AccountId: 011433970860
ContactId: 0b06bf78-700d-4036-9eb7-c8cbf56ba5e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 574250 ms
Total Talk Time (AGENT): 198454 ms
Total Talk Time (CUSTOMER): 279871 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/0b06bf78-700d-4036-9eb7-c8cbf56ba5e4_20250507T22:11_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII], it's [PII] in the care team. I've got an insured on the phone. Her name is [PII]. Um, her policy number is 755,880. She has verified all of her information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She is calling about claim number the 1st 1 359-6115.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim has many remarks on it and she just needs to speak to somebody so that she can get a good understanding of what all she still needs to send in.
[CUSTOMER][NEUTRAL] And how the claim was processed.
[AGENT][NEUTRAL] OK, send it on over.
[CUSTOMER][POSITIVE] Alright, thank you, Ms [PII] bye bye ma'am.
[AGENT][NEUTRAL] OK, you're welcome. Uh-huh.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, how are you?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Doing OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, you said you were needing some.
[CUSTOMER][NEUTRAL] have questions about my, yeah, about my claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright and so uh what was your question on the claim?
[CUSTOMER][NEUTRAL] Well, apparently there's a million remarks and things that are still needed. I submitted a whole bunch of paperwork, all the bills and whatnot, because I, you know, it was a lot. So I submitted a whole packet.
[CUSTOMER][NEUTRAL] And knew it was gonna take a while, but I, I got a text today saying that my claim was
[CUSTOMER][NEUTRAL] I don't know how they exactly said it. I don't know if they said it was ready or what, but so I'm now learning. I really do need somebody like you. You're, you're a claim specialist, is that correct?
[AGENT][NEUTRAL] Uh, yes, I'm in the claims department. I'm in the claims department, yes ma'am.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] You need my claim number and all that?
[AGENT][NEUTRAL] No, ma'am. She gave it to me.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Can you help me uh go over all these comments and remarks so that I can um know how to respond?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like the main.
[CUSTOMER][NEUTRAL] And I, I mean, it's
[CUSTOMER][NEUTRAL] Go ahead. I'm sorry. Am, am I going to get this in, in the mail, this remark?
[AGENT][NEUTRAL] Yes, ma'am, you are.
[CUSTOMER][NEUTRAL] OK. I mean, cause I don't know what I'm looking at, you know what I'm saying? And I looked in my, at the um
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] The information online, uh, it, it didn't even show me anything about this claim number 359-6115, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like the main thing that they're needing to uh finish processing your claim is the pathology report, uh, diagnosing, first diagnosing the cancer.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, so it looks like we do not have that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think that is just crazy that in all this stuff, it was not included. OK, so I will.
[CUSTOMER][NEUTRAL] Up to
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So do you, do you know which doctor, or the name of the doctor that diagnosed the cancer?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] OK, and do you know if that information was sent in?
[CUSTOMER][NEUTRAL] Doctor,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I asked for all the billing from uh Lehigh Valley Health Network, and it says HB diagnostic breast uh da da da da da.
[CUSTOMER][NEUTRAL] I don't know if you
[CUSTOMER][NEUTRAL] It has all the diagnosis codes.
[CUSTOMER][NEUTRAL] But you need a report.
[AGENT][NEUTRAL] Yes, ma'am. The pathology report, the pathology report, so.
[CUSTOMER][NEUTRAL] Is that what you're telling me?
[AGENT][NEUTRAL] Probably when you went in, uh, did they do a biopsy or something like that on you?
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] OK. So when you went in and had the biopsy done, uh, there was probably was a path report. I'm sure there was a path report that they had that actually diagnosed the cancer. And so that's what we're needing so that we can uh finish reviewing your claim for payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah, so whoever you whoever you went to.
[CUSTOMER][NEUTRAL] And uh I send that to the same place I sent it.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] All my other information.
[AGENT][NEUTRAL] Mhm, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Now what? What else?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see, let's go back.
[CUSTOMER][NEUTRAL] Said no lab tests were covered for and no office visits are covered.
[AGENT][POSITIVE] Yes ma'am, that's correct.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Let's see duplicate.
[AGENT][NEUTRAL] That is.
[AGENT][NEUTRAL] OK, the radiation delivery, uh, that was not covered because the policy does not cover, um.
[AGENT][NEUTRAL] The radiation chemo uh benefit does not cover other procedures related to the radiation.
[AGENT][NEUTRAL] So any of the devices or the uh the scans, medical supplies and equipment or anything the IV or the catheters that they use, uh, so I'm guessing you send in some information for that.
[AGENT][NEUTRAL] Those things are not covered under the uh under your radiation and chemotherapy benefit.
[AGENT][NEGATIVE] So those were not payable.
[CUSTOMER][NEUTRAL] But the radiation and the chemotherapy were covered, correct? It's just you're saying that any additional tests and stuff were not that they had to use in order to uh administer it.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, those
[AGENT][NEUTRAL] Yeah, any of the supplies.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and for your transportation, um, the policy only provides a transportation benefit when the distance is at least 50 miles, so you have to travel at least 50 miles away from your residence in order for them to pay the transportation.
[AGENT][NEUTRAL] Benefit
[CUSTOMER][NEUTRAL] I was on an IV and that's why they would not let me.
[CUSTOMER][NEUTRAL] Go myself. So I had to travel in from one hospital to the other.
[CUSTOMER][NEGATIVE] And they charged me $1,374 and so y'all don't cover that at all.
[AGENT][NEUTRAL] Not unless
[CUSTOMER][NEUTRAL] Because it wasn't far enough.
[AGENT][NEUTRAL] Yeah, because it wasn't over 50 miles, yes ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] Oh, I know it's possible I'm gonna keep.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And so all of your other, the surgeries, the anesthesia, the chemo and radiation, the um
[AGENT][NEUTRAL] Your drugs.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] All those other benefits the transportation. Yes, ma'am. All of that is dependent.
[CUSTOMER][NEUTRAL] I was hospitalized for a week.
[CUSTOMER][NEUTRAL] I would try
[AGENT][NEUTRAL] All of that is dependent upon us getting the actual pathology report.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that we can review it.
[CUSTOMER][NEUTRAL] Because I, I had, yeah, I had a
[CUSTOMER][NEUTRAL] Uh, I almost got sepsis from a um
[CUSTOMER][NEUTRAL] Infection where the surgery site was. So,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Yes, ma'am. So I see all of that.
[CUSTOMER][NEUTRAL] So it's related to the initial surgery, huh?
[AGENT][NEUTRAL] OK. I said, OK, I said I do see a lot of uh a lot of charges here.
[AGENT][NEUTRAL] But once we get the pathology report, they'll go back and review everything, you know, to see if we can make a payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Alright, was there anything else I can help you with? You just found it?
[CUSTOMER][NEGATIVE] I just find it bizarre.
[CUSTOMER][NEUTRAL] I, I
[CUSTOMER][NEGATIVE] No, no, I, I, I, I'm looking at all the paperwork that I sent y'all. It's just shocking to me that.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I, I have another.
[CUSTOMER][NEUTRAL] Had another um.
[CUSTOMER][NEUTRAL] Policy and submitted all of this, and that was never, never asked for. I, or, you know, it, it, I didn't look through here. I don't know how to read all this. But I will see if I can get you all a pathology report.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so you don't make a phone call to LVHN for a pathology report. I, I've submitted all this, but y'all don't do any follow up. I have to submit it, is that correct?
[AGENT][POSITIVE] Um, usually that is how it's done, yes ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Mhm. All righty. OK. Well, um thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty
[AGENT][POSITIVE] You have a great rest of your day. OK, bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. You too. Bye-bye.