AccountId: 011433970860
ContactId: eb4db4e4-8a03-4d5e-9c63-25e673730239
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430730 ms
Total Talk Time (AGENT): 90641 ms
Total Talk Time (CUSTOMER): 107669 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/eb4db4e4-8a03-4d5e-9c63-25e673730239_20250606T17:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My first name is [PII], and issue to my last, that would be V like Victor. I'm calling from Cora Health Services. I'm looking for claim denial.
[AGENT][NEUTRAL] OK, I can get clarification regarding that claim. um I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] My first name is [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, uh but can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, I have. That's going to be 1452947 M. like Mike L like Lima, number 8.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] The patient's name, [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that and then what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] Can I go ahead with the date of service or can I proceed with the client number?
[AGENT][POSITIVE] Oh yes, if you've got that claim number that would be great.
[CUSTOMER][NEUTRAL] OK, I have here the claim number. Please take note of this. The first claim number 344.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 27
[CUSTOMER][NEUTRAL] 40
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so it states here we're unable to pay a benefit as uh kinesiology, speech or occupational therapy are not covered benefits under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not a covered benefits.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. I believe because all the medical insurance policies will cover the medical services since it's related to the medical services. Um, I agree that patient policy
[CUSTOMER][NEUTRAL] All these services are excluded from the benefits, but we got a payment for other dates of services in [PII], then how that's possible?
[AGENT][NEUTRAL] Uh, for this same member?
[CUSTOMER][POSITIVE] You're right.
[AGENT][NEUTRAL] Do you have a claim that has that benefit that we paid?
[CUSTOMER][NEUTRAL] I have a data service and bill amount. You can double-check from your end.
[AGENT][NEUTRAL] From the the one that we paid that was the same benefit?
[CUSTOMER][NEUTRAL] To see how do you make a payment.
[CUSTOMER][POSITIVE] Yeah, you're right, I think.
[AGENT][NEUTRAL] OK, uh, go ahead, you give me that date of service.
[CUSTOMER][NEUTRAL] [PII] up until [PII].
[CUSTOMER][NEUTRAL] $606 even.
[CUSTOMER][NEUTRAL] This is the reference data of service, OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, uh, I'm not showing any for that amount, let's see.
[AGENT][NEUTRAL] Uh, do you maybe have the amount after major medical paid? That might be why.
[CUSTOMER][NEUTRAL] I think you guys made a payment of $110.
[AGENT][NEUTRAL] Mm, no. Well, let's see. Give me just a moment.
[AGENT][NEUTRAL] OK, so just so that I understand less, uh, while I'm trying to get all of this, um, was it for one of those kinds of therapies? Was it kines excuse me, kinesiology, occupational or speech therapy, or was this for physical therapy?
[CUSTOMER][NEUTRAL] This is for physical therapy, not for speech or occupational.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's not occupational.
[CUSTOMER][POSITIVE] You're right.
[AGENT][NEUTRAL] OK, give me just a moment let me take a look, give me just a minute because I think I did find this claim that you are referring to, um.
[CUSTOMER][NEUTRAL] We do have a lot of claims in [PII] that got processed and paid.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hey, would you mind spelling out, spelling it out your name for me, uh, in case of the clearly.
[CUSTOMER][NEUTRAL] Are you still with me?
[CUSTOMER][NEUTRAL] Are you with me? Hello?