AccountId: 011433970860
ContactId: bd784ca8-be10-4195-b1bb-88af5baef03e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 910539 ms
Total Talk Time (AGENT): 258654 ms
Total Talk Time (CUSTOMER): 161243 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/bd784ca8-be10-4195-b1bb-88af5baef03e_20250319T16:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I have a question about one of the claims I got on my, the checks I got on one of my claims. Uh, can you help me?
[AGENT][POSITIVE] I sure can help you with your claim. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, the policy number is 00640053.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have your policy here. I just need you to verify your date of birth, the mailing and email address on file.
[CUSTOMER][NEUTRAL] Uh, birth is [PII], uh the uh [PII], and what else did you need?
[AGENT][NEUTRAL] Your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the claim number that you'd like me to look at with you?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 356-795-7
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Yes, ma'am. That'll be fine.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I have your claim here and I see it was a pay claim. What questions did you have?
[CUSTOMER][NEUTRAL] OK. What the, what I had a question about was there was 4.
[CUSTOMER][NEUTRAL] Uh, claim EOBs that were sent in that had the chemo on it, but it, the dates were [PII], the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] The [PII] and [PII], but it didn't pay, it paid transportation on those, but it didn't pay for any chemo on that. What, what, what's going on with that?
[AGENT][NEUTRAL] Let me see, hold on one moment.
[AGENT][NEUTRAL] Let me see what these codes are. Hold on one moment.
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] What is the 7.
[CUSTOMER][NEUTRAL] It paid chemo chemo on [PII], but that was the only one it paid it on.
[AGENT][NEUTRAL] 1074. Let me see why the other one wasn't paid.
[AGENT][NEUTRAL] Let me look back. Hold on one second. So the one that wasn't um paid is for [PII]. Let me see what.
[CUSTOMER][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEGATIVE] No, no, the ones that I think that was paid for another claim. The ones that weren't paid, it paid transportation on these 4, but it didn't pay the chemo. [PII].
[CUSTOMER][NEUTRAL] [PII], [PII], and [PII], and there were EOBs from the Mutual of Omaha with all those with the charges on it.
[AGENT][NEUTRAL] OK, so let me look into this claim because on on this claim number, the only chemo dates of service are [PII] and [PII], which was paid for [PII]. So let me go, I need to backtrack and then I need to locate, let me do this, hold on one second.
[CUSTOMER][NEUTRAL] Showing what
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] I'm gonna look up for the dates for [PII], [PII], and [PII]. I'm looking to see.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] In [PII] too.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for [PII].
[CUSTOMER][NEUTRAL] It's 4 of them.
[AGENT][NEUTRAL] Which one was paid 356.
[CUSTOMER][NEUTRAL] It paid [PII].
[AGENT][NEUTRAL] Oh no, I'm looking at, I'm looking at um [PII], there's two claims here. I'm trying to see which one if they were both paid. Oh no, you're fine.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, OK, I'm sorry.
[AGENT][NEUTRAL] OK, so it says it's all on this, there must be multiple lines. Hold on one second.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So here's the [PII].
[AGENT][NEUTRAL] But see, these are just transportation. I don't see, let me pull up the um the documents. Hold on one second.
[CUSTOMER][NEUTRAL] I know, but
[CUSTOMER][NEUTRAL] We send in the EOBs we can send them again.
[AGENT][NEUTRAL] Because I see the dates, the missing dates, I see them, but they're just for transportation. I'm trying to find the key, the
[CUSTOMER][NEUTRAL] Right, that's what, that's.
[AGENT][NEUTRAL] EOBs for it. Hold on one second.
[AGENT][NEUTRAL] I'm just gonna place you on just another brief hold if you don't mind. I'm just gonna go through the document.
[CUSTOMER][NEUTRAL] Yes, yes, that's fine, that's fine. Mhm.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I'm looking for chemotherapy explanation of benefits for [PII], this is research, [PII], and [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] You know what? I'm not gonna do it. I'm gonna have claims call her back. That's what I'm gonna do.
[AGENT][NEUTRAL] Because this is research and I have to do multiple dates too?
[AGENT][NEGATIVE] Don't even do that cause it's gonna be some kind of pushback and it's gonna be your fault. So just do the work.
[AGENT][NEUTRAL] This is not an EOB.
[AGENT][NEUTRAL] Outpatient claim for, OK.
[AGENT][NEUTRAL] Are they thinking these are ELBs?
[AGENT][NEGATIVE] Maybe this is, oh my Lord. Oh, no, no, no, no, no. 42 pages and I gotta go through, oh wait a minute.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] But she's so sweet.
[AGENT][NEUTRAL] Just help her.
[AGENT][NEUTRAL] Medical claim.
[AGENT][NEUTRAL] 122.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause it was applied to the deductible and that's what Medicare approved. So Medicare, you're gonna put that, but you're gonna still have to pay your deductible, right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Occupation.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize again for that wait. So this is what I'm gonna do because I don't want um you to have to send anything that if it has been received because there's 12345 different um.
[CUSTOMER][NEUTRAL] Yes, that's fine.
[AGENT][NEUTRAL] There's 5 different sections with documents in it. So I'm gonna send this over to claims and have them look through the documents and see if we have in fact received the EOBs for these 4 dates, [PII], and then [PII]. And if so, to go ahead and reprocess the claim. If not, to give you a call back to let you know, uh we'll need you to resubmit it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK. Uh, I, because I printed them off of what it showed on the documents, so it shows you got them, but I don't know where, you know, I don't know what's going on. But some, you'll let me know back what I need to do then.
[AGENT][NEUTRAL] Yes, ma'am. If you don't hear anything from us, then that, then just know we're reprocessing the claim. If there, if the documents are here. If they're not, I'm gonna um give them your phone number and have them give you a call to let you know we still need it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That oh.
[CUSTOMER][POSITIVE] OK, all right, I'll, I'll leave this laying out so I'll know what to do if they call me then. OK, thank you for helping me with that, OK?
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] No, ma'am, that's all I, I needed for right now, so, OK. Thank you for your help, hon.
[AGENT][POSITIVE] All right. Yes, ma'am. Thanks for calling APL. You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Oh, all right, that's