AccountId: 011433970860
ContactId: bd7fcaa0-f0bc-49f5-984d-fc84e2fdf2b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466390 ms
Total Talk Time (AGENT): 163565 ms
Total Talk Time (CUSTOMER): 132308 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/bd7fcaa0-f0bc-49f5-984d-fc84e2fdf2b6_20250226T15:23_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. This is [PII] over in customer care. How are you doing this morning?
[AGENT][NEUTRAL] I'm fine thanks how are you?
[CUSTOMER][NEUTRAL] I'm doing OK, thank you. Um, I have an insured on the line who has a claim, well, a couple of claims that have been denied. He has some questions on, and I was looking at what was submitted and I'm not sure what else he needs to submit. It's a cancer claim. Is that something that maybe you could help with?
[AGENT][NEUTRAL] Um, let me take a look. Uh, what is the policy number?
[CUSTOMER][NEUTRAL] His policy number is gonna be 431-263.
[CUSTOMER][NEUTRAL] And we're speaking to Mr. [PII].
[AGENT][NEUTRAL] OK, give me just a second, and he said he needed to speak to a supervisor?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yeah, well, I just I'm having trouble I guess he didn't ask for a supervisor so I guess no I I just I'm having, I don't know what else he needs to submit on the claim, so I've read the denials but I also looked at what was submitted one of the denials was needing an itemized EOB, but the EOB I see has the amounts on it, so.
[AGENT][NEUTRAL] What was the claim number?
[CUSTOMER][NEUTRAL] 356-506-1
[AGENT][NEUTRAL] OK, give me just a second.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK, and did you verify all of Mr. [PII]'s information?
[CUSTOMER][NEUTRAL] Yeah, I did. Um.
[CUSTOMER][MIXED] And I looked at the previous claim too, um, trying to make sense of that, um, to see if that would help any because I was denied too and he was, he's just frustrated. I'm happy to explain it if you can educate me on what is exactly missing. I just couldn't make sense of what was missing.
[AGENT][NEUTRAL] Sure. Uh, so I am looking at the EOB, um, preferably the one on page 14 on that claim number that you gave me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the only issue is that this EOB has a date span. Most of them, um, these dates are in a date span, so it's like from [PII].
[AGENT][NEUTRAL] And so we would need the itemized bill which showing the exact days that he had the actual treatment on because that's how we process it in line as we pay by the date because say if we just did that paid that date that date span, what if he send in another bill with different dates and then we could potentially overpay him by by paying duplicate days because it doesn't specifically say what days he received the radiation.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. OK. Well, that makes, yeah, that makes sense.
[AGENT][NEUTRAL] So he could technically.
[AGENT][NEGATIVE] Yeah, like he could have either had it every single day from [PII], I mean from [PII], or he could have had it like for only 4 days of treatment, you know, if we don't know, and then say he sends in another bill that was for [PII] with the same code, we wouldn't know exactly what days we had already paid.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it was just in a date span.
[CUSTOMER][NEUTRAL] OK. All right, that makes, mhm.
[AGENT][NEUTRAL] So what I would recommend um is that if he could send just like a UB from his provider or even like maybe like a treatment schedule that has the actual day that he received, that he, he doesn't have to send another EOB. The, the um adjuster should not have asked for another EOB but if he has some sort of an itemized bill that just shows the actual day like.
[AGENT][NEUTRAL] The single days instead of a date span, then we'll be able to process the claim, you know, knowing exactly what days he, he was receiving treatment.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, alright, I can like I'm happy to, to, like I said, um, give me that information. I just was having a hard time pinning, pinning down what was actually wrong with it, but that makes sense. I see that now. Thank you for that.
[AGENT][POSITIVE] Yeah, sure. You know, you're welcome and let me know if there's any other questions, but yeah, just, I would just say, you know, hopefully just to help, you know, not have to, any more delay, but just anything that has, that lists out the dates that he, that he received the treatment, just so we can match up those days and then use the EOB to go ahead and pay that benefit.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, alright, I can let him do that thank you.
[AGENT][POSITIVE] Oh sure you're welcome.
[CUSTOMER][NEUTRAL] Alright, um, do you mind hanging just, I mean, I don't know. I don't think he'll ask for, I don't know, he's kind of, he was annoyed but he didn't ask for a supervisor yet.
[AGENT][NEUTRAL] Well, just, uh, I'm still on this queue, um, I think it's just me for now since of the meeting, so if he still needs anything, just, you know, just call back on the queue and you know, and I'll help you out or you can IM me if for some reason.
[CUSTOMER][NEUTRAL] Meeting, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] You can't get to me.
[CUSTOMER][POSITIVE] All right. Thank you. Have a good morning.
[AGENT][POSITIVE] Sure you're welcome you too.