[CUSTOMER][NEUTRAL] Until [PII]
[CUSTOMER][NEUTRAL] riding around the streets. She's like, I'm ready to go home. I'm like, no, like she's just, OK, well I have uploaded everything and um it should say.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Received or something for um Ava oh I know you're lying. I know I did have to say oops, there's been a
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I wonder if it actually came through though because sometimes it'll say oops there's been an error.
[CUSTOMER][NEUTRAL] And it um
[CUSTOMER][NEUTRAL] Come through.
[AGENT][NEUTRAL] Uh, give me a moment, because sometimes, uh, we'll send it through the online service center, it can take a while for us to see it, but give me one moment, let me just see.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] It's like God, I don't want to be in a strong warrior program. I want to be in the weak and, and like love don't let me be gentle.
[CUSTOMER][NEUTRAL] I did not want to be a strong warrior and uh he's like, so my child.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] If this one doesn't come through, I may just scream.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] What is today? The [PII]? OK.
[CUSTOMER][POSITIVE] Yes, got it.
[CUSTOMER][NEUTRAL] Come on, Day put one for your simple servant here.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, [PII], he's like not today.
[AGENT][NEUTRAL] Not right now.
[AGENT][NEUTRAL] He might not come when you want, but he's right on time, but I don't see it yet, but, um, and sometimes it can happen, you submit it through there or if you like, I can give you a fax number if you can fax it to us.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Don't have sex. Yeah, I mean shoot.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Let me just um.
[CUSTOMER][NEUTRAL] I don't know. I'll keep playing with it and try to get it up, but.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I don't have effects.
[AGENT][NEUTRAL] OK, and I would say, um,
[CUSTOMER][NEUTRAL] I mean because
[AGENT][NEUTRAL] If he does give you confirmation that it's been through, uh, come through, you can give us a call tomorrow and we can verify if it has the information we need on it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then we'll do um like the lady said 7 to 10.
[CUSTOMER][POSITIVE] Days, correct. Yeah. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Oh, OK. All right, well, I'm gonna send this and thank I appreciate your patience with me. I will get this um.
[AGENT][NEUTRAL] Oh, no, you're fine.
[CUSTOMER][POSITIVE] And because I took it as a photo, um, it was being sketchy with me, who knows at this point. OK, well, I'll get this, um, all sent in to you and I don't know what else I need. OK, thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Uh, yes, ma'am. Thank you for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.