AccountId: 011433970860
ContactId: 6d57fef2-6dcb-4234-91df-197b55c39d81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1018969 ms
Total Talk Time (AGENT): 214364 ms
Total Talk Time (CUSTOMER): 520035 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/2025/04/11/6d57fef2-6dcb-4234-91df-197b55c39d81_20250411T21:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. Is [PII] busy? Is she where we can talk to her?
[AGENT][NEUTRAL] Uh, it looks like she's on another call right now. Is there anything that maybe I can help you with? Or would you like me to ask her to call you back?
[CUSTOMER][NEUTRAL] Uh, well, she's been helping us with the, uh, claims that we sent in, uh, but I could ask you, I mean, [PII] is here with me. I'm right here and we sent a formman yesterday that he authorized me to visit with him.
[CUSTOMER][NEUTRAL] Uh, shall I give you, uh, like the claim number or the policy number?
[AGENT][POSITIVE] Yeah, you can give me either one of those and we can go from there.
[CUSTOMER][NEUTRAL] Alright, the claim that we're talking about is number 3561762. His account is 9A20631.
[AGENT][NEUTRAL] All right. And then on the policy, if you could just verify the name and date of birth, please?
[CUSTOMER][NEUTRAL] Go ahead. [PII], it's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you so much. OK, so.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so I've got the claim pulled up here, um.
[CUSTOMER][NEUTRAL] OK, I'm looking at the explanation of benefits that is at the top of a check that was written.
[CUSTOMER][NEUTRAL] And if you look almost to the bottom, it says [PII], who is the most dermatologist.
[CUSTOMER][NEUTRAL] And the reason for not paying #6 says it needs a pathology report. Well, on his, um.
[CUSTOMER][NEUTRAL] Um, sorry.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It states uh pathology, and he gives the uh
[CUSTOMER][NEUTRAL] It, it said, he, he calls it pathology, full thickness.
[CUSTOMER][NEUTRAL] Deeper tumor islands. I, I, I don't understand all that, but if you could look at his
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And his is the claim forms that have got a whole lot of pages on each one.
[CUSTOMER][NEUTRAL] And this one is dated.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See, these are the claims.
[CUSTOMER][NEUTRAL] Right here.
[CUSTOMER][NEUTRAL] 173.
[CUSTOMER][NEUTRAL] 1117312 and 14301. And that's the surgery that he had.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] What our question I guess is what more of the pathology report would you want? He states the pathology and he is
[CUSTOMER][NEUTRAL] Uh, he's a most dermatologist, which I'm sure you know what that is. I didn't, but he does all of the, he does the surgery, he runs it to see if he got all the cancer. He, he had to go back on Roberts, I think, 2 times. He keeps them in the chair and keeps the
[CUSTOMER][NEUTRAL] Anesthetic in the surgery.
[CUSTOMER][NEUTRAL] And until he gets a clear report.
[CUSTOMER][NEUTRAL] He, he does not stop the surgery. So this is his pathology report. He doesn't have a lab that gives him
[CUSTOMER][NEUTRAL] So I didn't know what else we could send you.
[AGENT][NEUTRAL] OK, um, let me take a look and see.
[AGENT][NEUTRAL] What was uploaded here. Um, I pulled the upload.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] We have the same thing on another one.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] How be it, I think they send theirs off, so it's, it's, let's finish Dr. [PII], don't.
[CUSTOMER][NEGATIVE] I shouldn't get ahead of you.
[AGENT][NEUTRAL] OK, 5, 1020.
[CUSTOMER][NEUTRAL] Do you see the 3.
[AGENT][NEUTRAL] Yeah, it looks like it was page 11.
[CUSTOMER][NEUTRAL] Claims
[CUSTOMER][NEUTRAL] Yeah, I don't see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then, um.
[AGENT][NEUTRAL] What was your question on one of the other denials?
[CUSTOMER][NEUTRAL] Uh well, it's uh up on um.
[CUSTOMER][NEUTRAL] 76.
[CUSTOMER][NEUTRAL] Tulsa dermatology.
[CUSTOMER][NEUTRAL] You'd have to go to Hershey, her claim form, and she doesn't do as detailed as uh Doctor [PII], but it was surgery.
[CUSTOMER][NEUTRAL] And uh you say you need the pathology report on that.
[CUSTOMER][NEUTRAL] Do I just call the uh because on her uh bill it says um.
[CUSTOMER][POSITIVE] I like melanoma in
[CUSTOMER][NEUTRAL] It it was his surgery on his arm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me look at what was submitted for that one here give me just.
[CUSTOMER][NEUTRAL] But there's nothing on her.
[CUSTOMER][NEUTRAL] Uh, receipts that actually says pathology report.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I, I didn't see it, so I, I don't know if, if I'm not looking at it right or.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It just says.
[CUSTOMER][NEGATIVE] Malignant, something, something in left upper limb.
[CUSTOMER][NEUTRAL] And it's 1 $1,103.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So basically, what am I to get you?
[CUSTOMER][NEUTRAL] So that those are considered because they were definitely surgery.
[AGENT][NEUTRAL] Yeah, I was looking to see what we have for the 768. I'm kinda, I'm still scrolling through this paperwork here.
[CUSTOMER][NEUTRAL] I know it was a lot.
[AGENT][NEUTRAL] Yeah, um, let's see.
[CUSTOMER][NEGATIVE] Uh, that's the one thing I hated to have to bother another person cares already had gone through all of this, I think. I don't know.
[CUSTOMER][NEGATIVE] We were stymied because [PII] was at the barn and
[CUSTOMER][NEGATIVE] And [PII] couldn't finish helping me.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so I see what you're talking about because I see the pathology report.
[AGENT][NEUTRAL] So I'm not exactly sure what else the examiner would need on it to process the claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] We can do one of two things. Um, I can schedule a call back for an examiner to give you a call and let them know what's going on with the claim and let them know that, you know, you need to know exactly what you need to get, if anything.
[AGENT][NEUTRAL] Uh, to have that portion of the denied claim reprocessed if you're OK with a call back I can do that, um, or I can get somebody on the line now if you'd rather, um, not wait for a call back.
[CUSTOMER][NEUTRAL] Well, um,
[CUSTOMER][NEUTRAL] Since this is Friday.
[CUSTOMER][NEUTRAL] Uh, what time do y'all leave at [PII]?
[AGENT][NEUTRAL] We leave at [PII] Central time.
[CUSTOMER][NEUTRAL] Oh, OK, so I'm not keeping you there. OK, right.
[AGENT][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] OK. I would like to resolve it, uh, if we could.
[CUSTOMER][NEUTRAL] On both of them, both surgeries.
[AGENT][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] The rest of the the not covered, you know, uh.
[CUSTOMER][NEUTRAL] But, but these, there's 3 claims on each one.
[CUSTOMER][NEUTRAL] And one doesn't have an amount, but it does the, the two.
[CUSTOMER][NEUTRAL] On Tulsa dermatology, on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 76, I think 73 uh might have I might have been.
[CUSTOMER][NEUTRAL] I don't know why.
[CUSTOMER][NEUTRAL] I guess we went back in. So if I need to call her and find out, but I know the one on the [PII] was surgery. She did a big surgery all the way up his arm and into his shoulder.
[AGENT][NEUTRAL] OK, yeah, and then the one on the.
[AGENT][NEUTRAL] 10, 510, that was the other one.
[CUSTOMER][NEUTRAL] Correct. Under [PII], all three of those charges were definitely surgery. I don't know why he broke them up.
[CUSTOMER][NEUTRAL] Uh, except that maybe every time he goes back and test and they haven't gotten all of the cancer, he comes back and, and operates more. It's the only reason that I could figure why he didn't just include it all in one thing, but the pathology report is there on his.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I, I, I did see that it was uploaded there, so, um.
[AGENT][POSITIVE] So yeah, I mean, you, I am happy to have somebody in the claim, somebody that actually processes claims and is a claim examiner. I'm happy to have them take another look at it um because I do see the pathology report and then have them give you a call, um, and then that way they can look at all the documents, the 40 pages, make sure that everything was processed correctly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then they can advise you on exactly what you would need to contact the provider for if you're OK with that.
[CUSTOMER][NEUTRAL] Right. Um,
[CUSTOMER][NEUTRAL] Doctor [PII] is no longer uh operating. He sold this practice, so for us to get hold of him is gonna be very difficult. But, um, you know, we can do some digging if they have to have something else, but I truthfully don't know why they would, but
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, will they call us back today or?
[AGENT][NEUTRAL] I can't guarantee that it would be today if you'd rather speak to somebody now in regards to it, I can call over and get somebody on the line instead of waiting for a call back.
[CUSTOMER][NEUTRAL] OK, which would get the best response?
[AGENT][NEUTRAL] It's honestly up to you, ma'am, just as far as, you know, urgency. If you prefer to just handle that now, um I can call over there if you don't mind waiting. Um, it would just give them time to research it and then give you a call back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It is I, I'm hesitant and I know you wonder why. We are in Wyoming and we have no cell service and we have no call waiting caller ID.
[CUSTOMER][NEUTRAL] So if something happened, we were on the phone.
[CUSTOMER][NEUTRAL] I would not know they were calling.
[CUSTOMER][NEGATIVE] They would just get a ring tone. And that's, uh, you know, if, if I let you off on the phone and I get on with somebody else calling, I won't know if you call me back.
[AGENT][NEUTRAL] OK, um, so.
[CUSTOMER][NEGATIVE] hopefully, hopefully I won't have anybody call me, but.
[AGENT][POSITIVE] OK, let me grab your first name again. I'm sorry.
[CUSTOMER][NEUTRAL] OK, uh, my husband's name.
[CUSTOMER][NEUTRAL] I'm [PII]
[AGENT][NEUTRAL] I have [PII] and then let me get your first name.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK [PII], hold the line for me one moment let me get somebody on the line in claims.
[CUSTOMER][NEUTRAL] All right, [PII]. You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] Celebrity and claim support.