AccountId: 011433970860
ContactId: 16397e6d-51dc-4b34-8624-3240f8629c03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1304540 ms
Total Talk Time (AGENT): 423147 ms
Total Talk Time (CUSTOMER): 441111 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/16397e6d-51dc-4b34-8624-3240f8629c03_20250417T20:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Yes, ma'am. How are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][NEUTRAL] Good. I have a couple of questions on some claims that were filed. I got the response and it said that nothing was paid on them, um, and I just need to ask.
[AGENT][NEUTRAL] Yes, the phone is going in and out. You said you had a question about some claims?
[CUSTOMER][NEUTRAL] Right, so I got a um an email that said that they had been finalized, but then the amount on it is $0 that they're not paying on them, um, and it's intensive care claims and I was in intensive care, so, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can definitely, I can definitely take a look at the claims and the policy and and go over it with you. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Not real sure what.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. May I have your policy number?
[CUSTOMER][NEUTRAL] 644-578 is one of them I think.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, I just need you to verify your first and last name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. And can you verify your mailing address and the email address on file?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and the claims are for you or your dependent or spouse.
[CUSTOMER][NEUTRAL] For myself.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII] and this claim is being paid out to you $900.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the claim, let me see, hold on, let me go back.
[CUSTOMER][NEUTRAL] And that is
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] No, OK, go ahead. I had two separate things I think I sent in one for ICU and one for.
[CUSTOMER][NEUTRAL] Travel or or something I don't remember what it was.
[AGENT][NEUTRAL] So it looks like they just
[CUSTOMER][NEUTRAL] There were several that I filed at the same time.
[AGENT][NEUTRAL] Like they just finished processing it today. Um, let me see.
[AGENT][NEUTRAL] This also daily hospital benefit is $300 a day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 69
[AGENT][NEUTRAL] Is there
[AGENT][NEUTRAL] I mean, you have a cancer policy. I can look and see if there's something filed under there.
[CUSTOMER][NEUTRAL] There was, there was one filed under ICU and then the others were filed under cancer, so they were filed two under two different ones. Yes, ma'am, but the 900 and something is already gone. It's doing a direct deposit, correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Right, that's direct deposit as well. This, OK, so this one has the denial.
[CUSTOMER][NEUTRAL] Does that have a date when that May?
[AGENT][NEUTRAL] Well, it just finished processing, um, it has like a generic date on it now of [PII] because it just finished processing. So at [PII], it goes out to the banks and everything will reset so we can see correct data, like [PII] it will show today.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh, OK. All right, great. Thank you.
[AGENT][NEUTRAL] You're welcome. Um, hold on one moment and let me see what this reason is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So that's for the ambulance? Yes. OK.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] And I didn't file ambulance. I don't, I think that was just attached to my bill. I, I wasn't trying to file an ambulance.
[CUSTOMER][NEUTRAL] I think that just showed the date, you know, when I went in is what I was trying to do there because I didn't have anything from the hospital.
[AGENT][NEUTRAL] So what um for this claim, what were you trying to file for?
[CUSTOMER][NEUTRAL] So they should cover my travel back and forth to [PII] [PII] to the cancer center. Um, it's what they've done in the past, and it was like at 51 cents, 52 cents a mile or something like that. Um, and so that's what that should have been for.
[CUSTOMER][NEUTRAL] And I read it on those forms, like that's what they told me to write.
[AGENT][NEUTRAL] OK, hold on, because let me see.
[AGENT][NEUTRAL] I don't see.
[CUSTOMER][NEUTRAL] And when I spoke with them at first they were like, no, you don't have that. And then she read my policy and she's like, you do have travel up to 500 miles to and from um to the cancer center. And so she told me what to write on there and
[CUSTOMER][NEUTRAL] How to do that and so I did but it looks like they, I don't know if maybe the next person overlooked it on my policy, but it is on my policy they paid paid me for it in the past.
[AGENT][NEUTRAL] OK. I'm not saying that they don't, I don't see a like a charge for travel. It's only daily hospital benefits, surgery, anesthesia, and ambulance. So I'm not saying you don't have mileage. I'm saying I don't see like a travel cost or charge.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, let me look at what
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's in there, um.
[AGENT][NEUTRAL] Let me take a look at the um documents that were sent over in the policy and then I can know, I can help you more clearly, OK?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for the wait. Um, we received a few different, um, submissions between [PII] and [PII], so I was going through all of them, um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] From what we received, there's nothing here for transportation. It's your claim form and itemized bills, um, which is why this claim has been denied because most of the denial reasons are asking for the pathology report because it's itemized bills from, um, some are Anderson and some are um rush.
[CUSTOMER][NEUTRAL] OK, no, that, that's, that's not, I don't think the ones I'm talking about. Um, so,
[CUSTOMER][NEUTRAL] The ones they travel.
[CUSTOMER][NEUTRAL] There were several for did you receive those? I think I sent on 3 different dates. Maybe I never sent the travel ones then.
[AGENT][NEUTRAL] I don't think you did because the last claim before this one was from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, they should have been for travel to MD Anderson in [PII], and there were several visits out there, um, that I sent the travel claims in.
[AGENT][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] Maybe I never faxed them or maybe you just never.
[AGENT][NEGATIVE] But there, no, I definitely didn't see anything for um [PII], and the only reason um
[CUSTOMER][NEUTRAL] You didn't get them?
[AGENT][NEUTRAL] My family is from Meridian, so I'm familiar with Rush and Anderson, but I didn't see anything from [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, but there's no like
[CUSTOMER][NEUTRAL] Yes, so when I try, when I go out.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's no um filing limit or like deadline, so you can still send that in and it can still be processed.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Sure, I have them ready. I, I, I thought I thought I faxed them all and, and put them in a rubber band and, you know, until it was finalized, but I will just refax them tomorrow when I go into work. But there were several travel claims um for, for visits at MD Anderson. And so what I'm wondering is, did
[CUSTOMER][NEUTRAL] I would have written it on the claim form, you know, the mileage and everything, because that's what that was. Um, but I also sent in like the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I guess yeah, but just to show my doc, you know what?
[CUSTOMER][NEGATIVE] OK, I think I'm wrong. I don't think I ever sent them because I had to go in on my my chart and show my visit, and I didn't ever do it. You're right, I'm looking for something I never submitted.
[CUSTOMER][POSITIVE] I'm so sorry. OK, so
[AGENT][MIXED] No, it's OK. I'm just glad we, you know, misplaced.
[CUSTOMER][NEUTRAL] Yes, I did, I've got them in a sack and I, I know what happened. I'll work on that tonight. Um, that's, that's my fault. Sorry about that. Um, so the ones that you're saying are denied um for lack of pathology.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] Yeah, so let me see, so there's
[AGENT][NEUTRAL] There's a few different denial reasons. Um, some of the ones like the daily hospital benefits, those were denied because they were paid on, that's part of that 900.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The, let me see what this other one is.
[AGENT][NEUTRAL] There's one in here. Um, well, actually,
[AGENT][NEUTRAL] 123, of the codes here were denied asking for the pathology report to give consideration for the procedure.
[CUSTOMER][NEUTRAL] OK, so let me ask you about this. So my original diagnosis is pancreatic cancer. They, in [PII], they removed my pancreas completely. Um, so I have no pancreas anymore.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Which so-called took away the cancer. However, it left me very brutal in many ways, which causes me to have to go in like to ICUs and things like that because I'm such a brutal diabetic. But I'm not just like a diabetic because I eat the wrong foods or because I'm a type one. It's because of the cancer diagnosis. And so the pathology is not gonna be pulled every time because I don't have a pancreas anymore.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So, do you see what I'm saying? Like it's all because of.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So will they not cover that?
[AGENT][NEUTRAL] So, let me do this. Let me get a claims examiner on the line for you, only because they're examining the claim and they know what they're, you know, they know what they're looking for and you know, those rules, and I would, I want you to have an accurate answer. Um, so I can get the claims examiner on the line for you and then they'll be able to talk about that and any other, um, you know, detail, more in detail.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, absolutely.
[CUSTOMER][NEUTRAL] OK, perfect. Thank you so very much. And then let me ask you one last question while I have you on the phone. What do you need me to send with this travel? Um, just like they told me just the address, you know, from home to [PII], um, but I've got to prove that I was coming out there for something. So do I just send like my office visit or like the time and date of my office visits, or how do you want me to do that?
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, no, no, no, you just have to, it just needs to be the address to your home, uh, well, from your home to the location you're receiving the treatments for, um, from, and it pays out 15 cents per mile and it needs to be a minimum of 50 miles, but as, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] But yeah, I do see your transportation benefit here, so.
[AGENT][NEUTRAL] Oops, it went in and out.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] So really, I don't need to go through and print out all of those. Yes, are you there?
[AGENT][POSITIVE] Yes, it went in and out. Yes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, so I don't need to go back and pull all of my my visit dates and times and all of that stuff just in that mileage.
[CUSTOMER][NEUTRAL] And the addresses.
[AGENT][POSITIVE] Correct, and the itemized bills.
[CUSTOMER][POSITIVE] Great. OK.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, so you do need itemized bill. OK, that's what I was asking what you need.
[AGENT][NEUTRAL] Mhm. The itemized bill is, yeah.
[AGENT][POSITIVE] And that will tell us the um the dates and everything, so you don't have to like get notes or anything.
[CUSTOMER][NEUTRAL] OK, bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's why I was trying to be, that's why I never sent it because I was like, how am I gonna go through my chart and like print out every time I was there every visit, you know, so, OK, that makes sense. I'll just get them to send me over billing for all of this. All right, well, I surely appreciate your help. Thank you so very much.
[AGENT][NEUTRAL] You're very welcome. Well, before I get a claims examiner on the line for us, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] I know, I believe that's it. Thank you.
[AGENT][POSITIVE] You're very welcome. Hold on one moment and thanks for calling APL.
[CUSTOMER][NEUTRAL] Hi, [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you?
[CUSTOMER][POSITIVE] Doing well [PII] thank you how are you?
[AGENT][POSITIVE] I'm doing good. Um, I have an insured on the other line. They
[AGENT][NEUTRAL] So she had pancreatic cancer. Now she's getting um
[AGENT][NEUTRAL] Like treatments because of the damage it did, and we're asking for a pathology report. I have the policy number. It's 644.
[AGENT][NEUTRAL] 574.
[CUSTOMER][NEUTRAL] OK, let me pull that up.
[AGENT][NEUTRAL] And we're, we're asking for a pathology report, but she's like, well, I, I haven't had one recently. This is just
[AGENT][NEUTRAL] Um, she says she's brittle and things, so she goes into the ICU every now and then because of the cancer, but she doesn't have like, I guess an updated pathology report. I didn't know how to, she's asking what to do.
[AGENT][NEUTRAL] I don't really know.
[CUSTOMER][NEUTRAL] So did she send in the previous one or we don't know.
[CUSTOMER][NEUTRAL] Because it says it's for the day's [PII] you don't see one?
[AGENT][NEUTRAL] No, I don't
[AGENT][NEUTRAL] I don't see a pathology report in there.
[CUSTOMER][NEUTRAL] Or you don't know?
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] I looked on on-base, I mean, there's quite a few um.
[AGENT][NEUTRAL] I guess like lines. So I went through all of them, but I don't see, I see itemized bills in the claim form. I didn't see a pathology report and that's what we're asking for, but she doesn't, she doesn't know if she can use the previous one. I didn't tell her she could. I didn't know how to answer the question.
[CUSTOMER][NEUTRAL] Well if that's all she has then yeah she would need to send that in but um I will um speak with her. I'm gonna pull up some of this mail and it it's and it's uh regarding the yeah I see that mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a lot too.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And she's been verified [PII]?
[AGENT][NEUTRAL] Yes, fully verified.
[CUSTOMER][NEUTRAL] And that's her phone number listed [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And [PII], right?
[AGENT][POSITIVE] Mhm. That's correct.
[CUSTOMER][POSITIVE] Alrighty you can go ahead and transfer when you're ready.
[AGENT][NEUTRAL] All right, thank you, [PII]. Hold on one moment.
[CUSTOMER][POSITIVE] Sure, you're welcome [PII].
[AGENT][NEUTRAL] Hello Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Hey, thank you so much for holding.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, I'm here hello.
[AGENT][NEUTRAL] Sorry, [PII], my phone just went completely out. I apologize.
[CUSTOMER][NEUTRAL] Hi Miss, my name is.
[CUSTOMER][POSITIVE] That's OK, go ahead and transfer. thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Besides
[CUSTOMER][NEUTRAL] Can you hear me OK