AccountId: 011433970860
ContactId: 0aa7f6ed-15e8-4df3-9f60-b57f3ef00c7f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 769159 ms
Total Talk Time (AGENT): 248373 ms
Total Talk Time (CUSTOMER): 339495 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/0aa7f6ed-15e8-4df3-9f60-b57f3ef00c7f_20250212T17:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling A with [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I was calling. I was wondering if you could check on a claim for me.
[AGENT][NEUTRAL] OK, I can help you with that. Can I get your name, please?
[CUSTOMER][NEUTRAL] Yes ma'am. My name is [PII].
[AGENT][NEUTRAL] Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] Your policy number.
[CUSTOMER][NEUTRAL] 1775159
[AGENT][NEUTRAL] Can I get your date of birth?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII].
[AGENT][NEUTRAL] Can you verify your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And lastly, your email address.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, Ms. [PII], thank you for that. You said you wanted to check the status of a claim?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and just the
[CUSTOMER][NEUTRAL] Cause I got a thing in the mail yesterday. Oh, I'm sorry, go ahead.
[AGENT][NEUTRAL] I mean, you can go ahead. So you got, you say you got something in the mail and what happened?
[CUSTOMER][NEUTRAL] Um, I got a thing in the mail from y'all yesterday stating that I still needed more information on this one claim, but I think it's crossed in the mail because I think you've gotten that information since then, but I need to find out for sure.
[AGENT][NEUTRAL] OK, what's the claim number that you received, um,
[CUSTOMER][NEUTRAL] Uh, the
[CUSTOMER][NEUTRAL] One second, it is pulling up right now. OK, the claim number.
[CUSTOMER][NEUTRAL] Confirmation.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] When you go on here, oh, it gives you the policy number. I don't see like a claim number under claim number all.
[AGENT][NEUTRAL] Are you on the online portal?
[CUSTOMER][NEUTRAL] Yes, I am, and it says it was put in February, [PII].
[AGENT][NEUTRAL] OK, it's
[AGENT][NEUTRAL] OK, so that one that we received on [PII], that's when we received the claim, but we haven't started working it yet, um, it's still pending.
[CUSTOMER][NEUTRAL] Oh gosh, well you are supposed to have 10 days or whatever. It's been like what, 56 already, business days.
[CUSTOMER][NEUTRAL] I think, well, let's see if it was out on the [PII], what is today? I mean what would today be for the bit.
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] I'm looking at the calendar. Give me one second.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] It's been 6 business days, so we have 10 to 15 business days to process.
[CUSTOMER][NEUTRAL] 10 to 15.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, before you've always told me 10. I've never heard you say 10 to 15 when I'm called.
[AGENT][NEUTRAL] Yeah, I mean, it's the least, the least amount of time it's 10 days, but it hasn't been 10 days yet. Like I said, it's only been in, um, it's only been, let me go back 1234, it's only been 6 days.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK, it, um, when I spoke with y'all about it last week, you said that you had received a bunch of papers that you had to go through for it, but my insurance company had also called me and told me they faxed over, uh, and I'm assuming that's the papers you're talking about, which I want to what I'm trying to make sure of is that you have everything, the EOB.
[AGENT][NEUTRAL] OK, I'm pulling up the actual document, um, let me see.
[AGENT][NEUTRAL] Do you know what the previous claim number is that we were needing more information?
[AGENT][NEUTRAL] For the data service.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm sorry, the previous claim number that was already been filed, you mean, or something?
[AGENT][NEUTRAL] Um, yes, ma'am, that you were stating that we were requesting more information.
[CUSTOMER][NEUTRAL] I see, it said it was for that one. It said it was for the uh service date of [PII], which is the one I'm waiting to be processed. Um, I have an older claim number from a few days ago.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, let me just pull up [PII]. I'm just trying to verify to make sure what we received is for [PII], um, and this is for the chemo, so give me one second.
[CUSTOMER][NEUTRAL] On here.
[CUSTOMER][NEUTRAL] Yeah, it's actually for the um no, it's not for chemo, it's for uh immunotherapy.
[CUSTOMER][NEUTRAL] Same difference though.
[AGENT][NEUTRAL] OK, so what we received on the [PII] is from um.
[AGENT][NEUTRAL] Blue Cross Blue Shield, they did fax something over.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And so it has the EOB there like it should have.
[AGENT][NEUTRAL] That's what I'm going through, um, because there's a few pages, so give me one second. Let me see if it's listed.
[AGENT][NEUTRAL] On what they sent over.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Ah
[AGENT][NEUTRAL] OK, so the EUB that they sent in to us, it doesn't show um.
[AGENT][NEUTRAL] It shows the date of service for [PII], but it doesn't show the charges for um the mean for [PII]. The only thing on here for [PII] is for.
[CUSTOMER][NEGATIVE] Oh no, not
[AGENT][NEUTRAL] Um, an office visit.
[AGENT][NEUTRAL] Uh, with the University of Texas Southwestern.
[CUSTOMER][NEUTRAL] See, I don't know what else to do.
[CUSTOMER][NEUTRAL] I'm not sure what else to do, because you know the OB, the full EOB is supposed to come to my portal, you know. Now, this is February, what?
[CUSTOMER][NEGATIVE] [PII] [PII], [PII] right should fully be there now. And when I go to the EOB, it shows to be there but not all there. And I even called Blue Cross and Blue Cross said, oh, that's not true, it's all there, not looking well then Blue Cross.
[AGENT][NEUTRAL] 12.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Something crazy there. Um, so do I need to call Blue Cross? What do I need to do because otherwise, I don't know how I'm gonna get you that EOB.
[AGENT][NEUTRAL] Yes, so you would need to call them and tell them specifically you're needing the EOB for [PII] that shows your um chemo charges and give them the total amount that you submitted to us and they should be able to send you that because like I said they sent over 15 pages and I went through the pages and
[AGENT][NEGATIVE] And looking at data service 11:18, which I looked at the other pages, but the only one that's for 11:18 would be a charge for an office visit.
[AGENT][NEGATIVE] And nothing for chemo.
[CUSTOMER][NEUTRAL] OK, and the 1118.
[CUSTOMER][NEUTRAL] Would that, was that on a Monday, by any chance? I'm trying to remember. Um, the reason I'm asking is one day in November, I went in, and they said, oh, I think I've had like, um, I'd been sick. And they said, we're gonna do it then.
[AGENT][NEUTRAL] So yes, ma'am, the [PII] is a Monday, but based on what you send in, um, as far as the claim for [PII], it's showing a charge of 43,76921.
[CUSTOMER][NEUTRAL] But the EOB isn't reflecting that.
[AGENT][NEUTRAL] They're on the EOB for that data service it doesn't for chemo. It shows for an office visit, so the EOB we need the EOB that shows chemo charges for that date.
[CUSTOMER][NEGATIVE] and that's literally what y'all told me last time, and I literally called them, and they literally said that they fixed it, and that they resent it to you with all of that on there. And that's what they keep telling me when I call back. I'm really at wits end. I'm very frustrated, and I don't know, is there something besides an EOB that would work? Probably not.
[AGENT][NEUTRAL] No, ma'am, is this, um, your particular of the policy, we have to process the claim based on actual charges and there's actual charges on the EOB, so that's what we would need to go ahead and pay for that data service or any.
[CUSTOMER][NEUTRAL] If I'm to get that, if I get that somehow to you today, will that be starting another 10 to 15 days over though?
[AGENT][NEUTRAL] No, ma'am, we are still, um, as long as we get the information in before we process, um, this claim, it would not be another 10 to 15 business days.
[CUSTOMER][NEUTRAL] OK, let me call Blue Cross and then give you all a call back cause they just keep telling me that they did send it, and they, and I even asked, I said, are you sure? I said, because I got this thing in the mail, and they said we included the immunotherapy and everything on there. And so I'm not sure what else to do, but I will call them right now. What is y'all's fax number again? Because what they said is they can, oh, I'm sorry, hang on my phone. Um, they said they can fax it over.
[CUSTOMER][NEUTRAL] Uh, to you.
[AGENT][NEUTRAL] OK, so our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm sorry, let me get back to
[CUSTOMER][POSITIVE] I'm so sorry, my phone, I'm trying to get where I can save it in my time.
[CUSTOMER][NEUTRAL] Sorry, I've been sick. OK, uh, so it's [PII].
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And if I go, let me, can you, uh, hang on one second.
[CUSTOMER][NEUTRAL] At the APL fax so I don't forget it.
[CUSTOMER][NEUTRAL] Um, while I have you on the phone, can you walk me through something? I'm in your website, um,
[CUSTOMER][NEUTRAL] I'm about to be anyway.
[CUSTOMER][NEUTRAL] All right, let me try it this way and see what happens.
[CUSTOMER][NEUTRAL] All right. So if I'm in your website, and I go down to, and I'm in the Blue Cross website, if I find it myself, what am I going to be looking for? Like I said, I've already went and did the only EOB that was on there, but apparently that wasn't the full EOB.
[AGENT][NEUTRAL] So if you go to um your portal for your insurance, you will be doing the same thing. You will find the one for data service on [PII] and for that provider, um where you're getting your um chemo and immunotherapy done, and it has to show the, for that date and then you would download that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And upload it to the portal.
[CUSTOMER][NEUTRAL] OK, that's what I'm. That's what I want to see if you can walk me through. My daughter's gonna be working late and sometimes I just, I'm not good with checking. I'm trying here. Hang on, let me see if I can pull it up this way.
[AGENT][NEUTRAL] So, are you looking at on your phone or a computer?
[CUSTOMER][NEUTRAL] Right now I'm on my phone. Should I be on the computer?
[AGENT][NEGATIVE] Yes, it won't let you um upload anything from, it won't let you do it from the phone.
[CUSTOMER][NEUTRAL] Oh, OK, hang on just a second. I have to go get my laptop then.
[AGENT][NEUTRAL] But like I said, the way you would do it is, I mean, it, I mean, actually it would kind of be hard for me to explain, but like say you would download.
[AGENT][NEUTRAL] You will save the document to your computer and then once you save it you will upload that to the portal where it says following.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, well I'm gonna first start with calling Blue Cross and see if I can get it faxed to you again that doesn't work then I'll go to the website. OK, well thank you ma'am. I appreciate it.
[AGENT][NEUTRAL] No problem, Ms. [PII]. Was there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No ma'am thank you bye bye.
[AGENT][NEUTRAL] No