AccountId: 011433970860
ContactId: 9cde3c4b-88cb-409c-b9e2-dfa0b3a19a15
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 649619 ms
Total Talk Time (AGENT): 155527 ms
Total Talk Time (CUSTOMER): 324431 ms
Interruptions: 7
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/9cde3c4b-88cb-409c-b9e2-dfa0b3a19a15_20250519T13:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling AP. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], how are you? This is [PII].
[AGENT][NEUTRAL] Fine. How are you?
[CUSTOMER][NEUTRAL] I'm good, I'm good. Um, I have a member on the line, she's a little upset about her claim. She's just saying that we keep asking for everything and she wants to make sure that that's all we need, um, which I, yeah, it's 736-888.
[AGENT][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what claim is it on?
[CUSTOMER][NEUTRAL] The most recent one, the one we're asking for the EOB for the radiation therapy, which I did explain to her that we need that to process any chemotherapy, radiation therapy, um, but she still says, she said she spoke to [PII] a few.
[CUSTOMER][NEGATIVE] Weeks ago and that she didn't tell her about that so basically she's just calling back when she said I, I was not aware and I just wanna make sure that's all you need. I don't need to be sending you stuff and then, you know, it's not what we, what you need and it's just that sad basically. It's on the 3602587.
[AGENT][NEUTRAL] OK. What's the claim number?
[AGENT][NEUTRAL] See what we got.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] My own base is not letting me pull up the document.
[CUSTOMER][NEUTRAL] Oh boy.
[CUSTOMER][POSITIVE] Happy Monday.
[AGENT][NEGATIVE] He was trying to pull it up, then I got an error.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] There's any issue rendering the document. OK.
[AGENT][NEUTRAL] Let me try this again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I know Friday I had a lot of trouble with my system.
[CUSTOMER][POSITIVE] No, it seems to be working better for me, yeah.
[AGENT][NEUTRAL] Oh, OK, I see she sent the itemized billing.
[AGENT][NEUTRAL] So yeah, we would need the explanation of benefits for this coverage because the policy is based on actual charges.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, and she did not send any uh any on the past documents. She didn't send any EOB, did she?
[AGENT][NEUTRAL] She didn't. OK, let me clean this something real quick.
[CUSTOMER][NEUTRAL] I don't think she did. I, I don't, I don't think she did, but yeah, just in case.
[AGENT][NEUTRAL] Let me see what we, what we pay then if we pay radiation in the past. Let's see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] No, we haven't paid radiation. We haven't paid any radiation.
[CUSTOMER][NEUTRAL] OK. OK. OK. So if you're ready for her, I did verify all the information. So all the information is correct in the system, OK?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, let me put her in. Have a good day.
[AGENT][NEUTRAL] Mhm you too.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for you, Ms. [PII]. I got Ms. [PII] on the line. She's in the claims department, and she will assist you from here.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Hello. Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you doing?
[AGENT][NEUTRAL] I am fine how are you?
[CUSTOMER][NEUTRAL] OK, um, fine.
[AGENT][NEUTRAL] And you have some questions in regards to your, your radiation coverage?
[CUSTOMER][NEGATIVE] [PII], I'm a little bit frustrated.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yes, yes. I'm frustrated. OK, go ahead. Uh-huh.
[AGENT][NEUTRAL] So it looks like on the most recent claim we processed for the, for the dates of [PII], you receive radiation. We have requested the explanation of benefits.
[CUSTOMER][NEUTRAL] OK. I'm not sure what to give you. The reason why I'm saying that.
[CUSTOMER][NEUTRAL] I first called and I asked before I sent him anything. I said tell me and I wrote them down, tell me everything that you need to process the claim.
[CUSTOMER][NEUTRAL] They told me one of the main things they need, the statement from the hospital with the codes telling exactly the treatment that I got. I, I, I, I called the hospital, they sent it to me twice. I sent in that information. Then the girl told me it's your office. That's not what they're looking for. They're looking for, and I may not call it right, the UMB or UBO whatever.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Whatever, that from the hospital, from the hospital. [PII] was the name of the girl. We called together. We spoke with the people. They're gonna say they're gonna, they would not send it to me. The hospital do not send that to me. They said it has to go to my insurance company. So [PII] was on the phone, gave them the fax number and everything. They faxed it to you. I called about 3 or 4 days later to confirm that you got it.
[CUSTOMER][NEGATIVE] The girl said yes we got it and we're going to process the claim. Now you're telling me that you don't have whatever you need. I am just totally confused, ma'am, to be honest, what must I do here?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let, let me take a look. Give me one moment.
[CUSTOMER][NEUTRAL] To try and get some sort of leverage.
[CUSTOMER][NEUTRAL] after the call.
[CUSTOMER][NEUTRAL] Alright thank you very very much. Only this morning for the first time since his diagnosis. [PII]'s office announced yesterday that he's been diagnosed with.
[AGENT][NEUTRAL] OK, I'm gonna take a look at the documents. I'm gonna put you on a brief hold. Give me one moment, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, Ms. [PII]. So, under your policy, the, the the the chemo radiation benefit is based off the actual charges under the plan. So we would need the explanation of benefits. It looks like you have Humana. So it looks like we will need your primary care explanation of benefits in order to determine benefits.
[CUSTOMER][NEUTRAL] OK, so I need to call you [PII].
[CUSTOMER][NEUTRAL] And tell them I need explanation of benefits on the radiation treatment, is that correct?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, and um then if I, if I get it um I can fax it to what's your fax number?
[AGENT][NEUTRAL] Our fax number is, let me know when you're ready.
[CUSTOMER][NEUTRAL] Yes, go ahead.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] And I can have them fax that to you.
[AGENT][NEUTRAL] And just make
[AGENT][NEUTRAL] Yes, and just make sure you have that reference, your policy number on the documents when they're faxed. And then I can also give you the claim number to reference. Sure, your policy number is 736888.
[CUSTOMER][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] What is the policy?
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] And then the claim number to reference as well is 3602587.
[CUSTOMER][NEUTRAL] And the claim
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Let's see if I have this right, 3602587.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Claim number.
[CUSTOMER][NEUTRAL] OK, I don't have to send it to anyone in particular, right?
[AGENT][NEUTRAL] Just make it attention claims department.
[CUSTOMER][NEUTRAL] Claims department.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right, I'm gonna try one more time. I mean, I'm, I'm trying so hard but it's just not do. So now you just need from your manner explanation of benefit. No estimation or estimation, estimation of explanation. OK, sorry, send it wrong explanation of benefit. All right, let me do that right now. Thank you so much, appreciate it.
[AGENT][NEUTRAL] Ofen. Yes, ma'am.
[AGENT][NEUTRAL] Yeah, explanation of benefits.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Nothing else. I just love for them to finalize it, but anyway, I, I'm trying. I know you all are trying to. Thank you so much.
[AGENT][POSITIVE] OK. You're welcome. Thanks for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright mhm bye bye.
[AGENT][NEUTRAL] Bye.