AccountId: 011433970860
ContactId: 5150d859-b2e3-4842-80b7-2aec454faa55
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 616840 ms
Total Talk Time (AGENT): 198858 ms
Total Talk Time (CUSTOMER): 307158 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/5150d859-b2e3-4842-80b7-2aec454faa55_20250603T19:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] also. That's unusual.
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] I have, I have a question, please. Uh, I, I have things mixed up. I'm filing for a wellness form for myself and I'm filing cancer forms for my husband, and now I'm confused.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you answer a question for me?
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] Uh, um, on my wellness form, I'm filing for 2 years for a mammogram.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they sent me the wellness form. Do I have to make duplicate forms, or can I file both on one form?
[AGENT][NEUTRAL] No, you just do the one form and then send you can send the documentation for both of the claims. You don't need to do two forms.
[CUSTOMER][NEUTRAL] OK, now what do you want for documentation?
[AGENT][NEUTRAL] Let's see what they asked for. Uh, let's see, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There's one kind of form your insurance card and I can't remember the initial W04 or something.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It has pretty much everything on it. Do you know what I'm talking about?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So.
[CUSTOMER][POSITIVE] The last time I saw it I did it online and I didn't even have to, I didn't have to send anything.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But now they said they don't do that because of HIPAA or something.
[AGENT][NEUTRAL] OK, so it looks like you can just check the box for the one wellness test that you had and then you could just put in, yeah, and then the dates of service, it doesn't even actually.
[CUSTOMER][NEUTRAL] I did.
[CUSTOMER][NEUTRAL] Well, it's gonna be for 2 years.
[AGENT][NEUTRAL] Right, so I would just put both dates in there if you can, if you can squeeze them in.
[CUSTOMER][NEUTRAL] It'd be for
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I is it a human that's looking at this form.
[CUSTOMER][NEUTRAL] Because I'm gonna write it out to the side if it is.
[AGENT][POSITIVE] That's fine. Yeah, that should be totally fine.
[AGENT][NEUTRAL] And actually let's see.
[AGENT][NEUTRAL] I guess it doesn't actually ask for any sort of itemized bill or anything like that on here. It just says to fill it out.
[AGENT][NEUTRAL] So, yeah.
[CUSTOMER][NEUTRAL] Well, I didn't see it either, but um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I can't believe that.
[AGENT][NEUTRAL] Let me see if I can find.
[CUSTOMER][NEUTRAL] I can really not asking.
[AGENT][NEUTRAL] If I can see.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] I'm trying to see if I can find any other information here on.
[AGENT][NEUTRAL] Because usually it asks for some sort of itemized receipt or something.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I don't know what this is the authorization to request information including protected health information. I don't know what that's supposed to be.
[AGENT][NEUTRAL] So that, yeah, that would just be like if they were gonna contact your doctor um to make certain that you went for the exam. So that's really all that is, that they have permission to contact the provider and get that information.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] And one of them.
[CUSTOMER][NEGATIVE] Jeez, I don't know. I really don't know anymore. I'm so confused.
[CUSTOMER][NEUTRAL] I've got page one and I have um
[CUSTOMER][NEUTRAL] I filled out section A. I filled out section B. Section C is just checking mammogram wants to date.
[CUSTOMER][NEUTRAL] And section D is my signature.
[CUSTOMER][NEUTRAL] And then I have page 3, it talks about section F claim on fraud statements.
[CUSTOMER][NEUTRAL] And then I have another page that says section G.
[CUSTOMER][NEUTRAL] Uh, it allows them, it allows, uh, American public life.
[CUSTOMER][NEUTRAL] To obtain data, data.
[CUSTOMER][NEUTRAL] Not limited to employment information, financial information. Do you see where I am on this?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because I don't know
[CUSTOMER][NEUTRAL] And then at the bottom it says it asks for my policy number, the signature of the patient.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] I don't know why I would have to, do I have to fill out all that?
[AGENT][NEUTRAL] Yeah, so that's the authorization for them to contact the provider to verify the actual um.
[AGENT][NEUTRAL] Date of service. That's what it's, that's what it's asking you to sign and date there.
[CUSTOMER][NEUTRAL] OK, well, it asks for a medical provider.
[CUSTOMER][NEUTRAL] Uh, it asks for the physician's name and the contact number. Well, the, my OBGYN.
[CUSTOMER][NEUTRAL] Uh, requests.
[CUSTOMER][NEUTRAL] For me to have the mammogram, so what I put her name down or do they want the place where I went for the mammogram? What do they want? That's what's so confusing here.
[AGENT][NEUTRAL] Just put your, uh, just put, yeah, just put your OB there.
[CUSTOMER][NEGATIVE] I don't understand it.
[CUSTOMER][NEUTRAL] OK, because she did write the order.
[AGENT][NEUTRAL] Right, exactly. So they can verify that the order was written through her.
[CUSTOMER][NEUTRAL] OK, and so I do fill out this G. I fill out this form G authorize them to request information.
[AGENT][NEUTRAL] Yeah, all 4 pages. Uh-huh.
[CUSTOMER][NEUTRAL] I'll fill out that.
[CUSTOMER][NEUTRAL] OK, the policy, the name of the patient's date of birth, signature. OK. This authorization is supplied by a personal representative, uh, my personal representative.
[CUSTOMER][NEUTRAL] So I just put the dates of both for the mammogram and and I do not need any documentation is what you're telling me.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Not that I see, it's not requesting anything. It always will say on these like what documentation is requested. Usually on page one, if it's needed with any sort of claim like it does on the cancer claim form. Page one tells you exactly what you need depending on what you're submitting. So there's, yeah, it's not asking for anything else additional.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] My, what my page says instructions for the patient. Complete the statement of insured A through F, I did.
[AGENT][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] And then it says complete G although it's not required, but it will reduce delays in processing should we need to request additional information regarding your claim, so I guess.
[CUSTOMER][NEUTRAL] That's that, huh?
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK, and I mailed this to um [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] OK, that made my life simple. Thank you. Oh, let me ask you something else. Do you know about now for the claim form for my husband for cancer?
[AGENT][POSITIVE] All right, good.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] If I send an itemized bill with, which has all the codes, the diagnostic codes, the procedure codes, the dates, the doctor, all that mess, do I still have to send an EOB because the EOB is confusing as heck.
[AGENT][NEUTRAL] Yeah, they, they still need EOBs from the primary and you don't need to, yeah, you don't need to worry about, uh, you know, just make sure that you're sending it for those dates that you're submitting.
[CUSTOMER][NEGATIVE] OK, now for the EOB they send about 7 pages when they send it. They want all that that doesn't pertain to anything else.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] That's what I don't understand why they want the EOB when I've got everything.
[CUSTOMER][NEUTRAL] Documented and you said from your primary, from your primary doctor or your primary insurance company or what?
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Primary insurance company.
[CUSTOMER][NEUTRAL] So that's where my, that's where my EOB is coming from.
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] I wonder if I could just send the part.
[CUSTOMER][NEUTRAL] that pertains to that or if they want all the other pages of everything, every other thing that he goes to the doctor for.
[CUSTOMER][NEUTRAL] I mean, some of it has diabetic foot care on there. Why would they want that?
[AGENT][NEUTRAL] Yeah, I mean, if you're able to just send for the dates of service that are relevant to the actual cancer treatment, that would be helpful. But if he's, if he's being seen on the same data service for something else aside from that, there's not gonna be a way, unfortunately, to filter that out. You're just gonna have to send it all and they'll they'll filter through all that information.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] OK. All right. Well, I appreciate it. You have helped me. Thank you so much.
[AGENT][POSITIVE] Yeah, not a, not a problem, [PII]. Have a good rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Uh, bye.