AccountId: 011433970860
ContactId: ae71fb7f-b0c9-4f17-89a5-ed5ac94e4ec1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 809559 ms
Total Talk Time (AGENT): 313886 ms
Total Talk Time (CUSTOMER): 257826 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/ae71fb7f-b0c9-4f17-89a5-ed5ac94e4ec1_20250219T16:23_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling the APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I um have a cancer policy with you and um.
[CUSTOMER][NEGATIVE] I got a text saying that one of my claims were complete, and I get on the website and I don't know how to upload.
[CUSTOMER][NEGATIVE] The you know, so I could see what was completed. I don't understand why I can't do that.
[AGENT][POSITIVE] Well, I can help you with that, Mr. [PII]. Yes, ma'am. I'm sorry, I didn't mean to interrupt you.
[CUSTOMER][NEUTRAL] Um, so
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Or, uh, can you tell me which one was completed and, and.
[AGENT][POSITIVE] Mhm, it would be pleasure. Yes, ma'am, I'll be happy to. Mr. [PII], do you have your policy number available?
[CUSTOMER][NEUTRAL] Anything about it.
[CUSTOMER][NEGATIVE] No ma'am, not right offhand.
[AGENT][NEUTRAL] That's not a problem. I could look it up by your social if that's OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] I'm getting everything pulled up bear with me just one moment please, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind verifying your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, thank you, ma'am.
[AGENT][NEUTRAL] OK, Miss. [PII], the reason you're not able to view that claim information is because it was processed yesterday. Sometimes it does take up to a full 24 hours to be able to view online.
[AGENT][NEUTRAL] Um, for it to be uploaded. That was claim number 356-465-0.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I don't, I don't know.
[AGENT][NEUTRAL] And let me take a look and see what's going on.
[AGENT][NEUTRAL] With your claim.
[AGENT][NEUTRAL] I'm just taking a quick look to see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you know your transportation and lodging is um if it's at least 50 miles away from your home.
[CUSTOMER][NEUTRAL] Oh yeah, it is.
[AGENT][NEUTRAL] For treatment or surgery.
[CUSTOMER][NEUTRAL] Yeah, um,
[CUSTOMER][NEUTRAL] It's a
[CUSTOMER][NEUTRAL] 200 miles one way and 200 miles back from from [PII] to [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Oh yeah, yeah, that's over 50 miles for sure, but sure, that's a long drive, isn't it?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh yeah, but they're good they're doing good for me so.
[AGENT][POSITIVE] Are they? That's wonderful. I love to hear that.
[CUSTOMER][NEUTRAL] Yes they are.
[AGENT][NEUTRAL] Now, for the Ashner's American Legion Hospital for 1025, they're needing an itemized bill.
[AGENT][NEUTRAL] From the provider's office showing the codes and charge amounts for each service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I, I made them. I didn't think you know that was gonna, uh, they're gonna be able to use that, but I do have one so I can send it to you.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And then for
[AGENT][NEUTRAL] The surgical procedure on [PII].
[AGENT][NEUTRAL] They're also needing the fully itemized surgery bill.
[AGENT][NEUTRAL] With diagnosis. Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] I didn't have no, nothing on [PII]. I don't think so.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Let's take a look further.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Ma, did they do maybe a biopsy or something like that?
[CUSTOMER][NEUTRAL] Uh, they did a biopsy of my lung on [PII].
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] just take a quick look for you.
[AGENT][NEUTRAL] Just getting that pulled up.
[CUSTOMER][NEUTRAL] That might have been whenever they get a scope of my stomach.
[CUSTOMER][NEUTRAL] I don't remember the date though.
[AGENT][NEUTRAL] It might have been.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the only thing I did.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] At Jennings, that would have been like a surgery.
[AGENT][NEUTRAL] OK, finally got those documents to come up. I was trying to look and see if I could give you some more information on that.
[AGENT][NEUTRAL] And it's just taking my computer a moment. I apologize.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's coming slowly but surely. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So no, the transportation, y'all just pay up to 50 miles and that's it.
[AGENT][NEUTRAL] It has to be over 50 miles for the transportation or lodging to click in. So what we're gonna need for the transportation portion.
[AGENT][NEUTRAL] It has to be associated with a covered charge for treatment or surgical charge.
[AGENT][NEUTRAL] So we'll have to have that itemized meal.
[CUSTOMER][POSITIVE] Oh yeah, I go for my treat.
[AGENT][NEUTRAL] And the
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] We'll have to have the physical location of the place of treatment or place of service.
[AGENT][NEUTRAL] And then they'll
[CUSTOMER][NEUTRAL] I have it written down on there.
[AGENT][NEUTRAL] OK. Let me get you to one of our cancer, um,
[AGENT][NEUTRAL] Claims adjudicators and let them look at this.
[CUSTOMER][NEUTRAL] They pay anything?
[CUSTOMER][NEUTRAL] Did they pay anything on anything I I sent them?
[AGENT][NEUTRAL] No, ma'am, not on this claim. They're just needing additional information.
[CUSTOMER][NEUTRAL] Really?
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] But let me get you to one of our representatives so they can look at this for you, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Thank you, Mr. [PII]. One moment, please.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing well [PII] thank you how are you?
[AGENT][NEUTRAL] I'm doing fine, thank you. I have policy number 79318.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Don't make me say the last name cause I forgot how she said Mo [PII].
[AGENT][NEUTRAL] I believe
[CUSTOMER][NEUTRAL] Wednesday Friday OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Anyway, um, she is calling me, she was trying to look at her claim. She couldn't get the claim, uh, that we just processed pulled up on the line, so I explained to her that sometimes it does take a little, um.
[AGENT][NEUTRAL] Yeah, up to 24 hours to be able to view in the OSC.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so we're going over the claim information. She couldn't remember a date of service of [PII].
[AGENT][NEUTRAL] And when I pulled the document up I don't see that data service in those claim documents.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] you know, unless I'm just overlooking it. I don't know. But then she um was stating that the
[AGENT][NEUTRAL] Her um treatment location is over 200 miles. It's from [PII] to [PII], and
[AGENT][NEUTRAL] Then I was telling her that we need the itemized bills with procedure codes and um diagnosis codes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEGATIVE] She just needs further information regarding this, no, no benefits being paid.
[AGENT][NEUTRAL] I tried to go over everything with her, but
[CUSTOMER][NEUTRAL] OK, yeah, it looks like.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It looks like that's what we're requesting is the itemization for um there's a surgery and also some inpatient uh care. um.
[AGENT][NEUTRAL] Surgery.
[AGENT][NEUTRAL] And then she's questioning, now, I told her that the lodging does have to be over 50 miles um to the
[AGENT][NEUTRAL] Place of ser the service location and it has to be for a covered treatment or surgery procedure. And she said it is for her cancer, so she's asking about the lodging as well.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And obviously she's been verified.
[AGENT][NEUTRAL] Oh yeah, I verified all of her stuff.
[CUSTOMER][NEUTRAL] And I'm not seeing the [PII] either, so I'm not sure where.
[AGENT][NEUTRAL] I know
[AGENT][NEUTRAL] I know it's hard for these cancer people to.
[AGENT][NEGATIVE] You know, being going through treatment and trying to get all this stuff in. I know it's hard.
[CUSTOMER][NEUTRAL] Right, and that's her phone number listed there the contact?
[AGENT][NEUTRAL] It is
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because it looks like there's some notes here, OK, um, and you said she was verified, right [PII]? Sorry.
[AGENT][NEUTRAL] Yes, ma'am, she is.
[CUSTOMER][NEUTRAL] OK, I'll speak with her.
[AGENT][POSITIVE] All right, thank you, [PII] let me get her on the line.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Ms. [PII], thank you for your patience. I have [PII] on the line. She's going to look at this claim further for you, OK?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Mm thank you for calling APL you have a wonderful day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye. Hello miss is it [PII] how do you say your name? I'm sorry [PII] OK [PII] alright great thank you my name's [PII]. I'm in the claims department so I'm taking a look at uh the information that was sent into us for your claim and it does look like we are requesting some additional information so I'm just kind of reviewing right now uh the notes and the.
[CUSTOMER][NEUTRAL] Uh, in the claim and what exactly is, uh, needed, um, now [PII] had said that we had some dates there that we weren't sure about as far as the surgery. Um, looks like it was [PII]. Is that an incorrect date?
[CUSTOMER][NEUTRAL] Uh, she said [PII], but I think that's whenever I went and did, uh.
[CUSTOMER][NEUTRAL] A scope for my stomach, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, to check and see if I had some cancer in the stomach, but uh.
[CUSTOMER][NEUTRAL] That's the only thing I could see that would be at Ashchner in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me just uh.
[CUSTOMER][NEUTRAL] But I don't remember sending anything in for that claim, I mean, you know, for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm just looking over what was uh sent in so it looks like we got a couple of things here that are um we're requesting some additional information so it looks like for um.