AccountId: 011433970860
ContactId: 82261d45-c19d-45c2-92e5-f6615dce9e79
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 715679 ms
Total Talk Time (AGENT): 344332 ms
Total Talk Time (CUSTOMER): 403514 ms
Interruptions: 12
Overall Sentiment: AGENT=2.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/82261d45-c19d-45c2-92e5-f6615dce9e79_20250131T16:17_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] I'm honestly just overwhelmed. So I just figured I'd call and see if that could help me. Um I'm I'm trying to.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Yeah, absolutely. How can we help?
[CUSTOMER][NEUTRAL] I'm trying to upload files, you know, for claims. I don't, I have no idea if I'm uploading it right or wrong or.
[CUSTOMER][NEUTRAL] Anything I don't know if you can help me. I don't know if you can see things on your end or.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I can definitely help with troubleshooting for sure, and if I can't help, I can escalate it to our IT department. Um, do you have your, do you have your policy number handy?
[CUSTOMER][NEUTRAL] I don't even know.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do hold on, let me look over what it is, it's 252-854-7.
[AGENT][POSITIVE] All right, perfect. And let me get that pulled up. And do you mind if I also get um your first name, last name, and a good call back number?
[CUSTOMER][NEUTRAL] [PII], great house, like a great big house and it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect. And I'm just gonna verify some information with you real quick, Miss [PII]. Um, would you be able to verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Sorry, it's loading so slow. There it is perfect, thank you. And that mailing address on file?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then just two other things real quick, Ms. [PII], if you could verify for me the email on file and the phone number. Well, the phone's the one you just gave me, so just the email on file if you can.
[CUSTOMER][POSITIVE] [PII] I [PII] I'm sorry [PII].
[AGENT][NEUTRAL] OK, it looks like the one I have might be your professional.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, [PII].
[AGENT][POSITIVE] Wonderful. Thank you so much. It, no, it was work. You had it. Um, all right, Miss [PII]. So let's take a look here. So it looks like we did receive some information yesterday. So what you sent in yesterday did come through.
[CUSTOMER][NEUTRAL] Was it .net? I can't remember which one, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I just don't know if I'm filing things do I need to I've just been filling out things and then uploading it like, you know what I mean and I don't know if it has to all go together in one.
[AGENT][NEUTRAL] Oh no, so you can upload it in multiple submissions and then they'll look through it and pull all the pieces they need and pull it together for a claim.
[CUSTOMER][NEUTRAL] Like one
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So what I've gotten so far, um, let me remember what all it was, um, uh, the doctor's office did send me whatever pathologies that they had.
[CUSTOMER][NEUTRAL] Um, but I don't know that I had the one. There's one I think that I don't know that I have the one where they actually.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They did pass out like where they checked things and biopsies or whatever but then it wasn't until they removed my thyroid at Baylor Scott and White, and then they determined it was cancer, right? So I don't know if that's in there or not. I don't, I can't understand the pathology reports to know if it says it. I can't tell if it's like because there was several times they checked things and like oh it's 80% chance and 50% chance and you know what I mean as they kept going deeper um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then finally when they took it out and then I know that my doctors said something about getting something from Baylor Scott and White but that I would have to go up to the office which is way far away from me where I'm at right now um and sign because it's not from them it's from Baylor Scott and White, and I don't know if that's the actual pathology maybe that's needed um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] It's just so overwhelming. I'm not gonna lie. I'm sitting here with like 50 pages, which is the EO EOI, you know, the explanation of benefits ELB, I guess.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yep, yep.
[CUSTOMER][NEUTRAL] I have a whole bunch of those. I was about to scan those in. I don't even know which ones you need. I was just gonna scan them all.
[AGENT][NEUTRAL] So
[AGENT][POSITIVE] Scan everything. Here's the thing, don't weed through all those papers. Don't worry about it, just get them submitted. Like our team does that they handle that they've had documents come in with like 1200 pages and like they know what they're doing and so just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] You don't have to worry about that. Like, let our team handle that. They're trained, they know what they're looking for and just submit what you have. Um, I would say that we do typically always need the positive confirmation of the diagnosis of cancer. So I know it's probably like the last thing you want to do, but if you need to go to the other medical center to get that, um, go ahead and get it. But don't feel like you have to wait to submit your documents until you get that. If you
[AGENT][NEUTRAL] Or you know, have time today and you wanna submit your EOBs and scan things and like upload them, you know, and you'll have to do it in chunks because it only does like 20 megabytes at a time. But you know, you upload a few and then upload a few more and then upload a few more like go ahead and just upload it all we'll read through it, we'll go through it. You don't have to worry about that. But then do go to that other medical center and try to get a copy of your pathology report, um, because they're gonna need it on this side.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know if it's already if they gave me one saying it does or not that's just the thing I can't read it to know if it's.
[AGENT][NEUTRAL] To know, then you can always just submit it and if we need a pathology report we're gonna send you a letter saying hey we still need this like we have all your other information and we're pending this we'll let you know mhm.
[CUSTOMER][NEUTRAL] Showing it or not, yeah like I don't know.
[CUSTOMER][NEUTRAL] OK, so you will let me know what's missing. OK, that's what I was gonna. They don't call. They'll just email me or text me or or write a letter. What do they do?
[AGENT][NEUTRAL] So if you're on the online service center you can actually check your claim status on there so you can like sign up for texts and it can send you a text like hey your claim is done being reviewed and then you just log online and if they're needing anything you'll see it in the comments on that claim, but they're always also gonna mail you a letter so um.
[CUSTOMER][NEUTRAL] Oh wait, I think I might, I think this might be it because it says per report 3 nodules were previously aspirated. One of the nodules harbor NRAS mutations and another HRAS along with TERT, which I know TART was the one that was the more aggressive cancer when he explained it mutations.
[CUSTOMER][NEUTRAL] So does that mean, cause this is the pathology report I'm looking at from US Southwestern Medical Center.
[AGENT][NEUTRAL] That might be it. I would submit that and
[CUSTOMER][NEGATIVE] So I might have submitted the right thing possibly. I don't mind driving over there. This is not, this is not the problem. I'm a, I'm a go-getter. My problem is I am down to 10 days between cancer last year and now I have cancer again. And so between that and taking my mom to the doctor, I'm almost out of days. So I'm down to 10 days. They're telling me this surgery is like I would need to be out like at least 4 to 6 weeks from my job.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Goodness.
[CUSTOMER][NEGATIVE] And if I miss, it's like $400 a day that they're gonna do me. Like this is just, this is why I'm so overwhelmed. I'm sorry not to dump that on you. Um, but it's just getting over.
[AGENT][NEUTRAL] No, that's OK. That sounds like a lot to be overwhelmed with.
[CUSTOMER][NEGATIVE] And just to get over there to sign something, I can't leave here to get there in time, do you know what I'm saying?
[CUSTOMER][NEUTRAL] We saw, OK. So maybe this is the right one though.
[AGENT][NEUTRAL] Yeah, no, and I, that sounds like, yeah, I mean without seeing the report and honestly I actually don't process claims and I'm not a doctor but that sounds right to me too, um, so I'd submit that and then if we do need something it's not like we're gonna be like, oh you can't, we're never gonna approve any of your claims because you missed something we're just gonna request it and reprocess when we get it and so we'll just keep working with you and go from there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And then I could talk to them and figure out exactly what they need if I don't understand, just call back and they'll explain to me exactly what I'm looking for, I guess.
[AGENT][POSITIVE] Yeah, absolutely. So once it gets to that point and they request a document, typically they'll give you pretty detailed explanation, but if they don't, we can always get you in touch or put in a callback request to get you in touch with one of our examiners who examines the claim, and they, because they look at those claims all the time and they see the reports, they'll be able to really help you identify and narrow down what exactly it is they need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because when I'm they I know one of the things that said um I got paperwork all over here I'm sorry um it talked about that I needed.
[CUSTOMER][NEUTRAL] But I'm, I'm trying to get over to my sheet where I wrote notes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Pathology itemized um medical bill. I don't know where to find that but I do have the EOBs and they did send me pathologies. I asked them to send me any medical records that they had whatsoever.
[AGENT][NEUTRAL] So from a hospital for an itemized medical bill there's a form. It's a UB04 form, and I don't think it's one they're necessarily going to give you, but it's the ones they send to us when they submit claims and they might be able to print one off for you um or email you one or put it in your portal. Mhm. Yeah, so there's two. If you're at an office visit, it's a different form name, but at a hospital, it's a UB like umbrella boy 04.
[CUSTOMER][NEGATIVE] But I didn't get any of that.
[CUSTOMER][NEUTRAL] And I could call the hospital, you think?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] UB 04. OK. Now what about if it's from the doctor's like because with the radiation come from the hos I think I went and took the pill at the hospital, but it should come from that, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] So, from hospital?
[CUSTOMER][NEUTRAL] No, the first one I took, I took at the office and then the second one I took at the.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The hospital.
[AGENT][NEUTRAL] So if you're if you're at an outpatient facility, a diagnostic facility, urgent care office visit in general, the form is CMS Charlie Sierra 1500.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] C M S
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1500, OK.
[AGENT][NEUTRAL] And those have all your procedure codes, your billings, everything.
[CUSTOMER][NEUTRAL] So call the doctor's office and ask for any CMS 1500 from the doctor's office, CMS 1500 and then UB 04.
[AGENT][NEUTRAL] Yep, and then the hospital.
[AGENT][NEUTRAL] UBO4.
[CUSTOMER][NEUTRAL] OK, that might help be able to make sure I get whatever I need. OK, and I, I was concerned. I was thinking that you had to have everything uploaded at once, but I was like I'm overwhelmed with it all and I don't know what all the uploads, so I just started uploading things and I was afraid it was gonna mess it back and kick it back, OK.
[AGENT][NEUTRAL] No, that's fine.
[AGENT][NEUTRAL] No, upload it as you have it if it tells you it's too much um maybe reduce like the amount of PDFs that you're trying to upload at once, um, but I would just upload it as you have it and there's no issue there we can weed through the rest of it like that's what we do and we're here to take care of that part.
[CUSTOMER][NEUTRAL] Yeah, I'll do a few.
[CUSTOMER][POSITIVE] OK, I appreciate it. Well, I'm going to upload everything I have then and I'm gonna call the doctor's office and the um.
[CUSTOMER][POSITIVE] Hospital and just ask if they have any of those things. I, I appreciate your help.
[AGENT][POSITIVE] Perfect. Oh, it's my pleasure. Is there anything else I can help you with, Ms. [PII]?
[CUSTOMER][POSITIVE] No, I think that's it. And just the fact that, uh, let me understand that if they don't have whatever they're gonna let me know cause that'll help.
[AGENT][POSITIVE] Absolutely and I definitely recommend signing up for those tax notices um that way you get that like alert that it's been done and you you know to go check that online service center.
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] Um, for, for your results on it will let you know either what's been approved. Oh perfect awesome I think.
[CUSTOMER][NEUTRAL] I do have it. I do have it.
[CUSTOMER][NEUTRAL] Because it says you will now receive notifications for OSC, uh, no, wait.
[AGENT][POSITIVE] That's beautiful.
[CUSTOMER][NEUTRAL] Your claim and or additional information has been received. You'll get a text, yes, I do have that.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, well thank you I will upload these and now and scan them in and then upload them into the system and I do appreciate your help.
[AGENT][POSITIVE] Yeah, it's my pleasure if you need anything else along the way just reach out, OK?
[CUSTOMER][POSITIVE] OK, thank you so much have a great day.
[AGENT][POSITIVE] My pleasure. Thank you.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] Bye bye.