AccountId: 011433970860
ContactId: 3974296e-347e-446e-a3b9-0a23c49f3f96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 531640 ms
Total Talk Time (AGENT): 168445 ms
Total Talk Time (CUSTOMER): 226112 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/3974296e-347e-446e-a3b9-0a23c49f3f96_20250610T14:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, hi, this is [PII].
[CUSTOMER][NEUTRAL] And I have questions about some of the claims that have been paid recently or or possibly more about claims that have been denied recently.
[CUSTOMER][NEUTRAL] Can you help me?
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII].
[AGENT][NEUTRAL] Thank you. Now, I need your policy number, please.
[CUSTOMER][NEUTRAL] Uh, yeah. Policy number is 019.
[CUSTOMER][NEUTRAL] 36823
[AGENT][NEUTRAL] And please verify your name again and your date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK. Thank you. Now, please verify your mailing address and your email address.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And you have us.
[CUSTOMER][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh my email address is [PII].
[AGENT][NEUTRAL] Yes, sir, and the claims you're calling about, are they for you or your dependent?
[CUSTOMER][NEUTRAL] No, they're all about me.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][NEGATIVE] I was diagnosed in March. Yeah, I was diagnosed in March with prostate cancer.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] There's been a lot of um activity since then.
[CUSTOMER][NEUTRAL] And I just noticed that a handful of claims said that you need more information.
[CUSTOMER][NEUTRAL] Please provide copies of your explanation of benefits and that kind of thing. So I really don't know what to do about the ones. I appreciate the ones you have paid, very grateful for that. I mean, even though it's a benefit, I pay for the insurance, but I'm still grateful for it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But you can probably see on your screen the ones that you have not paid.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Um, for example, one of the ones that was paid 0.
[CUSTOMER][NEUTRAL] Very specifically says cancer outpatient treatments.
[CUSTOMER][NEUTRAL] And I thought I had coverage for cancer treatments.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And yes, sir, you do have coverage. Um, what we need are the explanation of benefits from your primary insurance company because as your secondary insurance, we cover the charges um that your primary carrier does not pay. And your provider received notification and what normally happens is once they receive notification of the um additional information that we need, they'll resubmit the claim with that documentation so that we can get the claim processed and paid.
[CUSTOMER][NEUTRAL] So then any of the ones that.
[CUSTOMER][NEUTRAL] say that they need uh information from my primary insurance company. Should I be on the phone with Blue Cross calling them or should I?
[CUSTOMER][NEUTRAL] Should I be
[CUSTOMER][NEUTRAL] But since these are more recent.
[CUSTOMER][NEUTRAL] Should I just let this thing happen on its own and see what happens?
[AGENT][NEUTRAL] Um, yes, sir. You can let it happen on its own, or if you wanted to contact someone, you may want to contact the providers and make sure that they resubmit those claims with the requested documentation.
[CUSTOMER][NEUTRAL] Oh, OK, so then alright so that's.
[CUSTOMER][NEUTRAL] That's a little different than what I understood initially.
[CUSTOMER][NEUTRAL] Um, because it says provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Right, and the, and
[CUSTOMER][NEUTRAL] Uh, again, how would, how would, yes, go ahead.
[AGENT][NEUTRAL] Well, and again, the um the request went to the provider because the provider filed a claim.
[AGENT][NEUTRAL] And so, um we need the provider to resubmit the claim with the EOB from the primary insurance company because they have that information.
[AGENT][NEUTRAL] So they need to submit the claim along with the information because they already have it. They have the EOB from the primary insurance company.
[CUSTOMER][NEUTRAL] OK, so then so then University of Miami.
[CUSTOMER][NEUTRAL] So the University of Miami needs to resubmit.
[CUSTOMER][NEUTRAL] The claim UM.
[CUSTOMER][NEUTRAL] Resubmit claim.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] The explanation.
[CUSTOMER][POSITIVE] Of benefits
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] Blue Cross.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Is that, am I saying that correctly?
[AGENT][NEUTRAL] Yes, you're saying that correctly.
[CUSTOMER][NEUTRAL] OK, so then I, my next phone call has to be back to the business office at UM.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can you tell me if you're looking at your screen? I see one of these was was um.
[CUSTOMER][NEUTRAL] Requested information, I won't say denied.
[CUSTOMER][NEUTRAL] Uh, both of these things happened on [PII].
[CUSTOMER][NEUTRAL] Do you see any other, do you see any other, um.
[AGENT][NEUTRAL] Data service, yes, that.
[CUSTOMER][NEUTRAL] Uh, do you see it?
[CUSTOMER][NEUTRAL] Are there any other dates of service that you've denied?
[AGENT][NEUTRAL] Yes, sir, um, [PII].
[CUSTOMER][NEUTRAL] Also from UM
[AGENT][NEUTRAL] One from UM and let me get the other provider for you. One moment.
[CUSTOMER][NEUTRAL] OK, so wait from [PII] there's one from UM.
[CUSTOMER][NEUTRAL] And, and then you gave me another, this also on [PII].
[AGENT][NEUTRAL] Yes, sir, this other one is for.
[AGENT][NEUTRAL] This one is for the provider at UM radiology charges.
[AGENT][NEUTRAL] And this is for the professional thing. Let me pull the um claim so I can get the doctor's name for you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. The one for UM or for the hospital fees, and this one here is for the provider, the doctor's fees. And this is for Doctor [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Um, the first name is [PII].
[CUSTOMER][NEUTRAL] And what's the last name?
[AGENT][NEUTRAL] [PII] That's the first name and the last name is [PII]
[CUSTOMER][NEUTRAL] OK. So the Doctor [PII], basically.
[AGENT][NEUTRAL] Yes, sir. Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So now I have um.
[CUSTOMER][NEUTRAL] Now I have the [PII] and I have [PII]. Are there any other dates that we have?
[CUSTOMER][NEGATIVE] To get better information.
[AGENT][NEUTRAL] OK, let's see, one moment.
[AGENT][NEUTRAL] No, I'm only showing those 4, well, those 4 claims, which is a claim um for each date of service is a claim for the hospital and a claim for a provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it. OK, I will, I will reach back out to you and and ask them to resubmit with an explanation of benefits from Blue Cross.
[AGENT][NEUTRAL] OK. Is there, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No ma'am, that's gonna be good for today.
[AGENT][POSITIVE] OK. Well, I thank you, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You too. Thank you for your help. OK, bye-bye.
[AGENT][POSITIVE] You. You're welcome. Bye.