AccountId: 011433970860
ContactId: 80cde3f5-b762-481a-97db-998852c00445
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1112479 ms
Total Talk Time (AGENT): 329938 ms
Total Talk Time (CUSTOMER): 574018 ms
Interruptions: 6
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/80cde3f5-b762-481a-97db-998852c00445_20250203T21:01_UTC.wav
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[AGENT][POSITIVE] Afternoon. Thanks for calling Alis [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am. I was wondering if you might go over a couple of my claims with me.
[AGENT][POSITIVE] I can help you with that. Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] Your policy number?
[CUSTOMER][NEUTRAL] Oh goodness, I don't know it right off. I'm just gonna give you my social if that's OK. It is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] Can you verify your date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And lastly, your email address.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, Miss, thank you for that. You said you had a question about a claim.
[CUSTOMER][NEUTRAL] Well, I had those last 4 that came in, and 2 of them showed to be, I guess, would it be denied. It said they were paid at $0. But the question was the one that I actually turned in for, which was my chemo, I'm sorry, not my chemotherapy, my immunotherapy, which is the drug is called Keytruda. I know you'll cover that one and I know you pay on that one. And it doesn't even show on there. And we turned the EOB in for it and all of that, trying to figure out what happened to that claim, or did you see that claim?
[AGENT][NEUTRAL] Um, do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] I do. The date of service is [PII].
[AGENT][NEUTRAL] OK, give me 1 2nd.
[CUSTOMER][NEGATIVE] And it was after [PII], which was when my cancer policy restated for the year for my immunotherapy, and it doesn't show that y'all paid anything toward it, but it also doesn't show to be on there. And I'm not sure if I didn't send them the right thing or what happened.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] There's a $51,000 claim.
[AGENT][NEUTRAL] I'm trying to look to see.
[CUSTOMER][NEGATIVE] It was, it should have been in one of those last 4, those 4 that were just processed is where it should have been.
[AGENT][NEUTRAL] It could be, um, we need the UOB um for.
[CUSTOMER][NEUTRAL] We, we gave, we gave the EOB even my insurance dealt with a three-way call with your representative. She was great, your representative. She got the EOB, she got procedure codes, this lady was amazing. And she did a three-way with my Blue Cross people. And that's why I'm not understanding. I need to know what's going on, so I really need to get paid. It's all I have. I'm not working right now due to cancer and treatments.
[AGENT][NEUTRAL] Yeah, I'm just trying to figure out which um claim it is, um, or which one it is, so give me one.
[CUSTOMER][NEUTRAL] OK, I.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Oh, I was, I'm sorry, I'm talking out loud. I was looking at my phone. I'm pretty sure I have the EOD on my phone too, but we already sent it is what I'm saying.
[CUSTOMER][POSITIVE] They sent everything that day. They were great, and she assured your representative that that and your representative assured me that she had everything she needed to file that claim. Do you even see that claim as filed?
[AGENT][NEUTRAL] Well, that's on, that's on. I'm giving you one second. I'm, because there's a few on here so I'm trying to look to find out which one is the correct one.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Oh, I got you.
[AGENT][NEUTRAL] And you said what was the amount?
[CUSTOMER][NEUTRAL] And sure
[CUSTOMER][NEUTRAL] Uh, it was over 51,000.
[CUSTOMER][NEUTRAL] Abi.
[AGENT][NEUTRAL] OK, I'm looking through.
[CUSTOMER][NEUTRAL] And then I haven't looked at those others that that I was paid $50 for something and $25 for another I haven't even really took a look at what those are yet, but.
[CUSTOMER][NEGATIVE] It's that one that I'm most concerned with.
[CUSTOMER][NEUTRAL] And it's just one-time payment a year of 20,000 for immuno radiation, or chemo, and this would be strictly for.
[CUSTOMER][NEUTRAL] This would be my immunotherapy.
[AGENT][NEUTRAL] OK, so I'm looking at that claim that you're referring to, um, the total charge, um, was for 43,76921 for data service on [PII] and [PII], and we don't have the EOB for those, those two, and this is the last claim that was processed.
[CUSTOMER][POSITIVE] That is so awesome.
[AGENT][NEUTRAL] I mean, she might have spoke to somebody on the phone, but we haven't received the UOB yet.
[CUSTOMER][NEUTRAL] That is crazy
[CUSTOMER][POSITIVE] She sent it, she sent it right then and there. Your representative spoke with me and your representative said, I have it. It's all right here in my email. She said, nothing to worry about. I'm gonna get this processed. She said the EOB is here. Everything I need is here. I spent an hour and a half on the phone between your representative and the Blue Cross person.
[CUSTOMER][NEGATIVE] Oh, that is crazy. I am exhausted with this. What do I need to do now?
[AGENT][NEUTRAL] So I'm looking at the notes to see who you spoke with. Um, do you remember what day that you had spoke to somebody?
[CUSTOMER][NEUTRAL] Yes, I am. There's been
[CUSTOMER][NEUTRAL] Um, it's probably been 2 weeks now.
[CUSTOMER][NEUTRAL] I couldn't give you the exact date, but once it was on a Thursday or a Friday.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[CUSTOMER][POSITIVE] I only remember because my little granddaughter was getting her nails done and I was with her.
[CUSTOMER][NEUTRAL] And I had to sit on the phone with them while she was getting her nails done. She kept saying, Are you getting off the phone?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yeah, they told me everything was taken care of and I even looked in my email they sent it to y'all and they sent it to me.
[CUSTOMER][MIXED] And the lady on your end said, I didn't need to resend anything else because of the way she did it and the way that she took care of it with that representative personally. This lady was amazing. She told my representative from Blue Cross, she said, we need that EOB. We need these codes and can't process her until we get it. And the lady was great. The other lady too, she went right in and got it and said, here it is. So now I'm just so confused.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] So I'm looking at um.
[AGENT][NEUTRAL] The day that you're more like I spoke speaking about and which was more like 1:17 and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This, like I said on [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] We received some documents on [PII]. However, it does not have the EOB for those two days. There is 88 pages that we received and like I said, those, that's the reason why those two dates were not paid because it does not include the EOB. So in order for those dates to be paid, we need the EOB for those two dates of services for chemo.
[CUSTOMER][POSITIVE] That is so cool.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You start this.
[CUSTOMER][NEGATIVE] OK. Can, can you, can you walk me through? I'm gonna do it while I'm on the phone with you because I want this finished. I'm so tired. OK, I'm gonna go to my site. I'm at the blueprint portal.
[CUSTOMER][NEUTRAL] I'm not the most techy person in the world, so blueprint portal. OK, I'm in the blueprint portal portal. I'm pulling up my where my EOB should be. It might take me just a minute. I'm sorry.
[CUSTOMER][NEUTRAL] I would have already been on that had they not assured me, both of them that it was taken care of. I mean,
[CUSTOMER][POSITIVE] I figured it was taken care of.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, it's gonna take me a minute to locate it in my file. Is there not a way you could do a freeway with me right now with Blue Cross like she did and just get that handled?
[AGENT][NEUTRAL] Well, like I said, I mean they would have to.
[AGENT][NEUTRAL] Fax over the EB to us or mail it. I mean, and that's or if you have the online portal you can upload the document but I can't request it. I mean, um over the phone that when you called that day that was customer service but like I said, because I mean it can't be emailed. I I don't accept email like I said, we only get it through fax, mail, or like I said through the portal where you can upload it.
[CUSTOMER][NEUTRAL] Right, the lady said see.
[CUSTOMER][NEUTRAL] So what would she have gotten that day then, a fax or an email?
[AGENT][NEUTRAL] So, it looks like it was, I'm trying to see the way this was said.
[CUSTOMER][NEUTRAL] Your representative.
[AGENT][NEUTRAL] Because it won't show me, uh, it just shows that we received the document on the [PII], so they might have faxed it over to us.
[CUSTOMER][MIXED] OK, but they didn't fax the EOB?
[CUSTOMER][NEUTRAL] That was the whole conversation. I mean, the whole conversation was, and they both agreed it was there, so maybe I could get back in touch.
[AGENT][NEUTRAL] So what we would see they sent over um.
[CUSTOMER][NEUTRAL] With the
[AGENT][NEUTRAL] Charges, but there's no EOB attached.
[AGENT][NEUTRAL] There's procedure codes, but there's no EOB.
[CUSTOMER][NEUTRAL] OK, there should be.
[CUSTOMER][NEUTRAL] OK. Uh, can I speak with the representative that I spoke with that day and let her get this taken care of?
[AGENT][NEUTRAL] Well, like I said, I'm, I'm in the counselor department that processes these claims that day with a customer service rep, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Basically, like I said, that is information that we would need. And like I said, when she spoke to, when you had your insurance company on, on the line that day and we requested the codes, like I said, we received procedure codes, but we're needing explanation of benefits. So you're either, I mean, if you have that, then you would have to send over the explanation of benefits for the chemo before we can pay and that's anytime chemo.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Right, and that's exactly what she said this plan.
[AGENT][NEUTRAL] Immunotherapy or home or anything like that is submit, we have to have the EOB because we go based off of actual charges that are on the EOB and not bill charges.
[CUSTOMER][NEUTRAL] Right, and I totally, I totally get that, but I shouldn't have been told that day that everything was done. This has been 2 weeks now and now here I am again. Um, I'm going through my, OK, I'm gonna try to send this to you. I'm sorry, hold on just one sec.
[CUSTOMER][NEUTRAL] Not sure if I know how to be honest.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One sec here.
[CUSTOMER][NEUTRAL] And then is that gonna be a whole another processing thing again?
[AGENT][NEUTRAL] Yes, so the way it works, any time we receive any kind of claim information, we have a time frame to process claims so we don't process the same day we get information.
[CUSTOMER][NEGATIVE] All right, I realized that usually it's about 10 business days, but this has been far longer and I was told it was done, so I shouldn't have to wait another darn 10 days is what I'm saying.
[AGENT][NEUTRAL] Yes, ma'am. That's the way, like I said, when you speak to somebody in the customer service department, they're just telling you, I mean, basic information. So basically, I mean, she wouldn't have known if we had everything when SEC because they don't process, they only take the phone calls. We are the team that processes the claims.
[AGENT][NEUTRAL] And so when we would process the claim, the rep that processed the claim, she determined that she could not pay the chemo because the EOB was not in the documents that were sent over from your insurance company, and this claim was processed on Friday.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And the other two claims that are on there that are showing no pay, was that something that was not qualified or?
[AGENT][NEGATIVE] The only other claim that I'm seeing that it's no pay, um.
[AGENT][NEUTRAL] I mean, as a few clients, I'm not really sure which claims you because the claims that were processed on Friday, let me see where the, the ones that were processed on Friday were payments, so.
[CUSTOMER][NEUTRAL] It was 2.
[AGENT][NEUTRAL] Like, I would need a claim number to determine which one you're referring to where there's no payment.
[CUSTOMER][NEUTRAL] Oh, they're just, they're just on my, they're just on my side, but the 4 most recent ones, 2 were paid and 2 were not.
[CUSTOMER][NEUTRAL] That's what I was referring to.
[CUSTOMER][NEUTRAL] Alright, I'm back into the blueprint portal.
[CUSTOMER][POSITIVE] If I can make this happen. All right, now I'm gonna try to go find the claim real quick.
[CUSTOMER][NEUTRAL] I'm so sorry, ma'am. I just got done with immunotherapy and things. I'm just so tired. Um, let's look here.
[CUSTOMER][NEUTRAL] All right, completed claims, view the claims.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And the date is the [PII].
[CUSTOMER][NEUTRAL] Sometimes because I have so many clients, it's like fishing through, you know.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And they did it in a book. They did it like from a certain date to a certain day that I noticed instead of just the [PII]. That's why it made it so many papers, I believe.
[AGENT][NEGATIVE] But like I said, they sent us a lot of documents and and none of these documents it has, it'll be it only has procedure code and bill amounts because they send us 88 pages and there's no.
[CUSTOMER][NEGATIVE] So weird.
[AGENT][NEUTRAL] No EOB, so I mean, it's fine that there's a lot of dates, but like I said, long as it's the EOB showing that information.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEGATIVE] Well, that is insane. I wasted their time, they wasted my time and they didn't tell me correctly. I mean it makes no sense. Uh, let's see.
[CUSTOMER][NEUTRAL] Here's [PII]. We're getting to it. [PII]. All right. So there's the first one. There were several, of course, on [PII]. Uh, do you know what that claim is then? Can you see it?
[AGENT][NEUTRAL] Our claim number or?
[CUSTOMER][NEUTRAL] The last one.
[CUSTOMER][NEUTRAL] Oh well it would be their claim number I guess you wouldn't have that. uh OK, let me look.
[CUSTOMER][NEUTRAL] I think it ends in J something. I'm sorry.
[CUSTOMER][NEUTRAL] And to look at it so many times.
[CUSTOMER][NEUTRAL] OK, there's the [PII].
[CUSTOMER][NEUTRAL] The lady told me to try going under the [PII] because of the way they both it together. It doesn't make sense to me, but, yeah, cause these are all coming up on the [PII], and none of these are the big claim for my uh intruder.
[CUSTOMER][NEUTRAL] And that's what I'm looking for.
[CUSTOMER][NEUTRAL] I detail. These are smaller claims.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I guess I have to put a different day then because the [PII] there's nothing's coming up.
[CUSTOMER][NEUTRAL] And this is, she had that issue that day on the phone with the representative, and then the representative explained something about bulking them together from the [PII] [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I can't even find the claim.
[CUSTOMER][NEUTRAL] This is crazy.
[CUSTOMER][NEUTRAL] Oh, let me see if there's anything under the [PII].
[CUSTOMER][NEGATIVE] Oh gosh. Like I just wasted 2 more weeks.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Trying to dig up the [PII] here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Here's one.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] It was the [PII], all has to be closed.
[CUSTOMER][POSITIVE] I'm sorry to take up so much of your time. I'm just.
[CUSTOMER][NEUTRAL] Got to get to the bottom of this.
[CUSTOMER][NEUTRAL] Alright, well, when my daughter gets home.
[CUSTOMER][NEUTRAL] I will see if she can find it and I guess now we need to resend the EOBs.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Is it is it possible for me to fax you that EOB?
[AGENT][NEUTRAL] Yes ma'am, you can fax over the EB I can provide you the fax number.
[CUSTOMER][NEUTRAL] Let me get, let me get that from you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, and that's the number she gave that lady that day too, the lady that was supposed to fax it or email it or whatever she did, fax number APL.
[CUSTOMER][NEGATIVE] All right, and then you're telling me it could still be even once it gets sent over to you another 10 or more days.
[AGENT][NEUTRAL] Yes, ma'am. We process claims based on when we receive them as far as any type of information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Is there a way since I was improperly told by one of your own representatives that they could do a stat on this for me?
[CUSTOMER][NEUTRAL] I mean, I have dealt with this claim forever now. First of all, it took forever for my insurance company to even send the EOB even after they paid the bill. But like I said, your lady assured me she had everything she needed, even she said all that.
[AGENT][NEUTRAL] Yes, ma'am, I understand, but like I said, that was the customer service department and when she's on the phone with your insurance, they were supposed to send out information, so they only sent over the procedure code and not the EOB.
[CUSTOMER][POSITIVE] But she looked at it while I was on the phone, and her words were, we have everything. We have the EOB, we have the procedure codes, now we can proceed.
[AGENT][NEUTRAL] Yes, ma'am. I mean, I, I mean, I can ask, but like I said, we didn't receive everything and like I said, she doesn't process claims, she only takes the phone calls. So like I said, once the rep on the team processed the claim, they only had the procedure code.
[CUSTOMER][NEGATIVE] So that makes no sense.
[CUSTOMER][NEUTRAL] Maybe, maybe you could ask.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK, maybe you could, maybe you could track her down and ask her for me.
[CUSTOMER][NEUTRAL] Because I, like I said, that's 2 more weeks.
[CUSTOMER][POSITIVE] All right, I'll see if my daughter can try to send something again tonight when she gets home. Thank you.
[AGENT][NEUTRAL] No problem, Miss [PII]. Was there