AccountId: 011433970860
ContactId: 50c5b111-0413-4c5d-abde-4ac1e6862ea8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 598030 ms
Total Talk Time (AGENT): 234167 ms
Total Talk Time (CUSTOMER): 206827 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/50c5b111-0413-4c5d-abde-4ac1e6862ea8_20250224T15:49_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] in [PII]. I'm a broker. How you doing?
[AGENT][NEUTRAL] I am fine, Mr. [PII], and yourself?
[CUSTOMER][POSITIVE] Doing great, doing great. I'm trying to see if I can check on two claims if you have a moment.
[AGENT][NEUTRAL] Sure. OK, and Mr. [PII], do you have that policy number, please?
[CUSTOMER][NEUTRAL] Yes ma'am, let me take a look here.
[CUSTOMER][NEUTRAL] Of course my screen went, went off the minute uh you answered the phone that's how, that's how my luck is right here. Let's see. OK.
[CUSTOMER][NEUTRAL] First person
[CUSTOMER][NEUTRAL] Policy number is 2271246.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what um broker's office are you calling from?
[CUSTOMER][NEUTRAL] Uh, Crescent City Benefits and [PII].
[AGENT][NEUTRAL] OK, and that patient's name, date of birth?
[CUSTOMER][NEUTRAL] OK, let's see if it's if it's on here let's see.
[CUSTOMER][NEUTRAL] It is [PII] and claim number.
[CUSTOMER][NEUTRAL] Ends in 048 and 738. Let's see if I have the date of birth. I had it right here of course and.
[CUSTOMER][NEUTRAL] That's the way my morning's going. Let's see, it's.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We always have 100 things that happened before [PII] here let's see, um.
[CUSTOMER][NEUTRAL] It's, it's crazy. 7652.
[AGENT][POSITIVE] Awesome, thank you. And what was the claim number?
[AGENT][NEUTRAL] OK, the last digits?
[CUSTOMER][NEUTRAL] It looks like it's uh 738 and 048.
[CUSTOMER][NEUTRAL] I think the initial stuff sent in was just like a claim form and the uh direct deposit.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I know our system initially put up a um decline, but this is a takeover from Allstate. The company we took over had Allstate for years and Aflac before that and we switched to the APL so it is a takeover.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] It looks like that first claim number you gave, it was needing the pathology report, um, for initial diagnosis, and the second claim was processed and paid to the insured, and that was the amount of $750.
[CUSTOMER][NEUTRAL] OK, what do you show that was processed? What was the 750 breakdown?
[AGENT][NEUTRAL] Um, it's like $500 towards the PET scan for imaging, uh, $200 payments for PSA 1 [PII], the other [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I apologize, you said 500 PET scan and what was the other one? I'm sorry.
[AGENT][NEUTRAL] Uh, looks
[AGENT][NEUTRAL] I'm sorry, the other, there are two for PSAs, one for [PII], the other for [PII].
[AGENT][NEUTRAL] And then there was a $50 benefit for hormone, uh benefit for [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] It looks like for the chemo, uh, they're requesting a copy of the itemized billing.
[CUSTOMER][POSITIVE] Got it OK.
[AGENT][NEUTRAL] Showing procedure card, uh, procedure codes and charge them out for the service rendered.
[CUSTOMER][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I'm just looking at it with you. I like to pull it up so I can see what you're looking at so I can see if I'm missing something or.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] OK, so these aren't UBO.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] These aren't UB04s.
[AGENT][POSITIVE] Yeah, I'm sorry.
[AGENT][NEUTRAL] Then it looks like there was a surgery that they had on [PII] where they're needing that surgical path report.
[CUSTOMER][NEUTRAL] OK, I'm looking at right here.
[CUSTOMER][NEUTRAL] OK, surgical path report, let me write this down. I'm sorry. OK, so on [PII] we need the surgery report.
[AGENT][NEUTRAL] Uh, surgical path report.
[CUSTOMER][NEUTRAL] Now we
[CUSTOMER][NEUTRAL] Surgical path report we did send a big file over um and we had to email it because it was too big for us to upload and I know we sent a bunch of stuff I think they have it they might not realize they have it, OK, um, it was like 500 pages or something um.
[AGENT][NEUTRAL] What.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The [PII] surgical path and then for the chemo you said.
[AGENT][NEUTRAL] 1220 data service they're needing the uh billing.
[CUSTOMER][NEUTRAL] OK, and for the
[CUSTOMER][NEUTRAL] The chemo, you said you're missing.
[AGENT][NEUTRAL] It looks like they're requesting an itemized bill.
[CUSTOMER][NEUTRAL] OK, so this bill has chemo on it, but they're saying.
[CUSTOMER][NEUTRAL] They need a more detailed bill, is that what you're saying?
[AGENT][NEUTRAL] Uh, with the procedure codes and charge amount, yes, sir.
[CUSTOMER][NEUTRAL] OK, looks like this one has.
[CUSTOMER][NEUTRAL] Code on it and it says chemo and it has a charge. It's only like a $200 charge so so it's not really like a high chemo number um.
[CUSTOMER][NEUTRAL] This looprolide seems to be a big charge. 3, they um gave it to him 3 times and it's 33 grand. So I'm wondering.
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That has procedure codes date. I wonder, I have to Google what that is. It might be some type of um.
[AGENT][NEUTRAL] Let's see about the billing the provider's office showing the procedure.
[AGENT][NEUTRAL] Because in charge amount for each service rendered.
[CUSTOMER][NEUTRAL] So this has date code.
[CUSTOMER][NEUTRAL] And it says chemo and this one is date code looprolite. It's on page 4 of the 5 page um attachment with the bills.
[CUSTOMER][NEUTRAL] That's the one that was uploaded on.
[CUSTOMER][NEUTRAL] 2525.
[AGENT][NEUTRAL] And I see what you're saying.
[AGENT][NEUTRAL] Because it has a procedure code.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Might have transferred to a representative and they can explain cause
[AGENT][NEUTRAL] Um, give me one quick moment, Mr. [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh my [PII] that looks.
[AGENT][POSITIVE] Oops, no, that's a quick connect.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] Calling AL, this is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. How are you doing?
[CUSTOMER][POSITIVE] Good. How are you?
[AGENT][POSITIVE] I'm OK for Monday, working on my 2nd cup, hopefully it kicks in.
[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] Well, um, I have [PII], he's calling from broker's office, Crescent City Benefits, and he has a question about a claim status for a patient. Um, policy number 2271246.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's for the claim number 3566048.
[AGENT][NEUTRAL] And he's questioning as far as the chemo, where it states that we're needing itemized billing, um, showing the procedure codes and the charge amount, but he is stating per the information that was submitted, it has the procedure code as well as the amount.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can you give me that policy number because I'm not.
[AGENT][NEUTRAL] Oh, I'm sorry, it's um 227-1246.
[CUSTOMER][NEUTRAL] OK, part two
[AGENT][NEUTRAL] Uh, part two, I'm sorry, yes.
[CUSTOMER][NEUTRAL] And what was the policy, I mean the claim number again?
[AGENT][NEUTRAL] 356-6048.
[CUSTOMER][NEUTRAL] And for the chemo, OK.
[AGENT][NEUTRAL] Yeah, I explained um that for that uh for the chemo, they're needing billing with the procedure codes and charge amount, but he is stating what they submitted to show chemo and does have a procedure code and the amount for the chemo.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, I have it um pulled up.
[AGENT][POSITIVE] Awesome. Well, thank you, madam.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][POSITIVE] All right. Have a great one.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye.