AccountId: 011433970860
ContactId: 6daac31b-06f9-4b2a-a613-2b9f6afc2e27
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 842330 ms
Total Talk Time (AGENT): 367363 ms
Total Talk Time (CUSTOMER): 220345 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/6daac31b-06f9-4b2a-a613-2b9f6afc2e27_20250325T18:47_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, my name is [PII], and I have some questions about a claim and then just our policy in general.
[AGENT][NEUTRAL] OK, so this is your personal policy, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Um, may I have a callback number just in case we get disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Alright, well we've had three different ones but uh the current one, well I think this is the current one. I don't know, 02423.
[AGENT][NEUTRAL] It's OK, you can give me any.
[CUSTOMER][NEUTRAL] OK, 02423055.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] All right. OK. And may I have your date of birth and mailing address on file for verification?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what did you say address [PII].
[AGENT][POSITIVE] Perfect, thank you. Um, what is the date of service uh the, for the claim we're looking for?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't know. I didn't. I'm sorry, let me grab that.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I had something else in my hand. I didn't have that.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] And I think we just process one here in 3:17. Let me check the other ones and see if there's something.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me just
[CUSTOMER][NEUTRAL] Uh, [PII] and [PII], so 7 1024 and 73124.
[AGENT][NEUTRAL] OK, so yeah, it's gonna be on this one. OK, um.
[AGENT][NEUTRAL] Go back
[AGENT][NEUTRAL] OK, let me look at this explanation of benefits and see what happens.
[AGENT][NEUTRAL] OK, and this is for chemotherapy?
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I'm still waiting on the paperwork, bear with me.
[AGENT][NEUTRAL] We came here.
[AGENT][NEUTRAL] OK. All right, so, um, since the policy, um, covered extra charges, um,
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The amount of pay, yeah, with the insurance.
[AGENT][NEUTRAL] It looks like what we need is the explanation of benefits from the primary insurance, but let me double check if this is worth a little bit different.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] You.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah, it's basically that we need the explanation of benefits from the primary insurance showing that they pay and the amount they apply.
[AGENT][NEUTRAL] Um, do you have a copy of the explanation of benefits from your primary insurance?
[CUSTOMER][NEUTRAL] That's what I
[CUSTOMER][POSITIVE] Yeah, I mean that's what I sent most recently. I mean, I've given it to you before in a different way in a spreadsheet way, which is the way that it's most readily available to me from Medishare.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I found it in a more expanded version.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I sent that to y'all.
[CUSTOMER][NEUTRAL] Recently
[CUSTOMER][NEUTRAL] Like you said, I think you said [PII].
[CUSTOMER][NEUTRAL] Um, that's what I sent, and I understand, I mean, I, what the message is saying is your insurance didn't pay anything, so we're not gonna pay you anything. Is that basically what it's saying?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Not exactly. Uh, let me see.
[AGENT][NEUTRAL] Is that for the um I'm looking at the paperwork you send in, is that, that is the J 9271, it's an injection, right?
[CUSTOMER][NEUTRAL] Uh, on [PII] or [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, I had two treatments that would be past the plan year, you know, like I, I know I didn't qualify for anything because of the first year, I mean after you already paid for the first couple of ones.
[CUSTOMER][NEUTRAL] And then, um,
[CUSTOMER][NEUTRAL] Because it started, I mean, the 12 months started over. I had treatments, 2 treatments after that time that the 12 months started over.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] But they did not.
[CUSTOMER][NEUTRAL] So I really feel like.
[AGENT][NEUTRAL] I'm sorry, go ahead. Uh-huh.
[CUSTOMER][NEUTRAL] OK, go on.
[AGENT][NEGATIVE] But it doesn't, yeah, look, it doesn't look like they have applied anything like they have not paid just charge amount adjusted.
[CUSTOMER][NEUTRAL] No, you go on.
[AGENT][NEGATIVE] And then there's another like there's nothing that they uh apply or pay for it. It's all zeros.
[AGENT][NEGATIVE] So it looks like they adjusted $7150 and then uh there was $21,450 that were not legitimate um.
[AGENT][NEUTRAL] So it's like there's nothing that was applied. The only thing that I see here, let's see.
[AGENT][NEUTRAL] Is another coding which is the 96413, but that one is not part of the chemotherapy. The chemotherapy is the injection, the J 9271 and that's all in zeros.
[AGENT][NEUTRAL] So we're not seeing the actual charges.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] But I mean, so that's what you're saying because it's you're not showing that Medishare pay thing so you don't owe me anything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Yeah, if they didn't pay nothing, then there's nothing to pay.
[CUSTOMER][NEGATIVE] Probably I can't log in to the Medishare.
[CUSTOMER][NEGATIVE] And I can't find the copy of what I most recently sent you. All I can find is my spreadsheet chart, which that seems to show paying $530 for both of the [PII] and [PII] spreadsheet page that I have.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] The 5:30, let me tell, yeah, let me tell you what it's that for, OK, let me pull that code really quick.
[AGENT][NEUTRAL] Uh, that's 96413.
[AGENT][NEUTRAL] So that is the I fusion.
[AGENT][NEUTRAL] OK, so that's an IV infusion, um.
[AGENT][NEUTRAL] OK, let me get an examiner to, to go over this really quick, OK? Because I do see what you're saying, but I'm not sure if they're just looking at the other code and that's why they didn't look at that code or what happened. I really don't know. Um, I only see what they decided, which is that, that they don't see any charge amounts and that's why they didn't pay. Um, let me go ahead and
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me get an examiner really quick, OK, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling American Public Life. This is [PII]. Who am I speaking with?
[AGENT][NEUTRAL] Hi, [PII]. How are you? This is [PII].
[CUSTOMER][NEUTRAL] Hey so how are you doing?
[AGENT][POSITIVE] Hey, I'm good. How about you?
[CUSTOMER][NEUTRAL] Well, just living the dream one nightmare at a time, my love.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's a good one.
[AGENT][POSITIVE] But yeah, we're on the same page, it's OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, I have a member on the line that she said that she sent, uh, she believes she sent the information that we needed and that we're just overlooking the information. So, um, let me give you this policy number, um, yeah, let me go back. OK, that's 2423055.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and who's it on?
[AGENT][NEUTRAL] It's gonna be for [PII] like.
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Mhm. It is the most recent claim.
[AGENT][NEUTRAL] Which we're asking for actual charges. Mhm. And I'm looking at the EOB um the EOB she sent in which it does, uh, indicate some charges for the chemo infusion. I don't know if that's the one that, I mean, I don't know nothing about processing lands for cancer, so.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not sure if that's the one.
[CUSTOMER][POSITIVE] Me neither girl, so this is gonna be fun.
[AGENT][NEUTRAL] Oh my goodness, I know. Oh, this is so like, OK. We really need those classes because I have no idea. I know I pulled the code. I pulled the code and it did, it did say that that code, the 96413 is for chemo infusion, which I'm thinking that's chemo. So there is a charge there, so I'm not really sure what they're needing.
[CUSTOMER][NEUTRAL] Me neither.
[CUSTOMER][POSITIVE] Yes we do.
[CUSTOMER][NEUTRAL] OK, this is [PII] OK um she's in training, so let me.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] But it has to go through audit, so.
[AGENT][NEUTRAL] Yeah, because I thought maybe that.
[AGENT][NEUTRAL] Yeah, it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, um, go ahead and put her through. I'm gonna have to get with [PII] and see what it is that she's exactly needing.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, got you, got you. OK, well, I fully verify her, so, um, everything's been verified. The callback number, I think, let me double check if I, I usually write them down, so I don't really pay attention to what is in the system. Um, it's not the same. So let me give you the callback number just in case it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, give me one second, my headset's beeping at me. Hold on 1 2nd.
[AGENT][NEUTRAL] Oh, sure, yeah. Go ahead, go ahead.
[CUSTOMER][NEUTRAL] OK, there we go, are you there?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, I'm here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Damn. No, I'm just kidding.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] It didn't go
[AGENT][NEUTRAL] All right. Are you ready?
[CUSTOMER][POSITIVE] I am. I'm ready when you are.
[AGENT][POSITIVE] All right. OK, here she comes. Have a good day.
[CUSTOMER][POSITIVE] You too, love.
[AGENT][POSITIVE] Thank thank you, thank you for holding and being patient for me um Miss [PII] uh Miss [PII], I'm sorry, I got Miss [PII] on the line and she's gonna assist you from here. She's in the claims department, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] Hi Ms. [PII], this is uh [PII]. I'm in the, uh, claims department. Give me one second to just look everything over if that's OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] No problem, give me 1 2nd.