AccountId: 011433970860
ContactId: 8756f33d-ddf6-4f1a-90f8-ed8202ea838c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 193100 ms
Total Talk Time (AGENT): 96498 ms
Total Talk Time (CUSTOMER): 49852 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/8756f33d-ddf6-4f1a-90f8-ed8202ea838c_20250325T14:25_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], this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEUTRAL] Doing all right thank you um I've got a member on the line who's calling regarding a cancer claim um and it's stating for chemo that of course we need the primary EOB and uh he's pretty adamant that he did send that so he would like to review what was submitted.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, can I get that policy number?
[CUSTOMER][NEUTRAL] Yeah it's 972-05.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it is for part two, and that is who we're speaking with [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Part two, is it the most recent one I'm assuming?
[CUSTOMER][NEUTRAL] Yeah, the one ending in 837.
[AGENT][NEUTRAL] OK, let me get that pulled up so I can see what he submitted.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm let's see.
[AGENT][NEUTRAL] OK, so he is saying that he did submit the EOB for chemo.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] What we have the bills and then we have.
[AGENT][NEUTRAL] Oh, it's from the VA.
[AGENT][NEUTRAL] Oh, that's office visit. Sorry, let me look at the next page.
[CUSTOMER][NEUTRAL] Yeah, I did explain that to him.
[AGENT][NEUTRAL] Chemo admin.
[AGENT][NEUTRAL] So it said insurance pending, it's not actually been processed, it looks like.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, so,
[AGENT][NEUTRAL] Like on their bill or whatever it says charges, payments, adjustments and then it has like the 87 for the administration.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] But he just needs to give us the updated.
[AGENT][NEUTRAL] Yeah, just like an updated one because it says insurance pending and then patient balance so it they may or may not approve those full amounts and so they build Medicare and so we need like either an updated version of this that shows what was paid by the insurance or we need something from Medicare.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So he did submit something we could have used it's just that it's pending it had not been pro right it doesn't show anything that they may have paid it just says that they did bill Medicare that they just had not received anything and we need that information.
[CUSTOMER][NEUTRAL] Gotcha. OK.
[CUSTOMER][NEGATIVE] Doesn't show an amount.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you. OK, well I sure appreciate you checking that. I'll, I'll go ahead and let him know that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you bye bye.
[AGENT][NEUTRAL] You're welcome, [PII]. Bye.