AccountId: 011433970860
ContactId: 25f6e7b7-4c2a-4789-8075-8ffab60919ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420239 ms
Total Talk Time (AGENT): 115439 ms
Total Talk Time (CUSTOMER): 275451 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/25f6e7b7-4c2a-4789-8075-8ffab60919ad_20250114T18:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I think I pushed the wrong extension on accident. I was talking to [PII] about submitting some claims.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And I had a question for her and the only question because I know that I'm gonna have to go through a ton of different places to get diagnosis codes and so forth, do the Medicare forms that I get that show the diagnosis codes and so forth, would that work?
[AGENT][NEUTRAL] Yeah, so do you have like a, you have a secondary plan with us it sounds like?
[CUSTOMER][NEUTRAL] The what Medicare?
[CUSTOMER][NEUTRAL] Um, yes, we have, uh, just a, it was just a supplemental plan that the cancer policy is what we had, but we have Medicare and then we had.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, ma'am.
[CUSTOMER][NEUTRAL] Pardon me?
[AGENT][NEUTRAL] Oh yeah, no, go ahead. I'm sorry, I was just listening.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, we have, he's on Medicare. My husband diagnosed with cancer last year, so we've just been waiting until we can, you know, get most everything together, and I was just talking to [PII] on filing the claim, which she was very very helpful and but then I got thinking well instead of calling all these individual places that have because we've had, you know, home health and hospital visits and all kinds of stuff.
[CUSTOMER][NEUTRAL] Different doctors and infectious disease and so forth and so forth would be, can I send in the Medicare EOBs that showed everything that was done along with the pathology or the pathology report when he was officially for.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Diagnosed with cancer.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Does that work or do I need to contact every single place and have them.
[AGENT][POSITIVE] Let me double check. I think, yeah, I think that the EOB would definitely work since um.
[CUSTOMER][NEUTRAL] You know, because the
[AGENT][NEUTRAL] That's your primary. I'm gonna double check just to make sure because I don't want you to submit all that and then you know um let me just, and it's a cancer claim, right?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, and I've been talking to [PII] and I have the policy number.
[CUSTOMER][NEUTRAL] I just got to thinking well before I contact all the years and everything I mean it was so much, you know, rehab and hospital visits and transfusions and so many different things happened from May till now.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you know, infusion labs and that that would just be, it would take forever to get hold of all those people to send me.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Of codes.
[CUSTOMER][NEUTRAL] And I think when I get that Medicare in the mail.
[CUSTOMER][NEUTRAL] It does it by quarterly and it shows everything because the secondary doesn't pay unless Medicare approves it.
[CUSTOMER][NEUTRAL] And the secondary was actually Omaha Mutual.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] But everything should be on the Medicare claims, you know what I mean?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I don't even think I need to send the secondary the Mutual of Omaha.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because APL will only pay a certain amount of whatever was done right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, there's, yeah, there is always, I know, like a benefit max like a limit on it. um I had just reached out to my help desk. I'm just waiting to hear back as far as like if you're gonna need to contact each provider for like a bill with you know uh itemized or hopefully you can just do the EOBs here and that'll be much easier for you.
[CUSTOMER][NEUTRAL] OK, so as long as
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, because I think I think like right now I got.
[CUSTOMER][NEUTRAL] I have here and it on there it says the pathology lab it lists all the places Tulsa Hospital OU O on Heart and then it through the doctor is exactly what they did. Uh, does it have codes on it, service provider and billing code. It does have codes.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I would say because that's it tells exactly who the doctor is and who the what they did and heart heart muscle strain and all the it says service provided and billing code.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I was thinking at one time that they said that.
[CUSTOMER][NEUTRAL] So I think if I got hold of Medicare and just had them send me.
[CUSTOMER][NEUTRAL] Everything from May, from first diagnosis to end of this year, last year.
[CUSTOMER][POSITIVE] Then and then I can file another report next year when we know that he's all clear for sure.
[CUSTOMER][NEUTRAL] Hopefully
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Because he's still gonna have to be going in and having por port stuff done, you know, he's gotta keep that so I got him.
[CUSTOMER][NEUTRAL] Kind of keep an eye on it, make sure it doesn't come back.
[AGENT][NEUTRAL] Right. Yeah. OK, let's see.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And he's still going for neuropathy because the chemo gave him chemo-induced neuropathy.
[AGENT][NEGATIVE] Oh, no.
[CUSTOMER][POSITIVE] But better than having cancer, right?
[AGENT][NEUTRAL] I mean, yeah, that's true, that's true. Um.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] Yeah, it's just stinks but.
[CUSTOMER][NEUTRAL] So he's still in rehab for that so I know there's gonna be more things that I'm gonna be sending in next year, but I thought, well, I'll just do it by the year.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] You know, just figure everything out this year and then do everything at the end of next year when we know everything's hopefully.
[CUSTOMER][NEUTRAL] Don
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] So it looks like if you're gonna be filing a claim for any sort of hospitalization, surgery, chemotherapy, radiation, those do need itemized medical bills from the provider plus the explanation of benefits. So it looks lik[PII] you do have to have the itemized bill.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, alright, I'll just, that's OK. I've got all their information on these Medicare things, so I'll just put that on there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Is there anything else I can check?
[CUSTOMER][NEUTRAL] I'll just start working on it.
[AGENT][NEUTRAL] I know, yeah, sorry.
[CUSTOMER][POSITIVE] No, hey, it's OK. I'm not complaining. I'm glad that you know we had that supplemental policy for years and never did anything with it and then, then we needed it, you know, overnight, so I appreciate it.
[AGENT][POSITIVE] Yeah, yeah, absolutely. No worries. Anything else I can check on for you?
[CUSTOMER][POSITIVE] OK, well thank you so much.
[CUSTOMER][POSITIVE] No, I, I, I appreciate it thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK.