AccountId: 011433970860
ContactId: 1e9cfa60-65be-4446-8c7f-dcfeab071697
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 949760 ms
Total Talk Time (AGENT): 139332 ms
Total Talk Time (CUSTOMER): 147318 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/1e9cfa60-65be-4446-8c7f-dcfeab071697_20250304T20:52_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, you said your name is [PII]?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from [PII]. I am calling on behalf of a policy holder that passed away.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm calling on behalf of the next of kin.
[AGENT][NEUTRAL] OK, and um Miss [PII], um, let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, um, do you have a policy number for me?
[CUSTOMER][NEUTRAL] Uh, hold on one second, I don't.
[CUSTOMER][NEUTRAL] I think they gave me that. Let me see if it's in.
[CUSTOMER][NEUTRAL] Other notes.
[CUSTOMER][NEUTRAL] I have, member ID?
[AGENT][NEUTRAL] Let me try that.
[CUSTOMER][NEUTRAL] It's 207-842-2.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What's the name of the insured?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what's the date of birth for verification?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And you say you're calling on behalf of the nurse of um what's the name of that person?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] How may I assist you?
[CUSTOMER][POSITIVE] Yes, I am the dedicated advocate that's gonna assist with providing, um, the explanation. I understand you all need some explanation of benefits for Mr. [PII]. I just wanted to call and get exactly what it is you all are needing, um, so I can get that information gathered, um, for her.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, um.
[AGENT][NEUTRAL] Let me go over the claim, OK? Um, do you mind holding for me?
[CUSTOMER][POSITIVE] Uh, sure, no problem.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Ms. [PII]. OK, so basically, it's gonna be for any um chemotherapy, radiation therapy, or immunotherapy.
[CUSTOMER][NEUTRAL] OK, so you need ELBs that relate to any.
[CUSTOMER][NEUTRAL] Chemo
[AGENT][NEUTRAL] Chemotherapy, radiation therapy, or immunotherapy?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, for what time frame?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It looks like it's starting.
[CUSTOMER][NEUTRAL] Like during that his entire like.
[AGENT][NEUTRAL] I will say during the whole time because um I know she just started sending documents and um
[AGENT][NEUTRAL] Let me see if I have a specific day on any of these. Let's see, uh, no.
[CUSTOMER][NEUTRAL] I think he was diagnosed with [PII], so you all need it going back to [PII].
[AGENT][NEUTRAL] Yes. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now I have a question, um, does it have, does it have to be a full explanation of benefit or can y'all take like a claim history itemization report?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We pay actual charges.
[AGENT][NEUTRAL] So usually they ask for the um explanation of benefits to pay actual charges.
[CUSTOMER][NEUTRAL] OK, because the, the claim history, it'll show it shows pretty much everything that's on the explanation the benefit is just compacted.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, and so smaller.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] Um, you can send that.
[CUSTOMER][NEUTRAL] So it, it did show the bill amount it'll show what we paid, it'll show um you know if anything there was any kind of denied.
[CUSTOMER][NEUTRAL] Anything that didn't that was denied, patient responsibility, it shows all of that.
[AGENT][NEUTRAL] OK, let me have that name again and let me send that over and see if that will be OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] A claim history itemization report.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me ask um claims.
[CUSTOMER][POSITIVE] OK, no problem, thank you.
[AGENT][NEUTRAL] An apartment.
[AGENT][POSITIVE] You're welcome. OK.
[AGENT][NEUTRAL] It's gonna be one more minute, OK, let me see if I can get somebody in that department one moment.
[CUSTOMER][NEUTRAL] No. 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.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Ms. [PII]. I'm sorry for that wait. Um, yes, it looks like we are gonna need the EOB.
[CUSTOMER][NEUTRAL] Nope.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][POSITIVE] It cannot be the report. I'm so sorry.
[CUSTOMER][POSITIVE] It's all right. I just have a lot of work ahead of me.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] All righty.
[AGENT][NEUTRAL] Yeah, yes, and I said, I have the insurance on the line, not the member, and they're like, we still need to. I'm like, OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right. Thank you so much for your assistance.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today? Any questions or concerns?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No, ma'am, that's all I needed.
[AGENT][POSITIVE] OK. All right, well thank you for calling APL. Have a good afternoon.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] Thank you, bye bye.