AccountId: 011433970860
ContactId: 2c08ea72-ae32-4b00-b0df-dc2e2a7d6b11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 750820 ms
Total Talk Time (AGENT): 212753 ms
Total Talk Time (CUSTOMER): 390767 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/2c08ea72-ae32-4b00-b0df-dc2e2a7d6b11_20250421T17:10_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm doing good and you?
[CUSTOMER][NEUTRAL] Doing all right thank you. I've got a member I'm needing to transfer to you um she's calling regarding a uh claim uh for her cancer policy um it looks like we're there's some that we paid and then some we were just kind of missing some information for and I don't think she is quite understanding um the amount that we paid we sent by check and she's stating that it's not enough.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, even though it does state that's the full amount that we were billed for and that that was the actual charges, and I tried explaining that to her, um, so she's not sure what additionally she needs to do. I did tell her if that's incorrect, you know, then we would need that corrected information, um, so I think she's just really needing it.
[CUSTOMER][NEUTRAL] Further broken down, I think.
[AGENT][NEUTRAL] Alright, what's the policy number?
[CUSTOMER][NEUTRAL] That is 595659.
[AGENT][NEUTRAL] Is it the claim that was processed on 140 or 411?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Yes, uh, the one ending in 328.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is
[AGENT][NEUTRAL] OK, you can send her over.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII].
[CUSTOMER][NEUTRAL] Um, uh, I guess the
[CUSTOMER][NEUTRAL] The person I was talking to must have connected me with you.
[AGENT][POSITIVE] Yes ma'am, she said you needed.
[CUSTOMER][NEUTRAL] She had me on hold.
[AGENT][NEUTRAL] OK, she said you needed a little bit more explanation on your uh claim that we processed for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][POSITIVE] I have, I'm having trouble I guess with a Credo pharmacy. I've never had trouble like this with CVS. They, they were always so good about sending me exactly what I needed to send on to y'all for the policy. So y'all have issued me a check for.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, only 5,163 and, and the, you know, the policy is 10,000 a year. So on the back of the check it, there's two remarks.
[CUSTOMER][NEUTRAL] And it says please provide the itemized billing from the provider's office showing the procedure codes and charge amounts for each service rendered.
[CUSTOMER][NEUTRAL] So that's a credo needs to do that, right?
[AGENT][NEUTRAL] Uh, looks like they have express strips.
[AGENT][NEUTRAL] Is that who you receive uh.
[CUSTOMER][NEUTRAL] Well, yeah, it's, it, I guess it is Express Scripts. Uh, it's a Credo pharmacy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That my chemo pill comes from, but I guess this is Express Scripts.
[CUSTOMER][NEUTRAL] Cause I saw that on there too. I kept thinking this has to be from a credo.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, I don't even understand that. Uh, are they together? Are they part of each other? I don't get that either. A credo and Express groups.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] I'm, I'm still looking, OK, I'm still looking through your information, but all this, it says express strips on this one. Let me see what I'm going through everything that you sent in to us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Actually it does on my, yeah, that's what I sent in. It does say express cribs.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess I
[CUSTOMER][NEGATIVE] I don't know, it was so hard to get even when I got.
[AGENT][NEUTRAL] It looks like they are.
[AGENT][NEUTRAL] OK, it looks like they're they're still the same because they say thank you for choosing the Credo pharmacy.
[AGENT][NEUTRAL] Um, so I would contact them to see if they could send you something with the CPT codes or the codes for your chemo.
[AGENT][NEUTRAL] And it looks like that's what they're needing to finish processing.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Because 14 chemo and
[CUSTOMER][NEUTRAL] And that would come from them, right?
[CUSTOMER][NEUTRAL] From Express Script.
[AGENT][NEUTRAL] I, I would, I would contact a credo and if aredo cannot give it to you, um, then maybe check with Express Strips to see um who can get those codes to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So what, when I sent in didn't have codes on it, you're saying?
[AGENT][NEUTRAL] No, ma'am, it just has the uh dates of service.
[AGENT][NEUTRAL] Uh, the submitted charge amount, the approved charge amount.
[AGENT][NEGATIVE] And the payable it doesn't have any codes.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so, OK, so everything I send in that all needs codes for the chemo and then the other remark says benefits provided based on the actual charges obtained from the provider's billing for these dates of service.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What does that mean? What does that mean?
[AGENT][NEUTRAL] OK, so on the.
[CUSTOMER][POSITIVE] Benefits provided.
[AGENT][NEUTRAL] So on the last page it has the bill amount of 5,16311.
[AGENT][NEUTRAL] So that's we paid that amount.
[AGENT][NEUTRAL] For the um
[CUSTOMER][NEUTRAL] You mean that?
[CUSTOMER][NEUTRAL] Is that what I sent him?
[AGENT][NEUTRAL] Yes ma'am it is.
[AGENT][NEUTRAL] And that's on page 10.
[AGENT][NEUTRAL] Of the information sending.
[CUSTOMER][NEUTRAL] And where did they get that amount?
[CUSTOMER][NEUTRAL] Well, I see an amount here 6,0167731.
[CUSTOMER][NEUTRAL] I see that on a page.
[CUSTOMER][NEUTRAL] Do you see that one?
[CUSTOMER][NEUTRAL] It says patient totals.
[CUSTOMER][NEUTRAL] Well first it says in the first column submitted.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 8000
[CUSTOMER][NEUTRAL] You see that one?
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Where it says 8,0006.
[CUSTOMER][NEUTRAL] 64, I know.
[CUSTOMER][NEUTRAL] No, it says 86,179 62 under submitted then approved it says 62,000.
[CUSTOMER][NEUTRAL] Do you see that page?
[AGENT][NEUTRAL] I do. And uh that's the, those are what they're needing the actual uh CPT codes or the codes for the, for the chemo, so.
[AGENT][NEUTRAL] That's what they're needing the codes for those dates, all of those dates.
[AGENT][NEUTRAL] And once they get that they can go back and review those for additional payment.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] I still don't see the 5000 you're talking about.
[AGENT][NEUTRAL] On page 10.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Um
[AGENT][NEGATIVE] Of the information from Express rips.
[AGENT][NEUTRAL] And that one actually.
[CUSTOMER][NEUTRAL] Let me see here.
[AGENT][NEUTRAL] It's the very last page on the information that we're looking at.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] It's an invoice from Express Strips.
[AGENT][NEUTRAL] And it has your, yes ma'am it says Spirace or Spri cell, the 20 mg tablet.
[CUSTOMER][NEUTRAL] Oh, the invoice one?
[CUSTOMER][NEUTRAL] 00, I see. Oh, OK, I see it now.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That's the 5,0001.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I see 5000.
[CUSTOMER][NEUTRAL] 11481.
[CUSTOMER][NEUTRAL] On that invoice.
[AGENT][NEUTRAL] Uh, the bill amount was.
[CUSTOMER][NEUTRAL] Oh, but then there's a
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] The bill amount was $5,163.11.
[CUSTOMER][NEUTRAL] Right, oh.
[CUSTOMER][NEUTRAL] I do see that one. OK, build them out, OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So our
[CUSTOMER][NEUTRAL] And are y'all needing more dates of when I got the pills?
[CUSTOMER][NEUTRAL] Or just the codes.
[AGENT][NEUTRAL] Just the codes.
[AGENT][NEUTRAL] So they can see on this one they can see what type of pill you got because it does have a description in the name of the pill that you received. The other charges just have.
[AGENT][NEGATIVE] It doesn't, it just shows the date of service, your prescription number, and the charge amount. It doesn't list.
[AGENT][NEUTRAL] What type of chemo drug you receive?
[AGENT][NEUTRAL] I thought so it could be the same as the one that's on your invoice but we have no way of knowing if it is or if it's not.
[AGENT][NEUTRAL] So that's why we need that code, yes ma'am.
[CUSTOMER][NEUTRAL] Oh yeah, it, it.
[CUSTOMER][NEUTRAL] Oh, it is, but um.
[CUSTOMER][POSITIVE] Oh my goodness. OK.
[CUSTOMER][NEUTRAL] I hope they're gonna know what I need when I call them.
[CUSTOMER][NEGATIVE] They're, they're pretty difficult for me to work with anyway.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] What is the remark #2 mean benefits provided.
[CUSTOMER][NEUTRAL] Based on the actual charges obtained.
[CUSTOMER][NEUTRAL] Is that the amount of the check it?
[AGENT][NEUTRAL] Is that for the
[AGENT][NEUTRAL] Is that for the 5,163 11?
[CUSTOMER][NEUTRAL] I guess, I guess that's what it means that's the, that's the remark for the, uh, that means that's why I got that amount on the check.
[AGENT][POSITIVE] Yes ma'am, that's correct.
[CUSTOMER][NEUTRAL] But, but the first remark is saying they need.
[CUSTOMER][NEUTRAL] I my billing for the procedure codes, showing the procedure codes and charge amounts. So they haven't done the number one remark.
[CUSTOMER][NEUTRAL] That's what you're saying?
[AGENT][NEGATIVE] The one where we're asking for the itemized billing, no, we have not made payment on those.
[CUSTOMER][NEGATIVE] No, but I mean, you don't have it from, I never sent it to you, right? Because they didn't send it to me?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, I thought that's what all that was that I sent y'all.
[CUSTOMER][NEUTRAL] I thought all that was the [PII] billing.
[CUSTOMER][NEUTRAL] Maybe it is the billing, but it's not, but it doesn't have the code on it.
[AGENT][POSITIVE] That's correct, yes ma'am.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEGATIVE] It doesn't have any codes.
[CUSTOMER][POSITIVE] Oh, that's correct. OK.
[CUSTOMER][NEUTRAL] So each, each of those.
[CUSTOMER][NEUTRAL] Atomize things have to have a code on the page.
[CUSTOMER][NEUTRAL] Or they just need to send a statement saying it's the same.
[AGENT][NEGATIVE] Now it would be better if they can send us an itemized statement showing the codes.
[AGENT][POSITIVE] And the charge amount so that way we'd be able to, yes ma'am, we'd be able to match everything up.
[CUSTOMER][NEUTRAL] OK, I understand.
[CUSTOMER][NEUTRAL] OK. So, um, then my other question was, do I not, so I don't cash this check, right, right? Do I wait?
[AGENT][NEUTRAL] No, ma'am, you can cash it.
[CUSTOMER][NEUTRAL] On this
[CUSTOMER][NEUTRAL] And then if I, so if I, if I get all the codes, then
[CUSTOMER][POSITIVE] I, I should be getting the rest of the benefits.
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK, OK. I will call the credo and, and see what they can send me and so I can forward it to y'all then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for um explaining it. I'm, I'm sorry, I'm a little dense on this.
[AGENT][NEUTRAL] Oh no ma'am, you're fine, Ms. [PII] you're fine.
[CUSTOMER][POSITIVE] Oh, OK. OK, thank you so much.
[AGENT][POSITIVE] Alrighty, there's nothing else, thanks for calling AP and have a great, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I'm, I'm, I'll be getting.
[CUSTOMER][POSITIVE] Oh, I, I was just gonna say I'll be sending something to you hopefully soon.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, thanks for calling APO have a great rest of your day bye bye.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you bye bye.