AccountId: 011433970860
ContactId: b79601b0-58e5-4c7b-ad02-4a0b1cc6009e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460869 ms
Total Talk Time (AGENT): 97896 ms
Total Talk Time (CUSTOMER): 314420 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/b79601b0-58e5-4c7b-ad02-4a0b1cc6009e_20250617T17:19_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thanks for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How you doing?
[AGENT][NEUTRAL] On the
[CUSTOMER][NEUTRAL] I'm doing good. Um, I have a, um, insured on the other line. She, we were going over a claim. Um, she, well, let me give you the policy number first.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's 257-952-2.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's um
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The one in the 1756?
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, I was trying to pull up my notes. OK. So we went over it. I went over the denied um part and the, the radiation delivery is not covered.
[CUSTOMER][NEUTRAL] She's saying from what she received on her or what she sent in.
[CUSTOMER][NEUTRAL] Um, on like the ledger.
[CUSTOMER][NEUTRAL] The dollar amounts differ what was sent in from what we paid.
[CUSTOMER][NEUTRAL] It has nothing to do with what was, what it was denied for, but that's what she, she wants to talk to somebody about like in Onase when I pull up her claim on the ledger, it does show two different prices than the $275 that we paid, but
[CUSTOMER][NEUTRAL] That, that
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I think she's trying to loop that in with why it was denied and I'm trying to explain to her, but that.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The charge is 275. 80 and that's what we paid, but
[CUSTOMER][NEUTRAL] So she wants to get more information.
[AGENT][NEUTRAL] I don't know
[CUSTOMER][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] Send her on over.
[CUSTOMER][NEUTRAL] OK, thank you. Hold on one second.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Hello Miss [PII]?
[CUSTOMER][POSITIVE] Yes ma'am, thank you so much for holding. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][POSITIVE] OK, thank you so much. Appreciate you. You're welcome.
[AGENT][POSITIVE] Good morning. Thanks for calling APO. This is [PII]. I'm sorry, good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh hi [PII]. Yes, it is afternoon now, isn't it, but I do the same thing. I have to look at the corner of my computer to see what time it is. Oh, I'm kind of confused. I'm a recent claim that I submitted.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On the EOB it's saying I'm getting a check for 27,580, which I'm very thankful for, but it's saying non-covered.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Is the medical supplies and equipment used in the administration, and I understand that not being covered, um, and I questioned the other lady about my medicine, which was almost $5000 is the medicine, and she said, no, that wasn't denied, it wasn't submitted.
[CUSTOMER][NEUTRAL] So long story short, my initial.
[CUSTOMER][NEGATIVE] Uh, [PII] that I submitted for this claim I submitted on [PII] confirmation OSC 98311 and then I received an EOB from y'all because I failed to include the EOB with it and on [PII] I sent the EOB.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And both the EOB and my original submission mentions the medication. So I'm kind of confused.
[AGENT][NEUTRAL] OK, so let's see.
[CUSTOMER][NEUTRAL] The the chemo medicine, which was the Fluvestri.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so she paid the 275.80 on that one?
[AGENT][NEUTRAL] So she paid the 275.80 um because we paid the actual charges that are listed on the EOV.
[AGENT][NEUTRAL] So for Medicare,
[CUSTOMER][NEGATIVE] But that was for actually, that was administering in it and I didn't think the administering was covered. I thought the chemo medicine was covered.
[AGENT][NEUTRAL] Uh, that's the line she.
[CUSTOMER][NEUTRAL] Which on the EOB says drugs, that's the 4880.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. And those, that's the line she paid on.
[CUSTOMER][NEUTRAL] The $4880?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And so uh we pay the actual charges.
[CUSTOMER][NEUTRAL] At
[AGENT][NEUTRAL] That are approved by the um
[AGENT][NEUTRAL] By the um from the primary carrier and so 137.90 was approved by Medicare and then another 13,790 was approved by Blue Cross and Blue Shield so uh we combined those amounts and that's the amount we paid.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEGATIVE] I think I'm still confused. All this, all this is new. I know when y'all paid last year when I was getting chemo, well, this has been going over going on over a year now that I got two checks that I got two checks and then I had to stop submitting because I had reached my 20,000 limit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I'll have to go back and look at some of those.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'll have to go back and look at some of those, but anyway, it will literally total back up to that 20,000, um, because this was my may not.
[CUSTOMER][NEUTRAL] Data service. Let me see what else I've got here. I'm sorry to keep you on the line. Uh, I not, I had a treatment then I started new treatment.
[AGENT][NEUTRAL] Oh, no, ma'am, you're fine.
[CUSTOMER][NEUTRAL] Yesterday.
[CUSTOMER][NEUTRAL] I didn't have a treatment on [PII].
[CUSTOMER][NEUTRAL] That started yesterday. I'll submit that and when that's all said and done.
[CUSTOMER][NEUTRAL] And I'll need to, what I guess in y'all's best interest as well as mine from the back and forth I'll need to wait till I get my EOBs and then submit the ledger and EOBs all at one time.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Would that be beneficial? OK, that's what I, OK.
[AGENT][NEUTRAL] It would be because we have to know what the actual charges are about the that were uh approved by the major medical.
[CUSTOMER][NEUTRAL] OK, y'all read both births only what insurance approves.
[AGENT][POSITIVE] Yes, ma'am, the actual charges that they approved, yes ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] Basically, is that right? OK.
[CUSTOMER][NEUTRAL] That was approved um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, being on Medicare is all new to me because last year when I initially did my submissions I was still on my employer insurance.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So I've been on Medicare since January that that that explains a lot. It's a little bit different.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] OK, well thank you so much for your time, [PII]. I appreciate it and that helps me tremendously.
[AGENT][POSITIVE] You're welcome. And Miss [PII], is there anything else I can help you with on today?
[CUSTOMER][NEUTRAL] That's it today.
[AGENT][POSITIVE] All righty, well you have a great rest of your day.
[CUSTOMER][POSITIVE] Y'all will be hearing from me in the near future. OK, thank you so much.
[AGENT][POSITIVE] All righty.
[AGENT][POSITIVE] You're welcome bye bye.
[CUSTOMER][NEUTRAL] All right bye bye.