AccountId: 011433970860
ContactId: 37b05fcb-ef1b-461c-9c7e-9770abceb749
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1121859 ms
Total Talk Time (AGENT): 477898 ms
Total Talk Time (CUSTOMER): 564122 ms
Interruptions: 9
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/37b05fcb-ef1b-461c-9c7e-9770abceb749_20250122T21:04_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes ma'am, I need to talk to you about uh my APL account please.
[AGENT][NEUTRAL] OK, you're the insured and you have a question regarding your policy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][NEGATIVE] I want my claim was declined.
[CUSTOMER][NEUTRAL] And your reasoning for declining.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you have a
[CUSTOMER][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] No, ma'am, that's OK. Go ahead. I didn't mean to interrupt you.
[CUSTOMER][NEUTRAL] No, uh, I don't understand because in order to continue processing your claim, please provide us with the following itemized billing for the surg formed, you have that.
[CUSTOMER][NEUTRAL] You know, and each one of those things that talks about an itemized billing you have it. The only thing you do not have is the pathology report and I did not know nor did I have the pathology report until yesterday.
[AGENT][POSITIVE] OK, yes, I want.
[CUSTOMER][NEUTRAL] So I, I, you know.
[AGENT][NEUTRAL] I'll be happy to take a look at your claim. I can help you. Um, I just need to first off get some information from you first. So who am I speaking with, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And Miss [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] OK, let's, can we start that again? That's OK. That's OK.
[CUSTOMER][NEUTRAL] I was reading the the bill area code 352.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 512
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then your policy number, please?
[CUSTOMER][NEUTRAL] OK, hold on, I gotta try to figure out how to get to that policy number is.
[CUSTOMER][NEUTRAL] 138.
[CUSTOMER][NEUTRAL] 1309
[AGENT][POSITIVE] OK, thank you. So give me a couple of moments and I to get all of your information pulled up.
[AGENT][NEUTRAL] OK, so Miss [PII], the information that I do provide for you today would be a verification of benefits and not a guarantee of payment, and I will need to verify several things with you, um, first for security so for.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] First off, if you could
[AGENT][NEUTRAL] Miss [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. If you gave me your date of birth, I didn't hear. Did you hear me ask you for your date of birth?
[CUSTOMER][NEUTRAL] No ma'am, it was cutting out. It's [PII].
[AGENT][NEUTRAL] Uh, OK, I don't know. Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The phone number we have on file for you is the same as the one you gave me, so that is your best contact number that we should have. Is that the correct information? OK. And the last thing to verify is gonna be your email address and this does appear to be your work email.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] No, ma'am, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so now I can come back and update it to your personal email. What is your work email? because that is what we have on file for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so give me just a moment and we can update that to your personal if you would like. OK, so you're welcome. Yes ma'am, so, um, give me just a second now my.
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][NEUTRAL] And my screen is.
[AGENT][POSITIVE] Moving slowly. I'm sorry.
[AGENT][NEUTRAL] OK, so what is your personal email again? It may be, it may be, are you, do you have snow where you are? Did you get any of that?
[CUSTOMER][NEGATIVE] I think it's the weather it's messing everybody.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No, I'm, I'm in [PII].
[AGENT][NEUTRAL] You're farther south. Oh yeah, OK, OK.
[CUSTOMER][NEUTRAL] Yeah, but it's only 40 degrees today, and you know, it's hard when you're.
[AGENT][NEUTRAL] Well, that's cold for [PII].
[CUSTOMER][NEUTRAL] Yeah, it's hard when you have a whole school of special needs kids and they're used to going outside, and then you have to keep them in all day.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Bless. Yes, ma'am. I know that. Sure, I'm sure it does. I can only imagine. Um, OK, so what is your personal email again and I'll get that changed for you.
[CUSTOMER][NEGATIVE] So that makes it really hard.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To
[AGENT][NEUTRAL] With [PII] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, [PII] at first.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, thank you so much. So I have got that updated for you. All right.
[AGENT][NEUTRAL] OK, and do you have a specific claim number that you would like to look at, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh yes ma'am, the, the last one, the claim number is 355.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 3402
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so, OK, I can't see that one. Let me get the remarks pulled up. This was for dates of service.
[AGENT][NEUTRAL] [PII] and [PII] of this year, is that correct? OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so I do see, and so the, the line item that needs um where it has the remark regarding the pathology report. Did you say that you do have that now? You just got that? OK, so what you can, OK, so you can just upload that information into the portal because I can see that's how you've been submitting all of your claims.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Now, I did not, I, yes, ma'am. I just got it yesterday.
[CUSTOMER][NEUTRAL] Mhm. So how do I, that's, I'm having a problem. I don't understand how to upload it. Do, how do I go back in so that it, it attaches to because every time I do, OK, so it will not, OK.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] It, it won't.
[AGENT][NEUTRAL] Yeah, it won't, but our system correct, our system they will know that OK, for data service 17 we were needing this pathology report because and it will tie it together. So it's just on your end, it does look like you're submitting a whole new claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, because that I didn't want to do it and then it not be and then and number 3 down and this.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Anesthesia benefits are based on benefits allowed under surgery benefit. Please send the surgery charges for that date. That's what I was telling you that the surgery charges are in the bill.
[AGENT][NEUTRAL] Let's see, the anesthesia? OK.
[CUSTOMER][NEUTRAL] Because if you go to the bill.
[CUSTOMER][NEUTRAL] The bill has each um.
[CUSTOMER][NEUTRAL] Hold on, let me try to figure out how to, because I went to, I went to view files and it's the second one in the T1 GPDBD, the second one in, and that's the PDF file for the Moffett bill.
[CUSTOMER][POSITIVE] And it has the received code, the service codes, it has everything, quantities, units and everything.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, give me just one moment to look at a couple of the other codes remarks.
[AGENT][NEUTRAL] OK, so you're saying, and then I see there's another line item stating that in order to give consideration to this data service, we will need a fully itemized hospital slash facility billing with all charges fully identified.
[CUSTOMER][NEUTRAL] You can look at this bill and see every bit of it's fully identified.
[CUSTOMER][NEUTRAL] Every
[CUSTOMER][POSITIVE] Wonderful bill.
[AGENT][NEUTRAL] OK, so what I can do is I can send a request to have one of the examiners further look at this and give you a call back if you would be OK with that, um, and they would give you a call back within the next 24 hours, but I can send a request, um, to ask them to do that if you would like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am, because I'm doing this the way when all of this cancer started, they had me do it, you know. And then also the pathology report came back.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, after they took out both sides, I did lumpectomy on both sides, that no evidence was found of the disease. However,
[CUSTOMER][NEUTRAL] I'm still gonna have to have 7 weeks of radiation, and then I'm still gonna have to have from April till December of immunotherapy.
[CUSTOMER][NEGATIVE] But if the pathology report says no evidence of the disease, does that mean y'all aren't gonna pay me anymore?
[CUSTOMER][NEUTRAL] Because the pathology reports there's no evidence of the disease.
[CUSTOMER][NEUTRAL] I don't think that's fair because, you know, when the surgeon was telling me yesterday, she says, well, I figured you'd be jumping up and down. I said, no, ma'am. Are you, does this mean that tomorrow when I wake up today, you tell me no evidence of the disease. But tomorrow when I wake up, my feet's gonna be back to normal, my legs are gonna be back to normal, my hands are gonna be back to normal?
[CUSTOMER][NEUTRAL] This che uh chemo cough that I have that keeps me up all night long, it's gonna be back to normal. I said, I don't see how you can want me to rejoice in the fact that no evidence of the thing.
[CUSTOMER][NEUTRAL] When I still have the 2 nodules in my lungs now and my kidney.
[CUSTOMER][NEUTRAL] The place in my kidney. And but yet your pathology says no evidence of the disease. She said, ma'am, it's no evidence still in the breast.
[CUSTOMER][NEUTRAL] pieces, but if they go in and they do the biopsy in the, the kidney, and it comes back that it's cancer, then it's gonna be kidney cancer associated with breast cancer. I said, so why are you saying no evidence of the disease on the biopsy if you still don't know the lungs and the kidney are are not part of the breast cancer?
[CUSTOMER][NEGATIVE] So, and then I get your thing today that denied my claim because you need all of this other stuff and I'm looking at, you know, 23 pages of this bill, which is astronomical, and it lists every item line by line by line, and, and it's like, I don't understand what else you want because, you know, it, it's line by line by line on everything.
[AGENT][NEUTRAL] OK. So, no, oh no, no, you're not. No, you're not. You have a lot going on and I, no, ma'am, I'm not taking it wrong in any way. Um.
[CUSTOMER][NEUTRAL] So I'm sorry. I know I'm being rude. I'm sorry.
[AGENT][NEUTRAL] I'm still, let me, let me just look at a couple more. OK, so I wanna make sure that when I send the request over to have one of the examiners to, you know, look over the information and then give you a follow up call.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That you did include the you said the, uh, I'm so sorry. I'm stumbling on myself, Ms. [PII] in what I'm trying to ask you that you did include the surgery charges, that is part of the information that was uploaded.
[CUSTOMER][POSITIVE] It is OK.
[CUSTOMER][NEUTRAL] Mhm. Yes, ma'am. Well, this is the bill from the hospital.
[AGENT][NEUTRAL] Is that correct? And also,
[AGENT][NEUTRAL] And is it an
[CUSTOMER][NEUTRAL] General and, and.
[AGENT][NEUTRAL] Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] Anesthesia level 2 1st 30 minutes, level 2, the additional 15 more minutes. So I'm assuming the level 2 and the level 2 additional minutes was the actual surgery itself.
[AGENT][NEUTRAL] And then it does list.
[CUSTOMER][NEUTRAL] But I can go ahead, you see it says the breast, yeah, it says the injections, it says breast exam, uh, the, they put um.
[AGENT][NEUTRAL] The charges.
[CUSTOMER][NEUTRAL] Inside my right breast before you have breast surgery, they and, and put these, it's 4 little radi radon.
[CUSTOMER][NEUTRAL] things they put it into your actual nipple, and then that shoots out a blue dye throughout your breast that the cancer was in, as well as down into your lymph nodes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But it has the pre-op, pre-op, all of that stuff. It has the mammograms surgical which
[CUSTOMER][NEUTRAL] The um
[CUSTOMER][NEUTRAL] When they do, because there were two sides, the, the right breast and the left breast, and there were two sides, and that has to be done under the mammogram because the mammogram machine locates where, because the day before you go in and they put these clips inside of you, so that this mammogram machine goes right over the top of where the clips is and that tells the surgeon how to cut you open, where to cut you open at.
[CUSTOMER][NEUTRAL] So I wonder if
[CUSTOMER][NEUTRAL] Well, you send that message over to them. I'm gonna go ahead and call them off at hospital back and see if there is an additional.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If there's an additional um.
[CUSTOMER][NEUTRAL] To see there's it, the first part of this takes apart the tissues and takes it, you know.
[CUSTOMER][NEGATIVE] Yeah, it's, it's all taken apart the tissue samples and visualizations of getting them.
[CUSTOMER][NEUTRAL] This the and then is injections so I don't know. Let me call Moffet while you call and put that other call in and I'll call Moffit and see if there is another bill.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] But this said, the lady told me when she gave me this bill last week, it was from the, the.
[CUSTOMER][NEGATIVE] All the bill from the thing, but $34,000 doesn't seem like it's all the bills.
[AGENT][NEGATIVE] It doesn't really sound like it to me based on what you've described.
[AGENT][NEUTRAL] As, you know, as far as your procedure and everything, but obviously, I can't say that for sure. I'm not, you know, obviously with the facility. Um, but when you call them, I would just go over like what the comments specifically, like for that anesthesia benefit where it's talking about they're allowable under the surgery that we need these charges to place in the surgery charges for the state.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But you're saying that was
[AGENT][NEUTRAL] Included already. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, the general anesthesia 1st 15 minutes is $749 and each additional 15 minutes is.
[AGENT][NEUTRAL] OK, but
[AGENT][NEUTRAL] I said
[AGENT][NEUTRAL] All right. So that is for the anesthesia part. They're wanting the actual surgery charges.
[CUSTOMER][POSITIVE] It has everything
[CUSTOMER][NEUTRAL] OK, from the doctor, doctor.
[AGENT][NEUTRAL] Because it's, yes, because your benefits for anesthesia are based on
[AGENT][NEUTRAL] Do your surgery benefits. So that's what they're needing on that part.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, let me go ahead and.
[CUSTOMER][NEUTRAL] If you can uh.
[CUSTOMER][NEUTRAL] If you can
[CUSTOMER][NEUTRAL] Because that lady sends my, my thing over right away. I'm still at work, so by the time I get home tonight, still have the bill sent over to my [PII] account.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So I can just send you that and the pathology tonight.
[AGENT][NEUTRAL] Yes, you can upload anything that you have. Go ahead and upload that into your portal, and I will make a note regarding our call. Um, as far as that 18, you know, it's, I will explain to them where it's asking for a fully itemized hospital and facility billing that you stated that, you know, that was already submitted.
[CUSTOMER][NEUTRAL] And then that way by.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Is there, now, when they, someone calls you back on this, Ms. [PII], I can't tell you what the phone number is going to come up on your phone because it's not gonna be our [PII] number. And I know that we're all kind of leery of answering numbers that we don't recognize.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, but,
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh, let's say one other thing I was gonna tell you on that.
[AGENT][POSITIVE] Is there a time I, I can put in the request if there's, you know, a time that's better than another for someone to give you a call and we can try after and you're on Eastern time.
[CUSTOMER][NEUTRAL] After [PII] tomorrow. Yes, ma'am. After [PII] tomorrow.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I am a teacher and today is my first full day back at work. So, you know, I just trying to handle this after I get off of work.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, well, I will also include that in my, in my request.
[CUSTOMER][POSITIVE] OK. Thank you very much, ma'am, for all your help.
[AGENT][POSITIVE] Absolutely. You are very welcome. Is there anything else that I can help you with today, at the moment?
[CUSTOMER][POSITIVE] No, ma'am. No ma'am. You have been such a godsend. Thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, well, uh, that was very sweet of you to say, but it was my pleasure in helping you today and um.
[AGENT][POSITIVE] I hope you have a very nice evening.
[CUSTOMER][POSITIVE] All right, thank you very much, ma'am. God bless you. Bye bye.
[AGENT][POSITIVE] You're welcome. God bless you too, Miss [PII]. Thank you.
[CUSTOMER][NEUTRAL] Bye bye.