AccountId: 011433970860
ContactId: 04a76190-3f06-4e54-8376-a8ff7ea35f47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 628320 ms
Total Talk Time (AGENT): 201451 ms
Total Talk Time (CUSTOMER): 255432 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/04a76190-3f06-4e54-8376-a8ff7ea35f47_20250609T12:25_UTC.wav
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[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], my name is [PII]. Last name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] How can I help today, [PII]?
[CUSTOMER][NEUTRAL] OK, I have a couple of questions. OK, uh, I'm looking at the form that we submitted in, uh, for the claim that y'all sent over for the cancel forms. OK, on here it asks for the.
[CUSTOMER][NEUTRAL] Uh, pathological for the report that was submitted in. I don't know if they overlooked it or they didn't see it. It gave the date that he was diagnosed with the biopsy report attached to that.
[CUSTOMER][NEUTRAL] And that was stated in that report as of [PII].
[CUSTOMER][NEUTRAL] I don't know if they overlooked it and that has the Methodist information on there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a claim number that we're like uh speaking on specifically?
[AGENT][NEUTRAL] Or do we have a policy number?
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Hold on real quick, let me get that for you.
[CUSTOMER][NEUTRAL] Um, the actual policy is 258-2109.
[AGENT][NEUTRAL] All right. And then if I can verify date of birth and address, please?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] Address is [PII].
[AGENT][NEUTRAL] Yeah, and the claim was under [PII] or was it under you?
[CUSTOMER][NEUTRAL] It's it's under billing.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because what the doctor is trying to understand is there is no form in here for him to fill out.
[AGENT][NEUTRAL] For the doctor, you mean?
[CUSTOMER][NEUTRAL] That's why.
[CUSTOMER][NEUTRAL] Yeah, because in order for him to fill out a form there's nothing in here for him to fill out. Everything that you we have is only for [PII].
[CUSTOMER][NEUTRAL] Now if there's a form that we need to pull off, I need to know where I need to go to pull a form for the physician because there's nothing here showing that.
[CUSTOMER][NEUTRAL] Because they're telling me that.
[CUSTOMER][NEUTRAL] All the stuff that we submitted.
[CUSTOMER][NEGATIVE] Is not correct and I mean I'm not understanding why it's not correct and that was all the information there.
[CUSTOMER][NEUTRAL] I mean it has the biopsy, it has all the report there.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Yeah, there's a couple different.
[AGENT][NEUTRAL] Reasons it looks like on denials on this that I need to pull, I need to try and pull everything that was submitted just to see.
[AGENT][NEUTRAL] Kind of
[AGENT][NEUTRAL] Because it's asking for an explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] And then I see.
[CUSTOMER][NEUTRAL] Transportation
[AGENT][NEUTRAL] It's asking for medical history.
[AGENT][NEUTRAL] And then for the radiation, it looks like
[CUSTOMER][NEUTRAL] Yeah, because he just started radiation and chemo.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because everything was done and report was done on the [PII] is when he was first diagnosed with this.
[CUSTOMER][NEUTRAL] I have to be careful I did to the middle of our list.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] There are a couple line items that show are just not covered unfortunately, like it does say lab laboratory tests are not covered.
[AGENT][NEUTRAL] And then it does say on like [PII] 17.
[AGENT][NEUTRAL] And then on
[AGENT][NEUTRAL] Those were like office visits, it looks like.
[AGENT][NEUTRAL] It does say.
[AGENT][NEGATIVE] Policy does not provide a benefit for office visits.
[CUSTOMER][NEGATIVE] you have a problem there.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So it looks like on [PII] you had submitted.
[AGENT][NEUTRAL] Um, it looks like a chemo treatment, and that one's asking for the explanation of benefits from the primary.
[CUSTOMER][NEUTRAL] Yes ma'am, the driver has been through there. She said she can be back from there in about 10 minutes. Is that OK?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hey, I have a
[CUSTOMER][NEUTRAL] Um, I do recall her turning around in that area, but she probably, she may have been a little early if not later.
[AGENT][NEUTRAL] Well let me see, so for the first you're looking also the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] For the first occurrence benefit, that was also one that was on here.
[CUSTOMER][NEUTRAL] So that's OK.
[AGENT][NEUTRAL] All right, so I've got these pages pulled up. Let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's a 4.
[CUSTOMER][NEUTRAL] I had told my mom that she was coming back around.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Take that to the high school.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] OK, so on this it looks like there was 28 pages that you uploaded. Does that sound about right?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, it's more than that, it's more than that.
[AGENT][NEUTRAL] OK, it looks like each one was 246.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's more than that.
[AGENT][NEUTRAL] Yeah, it looks like there was 29, 28.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I don't know
[AGENT][NEUTRAL] So I'm gonna need to
[AGENT][NEUTRAL] Look through this and have a claims examiner go through it to see if there was anything that was exactly missed. It's quite a few pages. Can I give you a can I give you a call back because I don't wanna leave you, it's gonna take a minute.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and meanwhile because like the doctor said if we are needing explanation of benefits, he needs to know because I know like he said usually if they're having to explain anything he needs to know where is a physician's form because he there's nothing here showing where he has to fill out anything.
[CUSTOMER][NEUTRAL] Or he has to fill out showing anything.
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] OK, I got you.
[CUSTOMER][NEUTRAL] Because usually, yeah, usually when a doctor has to explain anything, there's a physician's form.
[AGENT][NEUTRAL] Right, and I see what you're saying. It's just the, the portion for the statement of the insured.
[CUSTOMER][NEUTRAL] And there's, yeah.
[CUSTOMER][NEUTRAL] Yes, and there's nothing here showing that.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And they're asking us for more information, but there's no physician's form for me to fill out if they're asking me for this.
[AGENT][NEUTRAL] OK. All right. So yeah, let me.
[CUSTOMER][NEUTRAL] Because they're not gonna take a letter or anything from him. They're gonna need, he has to fill out, or he has to put in codes and like he told us, there's a code, there's certain things he has to put in for them to say, hey, OK, these are codes that has to go in a certain order.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah, let me, what is a good call back number for you?
[CUSTOMER][NEUTRAL] It's gonna be area code [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just to confirm, [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, so I'm going to get with the claims examiner that process this and then what we'll do is we'll go line by line and we'll go over exactly what exactly needs to be submitted to get this remedied that way there's no confusion on it OK? so I'm gonna find out exactly what's needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, I'll give you a call back.
[CUSTOMER][POSITIVE] OK and thank you so much.
[AGENT][POSITIVE] You're welcome, [PII]. Have a good rest of your day. I'll speak to you soon.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.