AccountId: 011433970860
ContactId: 07525a4c-428d-4d91-bd71-1f8ea20b6636
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 773200 ms
Total Talk Time (AGENT): 360805 ms
Total Talk Time (CUSTOMER): 328861 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/07525a4c-428d-4d91-bd71-1f8ea20b6636_20250421T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes. Did you say [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, OK, [PII]. Thank you. Um, I may have the wrong uh extension, but, um, I have a question about a claim that I already put in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I received a check.
[CUSTOMER][NEUTRAL] But it's not the usual amount that I, my, my benefits paid and I don't understand the, on the back it, it has some remarks.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, and so,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't know how, how do we start with this? Do I tell you my name and.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, so those notes can be a bit confusing um I can definitely get that claim pulled up and uh get some clarification on that for you. um, what was your name please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII], and I have a policy number or a reference number here.
[AGENT][NEUTRAL] Um, if you've got that policy number, please.
[CUSTOMER][NEUTRAL] Oh, it's the same OK it's 00595659.
[AGENT][NEUTRAL] OK, and then [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you and I'm just gonna verify some information really quick um can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] It's a what account? [PII], yes, [PII].
[AGENT][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] Perfect, thank you for verifying all of that, [PII]. OK, so let's take a look at this claim. Uh, looks like we paid a benefit of $5,163.11. Let me take a look at these notes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and it's, and it, it should be 10,000 a year. It's for a chemo pill. And y'all have been paying me for a few years now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But this, uh, my insurance switched to a Credo Pharmacy instead of CVS which I've had in the past, but I, in [PII], it switched to a Credo. So apparently I didn't get everything I needed to forward to y'all because
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think that's what the codes are saying, but I, I don't really know what they mean.
[AGENT][NEUTRAL] Mm, so sure, so for the item that we did pay that amount on, uh, it does state that the benefits we provided are based on the actual charges obtained from the provider's billing, uh, for this date of service.
[AGENT][NEUTRAL] So if that's not correct we do need to get that correct information as for the other one it does state that we're missing the itemized bill from the provider's office that shows uh procedure codes and the charge amounts.
[CUSTOMER][NEUTRAL] OK, so how do I, do I get that from them? I have to get, get that.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, uh, you could just call wherever it was that you went for treatment and ask them for the itemized statement that shows any diagnos or excuse me, um, any procedure codes, um, and they'll be able to send that to you and then you could just send it right to us.
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] But um
[CUSTOMER][NEUTRAL] So it, that doesn't come from the pharmacy? The, the
[CUSTOMER][NEUTRAL] The the out of my statement with procedure codes, who does that come from?
[AGENT][NEUTRAL] Um, I mean if that's through the pharmacy then, uh, wherever it was, so I have two dates of service here if this clears anything up, um, so the benefit that we paid for that was from, uh, [PII], the one that it's stating we're missing information that was, uh, [PII]. So whatever, uh, we just need further information well [PII] through the.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The rest of the year it looks like, yes, um, [PII] so yes um that's we're just missing that itemized statement.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, well,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I guess on [PII].
[CUSTOMER][NEUTRAL] It's switched from CVS pharmacy.
[CUSTOMER][NEUTRAL] This is of [PII], um, to a Credo pharmacy who I sent the information from A Credo, so they probably didn't fill the chemo pill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I probably still have pills, what I'm saying before I got the next batch from them, which must have started on the [PII]. See, I had pills from the previous year.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, from CVS but they switched me over to a Credo.
[AGENT][NEUTRAL] I see, yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] See what I'm saying? So the, so they probably didn't fill a prescription for me maybe until [PII]. Uh, I'm not, or maybe they didn't get.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The information to switch it to me.
[AGENT][POSITIVE] Sure, um, I would definitely try to give them a call and find out, um, so that you know we can pay those benefits, um, if we're able to.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But what do I ask them if, if I wasn't even there, um, you know, patient yet.
[AGENT][NEUTRAL] Any
[AGENT][NEUTRAL] If you were
[AGENT][NEUTRAL] Sure, I would, uh, well that's the, that would be the first thing I would ask if they had anything, any sort of itemized statement from [PII], um, and get that. If not, then this might be the only thing that we are able to pay if that's the case.
[CUSTOMER][NEGATIVE] Oh, I don't, I don't understand cause.
[CUSTOMER][NEUTRAL] Uh, they've, I've gotten all year I've gotten my chemo pill from them. So,
[CUSTOMER][NEGATIVE] Uh, you know, I don't understand why.
[CUSTOMER][NEUTRAL] The, the money is not, you know, it's like half the money that I usually get per year.
[AGENT][NEUTRAL] Sure that's based again based on the information that we received um for what it says is that was the actual charges uh that we got from the provider's billing so that was the amount that we received so again if that's not correct, you would need to reach out to them and get that correct information to us.
[CUSTOMER][NEGATIVE] I don't even know what to ask them for. I, I'm just totally confused.
[AGENT][NEUTRAL] That just that out of my statement sure um I would just explain of course that you do have a cancer policy and you're trying to file a claim for these benefits honestly just saying that they should know what to give you.
[CUSTOMER][NEUTRAL] Well, that's what I told him in the first place and that's what I got.
[CUSTOMER][NEUTRAL] So I, uh, that's what I'm, when I call back.
[CUSTOMER][NEGATIVE] Uh, I, I, I, I got, I mean, I don't, I don't understand it.
[AGENT][NEUTRAL] The, so again, based on the information that we have, that was the total amount was what we paid.
[CUSTOMER][NEUTRAL] So what's the
[CUSTOMER][NEUTRAL] So is some information missing, you're saying?
[AGENT][NEUTRAL] If that is incorrect, then it would appear so um so if that amount that we paid was incorrect, that's based off of the information that we received.
[CUSTOMER][NEUTRAL] Maybe something
[CUSTOMER][NEGATIVE] And I don't know how I'm gonna get them to, I have trouble with the credo. They, I just thought, they don't understand what I need and I don't understand what they're doing. And it was, and see me.
[AGENT][NEUTRAL] Oh, yes, unfortunately all of the providers are so different and some can be pretty difficult. I understand.
[CUSTOMER][POSITIVE] Well, CVS was so much easier even to get the medication. There were no problems. I got, I could call them and get that statement, you know, for the year before. I would send, I send it to y'all and now all of a sudden, I can't get the right information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] I'm not familiar with the Credo, but I know CVS is really good, like you said, they're very upfront.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So if I um.
[CUSTOMER][NEUTRAL] Made a copy of this uh on the back of the check. There's um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Those two remarks.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] If I, if I sent that to a credo, are they gonna know what?
[CUSTOMER][NEUTRAL] What I'm meaning?
[AGENT][NEUTRAL] They should, um, again it's, it is pretty pointed as to what information we're needing.
[AGENT][NEUTRAL] And I would just explain if this amount that we paid that $5,163.11 we paid that based off of the actual charges um for the information that we received. So if that amount is wrong um then you would need to let them know that as well and that you need that correct total amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, need correct full amount.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so I'll call them and I'll see if I can get anything else from them and then I just thought and I, I, I think I mailed it to y'all before, yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Yeah, I'm sorry. I know it's extremely confusing and I wish there was more I could do to help.
[CUSTOMER][NEUTRAL] I'll just mail it.
[CUSTOMER][NEUTRAL] Well, do I need to, when I mail?
[CUSTOMER][NEUTRAL] If they send me additional information and I mail it to you, do I have to fill out another form, uh, claim form?
[AGENT][NEUTRAL] Yes, uh, so for this, well, it depends on what they send you. I know it's confusing, um, so for this one if it's just simply that missing information you can just send that to us and we'll be able to locate or uh associate it with this claim. however, if it's revised information if it's different, um, for example, if it they send you a completely different amount for this 5,163. 11 cents, uh, then that one would need to be, uh, with a separate claim form.
[CUSTOMER][NEUTRAL] Um, OK, another claim form, OK, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So do I not cash this check yet until all this is?
[CUSTOMER][NEUTRAL] figured out.
[AGENT][NEUTRAL] You know,
[AGENT][NEUTRAL] Let's do this [PII] um if you don't mind I'm gonna put you on a brief hold and I'm going to reach out to our claims specialist um just so that they can tell exactly like the best route um to do this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So give me just a moment I'll get right back with you, OK?
[CUSTOMER][POSITIVE] That would be great.
[CUSTOMER][POSITIVE] OK, OK, thanks.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Thanks for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][POSITIVE] I'm doing good and you?
[AGENT][NEUTRAL] Doing all right thank you. So I've got a member I'm needing to transfer to you um she's calling regarding a uh claim uh for her cancer policy um it looks like we're there's some that we paid and then some we were just kind of missing some information for and I don't think she is quite understanding um the amount that we paid we sent by check and she's stating that it's not enough.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, even though it does state that's the full amount that we were billed for and that that was the actual charges, and I tried explaining that to her, um, so she's not sure what additionally she needs to do. I did tell her if that's incorrect, you know, then we would need that corrected information, um, so I think she's just really needing it.
[AGENT][NEUTRAL] Further broken down, I think.
[CUSTOMER][NEUTRAL] Alright, what's the policy number?
[AGENT][NEUTRAL] That is 595659.
[CUSTOMER][NEUTRAL] Is it the claim that was processed on [PII] or 411?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yes, uh, the one ending in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] charges.
[CUSTOMER][NEUTRAL] OK, you can send her over.
[AGENT][POSITIVE] OK thank you bye bye.
[CUSTOMER][NEUTRAL] OK.