AccountId: 011433970860
ContactId: e8ad2d14-2314-4113-837e-22e6b04e15c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314170 ms
Total Talk Time (AGENT): 159390 ms
Total Talk Time (CUSTOMER): 139215 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/e8ad2d14-2314-4113-837e-22e6b04e15c6_20250520T21:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hey [PII], it's Kiki and care team. How are you today?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEGATIVE] Uh, I feel like I need a nap. But I took a, but I took a nap at lunch. You think I would be, but it went so fast. I didn't even feel like I went to sleep.
[AGENT][NEUTRAL] Same.
[AGENT][NEUTRAL] Oh God
[AGENT][NEGATIVE] I was [PII] and say that hour just is not long enough. By the time you fall asleep, you're having to turn around and wake up and then you're just mad.
[CUSTOMER][NEUTRAL] Right, cause usually like nap time for me is like 2 hours at least.
[AGENT][POSITIVE] Oh easy, yeah.
[CUSTOMER][NEGATIVE] But this, it was just like, what in the world did I even go to sleep? Um,
[AGENT][NEUTRAL] I know it.
[AGENT][NEUTRAL] I know it
[CUSTOMER][NEUTRAL] Can you help with the NetLink claim?
[AGENT][NEUTRAL] I should be able to, yeah.
[CUSTOMER][NEGATIVE] OK, I have an insured on the phone. She's a little irritated, um.
[CUSTOMER][NEUTRAL] And I was trying, I forgot how to pull up the information to show cause she thought that physical therapy was covered, which it is, but apparently, the claim was processed as uh OT, KT and ST not covered.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] But I'm trying to find on the claim where it shows what type of service was performed and I thought by that is it by the um.
[CUSTOMER][NEUTRAL] NPI number.
[CUSTOMER][NEUTRAL] Well, I don't know.
[AGENT][NEUTRAL] Um, usually they can, but sometimes the codes that they use like that they bill are an indicator of the type of services, so.
[AGENT][NEUTRAL] Um, what's your policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 250-181-6 uh do well.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And I put in the code, the
[CUSTOMER][NEUTRAL] But didn't say.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I used to process these long time ago, but I forgot.
[AGENT][NEUTRAL] It's OK, um, what's the claim number that we're looking at?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 3600737.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let's see what we got going on here.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][POSITIVE] I benefit cases.
[AGENT][NEUTRAL] So this is saying kinesiology, speech, or occupational therapy are not covered.
[AGENT][NEUTRAL] I think it's gonna be that modifier.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Alright now how to look up a modifier.
[AGENT][NEUTRAL] Let me double
[AGENT][NEUTRAL] It's gonna be something that I don't think it's just out there in our system to look at. It would be helpful for examiners at least but for you guys too I'm sure.
[AGENT][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see, well, no, that just says that the modifier G 0 is telehealth services.
[AGENT][NEUTRAL] For acute stroke, um, maybe.
[CUSTOMER][NEUTRAL] How do you
[AGENT][NEGATIVE] I don't think that's right.
[CUSTOMER][NEGATIVE] How you gonna do therapy at the telehealth. I just don't get these people.
[AGENT][NEUTRAL] Yeah, I don't think, um, that, I wonder if that's GO and not G0. That's what I'm thinking it might be. Let me see.
[CUSTOMER][NEUTRAL] I was Geo.
[CUSTOMER][NEUTRAL] Remember a long time ago someone asked can we do dental telehealth? I was like, how does that work? How are you gonna not.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I mean, you need to be present in order for that.
[AGENT][NEUTRAL] I mean, unless it's like a.
[AGENT][NEUTRAL] toothache or something? Or you just, so,
[CUSTOMER][NEUTRAL] It's like, can you look at this too for me, please?
[AGENT][NEUTRAL] GO right GO services delivered under an outpatient occupational therapy plan of care.
[CUSTOMER][NEUTRAL] Oh, so it was.
[AGENT][NEUTRAL] I think that's what it's supposed to be mhm so I think it's GO not G 0.
[AGENT][NEUTRAL] And so for the therapeutic exercises and stuff like that, like that's fine. But when you look up that code, it's occupational therapy and they
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] don't have occupational that I'm aware of. They only have physical therapy.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] We have physical, yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So part of the code I'll tell her that she's gonna have to talk to her doctor.
[AGENT][NEUTRAL] Yeah, just tell her right per the way that it was billed, it was not for physical therapy, which is covered. It's for occupational therapy and per the remark code, it does not state that her physical therapy is not covered. It states that kinesiology, speech, and occupational therapy are not covered.
[CUSTOMER][NEUTRAL] Awesome. I was informed her how much is this claim? I'm being nosy. I'm sorry.
[AGENT][NEUTRAL] Your phone.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 0 $92. At first I thought it was like $1 so I was like, what? I have $1 you better give me $2 bill.
[AGENT][NEGATIVE] Right, come on, yeah.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So y'all supposed to pay, but whatever. All right, thank you.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Right, you too.
[CUSTOMER][POSITIVE] All right. Have a good one.
[CUSTOMER][NEUTRAL] Mm bye.
[AGENT][NEUTRAL] Bye.