AccountId: 011433970860
ContactId: f517103f-46d9-4f15-8530-dc21c25d2fcf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 972820 ms
Total Talk Time (AGENT): 265041 ms
Total Talk Time (CUSTOMER): 473340 ms
Interruptions: 6
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/f517103f-46d9-4f15-8530-dc21c25d2fcf_20250522T20:41_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] I'm calling to check the status of um some claims that I have.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and may I ask who's calling to verify claim status for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And Ms. [PII], uh, what's that policy number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 1836605
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address, please.
[CUSTOMER][NEUTRAL] Date of birth is [PII]. Mailing address [PII], and email address is [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I show claims were received on the [PII] and are in line for processing.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, I'm checking on the one for my daughter [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, looks like for several claims or several days of service, uh, it looks like it processes physical therapy is not covered under the policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] The one for today or the ones that are in process right now.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, no, this one, like claims were received on the [PII] and processed, well, they were received today and processed today.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As a physical therapy is not covered.
[CUSTOMER][NEUTRAL] No, I, I.
[CUSTOMER][NEUTRAL] So she had some on there like they put it all together, the physical therapy therapy and the non-physical therapy one. And so,
[CUSTOMER][NEUTRAL] I did what was instructed, which was send the itemized billing for like Dr. [PII].
[CUSTOMER][NEUTRAL] So, even though there's physical therapy on some of those dates,
[CUSTOMER][NEUTRAL] It was the one that said Navakovitch that were non physical therapy. Those are like the office visits.
[AGENT][NEUTRAL] Do you have those specific dates of service?
[CUSTOMER][NEUTRAL] Um, I had
[CUSTOMER][NEUTRAL] I know, I cause I had gone through them a couple of times with representatives when they sent me the, when they said like the first go around that hey they were physical therapy, oh no, they said that they needed to be um
[CUSTOMER][NEUTRAL] Those data services. Well, they needed the diagnosis code.
[CUSTOMER][NEUTRAL] And this is back on.
[CUSTOMER][NEUTRAL] Uh, the [PII] or [PII] or something like that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It was like 3:13.
[CUSTOMER][NEUTRAL] And then 328.
[CUSTOMER][NEGATIVE] Um, hold on, I, I'm dri oh shit, I'm driving.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so I know 3:13, 328, and then.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] What like on the thing where it says provider if it's you know that's for the that's her.
[CUSTOMER][NEUTRAL] Non-physical therapy cause the lady made me call out the codes and she checked them.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] She said yeah, they're like M2525.582, I believe.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, M 25562.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 43
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I see a claim for 3:13, but it looks like it was for surgery, uh, not for an office visit.
[AGENT][NEUTRAL] It was like 2 procedures and we paid 1 in the amount of 296.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah, but we, but we, we've had office visits since then and that's what they told that's what they told me I needed to submit. So when I submitted them earlier in the month and they sent the denial saying we need to diagnose this code cause it was like the whatever, whatever, you know, when they sent out the the claim has not been um accepted or whatever. Oh, I'm you know what, I have the paper right here in front of me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it was the D10400. Um, it says your claim is acknowledged. However, in order to provide further consideration of the loss under the policy, we need to support documentation evidence, including the itemized bills with diagnosis codes, and so that's what I submitted.
[AGENT][NEUTRAL] Do you have that claim number?
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One was
[CUSTOMER][NEUTRAL] 360-155-9
[AGENT][NEUTRAL] 360-1559.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It was like on here they have a data service was.
[CUSTOMER][NEUTRAL] Um, 3:10.
[CUSTOMER][NEUTRAL] And that's the one that had the, the annotation of we needed a you know, diagnosis code.
[CUSTOMER][NEUTRAL] But I had like I submitted multiple, so they all came back with this um.
[CUSTOMER][NEUTRAL] Yeah, type of response, but I have her dates of services. I just pulled over.
[AGENT][NEUTRAL] I want.
[CUSTOMER][NEUTRAL] Um, like 3, like 3:10, it says the date of
[CUSTOMER][NEUTRAL] But yeah, it says 3:10 [PII] detailed established office visit uh but the reference date on here is 3-11 on [PII] and then.
[CUSTOMER][NEUTRAL] She had a surgery on the [PII].
[CUSTOMER][NEUTRAL] And then we had another visit.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] And then, um, hold on.
[CUSTOMER][NEUTRAL] So we had another visit, trying to find it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's like a 3 time.
[CUSTOMER][NEUTRAL] Hold on, [PII], I'm sorry.
[CUSTOMER][NEUTRAL] I'm sorry, baby, I was trying to park it. I apologize.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] And I'm not trying to be difficult. I just thought I had did what was.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hart, leave the iPad in here, baby.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I try a honeydew smoothie, please, a small one.
[AGENT][POSITIVE] Oh, that sounds good.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, let's get some of the boat. I don't know. What do you think though?
[AGENT][NEUTRAL] 3208.
[CUSTOMER][NEUTRAL] OK, let's try the pop and pearls.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Strawberry, OK.
[CUSTOMER][NEUTRAL] I hope you don't you wanna get?
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] It looks like for the 3.
[CUSTOMER][NEUTRAL] Mhm. No.
[AGENT][NEUTRAL] Uh, 28 data service, uh, the process is not covered since there was no charged amount for that date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The 328 1?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] 3:13.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, they pay that for the surgery.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][NEUTRAL] 4310.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So the 3281 was in they said there was no charge for Dell, but we would have, I didn't know at this point.
[AGENT][NEUTRAL] For the 3:10. 0, well, this is getting processed today.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] For the 3:10, it looks like, like I said, it's been processed today, but it looks like um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] They paid $100 for that data service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And the one for the 313 and 328 was processed today too. And so a check would be mailed for 296 for that uh 3:13 data service for the surgery.
[AGENT][NEUTRAL] But the 328, uh, it looks like it processed as there's no charge.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][MIXED] Yeah, but I have to pay for it, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I can pay for it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, you did a very good job asking her. I'm very proud.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Uh, looks like mostly it's just processed today.
[CUSTOMER][NEGATIVE] I'm so sleepy I to fight [PII], OK.
[AGENT][NEUTRAL] Oh, don't fall asleep. I have same way.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Project.
[CUSTOMER][NEUTRAL] I could tussle with Jesus right now.
[CUSTOMER][NEGATIVE] Me and my friends always joking like, so who's gonna get it this day? I'm like, oh the diet can get it today. That's how sleepy I am.
[AGENT][NEUTRAL] It's just one day. It just, I don't know what's, it just, uh, maybe cause it's supposed to be raining. It's a long day too, yeah.
[CUSTOMER][NEUTRAL] Oh God.
[CUSTOMER][NEUTRAL] It's long.
[CUSTOMER][POSITIVE] I teach and so we just been staring at four walls all day. I'm like like make us free, give us our freedom please.
[AGENT][NEUTRAL] Are you almost out of school? Are school is almost over?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, today was the last day finally.
[AGENT][NEUTRAL] Oh, my son, I bet you wish he was today, his last day. His is tomorrow.
[AGENT][NEGATIVE] He doesn't wanna go.
[CUSTOMER][POSITIVE] Oh my, that's cool right there.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't blame them.
[AGENT][NEUTRAL] I don't need it, but I need his report card, so he needs to go.
[CUSTOMER][NEUTRAL] They don't let y'all pick them up. We let ours set them up whenever.
[AGENT][NEUTRAL] [PII] said we can pick him up. I just don't.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] want to try to take off work to go pick up his report card when he can just go for a couple of hours.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh look, just look online cause you gotta always have it online.
[AGENT][NEGATIVE] They are gonna be there for 4 hours and it's, it's not like they're gonna have any work.
[CUSTOMER][NEUTRAL] I always tell my
[CUSTOMER][POSITIVE] Oh, well, that's a half a day. That's not bad.
[AGENT][NEUTRAL] Yeah, and plus I'm sure they'll have some busy work or coloring or something for them to do, but he just don't want to go because it's gonna be only him.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] They're called our little helpers then.
[AGENT][NEUTRAL] Yeah, it's only him and two little girls and he don't want to go. I was like, it would be fine. Y'all can play together.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] But you know, I, my, yeah, my students, we have the longest recess and like they just went by each class and all the teachers just gave like extra, you know, leftover treats and it was just, we watched a movie. I ordered a pizza like 3 or 3 of us, so we had a good time.
[AGENT][POSITIVE] Oh, that would be nice. I bet if he, if his teacher did that, he wouldn't mind.
[AGENT][NEUTRAL] They watched movies yesterday and then they had a game day the day before, so.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] I get it. I have kids, you know, it's kinda hard to get sits and stuff.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but um if they're processing them right now.
[AGENT][NEUTRAL] And like I explained to him, I say it's your last day, and then, you know.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're gonna be out for 2 months, you'll be good.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Just one more, just a half day, you'll be good to go.
[CUSTOMER][NEUTRAL] A day you can make it.
[AGENT][NEGATIVE] Yeah, they can make it. He's just stubborn.
[CUSTOMER][POSITIVE] Thank you. Goodbye. Yeah. Oh, I get up I pull them too.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, it makes me kind of want a honeydew, um, what do you call it? um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Bubble tea.
[CUSTOMER][POSITIVE] No problem. That's you, that's exactly where we went. That is exactly what we did, and it is good.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] That, that honeydew is so good. It is so good. It's the best to me. I don't like the other ones, but I love, uh, honeydew.
[CUSTOMER][POSITIVE] I've never had one, but I like honeydew and it is good.
[CUSTOMER][NEUTRAL] My and my daughter got strawberry tea or some type of tea with the strawberry fruit tea with the, with the popping things.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] They even have it in the grocery store now, but I don't like it too much cause it's just the little, little, yeah, and when they burst, it just like you, they leave a film like it's some little plastic or something. It's like, this is not the same.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, it tastes different.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Uh, yeah, so it is pretty interesting, but I like it.
[AGENT][NEUTRAL] I might just have to get one after work.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's gonna look good with the white la. I'm sorry, my internal thoughts came out.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] Well, is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] No, ma'am, that's it. Thank you so much. Oh, that's good.
[AGENT][POSITIVE] Alright, you're welcome. You have a great day and enjoy your milkshake.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] Alright bye bye. Mhm.
[AGENT][NEUTRAL] Bye.