AccountId: 011433970860
ContactId: 65ec23d6-3c9a-4be5-bbd9-37bfcb412b3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 849400 ms
Total Talk Time (AGENT): 291128 ms
Total Talk Time (CUSTOMER): 271940 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/65ec23d6-3c9a-4be5-bbd9-37bfcb412b3f_20250408T16:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Louisiana Blue Blue Cross and Blue Shield of Louisiana on behalf of a member. Um, I'm calling because the member, um, was told she needed to give additional breakdown of the EOBs that we have provided to her for her claims for you guys to pay us a supplemental cancel policy, and we're a little confused as to what other information you could be requesting because there's not anything else we can send.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Um, I don't have a policy number. I do have her social security number.
[AGENT][NEUTRAL] OK, that'll work. What is that?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Um, I can just get, we don't have the direct number so I can give you our [PII] number. It is one second.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was the patient name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, uh let me see.
[AGENT][NEUTRAL] And she was the patient, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you know what date of service this is for?
[CUSTOMER][NEUTRAL] Um, one of the data services [PII]. There's a couple of other, but that's the one I was specifically looking at at the current moment.
[AGENT][NEUTRAL] OK, let me get that pulled up.
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] Uh, the explanation I have, explanation of benefits received does not list the amounts applied to the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] And it's the EOV that shows it's from Louisiana Blue.
[AGENT][NEUTRAL] Um, let me pull up what we received. Maybe that's the problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] 1021 24.
[AGENT][NEUTRAL] OK, let me, it's pulling it up. Give me just a moment.
[CUSTOMER][POSITIVE] No problem, take your time.
[AGENT][NEUTRAL] OK, see pathology.
[AGENT][NEUTRAL] OK, let's see, I've got a medical claim detail, but is that how your EOB reads?
[CUSTOMER][NEUTRAL] Um, I know she said she sent she might not have sent the whole page, but yeah, it says it does say medical claim details and then it'll have the
[CUSTOMER][NEUTRAL] Provider name data service type of service and then see notes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the notes break down the claim details.
[AGENT][NEUTRAL] OK, so it shows there was an 8,568 discount was 152707.
[AGENT][NEUTRAL] Not covered 3157 plan paid 349081.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, I don't really know what is missing.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Yeah, because I see your EOB, it looks like it, I mean it breaks everything down, so I'm not sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see what this line that's referring to.
[CUSTOMER][NEUTRAL] I know she said someone told her they specifically needed the claim line for the like this one was for a PET scan so they specifically needed the PET scan claim line, but we don't break the EOBs down by the individual claim lines so we can't do that.
[AGENT][NEUTRAL] OK, because what she submitted, let me she submitted.
[CUSTOMER][NEUTRAL] I for that date but.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] OK, she submitted 3,157.
[AGENT][NEUTRAL] 4125. OK, I think that's probably where the problem is. Let's see, 3000.
[AGENT][NEUTRAL] 72553 26 let me see.
[AGENT][NEUTRAL] I think that's where we're having a problem is matching these up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I put you on a brief hold real quick? Let me check back in with the member, uh, to let her know I'm speaking with you.
[AGENT][POSITIVE] Yeah, absolutely, absolutely.
[CUSTOMER][POSITIVE] Alright, thank you, alright, hold on. If you're a member struggling with chronic disease or other health issues, we're here to help with resources, education, and support at no extra charge. You can be stronger than any diagnosis or health condition. Visit [PII] stronger to find out more about our care.
[CUSTOMER][POSITIVE] OK, I'm back. Thank you for holding.
[AGENT][POSITIVE] OK, thank you. Um.
[AGENT][NEUTRAL] Yeah, I think that's what the issue is we're not able to match up what she submitted um with the EOB because on our end since this is a a cancer policy it does have to match so she submits the charge we have to be able to identify that exact charge.
[AGENT][NEUTRAL] On the EOB, um.
[AGENT][NEUTRAL] I'm trying to think what we can do, um.
[CUSTOMER][NEUTRAL] Trying to figure out what or is it possible she sent the cause that says.
[AGENT][NEUTRAL] Yeah, she said so she sent the pathology report, which that's not really, I mean we need the pathology report just for documentation, but.
[CUSTOMER][NEUTRAL] 4,
[AGENT][NEUTRAL] Um, and then she sent.
[AGENT][NEUTRAL] Uh she did send the itemized bill of charges.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I wonder if she didn't send all of the EOBs because this EOB is not the.
[CUSTOMER][NEGATIVE] That's not the full charge, and that might be part of the problem.
[AGENT][NEUTRAL] Yeah, because it looks like.
[CUSTOMER][NEUTRAL] Um, give me one.
[AGENT][NEUTRAL] I've got I've got an EOB for a total of 8,857.
[AGENT][NEUTRAL] Just got two charges on it, one for 8,568, 1 for 289.
[AGENT][NEGATIVE] And then she sent another item and another itemized bill from [PII] from the hospital.
[AGENT][NEUTRAL] Um, and then another EOB that totaled 4,82658.
[AGENT][NEUTRAL] Those dates of service range from [PII] to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and then [PII], another EOB 99 through [PII] for 5761 60.
[AGENT][NEUTRAL] And another 1, uh, [PII] [PII].
[AGENT][NEUTRAL] So let's see, um.
[AGENT][NEUTRAL] I'm trying to decipher, well, so.
[CUSTOMER][NEUTRAL] 10:21.
[AGENT][NEUTRAL] Would I be able to, I know I, I don't wanna take up a ton of your time, but really who could best figure this out would be our claims department.
[AGENT][NEUTRAL] Um, because they can look at exactly what we need, is there a way that you could speak with them or, um, you know, let the patient know that you're working on this with us to get it resolved, um, and I can transfer you over to our claims department. Would that be OK?
[CUSTOMER][NEUTRAL] Um, yes, I can speak to the claims department. Um, I will probably have to tell the member that I would need to call her back though, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you want me to transfer you over or you wanna tell her real quick?
[CUSTOMER][NEUTRAL] Uh, let me.
[CUSTOMER][NEUTRAL] Yeah, let me tell her real quick that I will call her back after I speak to the claims department, and then, uh, I'll come back and let you transfer me.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] You're welcome. Alright, hold on.
[CUSTOMER][POSITIVE] Thank you for holding. We appreciate your call. We look forward to providing you with exceptional service and support when we return to the line.
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[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] OK, OK, give me one moment, OK?
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi, this is [PII] on the care team, and I've got a primary insurance on the line. Um, she's trying to help the insured because there was a claim that we denied and the primary explanation of benefits was submitted, but
[AGENT][NEUTRAL] I can't figure out what exactly is missing on the claim matching up to the EOBs of the primary.
[CUSTOMER][POSITIVE] OK, I'd be happy to take a look. [PII], can you give me the policy number please?
[AGENT][NEUTRAL] Uh, policy number is 769779.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I've got um [PII] on the line from the primary insurance.
[AGENT][NEUTRAL] Um, the EOBs, and I can give you the claim number.
[CUSTOMER][NEUTRAL] OK, go ahead with that claim number.
[AGENT][NEUTRAL] Claim number is 3,583,910.
[CUSTOMER][NEUTRAL] And it's uh you said [PII] is uh the provider?
[AGENT][NEUTRAL] Yes, [PII] is with the primary uh insurance.
[CUSTOMER][NEUTRAL] And Ms. [PII], OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And what's a good call back number they gave you? Is that the number on the screen there?
[AGENT][NEUTRAL] Uh, it's [PII] no, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, and so we're trying to match up the information for that claim 358.
[CUSTOMER][NEUTRAL] 3910.
[AGENT][NEUTRAL] Yeah, I just have
[CUSTOMER][NEUTRAL] And um with
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEGATIVE] I just couldn't decipher what exactly is missing or what's not matching.
[AGENT][NEUTRAL] According to the EOBs, so.
[AGENT][NEUTRAL] So I was just gonna see if you could help her walk through it.
[CUSTOMER][NEUTRAL] Yeah, yeah, it looks like the surgery and the imaging for [PII] on imaging and [PII] on the surgery. OK, I pulled up the um mail itself so I can go ahead and take a peek through it. If you wanna go ahead and transfer him and uh the patient information was verified, [PII].
[AGENT][POSITIVE] Yes, it was, yes, I did get that verified, yep.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][POSITIVE] OK, well, thank you so much.
[CUSTOMER][POSITIVE] Alright, well you can go ahead and you're welcome have a great day.
[AGENT][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, hi, this is [PII]. I'm on the claim support team and.
[AGENT][NEUTRAL] Oh