AccountId: 011433970860
ContactId: 3df0c7d4-fade-47e5-a2cd-d5ae31a75e4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330079 ms
Total Talk Time (AGENT): 210016 ms
Total Talk Time (CUSTOMER): 222307 ms
Interruptions: 14
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/3df0c7d4-fade-47e5-a2cd-d5ae31a75e4e_20250206T19:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APA. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi Miss [PII], this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm good.
[CUSTOMER][MIXED] Glad to hear it. I've got an insured on the line. Uh, she is calling regarding a cancer claim that she filed. Uh, we denied it as, um, apparently we need more information from a fully itemized hospital bill. She wants to go over with y'all what was submitted. She said that she did submit everything that she always has, um, for chemo and it's always paid before, so she's a bit confused by this.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Yes, it is 252-744-1.
[AGENT][NEUTRAL] OK, give me one second. OK, and what's the name supposed to be?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So we are speaking with [PII] um but it is for part two, and I got the claim number in question when you're ready.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] It is 356-03007.
[AGENT][NEGATIVE] 307 office bills are not covered. That's why in the chemo, but they need the itemized bill for that chemo. Yeah.
[CUSTOMER][NEUTRAL] Yeah, she did say that she sent in all I guess you know she had filed for this before and she said that she sent in all of that information and wants to just make sure that that's accurate.
[AGENT][NEUTRAL] OK, I can, I can speak to her. I can see, can I help her? OK.
[CUSTOMER][POSITIVE] All right. I sure appreciate it. Thank you. All right, bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] M A.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] My name is [PII] and I'm in the claims department. How you doing? And you're calling about your claim that was denied acting for the itemized hospital bill for data service 116 of 225? Yes ma'am.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Let me see what you send in on that and I can tell you why they need to autoize hospital bills.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And it is uh 116 of 2025. Yeah, cause on this look like it's just an EOB.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh-huh. And without the, without the information on here for to be able to pay the chemo, we have to have the chemo codes and I do see you had chemo, but the code's not on here for us to be able to determine if it's a payable chemo code. So you say in the past they used this?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yes, OK, so let me ask you this question. I submitted another one. So, um, if I get out of my bill, will it throw me all the way back from, from the beginning? I'm gonna have to send you one for this claim and the one that I just submitted yesterday.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] What do you mean by throw you all the way back? What do you mean throw you all the way back?
[CUSTOMER][NEUTRAL] So like what is
[CUSTOMER][NEUTRAL] Like I know that every time I see like I've been told, you know, it takes to process.
[AGENT][NEUTRAL] Oh yeah, it's gonna take 7 to 15 days whenever a client come in the office, it don't file right in front of somebody else just because we ask for additional information, yeah, it's.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, ma'am. I mean, I'm asking, I'm asking because you're asking me for more information. Will it start all the way over. That's the question I was asking.
[AGENT][NEUTRAL] It would start
[AGENT][NEUTRAL] It, I don't know what you mean by start over, but they would just get this whatever you send in they would review it to see what can be paid on it when, whenever they come in and we have 7 to 15 working days to review a claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so the 7 to 15 starts all the way over, OK.
[AGENT][NEUTRAL] I'm, I'm, so I'm not sure, uh.
[AGENT][NEUTRAL] Yes, ma'am. Yes ma'am. Yes ma'am. I thought that's what.
[CUSTOMER][NEUTRAL] Even though the plane is right there.
[AGENT][NEUTRAL] That's right. It will. It wouldn't jump in front of someone else that's waiting to be processed because we asked for additional information. So yeah, it would, it would, it would be a problem.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK, so, so my question is, well, all due respect, I already have a claim that you have not denied, so that's what my question is. So if I sit here and send you another thing, are you gonna tell me you're gonna start that all the way over again?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, but one, you know.
[AGENT][NEGATIVE] You don't, you don't, you don't, you don't have, you don't have one that have not been processed. One was just processed today. It was just processed today.
[CUSTOMER][POSITIVE] Yes, I do.
[CUSTOMER][NEUTRAL] And I just
[CUSTOMER][NEUTRAL] But I sent two. I have one for the data service of 116 and then one for the data service of [PII].
[AGENT][NEUTRAL] Uh-huh
[AGENT][NEGATIVE] Yeah, the 127 was uh-huh, that one was processed. So when you see, when, when a client come in the office, however you send, no one of them paying. One of them is denied, one was denied on [PII], which was today, and one is being paid today, paying a benefit of $500 for your image that you had an image done. That's been processed and that's been paid. So now.
[CUSTOMER][NEUTRAL] I just submitted it yesterday.
[CUSTOMER][NEUTRAL] So you deny both of them?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] If you send a new claim in, even if you send it right now, it don't come directly to the adjuster. It gets set up and it goes, if you fax it, it goes with the fax representative who set those up and depending on what day they on, they'll get it set up in the system or if you upload it, it'll be uploaded as today.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] which is the [PII] and then we when whenever we make it to the day of the [PII], right now we on [PII], but we're not on the day of [PII]. So if you process, you send it in today and upload, it'll fall in with the claims that's waiting to be processed on [PII], uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I under I understand, ma'am. Thank you so much for clearing that up for me.
[AGENT][NEUTRAL] You're welcome. Do you understand what we need.
[CUSTOMER][NEUTRAL] I was, I'm gonna get out of my, I know, I'm gonna ask for it. I'm gonna request it now so that I can provide it for those two, claims, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that's, that'll be fine. OK, anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] No, ma'am, that'd be all.
[AGENT][POSITIVE] All right, thank you for calling American Public Life, Ms. [PII]. You have a great day.
[CUSTOMER][POSITIVE] Thank you. You do the same. Thank you so much, ma'am.
[AGENT][NEUTRAL] Bye bye.