AccountId: 011433970860
ContactId: 63706229-7d94-4db0-89c5-ea6d73b75388
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322140 ms
Total Talk Time (AGENT): 91197 ms
Total Talk Time (CUSTOMER): 188366 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/2024/12/30/63706229-7d94-4db0-89c5-ea6d73b75388_20241230T15:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII], and I was wondering if you might be able to help me with um a couple claims.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII] that's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is um 02100475.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] The data service for this particular claim was from [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Total bill amount was $2750.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and I believe I just located the claim hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 34
[AGENT][NEUTRAL] It's coming up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we received it on [PII], and on, did you need the claim number, like the full claim status, or you have particular question?
[CUSTOMER][NEUTRAL] Well, the, the problem is is Cigna, OK, so Cigna reprocessed the claim leaving a different um patient responsibility, um, and we did send that over to you um it went out, it looks like, uh, [PII]. Now when I tried to check it online, of course it says that there's no claims to be displayed, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I don't, so have you received the new one yet or I guess not because you said [PII].
[AGENT][NEGATIVE] Well, so that was the original one. So the, we did receive the second one on [PII], but the reason the claim was originally denied was because there's no chemotherapy benefit when it's administered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In a physician's office or an outpatient facility. So,
[AGENT][NEGATIVE] It's still, it's not covered.
[CUSTOMER][NEUTRAL] Oh wow, OK.
[CUSTOMER][NEUTRAL] OK, when given.
[CUSTOMER][NEUTRAL] In AMD office.
[CUSTOMER][NEUTRAL] Or facility, uh of course why would our, why would our people not know that? Oh, I'm sorry, did I say that out loud? OK, alright, so, yeah, OK, so all of these claims then that I have for her.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have, oh my gosh, um, 105, 10 6, 1010, 10 2, 10 4.
[CUSTOMER][NEUTRAL] Um, and 10 9, um.
[AGENT][NEUTRAL] These are all of [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah, so, yeah, um, so what I see, 105, 106.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 10:10, 10 102 is the 1st 1, 10 4.
[CUSTOMER][NEUTRAL] 10 9. OK, so they start at 102 and they go till what was it 10:10 um.
[AGENT][NEUTRAL] So it looks like they were all denied for the same reason.
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] Same reason, OK. So, and you have all of the, I'm assuming you have all the new ones because they all got sent, but it's still denying for the exact same reason. So patient is going to be.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh it's gonna be liable for these. This is great and I know she's gonna be like, well, I don't understand why am I just getting billed now because, well.
[CUSTOMER][NEGATIVE] Your insurance is not paying them. That's why, um.
[CUSTOMER][NEUTRAL] Yeah, I mean, it's her co-insurance and I would assume she knew this with her policy, I would hope, I don't know. Um, OK. [PII], what's your last initial?
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] OK, and a reference?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] All right, well, perfect. Well, thank you so much, [PII]. I will make note on all of these accounts, get them billed to the appropriate person and then go from there. So, um, happy [PII], and I hope you have a great rest of your day.
[AGENT][POSITIVE] [PII] to you also. Thank you and thank you so much for calling APL again, all the information provided was a verification of benefits, not a guarantee of payment, and [PII] to you also.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.