AccountId: 011433970860
ContactId: 8eddc3c4-0fd2-46a3-ab3f-5473238e9850
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1143670 ms
Total Talk Time (AGENT): 473909 ms
Total Talk Time (CUSTOMER): 394071 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/8eddc3c4-0fd2-46a3-ab3f-5473238e9850_20250121T21:56_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] over on the care team again.
[AGENT][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] Hi, all right, I've got another insured on the line, um, so she filed a cancer claim with us and, um, for the most part it looks like we're missing uh out of my statements with the diagnosis and procedure codes, but she, there is a couple for the transportation she said she thinks she might have put incorrect information on the claim form.
[CUSTOMER][NEUTRAL] Um, and so she's not sure and just kinda wanted to review what was submitted because she did assure me that she did receive treatment and it was over 5 hours away.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. What's the policy number?
[CUSTOMER][NEUTRAL] It is 01590903.
[CUSTOMER][NEUTRAL] And it is for part one. do you have that claim number?
[AGENT][NEUTRAL] Is is the most recent one?
[CUSTOMER][NEUTRAL] Uh, the one ending in 262, yeah, because I think there's one that's processing. She did say that she that information again she's not quite sure what it was, so she doesn't know if that was the supported documents that we needed or not, um, but I did tell her, you know, you could just kind of wait and let it process and we'll be able to let her know but she's really curious about the transportation aspect.
[AGENT][POSITIVE] OK, I got it pulled up. Thank you.
[CUSTOMER][POSITIVE] All right, yeah, thank you, bye bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] It is [PII] in the claims department. I understand you have questions on claim 3551262.
[CUSTOMER][NEUTRAL] Yes, how are you?
[AGENT][POSITIVE] Great.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII], so you have some questions concerning the transportation.
[CUSTOMER][NEUTRAL] Yes, it said on here um it was.
[CUSTOMER][NEUTRAL] Denied because it needed physical address.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But you guys, I, I know I put the address on the claim form, um, and then you'll have my home address.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Um, I'm not sure what more you guys kind of need to make that.
[AGENT][NEUTRAL] OK, so let me look at what you submitted, um.
[CUSTOMER][NEUTRAL] Accurate.
[CUSTOMER][NEUTRAL] Which I very well could have filled it out incorrectly. I will admit that. Uh, I was confused on what to do.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, um, it's pulling all the pages up. So far, I don't see a claim form, but let's all the pages pull up before I say for sure.
[AGENT][NEUTRAL] OK, that looks like it could be a claim form.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK. So for the, for the data service of [PII], we stated we needed a physical address um.
[AGENT][NEUTRAL] And there is no address for that particular data service.
[CUSTOMER][NEUTRAL] Of where it was held.
[AGENT][NEUTRAL] In section C. Mhm.
[CUSTOMER][NEUTRAL] Of where the surgery was?
[CUSTOMER][NEUTRAL] OK, so what do I need to do? I, I uploaded the detailed statements and the pathology report. What do I need to do to rectify that?
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] So, um,
[AGENT][NEUTRAL] You would just need to provide us, um, you can upload and let us know um the address for that particular day of service, the address to where that surgery was, um.
[CUSTOMER][NEUTRAL] Via via another claim form or?
[AGENT][NEUTRAL] You would, you can put it on the claim form.
[CUSTOMER][NEUTRAL] So fill out another claim form.
[AGENT][NEUTRAL] Where in section C where it says transportation.
[AGENT][NEUTRAL] And it has begin date of travel, method, street address, city and state.
[CUSTOMER][POSITIVE] Thank.
[AGENT][NEUTRAL] You will put that data of service.
[AGENT][NEUTRAL] The method of travel, the street address, city and state.
[CUSTOMER][NEUTRAL] OK, so let me ask you this.
[CUSTOMER][NEUTRAL] Do I need to do a new claim form for every, but the last girl I talked to said I didn't, but for like every method of treatment so like the each surgery, do I need to do a new claim form and then every time I do chemo, do I need to upload another claim form?
[AGENT][NEUTRAL] If you
[AGENT][NEUTRAL] If you are, if you wanna if you're claiming transportation now.
[AGENT][NEUTRAL] We can't just assume that, you know, each treatment because, you know, dealing with a lot of patients, we know that sometimes each treatment sometimes don't be at the same place or they stop treatment, so we just can't assume that each one of your treatments and everything is gonna be at the same location and we just don't say, oh we see this address in the system, we're just gonna use that.
[AGENT][NEUTRAL] So if you know that you're traveling 50 miles or more, if you know you're traveling that distance,
[CUSTOMER][NEUTRAL] OK, that makes sense.
[AGENT][NEUTRAL] And you want that transportation to be reviewed, then I would fill out a claim form. I will attach the claim form because you're supposed to have a claim form for each thing you file. You, you're not really supposed to just submit an itemized billing and we're like, OK, what is this? So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I need to submit a claim form for.
[AGENT][NEUTRAL] And it could just be, it don't have to be the whole like everything, at least the page 2 that has the most important part which is the address. So if you know that you travel that distance.
[CUSTOMER][NEUTRAL] Both surgeries.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For chemo, radiation, immunotherapy or surgery, then it would be best to make sure you fill it out with the address that way it can be reviewed. If it's not, then it's gonna be denied asking for it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I can refill out this, so I need to just reupload this this section this page of section A, B, and C on it and sign it and then but now moving forward.
[CUSTOMER][NEUTRAL] When I do chemo and I and aside from the transportation part to get payment because I know you guys pay also for the chemo treatment, do I need to just submit an itemized bill for that or what does that look like?
[AGENT][NEUTRAL] OK, while I pull up your policy. All right, while I pull up your policy, this is a verification of your coverage, not a guarantee for payment. Um, let me look and see, um.
[CUSTOMER][NEUTRAL] Uh, to receive payment for it.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Alright, let me look up your policy.
[AGENT][POSITIVE] OK, so the good thing that with your policy is it's an indemnity amount. So that means that
[AGENT][NEUTRAL] Your amount is $1500 per month. So,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You will submit an itemized billing for that, um, and you don't have to submit an EOB. Like some of our policies pay like $20,000 or $15,000 and so they would have to submit itemized billing.
[AGENT][NEUTRAL] And an explanation of benefits from their primary carrier. But yours is just in a monthly indemnity amount. So the only thing that we would need from you is the itemized billing with the procedure codes for your chemo, radiation or immunotherapy.
[CUSTOMER][NEUTRAL] OK, so let me ask you another question, and you may not be able to help me. I uploaded um the my EOB from [PII].
[CUSTOMER][NEUTRAL] And it's on there but I I'm not sure if it's accurate for what you guys are needing so like the um.
[CUSTOMER][NEUTRAL] But the code you're talking about, let me see.
[AGENT][NEUTRAL] The procedure codes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, when I was just looking at it because you had mentioned that and I wanted to make sure that like what I uploaded was the right thing, so it's just like my statement from [PII] [PII].
[CUSTOMER][NEUTRAL] But I'm not seeing like procedure codes on it.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And it's got like account number and stuff and.
[CUSTOMER][NEUTRAL] And it's considered the itemized billing.
[AGENT][NEGATIVE] No, because this, this doesn't even show a drug name.
[AGENT][NEUTRAL] But looking at this, we wouldn't even know.
[CUSTOMER][NEGATIVE] No, no, no, those are for my surgery. That's for my surgery. Not for, no, no, no. Yeah, they're, that's not for the chemo. I don't start chemo till next week.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh, OK
[AGENT][NEUTRAL] Oh, OK, OK. I was like, no.
[AGENT][NEUTRAL] OK, so I thought you, OK.
[AGENT][NEUTRAL] So you just was
[CUSTOMER][NEUTRAL] But I didn't know, even with
[CUSTOMER][NEUTRAL] I mean even with that I don't see any for any of it I just don't see procedure codes.
[CUSTOMER][NEUTRAL] On it.
[CUSTOMER][NEUTRAL] Um, for anything. So I don't know if that's gonna be an issue for the surgery.
[AGENT][NEUTRAL] Well, did you get this from the billing department? Did you get this from the billing department? Is this, uh, this is not what.
[CUSTOMER][NEUTRAL] Yes, that's directly from MD.
[AGENT][NEUTRAL] From the billing department.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] From MD [PII], yes.
[AGENT][NEUTRAL] But usually this is not what their billing statement looks like.
[AGENT][NEUTRAL] Is this what they sent to you in the mail or like?
[CUSTOMER][NEUTRAL] I don't know, that's what
[CUSTOMER][NEUTRAL] Uh, no, my chart, that's their digital.
[AGENT][NEUTRAL] OK, see, OK, that's, yeah. So if you would call MD [PII] and ask them for itemized billing with procedure codes, they will send you what you need.
[CUSTOMER][NEGATIVE] OK, alright, so that's probably what uh uploaded still won't work.
[CUSTOMER][NEUTRAL] Probably.
[AGENT][NEUTRAL] For what? For what are you talking about? The surgery?
[CUSTOMER][NEUTRAL] For it to be paid for the surgeries, right.
[AGENT][NEUTRAL] Mm mm. And then the surgery, you need the surgery. So, when we asked for, I'm not sure if you read the remark code. When it asks you to um to get the surgery bill, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You need to contact your surgeons and get that bill.
[CUSTOMER][NEUTRAL] So they work for MD [PII].
[CUSTOMER][NEUTRAL] That's all like it's all on that bill and it's separated by physician.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah, you would need to contact in the Anderson and ask them for itemized billing.
[CUSTOMER][NEUTRAL] Automized. OK, I'm writing this down. OK, let me ask you another question.
[CUSTOMER][NEUTRAL] While I got you on the phone, um.
[CUSTOMER][NEUTRAL] Am I better off then so.
[CUSTOMER][NEUTRAL] What did you just tell me uh for chemo?
[CUSTOMER][NEUTRAL] I don't have to submit a claim, but if I want the transportation I need to.
[AGENT][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] But I do need to submit.
[CUSTOMER][NEUTRAL] When I do the chemo you said I do need to submit a claim for transportation but not for the yeah for the transportation part since it's so far but not for the um.
[AGENT][NEUTRAL] What I
[AGENT][NEUTRAL] A claim form
[AGENT][NEUTRAL] OK. So,
[AGENT][NEUTRAL] What I was stating is, if you decide to just send us the itemized billing with no claim form attached, right? And we just review what you sent if you know that you're going to claim, if you want to have us look at your transportation.
[AGENT][NEUTRAL] You would need to send us the claim form with the address on it.
[CUSTOMER][NEUTRAL] OK, right, but if I don't do transportation, just the itemized billing is good enough.
[AGENT][NEUTRAL] Yeah, that's what you, yeah, that's, that's, that's fine. I mean, we, you know, that, that is fine. We probably will still ask you because we have to, if we.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If we see anything that is possible payable for transportation, we will still pull that line out and ask you for the itemized billing. And some people will call and say, well, I didn't go 50 miles no more, you know, OK, that's fine, but we still have to ask you for it because sometimes you may forget and like, oh yeah, I do have that benefit. So, you know, you may.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] May see it on your EOB from us that says need facility bill and you be like, well I didn't travel there. I don't need to send it to you but um but if you know that you're that you did travel that distance and you want that to be reviewed and payable on that claim, then it's best to make sure you send us everything that you need to send us.
[CUSTOMER][NEUTRAL] OK, and is it better to just do it all at once or is it OK that I'm kind of sectioning it out like this?
[AGENT][NEUTRAL] What you mean as what filing a claim as you get them or do it all at one time?
[CUSTOMER][NEUTRAL] Yeah, well, well, like, so I had surgery on [PII] also. I had two surgeries, um.
[CUSTOMER][NEUTRAL] But it's not on this.
[CUSTOMER][NEUTRAL] This billing statement yet, so would I be better off just completing the travel claim part for just the surgery that's a part of this itemized and then filing another one once I have the next itemized billing for all of that.
[AGENT][NEUTRAL] Like we can't pay transportation until there's a surgery, until we see there's a payable surgery. So, um,
[CUSTOMER][POSITIVE] So that it's not too muddy.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And if you don't have the itemized billing for that, it's just best to wait until you have all of your documents instead of sending pieces.
[CUSTOMER][NEUTRAL] And then file it together.
[AGENT][NEUTRAL] Yeah, because it's gonna, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's what I needed. I'm taking care of at least this part right now for the surgery.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] 20 I'll get this uploaded and then I'll call MD [PII] for an itemized bill with procedure codes.
[AGENT][NEUTRAL] And just to let you know, the surgery code from the surgeon may be on it, but you have to understand that MD [PII] is a facility, right? And what they may give you is what the facility charges and it, or the facility bill. It may not have what the surgeon's procedure codes on there. That's what I was trying to explain when it comes down to the surgeon's, um, the surgeon's bill, but
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] I'm just talking about what I know and what we see. So it may be on there and it may not. Just giving you a heads up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine, yeah.
[CUSTOMER][NEUTRAL] I can uh I can ask them about that too.
[CUSTOMER][NEUTRAL] And see if they can't make sure to send me all the correct information.
[CUSTOMER][POSITIVE] So, OK, I appreciate you. I may end up calling back. I've had a lot of anesthesia, so I feel like I'm a little brain foggy all the time.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Oh, not a problem at all. Is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Um, I think that's it for now. Thank you so much for your time.
[AGENT][POSITIVE] You're welcome thank you so much for calling APL. You have a great day bye bye.