AccountId: 011433970860
ContactId: 9705036c-33c4-4e7d-9490-8349d1f2afc4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1228739 ms
Total Talk Time (AGENT): 481191 ms
Total Talk Time (CUSTOMER): 556298 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/9705036c-33c4-4e7d-9490-8349d1f2afc4_20250505T17:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I just had one question for you about the date of an earlier claim.
[AGENT][NEUTRAL] OK sir, I can help you with the claim date. Can I please get your name and your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII]
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] And the number is [PII] you're welcome. The number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And [PII], what is your policy number, please?
[CUSTOMER][NEUTRAL] It is 01386480.
[AGENT][NEUTRAL] OK, let me look that up real quick for us.
[CUSTOMER][NEUTRAL] OK, and, and I'm not um inquiring about I, I did submit a bunch of claims.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On this past Friday, but I'm wondering, um.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] I and I hadn't filed for a claim in quite a long time, like maybe 4 or 5 years. I'm wondering how far most of those claims were very recent claims that I issued on Friday going back maybe just the last 6 months or so. I'm trying to figure out when um.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When did I first issue what what was the last claim that I did file before this past Friday so I know how far to go back in terms of some other possible claims.
[AGENT][NEUTRAL] OK. Yes, I can absolutely look that up for you. Um, real quick, I'll need to just verify your policy. Can you give me your date of birth, sir?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you, and then I'll also need to verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I'm sorry when there was one other thing on there, uh, what else did you want?
[AGENT][NEUTRAL] And I do see the phone number that you gave me to call you back on is that your cell phone number, sir?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK. Thank you very much, [PII]. I appreciate you verifying your policy. OK, so looking at your
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] No, I appreciate your help. Thank you.
[AGENT][POSITIVE] Uh it's no problem at all. I enjoy helping people, um, looking at your claims before [PII], which was the last thing you filed.
[AGENT][NEUTRAL] Before this was [PII].
[CUSTOMER][NEUTRAL] [PII] and was there one other claim before that or how many claims um in total had I had previously?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, let me look.
[AGENT][NEUTRAL] For yourself, um, we have.
[AGENT][NEUTRAL] 123456789.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm looking 1011, 1213, 14 that were filed.
[CUSTOMER][NEUTRAL] 14 including the ones from this past Friday.
[AGENT][NEUTRAL] No, that was before this past Friday, um, the ones this past Friday were you have 12345678.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That were filed on Friday.
[CUSTOMER][NEUTRAL] OK, could you give me the dates then of the prior I had, I did not realize I did 14, so I did 14 claims even before August our, our.
[CUSTOMER][NEUTRAL] [PII] was the last of 14 claims.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Alright, I'm sorry to do this to you, but could you tell me what the dates of the claims were before that?
[AGENT][NEUTRAL] Yes, sir. Um, we've got two that were filed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Two that were filed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One that was filed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Two that were filed on [PII].
[AGENT][NEUTRAL] And 12345 that were filed on [PII].
[AGENT][NEUTRAL] And then one that was filed on [PII].
[AGENT][NEUTRAL] And that's it.
[CUSTOMER][NEUTRAL] Alright, let's see 578.
[CUSTOMER][NEUTRAL] 1012 13, I think I'm, I'm missing um one and I I've got um I've got.
[CUSTOMER][NEUTRAL] One on [PII]. Another one on [PII], I'm sorry, [PII] unless were there two claims on the [PII] date?
[CUSTOMER][NEUTRAL] Or just one.
[AGENT][NEUTRAL] Yes, 2 on [PII].
[CUSTOMER][NEUTRAL] Oh, OK, well then that does add up. Perfect, 679 1314. OK, then my only other question is can you actually tell me what the claims were for on [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Because I'm trying as I go back and try to get the things that I've missed in the past, I don't want to send in a claim for a second time that I might have already sent in before to you.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, I understand, um, this one was for date of service on the, the one that we received on [PII] was for date of service of [PII].
[AGENT][NEUTRAL] And it was North Dallas Pathology Services.
[CUSTOMER][NEUTRAL] OK, so that was for a, a prostate biopsy?
[AGENT][NEUTRAL] Um, let me see if it tells me what it's for. I can give, it says lab.
[AGENT][NEUTRAL] Lab and the charge amount was $3,579.68.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 3000.
[AGENT][NEUTRAL] And it was for lab work.
[CUSTOMER][NEUTRAL] You said 3590.
[AGENT][NEUTRAL] I'm sorry, let me go back and um let me see and it was filed under lab work it's $3,579.68 and the claim was denied because lab um charges are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Laboratory tests are not covered under this policy is what it is.
[CUSTOMER][NEUTRAL] OK, so there nothing was received for that?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. Um.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][POSITIVE] I'm glad you pointed that out because maybe I need to do something a little bit differently on the current ones because if I'm not mistaken.
[CUSTOMER][NEUTRAL] If that was on [PII], it was for a.
[CUSTOMER][NEUTRAL] A biopsy of my prostate, which they did do lab work to find out what the result of the biopsy was, but the biopsy itself was outpatient surgery.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] Yes, and maybe, uh.
[CUSTOMER][NEUTRAL] So did they, did they cover the outpatient surgery portion but not the lab portion or did they not cover anything?
[AGENT][NEGATIVE] It wasn't covered on anything because everything was turned in as lab.
[CUSTOMER][NEUTRAL] OK, and how do I specify like on the ones that I did on Friday.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I haven't done any for I guess going on about 4 years or more, um, I didn't see any place to specify something is lab or or not lab and so I did add like a recent biopsy and and I I thought that because it was a biopsy um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That it would be treated as like an outpatient.
[CUSTOMER][NEUTRAL] Um, surgery, but do you, do, do I or do you, um, how do you know, because I do know that you're correct that there are labs associated with the biopsy because once they take the biopsy they do the labs to find out whether it was malignant or not and I understand also that I don't get any kind of uh reimbursement for the labs itself but I did think.
[CUSTOMER][NEGATIVE] And I thought that they had told me previously that that every time that I went in for a biopsy um that it's outpatient and that that would be covered up to $200 so do, do I, am, am I supposed to specify that somehow or like when you said that those were specified as labs and so nothing was received.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did I, did I somehow specify his labs or did you all or how do I make sure because I did I did send in another one for a biopsy on this past Friday but I didn't really, I didn't label it anything I didn't label it labs and I didn't label it biopsy but as a part of it like you all said to send in the um the charges and to send in the related.
[CUSTOMER][NEUTRAL] Statements from my Blue Cross Blue Shield insurance that explained how much they paid and how much I paid and so I did that and it also broke it down between the biopsy itself and then the additional labs related to that so how do I help to convey that there is um the outpatient surgery portion.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Separate, but in addition to the labs because I, I didn't even know that I've been denied um that one in the past because I, I, I thought that they said that any time I had an outpatient biopsy that that it would be covered.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so when you, when you send in your claim yourself, you'll need an operation, um report um that it was.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] An operation
[AGENT][NEUTRAL] Along with your EOB and your itemized statement.
[AGENT][NEUTRAL] So there should be yeah operation report that goes with it to show that it was.
[AGENT][NEUTRAL] An outpatient procedure for surgery.
[CUSTOMER][NEUTRAL] OK, even if the and let me go back and look at the most recent one I said because I could have sworn that on the um.
[CUSTOMER][POSITIVE] Like I've never been told that before but that's very helpful for me to know because I didn't know that so you're saying that I need a surgery report.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, if you look and I'll tell you a really really good place to go to uh I use it all the time it's a cheat sheet when you um go and look at the claim form itself for the cancer claim form that first page.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Is a good cheat sheet that tells you everything that you need to send in with your claim.
[CUSTOMER][NEUTRAL] OK, and I'm, I'm looking at that with, oops, I'm sorry, I'm looking at that with you right now. Let's see, um.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] RG
[CUSTOMER][NEUTRAL] Station.
[AGENT][NEUTRAL] You'll see it at the top um where it says operative report.
[AGENT][NEUTRAL] And it says, um, may be required for filing a claim for multiple surgeries performed on the same date.
[AGENT][NEUTRAL] But I would send it in even if you have one surgery, just so that they know.
[AGENT][NEUTRAL] That this is
[AGENT][NEUTRAL] An outpatient surgery and it wasn't all lab work. It also goes by the way that the facility codes the itemized statement, whatever their diagnosis and procedure codes are.
[AGENT][NEUTRAL] And the way the explanation of benefits from your primary shows the diagnosis and procedure codes on what they paid.
[AGENT][NEUTRAL] So if the facility didn't specify in the diagnosis and procedure codes that it was an outpatient surgery, you may need to talk to them and let them know that.
[AGENT][NEUTRAL] It was filed under lab by their procedure codes and maybe they can send in uh a claim correction.
[AGENT][NEUTRAL] And there's no time limit for a claim correction, they'll just need to send a letter as to why it's being corrected.
[CUSTOMER][NEUTRAL] OK, so if I give you a code because it's gonna be the same code each time, can you tell me then if it, if it does not qualify or if it doesn't um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] If it's the wrong code.
[AGENT][NEUTRAL] Uh, no, I don't have a way to do that, but I can, um,
[CUSTOMER][NEUTRAL] Because I noticed on oh OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let you speak to somebody in the claims department that can look at that claim and see how it was processed so that they know that it was a surgery and maybe advise you on what to do if you wanna speak to a claims specialist.
[CUSTOMER][NEUTRAL] If you don't mind, then uh I, I, I do have one other question, but then I, if you don't mind, I will have you transfer me over to help. So I am looking at the cancer claim form and I am looking at the section instructions for the inserted patient and I do see where it says the indicated documentation must accompany the completed form.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Is it saying then that um.
[CUSTOMER][NEUTRAL] And there's like there's 12345 bullets is it saying that all 5 of those things have to accompany each claim like the pathology report, the let's see what is the second thing, because, because what I did send in every time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, let's see here.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] Wow, OK, and now I do see something that's there because I thought that all I needed to send in was the itemized medical bill and the explanation of benefits.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But now I'm looking back up there to the line before and it it it's saying that for every biopsy that I have to send a pathology report.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, pathology report must be submitted when filing a claim for initial diagnosis, new diagnosis, and surgery, including biopsies.
[CUSTOMER][NEUTRAL] Alright, so I need to go back to my doctor and try to get a pathology report for all of those past uh.
[CUSTOMER][NEUTRAL] For all of those past biopsies.
[CUSTOMER][NEUTRAL] Um, so the biopsy itself is not enough without the, the, the.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Biopsy report or the pathology report.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Correct, because it has to show the, it has to show the diagnosis of cancer in order for it to be filed on the cancer claim form. Those two things have to match.
[CUSTOMER][NEUTRAL] Wow, OK. I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, yes, I hope that they can go back that far with those um.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Things because I didn't know I didn't even know that I've been denied in the past so have I had there been other ones that I was denied as well?
[AGENT][NEUTRAL] Uh, yes, sir. Let me look.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So you said the one on [PII] was denied.
[AGENT][NEUTRAL] On
[AGENT][NEGATIVE] Yes, that one was denied for um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Being lab only and then 244949. Let me see what this is.
[AGENT][POSITIVE] I'm looking at the others real quick for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Couple of my computer's decided to be a little bit slow sorry about that.
[CUSTOMER][POSITIVE] That's all right. I just appreciate your time and help. No problem.
[AGENT][POSITIVE] It's not a problem at all, sir. I enjoy, like I said, I enjoy helping folks.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, one got denied for being a duplicate, um.
[AGENT][NEUTRAL] The claim number and it was on [PII], the claim number that was a duplicate was 2954951.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] That was done on [PII]. It was received on
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And it says to look at claim number 24 I'm sorry 2944949 which was paid so that duplicate claim was previously paid um and it was submitted on [PII].
[AGENT][NEUTRAL] And it was.
[AGENT][NEUTRAL] For urology clinics?
[AGENT][NEUTRAL] In the amount and the amount that was paid was $491.75.
[CUSTOMER][POSITIVE] OK, I tell you what, and I'm so sorry to do this. I have sort of an urgent call coming in. I may call back to check with you on the rest in just a few minutes. Thank you very much for your time and help.