AccountId: 011433970860
ContactId: 990a4f73-db4c-487b-804f-ffbc43ad2566
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 675070 ms
Total Talk Time (AGENT): 197481 ms
Total Talk Time (CUSTOMER): 247278 ms
Interruptions: 9
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/990a4f73-db4c-487b-804f-ffbc43ad2566_20250506T18:22_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Yeah, I just went online to take a look because I put a claim in and I haven't been paid but now it looks.
[CUSTOMER][NEUTRAL] I got a remark saying it wasn't paid because of a reason and I wanted to double check I I think it's a misclassification.
[AGENT][POSITIVE] OK, I'll be happy to assist.
[AGENT][POSITIVE] I'll be happy to assist with your claim today. May I have your policy number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number 02457148.
[AGENT][NEUTRAL] And your name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII] [PII].
[AGENT][NEUTRAL] And if you can verify your email address?
[CUSTOMER][NEUTRAL] Verify what? I'm sorry.
[AGENT][NEUTRAL] Your email address?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and what's the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, let's get a check date. Does have a claim. There's a claim number. Does that help?
[AGENT][NEUTRAL] OK, is it a claim for yourself or a dependent?
[CUSTOMER][NEUTRAL] It's for myself 356-063-560647.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, looks like that's data service [PII].
[CUSTOMER][NEUTRAL] And it goes on, there's probably more than that one.
[CUSTOMER][NEUTRAL] Cuz there's like there's a lot but.
[CUSTOMER][NEUTRAL] Probably more than one claim, but they're probably all the same thing.
[CUSTOMER][NEUTRAL] Uh, let me check online.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Are you looking up something or you need me or?
[AGENT][NEUTRAL] I'm pulling up the um paperwork that you sent in because I'm showing that it was denied for.
[AGENT][NEUTRAL] Three different things and I just wanna see which one of the 3.
[CUSTOMER][NEUTRAL] And it's, and it's not, and those aren't the three things.
[AGENT][NEUTRAL] Yeah, that.
[AGENT][NEUTRAL] That looks like a
[CUSTOMER][NEUTRAL] You cover, you, you cover physical therapy, yeah.
[AGENT][NEGATIVE] That's a fracture.
[CUSTOMER][NEUTRAL] I had surgery.
[AGENT][NEUTRAL] The diagnosis is for fracture. Um, let me see what the
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] H
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So that was for physical therapy, not occupational therapy.
[CUSTOMER][NEUTRAL] Definitely physical therapy. I mean it was surgery. I mean, I couldn't even move my arm, my fingers, nothing.
[AGENT][NEUTRAL] OK, because they have the.
[AGENT][NEUTRAL] And you were hospitalized for, because they have on here the visit date was between [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, the hospital visit was prior to that, and I was coming back for the physical therapy after I got out.
[CUSTOMER][NEGATIVE] I couldn't even I couldn't move my fingers. I couldn't move my arm or anything.
[AGENT][NEUTRAL] OK, cause I don't know.
[AGENT][NEGATIVE] Why she would think it was occupational therapy because I can't even see what the charges are for. I just see that the deductible was $8,152.48.
[CUSTOMER][NEUTRAL] Yeah, so, and I've been wondering about this, so I figure, well, it's taking longer it's a bigger bill I get paid on the other ones I put in.
[CUSTOMER][NEGATIVE] And so then I went back and looked and it says occupational therapy, speech and stuff. I'm like none of those.
[AGENT][NEUTRAL] Um, let me see, there was another claim.
[AGENT][NEUTRAL] From the same provider.
[CUSTOMER][NEGATIVE] There should have been a couple claims for this. Yeah.
[AGENT][NEUTRAL] Let me see if
[CUSTOMER][NEGATIVE] I ended up paying it because it wasn't getting paid, so I paid it directly and now.
[CUSTOMER][NEGATIVE] Now I'm out of money for it because I didn't want to go to collection so I paid it.
[AGENT][NEUTRAL] Oh, that's what it is. They're billing it as occupational therapy.
[CUSTOMER][NEUTRAL] Who is?
[AGENT][NEUTRAL] HCA Florida University Hospital.
[CUSTOMER][NEUTRAL] So I need him to get that.
[AGENT][NEUTRAL] So the hospital.
[AGENT][NEUTRAL] Is yeah on the claim forms.
[AGENT][NEUTRAL] The hospital
[AGENT][NEUTRAL] Matter of fact, did you send us this?
[CUSTOMER][NEUTRAL] I sent it to you, yeah.
[AGENT][NEUTRAL] OK, do you have it so I can show you where it says occupational therapy on there?
[CUSTOMER][NEUTRAL] OK, well I have the different things let's see.
[AGENT][NEUTRAL] It's the UB
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Form that you got from the hospital?
[CUSTOMER][NEUTRAL] UV
[AGENT][NEUTRAL] That's what it's called. You, you put on there. Are you sure you sent this?
[CUSTOMER][NEUTRAL] I know what a UV is. I had the, the statement and then and then I showed then I put the uh.
[AGENT][NEGATIVE] No, this someone else sent this.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I don't know.
[AGENT][NEUTRAL] OK, well, they're billing it.
[CUSTOMER][NEUTRAL] So I need to go to the hospital and have them redo the billing?
[AGENT][NEUTRAL] I mean, I can't tell you to do that cause that would.
[CUSTOMER][NEGATIVE] Well, no, I mean it's wrong I need to get it. I need to get it submitted correctly because I paid for it.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] But if I can say.
[AGENT][NEUTRAL] I can say if they did not build this correctly, then yes.
[AGENT][NEUTRAL] If they, cause they build it OK.
[CUSTOMER][NEUTRAL] Well they didn't if it's occupational.
[AGENT][NEUTRAL] OK, but just let them know they billed it as occupational therapy and not physical therapy.
[CUSTOMER][NEUTRAL] OK, I'll give him a call.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if I can get all those bills.
[CUSTOMER][NEUTRAL] Corrected because that's over that's about $11,000 out of my pocket I paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll give him a call and then and then after I get then I just resubmit.
[AGENT][NEUTRAL] Yeah, just send us the um corrected um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The correct claim form showing that it's um physical therapy and not occupational therapy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] I had another one and it was interesting because.
[CUSTOMER][NEUTRAL] And I'll probably have to call the insurance. It was the care matrix. I get paid 800. There was one payment I didn't get, but they didn't have the claim form filled out.
[CUSTOMER][NEUTRAL] I'll see if they can submit that for the care matrix.
[CUSTOMER][NEUTRAL] They were paying trying to get the even one I got.
[CUSTOMER][NEGATIVE] It took forever.
[CUSTOMER][POSITIVE] OK, let me get on the call the hospital and get this, get the big one corrected. That's the most important thing.
[CUSTOMER][POSITIVE] OK, I appreciate your help. Thank you. Oh, can I ask you one other question?
[AGENT][NEUTRAL] Oh, was there anything else I could assist with today, Mr. [PII]? OK, go ahead.
[CUSTOMER][POSITIVE] Uh, I think this was paid directly. I'll, I'll look. It was probably paid directly to them, uh, to the doctor or surgery center. OK, let me just call and get this other one back. OK, thank you so much. I appreciate it. Take care.
[AGENT][POSITIVE] Alright, well thank you for calling APO. Have a good day thanks.
[CUSTOMER][NEUTRAL] Yeah, is there a special code or something physical therapy or what the code is?
[AGENT][NEUTRAL] Um, that depends on what they, they did.
[AGENT][NEUTRAL] So it's a it's a lot of different codes. It can be up to 1015 codes, but it and each code is specific to what they actually treated you for, um, but for the main part you just need to let them know hey you build.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, you build this because they build this to your, your major medical as well as occupational as well. So just let them know you build this as occupational, but y'all gave me physical and it may be that they did give you occupational but you weren't aware of it.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] But regardless, they billed it as occupational.
[CUSTOMER][NEUTRAL] No, it wasn't. I know the doctor ordered physical therapy.
[AGENT][NEUTRAL] OK. Well then, if the doctor ordered physical therapy, then they should not be billing and they, and you got physical therapy, they should not be billing as occupational.
[CUSTOMER][NEUTRAL] And it wasn't occupational, you know.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me get this straight then this I think this is gonna be hard to do, but let me try to get it straight.
[CUSTOMER][POSITIVE] I appreciate your help thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. You have a good day mhm bye bye.
[CUSTOMER][POSITIVE] Take care.
[CUSTOMER][NEUTRAL] You too bye.