AccountId: 011433970860
ContactId: 4fb1f7fd-a5ba-4807-9ca7-d16c036bffb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 614500 ms
Total Talk Time (AGENT): 399380 ms
Total Talk Time (CUSTOMER): 157035 ms
Interruptions: 3
Overall Sentiment: AGENT=0.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/4fb1f7fd-a5ba-4807-9ca7-d16c036bffb9_20250425T20:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hey [PII], this is, oh my gosh, I'm so happy I got you. Hey [PII], it's [PII]. How are you doing? Now that I've seen your face and I put it all together, I'm like, [PII].
[AGENT][POSITIVE] Hey, I'm good how are you?
[AGENT][NEUTRAL] How are you, ma'am?
[CUSTOMER][POSITIVE] I'm doing good. Um, OK, so I have policy number 736951.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's claim.
[CUSTOMER][NEUTRAL] Claim number 358-8117 is for part two.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, so there's 2 charges on here 2 lines on here for FM.
[CUSTOMER][NEUTRAL] Trans A.
[CUSTOMER][NEUTRAL] Um, it's for residents in, so the codes were denied but saying that there was no treatment received, so he couldn't, so they, we couldn't pay out for the transportation, or I'm sorry, for the, the lodging. So.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, she's saying, but it was treatment done. It was some type of like cellular treatment, and he had to stay in the hospital for 30 days and while he was in the hospital, she was at the hotel and then he came and joined her, but he, she said he did receive treatment and wanted to speak to a rep to see what she can do to or submit to like show us that it that he was in treatment.
[AGENT][NEUTRAL] Uh, give me just a second. Yeah, no, that's fine.
[CUSTOMER][NEUTRAL] But I didn't know how to answer that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so.
[AGENT][POSITIVE] Just love it man.
[AGENT][NEGATIVE] PR BFT is fake.
[AGENT][POSITIVE] Love it.
[AGENT][NEUTRAL] OK, I'm trying to look at the policy to see. I'm pretty sure it's family, transportation and lodging is what that stands for, like family member.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I'm pretty sure that's what that is, and let me look, so we did not.
[AGENT][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Did she give you a date that he was in the hospital for this?
[CUSTOMER][NEUTRAL] No, um, she, but she did mention it was 30 days he had to stay in the hospital cause they like took his cells out and then did something to him and put him back in his body. Like, she explained the whole thing. I'm like, I really, I'm not really the person to give all this to.
[CUSTOMER][NEUTRAL] But I was, but I was listening though.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Well, I hear you. I don't know what you're talking about, but I hear you.
[AGENT][NEUTRAL] OK, because I have put in every date between [PII] and [PII], and we don't have any record, oh shoot, I was on park.
[AGENT][NEUTRAL] What's on part one, OK, let me try this again.
[AGENT][NEUTRAL] [PII], so way to go, [PII]. Pay attention. OK. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's OK. It's almost the end of the day.
[AGENT][NEGATIVE] Not for me, girl. I don't leave till [PII].
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[AGENT][POSITIVE] I appreciate it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so so far I appreciate that. um OK, so I've almost done this again except for under the correct participant and we don't have anything that shows he was in the hospital or anything like.
[CUSTOMER][POSITIVE] I'll be with you in spirit.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] All I see.
[AGENT][NEUTRAL] Is that one line and then.
[AGENT][NEUTRAL] For [PII] through [PII]. Was that the same like procedure or is that like the next?
[CUSTOMER][NEUTRAL] I think that's like the next set because she said.
[AGENT][NEUTRAL] Like, was that part of the same, the, OK, part of the same 30 days because it looks like [PII] through [PII], so it's probably part of the same because I bet it's limited. Mhm. OK. So, uh.
[CUSTOMER][NEUTRAL] That's the same.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because she said he um.
[CUSTOMER][NEUTRAL] Oh yeah, it's the same. He stayed in there and then he came and
[CUSTOMER][NEUTRAL] Um, stayed with her for the last 30, for the last half of it, I mean.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Yeah, I've put in all of those dates. Now I do have.
[AGENT][NEUTRAL] The only thing I have that includes [PII] is where it looks like there was maybe office visits, um, and the office visits are not covered, so but I don't have anything for November.
[AGENT][NEUTRAL] Like I don't, I'm trying to see if there's anything that may be hiding in here.
[AGENT][NEUTRAL] See, [PII]. I have a hospital stay from [PII] to early [PII].
[AGENT][NEUTRAL] And then the only other thing we have before November is March like we don't have anything showing so what we're gonna need is we're gonna need to see that I mean I can still look at um.
[AGENT][NEUTRAL] I can look at what was submitted to, but.
[AGENT][NEUTRAL] Um, what was this? 8117?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Unless we have proof of treatment because it's not payable unless we have paid.
[AGENT][NEUTRAL] Because of treatment or hospital stay or, you know, whatever the case may be, however the policy reads. And so that's why it was denied because what it's stating.
[AGENT][NEUTRAL] You know, um,
[AGENT][NEUTRAL] It is specifically that treatment's not been received. So it says it's payable when a covered person who has been diagnosed is having cancer received, receives covered radiation, chemo, immuno, bone marrow or stem cell transplant or surgery in a hospital that is at least 50 miles from their home. Um, on your recent claim, it appears there was no covered treatment received, therefore, transportation and lodging is not covered for the state. Please refer to your policy contract.
[AGENT][NEUTRAL] So it's because we don't have any record of anything for those dates. All we have based off of just looking at this is that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They were, they had some lodging and it's like OK that's fine but we don't have any record of anything else.
[CUSTOMER][NEUTRAL] Treatment to go with it. So she needs to send like the itemized bill and, well, really, that's everything.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I would tell her that based off of the documentation that we've received, which I'm looking, I'm trying to look through that now it's 27 pages, but based off of what we have, we don't have, well, there's 12:13 right there.
[CUSTOMER][NEUTRAL] Anything
[AGENT][NEUTRAL] Oh, it's nuclear medicine and imaging. That's not treatment.
[AGENT][NEUTRAL] Let me check that CPD code.
[CUSTOMER][NEUTRAL] So she needs to send in the um itemized bill for [PII] through the [PII] and then for well for both of them.
[AGENT][NEUTRAL] Yeah, for both of them. She needs to send in the itemized bill for the treatment received because just.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just looking at it, um,
[CUSTOMER][NEUTRAL] It just looks like they went to the hotel.
[AGENT][NEUTRAL] Uh-huh, it just looks like they went to the hotel. Now, I do see where it looks like there was like some type of IV therapy or treatment or whatever the last part of December, but that doesn't cover this lodging and if he was staying with her during that time, then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] You know that makes sense that we wouldn't be paying for this. It has to be those dates and all I have are the [PII] and [PII], um where he was there maybe overnight or something, you know, um, I'm trying to get through this because I know you need to get back over to them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yeah, there's 12:31316. He was in the hospital.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see what this, because there, we have several bills, but.
[AGENT][NEUTRAL] I looked in the history and I don't see anything and then.
[AGENT][NEUTRAL] 124 so that's early or late January and then.
[AGENT][NEUTRAL] We have this bill for room and board.
[AGENT][NEUTRAL] At the hotel and it's like, OK, none of this matches up with the bills that we have that's why we need proof of treatment so itemization for the treatment received is what we're gonna need to be able to go back and reconsider this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so like the UBO4.
[AGENT][NEUTRAL] Yes, um, and yeah, I would say that and I would say if she has, you know what, just tell her to send that in because if we need anything else, I don't even know what all we would need. I'd have to go looking and figuring out what this particular policy, what it requires. I would just say we need proof of treatment.
[CUSTOMER][NEUTRAL] It was the hospital.
[AGENT][NEUTRAL] So hospital bill, whatever it is that she has for proof of treatment during that [PII] through [PII] where where they have that hotel bill we need that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alrighty well thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Alright have a good weekend.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.