AccountId: 011433970860
ContactId: a829315a-1d49-4195-9dea-04b719344ac8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 641020 ms
Total Talk Time (AGENT): 195372 ms
Total Talk Time (CUSTOMER): 279388 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/a829315a-1d49-4195-9dea-04b719344ac8_20250211T14:46_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm transferring [PII], who is the broker for Home Comfort Enterprises. He's calling in reference to customer number.
[CUSTOMER][NEUTRAL] 259-573-1
[CUSTOMER][NEUTRAL] Should be for [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, um, I don't know the date of service for [PII] it's for his son, uh, for his physical therapy, evidently we denied the claim.
[AGENT][NEUTRAL] What is the son's name?
[CUSTOMER][NEUTRAL] Uh, just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Probably [PII].
[AGENT][NEUTRAL] Are you under the right policy?
[CUSTOMER][NEUTRAL] Uh, [PII], yeah, I'm under [PII].
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mm, no, I know I get that you're under the correct policy with the names, but are you under the right policy that he's calling in regards with the questions about the claim? It was the question.
[AGENT][NEUTRAL] But you can send them over. I'll be able to assist them, but it wasn't the right policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, it's med link, isn't it?
[AGENT][NEUTRAL] Yes, that's correct. However, if you go to CUINQ there's multiple policies. One that expired [PII].
[AGENT][NEUTRAL] That's the one that he may be calling about the claim status of that one of those claims.
[CUSTOMER][NEUTRAL] Oh, it didn't
[CUSTOMER][NEUTRAL] OK, I bet let's look at left.
[AGENT][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Yep. Here's his other policy I bet this is one.
[AGENT][NEUTRAL] I have the policy. I pulled it up. You can transfer him.
[CUSTOMER][POSITIVE] All right, well thank you so much.
[AGENT][POSITIVE] Mhm. Have a good day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hello, how are you doing?
[CUSTOMER][POSITIVE] Good morning how are you doing?
[AGENT][POSITIVE] I'm good, thanks for asking. How are you doing this morning?
[CUSTOMER][NEUTRAL] Didn't have
[CUSTOMER][POSITIVE] Thank you, dear, doing good. My name is uh [PII].
[AGENT][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] And uh I am calling. I'm a broker in [PII] Rouge. I am calling about.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] About [PII]
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Family reek.
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], yeah, [PII] in my name, my, my, his name might be [PII], I guess. I don't know.
[AGENT][NEUTRAL] You're calling on behalf of the son, correct?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You're calling about a claim for [PII] the son, correct?
[CUSTOMER][NEUTRAL] Yeah, yeah, yes, ma'am. Yes, ma'am. He, his son, uh, is handicapped and he gets physical speech and occupational therapy. We cover physical therapy in the clinic.
[CUSTOMER][NEUTRAL] But we don't cover speech and occupational therapy.
[CUSTOMER][NEUTRAL] And he hadn't been able to get anything paid. I don't know if you can look over those claims and see what is going on.
[CUSTOMER][NEUTRAL] And uh what we can.
[AGENT][NEUTRAL] Do you have [PII]'s date of birth for me, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I'm trying to look it up. Let me see something here.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh goodness [PII] here, let's see.
[CUSTOMER][NEUTRAL] I had it. It just, it, it just went off the screen. Alright, let's see.
[CUSTOMER][NEUTRAL] ATL.
[CUSTOMER][NEGATIVE] Uh, what what what what come on.
[CUSTOMER][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] Let's see your commission.
[CUSTOMER][NEUTRAL] Alright, let me get back into this thing here pop me out. Let's see.
[AGENT][POSITIVE] Mhm take your time.
[CUSTOMER][NEUTRAL] You got to with these computers, you know.
[CUSTOMER][NEUTRAL] Alright, let's see here, uh, elite.
[CUSTOMER][NEUTRAL] Download download report.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There she goes.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Alright, let's see.
[CUSTOMER][NEUTRAL] OK group report.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Or uh.
[CUSTOMER][NEUTRAL] Wait a minute. Am I looking at the right one?
[CUSTOMER][NEUTRAL] Elite service. Nope, that's the wrong one. All right, I need to look at home comfort.
[AGENT][NEUTRAL] Do you have the [PII]'s date of birth? I'm still waiting for you to verify that for me if you don't mind.
[CUSTOMER][NEUTRAL] Yeah, I saw I, I downloaded the wrong report, so this, this, this, this should do it here.
[AGENT][POSITIVE] No worries.
[CUSTOMER][POSITIVE] All right, home comfort here we go.
[CUSTOMER][NEUTRAL] [PII], OK, and you want.
[CUSTOMER][NEUTRAL] His date of birth?
[AGENT][NEUTRAL] Yes, [PII]'s date of birth. Do you have [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII], OK, that's the son, [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So let me look at his policy to verify.
[AGENT][NEUTRAL] What type of benefits you have?
[AGENT][NEGATIVE] Looks like none of them are getting paid.
[AGENT][NEUTRAL] So you're calling about
[CUSTOMER][NEUTRAL] Yeah, I, I mean, we at least ought to get a physical therapy paid if he's got physical therapy.
[AGENT][NEGATIVE] But see, they're not, I'm about to pull up a claim to see cause if they're coding it as something else other than physical therapy, then it's not gonna be covered.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEGATIVE] If it's, it's occupational therapy, then it's not gonna be covered.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Cause physical therapy and occupational therapy is two different things. Physical therapy is the mobility of helping you with your
[CUSTOMER][NEUTRAL] Believe me, I know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I've, I've got a handicapped son. I've been dealing with the physical and occupational and speech therapy.
[AGENT][NEUTRAL] Right, so the policy doesn't cover it.
[CUSTOMER][NEUTRAL] For literally, literally 40 years.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So, when they coding it, they're sending it in.
[AGENT][NEUTRAL] GO and GO is for occupational therapy. That's what they're sending in the claims that considered as occupational therapy and not just physical therapy. And occupational therapy is not covered under the policy. That's why the claims keep being denied.
[CUSTOMER][NEUTRAL] OK, and what is the code we need for physical therapy?
[AGENT][NEUTRAL] Well, the, um, you have to contact the billing department to make sure that they're coding it correctly. If it's for physical therapy, then it should be for physical therapy. If it's for occupational therapy, then it should be for occupational therapy. But when they
[CUSTOMER][NEUTRAL] Or GO GO is occupational and physical is what?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I'm not sure how they would code it, but when we put the code into the system, it'll tell us what it is.
[CUSTOMER][NEUTRAL] Alright, so I've got it, I've got to uh.
[CUSTOMER][NEUTRAL] Call his physical therapy and tell them to code it as physical therapy instead of occupational then, right?
[AGENT][NEUTRAL] If it's, so if the services that they're performing is physical therapy, then it should be for physical therapy.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK, well, that's what we'll do then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the reason why the claims are not being paid cause all of them are for occupational therapy.
[CUSTOMER][NEUTRAL] Right, that's just a, a biller being lazy and putting the first thing in there she feels like putting in there.
[AGENT][NEUTRAL] Right. And that may be the case. She may be coding it wrong. However, if she's coding it wrong, you need to, they should reach out.
[CUSTOMER][NEUTRAL] Sure, that's what happened was code they were coding it.
[CUSTOMER][POSITIVE] They were coding it wrong at River City, which is elite services also. So, anywho, I sure appreciate it, and that's what I thought the problem was. And I guess the way to alleviate it is to call the billing department over at the physical therapy and just tell them to code the thing for physical therapy instead of occupation.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If it's for physical therapy instead of occupational therapy, if it's not occupational therapy, if they're not giving him speech therapy or anything, then it shouldn't be for occupational therapy. It should be for physical therapy if they're doing mobility therapy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, sounds good all right my dear, well thank you so much I sure appreciate it.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] That ought to do it. Thank you so much.
[AGENT][POSITIVE] Thanks for calling APL and you have a great day.
[CUSTOMER][NEUTRAL] Yes ma'am bye bye.