AccountId: 011433970860
ContactId: 55612b97-f06d-4bcb-a3fa-f93aa94fbecd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 828080 ms
Total Talk Time (AGENT): 283817 ms
Total Talk Time (CUSTOMER): 247083 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/55612b97-f06d-4bcb-a3fa-f93aa94fbecd_20250620T18:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, so I'm, I'm calling. I received a letter today, um, I was, I received, um.
[CUSTOMER][NEGATIVE] Uh, on one of my mammograms on my wellness one I received that one. The other one it says, um, benefit name not found that data service y'all have on here is wrong.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, uh, let me have um your name and the policy number.
[CUSTOMER][NEUTRAL] Uh, it's [PII]
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And a callback number just in case we get disconnected Miss [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Do you have the policy number, Miss?
[CUSTOMER][NEUTRAL] Um, no, I don't. Let me look, hold on.
[CUSTOMER][NEUTRAL] Yeah one.
[CUSTOMER][NEUTRAL] No, my date of birth and all that if you need it.
[AGENT][NEUTRAL] Um, if you're looking at an explanation of benefits, it's gonna be the confirmation number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh that.
[CUSTOMER][NEUTRAL] And policy number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Reference claim number.
[CUSTOMER][NEUTRAL] Reference number, is that what you're needing?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like 02521898.
[AGENT][NEUTRAL] OK, thank you, Ms. Ew. For security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] [PII] mailing address [PII]. My email is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let me look at this um claim.
[AGENT][NEUTRAL] Can you see the claim number?
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] OK, what is that claim number just to make sure.
[CUSTOMER][NEUTRAL] 36
[CUSTOMER][NEUTRAL] OK, it's 3, I'm sorry, 361-286-6.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] It's on a mammogram.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I see a mammogram on [PII].
[AGENT][NEUTRAL] And then I see another charge on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh that's supposed to be [PII].
[AGENT][NEUTRAL] 34. OK. OK, let me look at the paper.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] It wasn't paid out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull the details.
[CUSTOMER][NEUTRAL] And it was done at the same facility.
[AGENT][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm just gonna pull the paperwork. OK one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you mind holding for me? I'm just gonna go ahead and go over everything we received that day.
[CUSTOMER][NEUTRAL] No, I don't mind. I don't mind.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for me Ms. [PII]. OK, so I see that there are two submissions for each one of them for [PII] and [PII]. It looks like on the paperwork on the form, it is, I think 20 of 25, and that's the reason we processed like that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, um, on [PII] I had a mammogram done. That's when I submitted. I got payment on that one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then there was another one I submitted for the year of [PII].
[AGENT][NEUTRAL] On the paperwork, it looks like it has 25 instead of 24, so you just need to submit that one again with the correct year.
[CUSTOMER][NEUTRAL] OK, [PII], [PII]. OK, and another question on um one of my um claims I did they got paid on, I think it was my surgery on um [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 113 2025.
[AGENT][NEUTRAL] In turning.
[CUSTOMER][NEUTRAL] I mean, I'm sorry, 131 2025. I don't know I got 13 of my kids.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but yeah, and what was the.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] To pay for what was it for anesthesiologist? Was it for the doctor, the surgery?
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Was that payment what all does it consist?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, yes. All right. So the, there's $200. It's OK. There's $200 for the facility. So those $200 is for the facility. There is $126 for the surgery itself, the surgery, and there is a benefit of $31.50 for the anesthesia.
[CUSTOMER][NEUTRAL] Yeah, I got herbal kid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 51, OK.
[CUSTOMER][NEUTRAL] I was wondering that's OK and what about the doctor?
[AGENT][NEUTRAL] Mm. Mhm.
[AGENT][NEUTRAL] Um, we do not cover, yeah, we do not cover the doctor itself. We do only cover the surgery, the anesthesia, and the facility. Those are the ones that we cover.
[CUSTOMER][NEGATIVE] I had to pay her too.
[CUSTOMER][NEUTRAL] OK, that's what I wanted to get.
[CUSTOMER][NEUTRAL] The surgery, and you don't cover, did you say you cover anesthesiologist?
[AGENT][NEUTRAL] We did cover for the anesthesia, um, that was the $31.50 we, we covered. Mhm.
[CUSTOMER][NEUTRAL] Or no.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEGATIVE] OK, alright, it wasn't listed correct. OK, it wasn't correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will re resubmit that other one for that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mammogram.
[CUSTOMER][NEUTRAL] OK, and the other ones that's pending, I think it was for like a colonoscopy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you see that one?
[AGENT][NEUTRAL] Let me see, let me see what is this for one moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 1 24 2.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] I'm waiting on the paperwork.
[CUSTOMER][NEUTRAL] 320.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I cause I know when I go look everything says pending, pending, pending, pending, pending. I said, I can't remember everything I submitted.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Cause when they said I could go back here, I went, OK, I'm just gonna submit it all.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that's that and um let me see.
[AGENT][NEUTRAL] OK, for the testing, you send it on the ones that you send in [PII] or [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see, the [PII] I think was for the doc I mean for.
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] I'm trying to think here the [PII].
[CUSTOMER][NEUTRAL] In the [PII] I guess for both. I mean, I mean what do I have pending?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Could you tell me that?
[AGENT][NEUTRAL] OK, well, the only thing that I see here um is the two claims that we process. So the one for the mammogram which we just need to fix that, the date of the year for that [PII]. And then we have the surgery one. the surgery one had, um, let me see, let me see how many line items.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we had the office visit, which is not covered. You had the surgery, anesthesia in the hospital, and then it has the first occurrence, but that's for internal cancer only. So that one didn't apply. And those are the only ones that I see here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so I just need to submit the colonoscopy?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the other mammogram that the fix the date on that one.
[AGENT][NEUTRAL] Yeah, for the [PII] and if you have uh the colonoscopy, you're trying to get a benefit like wellness preventative or what what try what?
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, just the wellness just wellness benefit.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me check and see how many you get a year. One moment.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it looks like um for the
[AGENT][NEUTRAL] Diagnostic testing, you get one per year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. So if you already, if, if that colonoscopy is for [PII], it will not cover because we already send the benefit for the mammogram.
[CUSTOMER][NEUTRAL] Do, yeah.
[CUSTOMER][NEUTRAL] The mammogram was for breast.
[AGENT][NEUTRAL] Yeah, but we only do one diagnostic testing per year. So it can be a mammogram, it can be a colonoscopy, yeah. Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, right.
[CUSTOMER][NEUTRAL] Oh, OK, so if I have a mammogram and.
[CUSTOMER][NEGATIVE] Going off we only get reimbursed just for one, not for each.
[AGENT][NEUTRAL] For one, yes.
[AGENT][POSITIVE] Correct. Yes. Mhm.
[CUSTOMER][NEUTRAL] Procedure, oh, OK. Oh, OK, I misunderstood that.
[AGENT][NEUTRAL] Yeah, it's OK. It's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll just resubmit the uh.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] The mammogram for um 32024.
[AGENT][NEUTRAL] Yes, OK. Yes.
[CUSTOMER][NEUTRAL] OK. No.
[CUSTOMER][POSITIVE] I, I got you now. OK, I'm, I'm catching on.
[AGENT][NEUTRAL] No, it's OK.
[CUSTOMER][POSITIVE] All right. All right. Thank, thank you so much.
[AGENT][POSITIVE] Mm. You're welcome. No problem. Is there anything else I'm gonna help you with today? Any other questions or concerns?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That's resubmit that data service.
[AGENT][POSITIVE] Yeah, OK, yes. Once we receive that, we'll go ahead and process, OK? You're welcome and thank you for calling APM. You're welcome. Have a good afternoon. Bye-bye.
[CUSTOMER][POSITIVE] All right, thank you so much.
[CUSTOMER][POSITIVE] Alright thank you so
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you