AccountId: 011433970860
ContactId: c1d6b18e-af61-4522-9991-0ffd1d1ccacd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 552280 ms
Total Talk Time (AGENT): 231736 ms
Total Talk Time (CUSTOMER): 133135 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/c1d6b18e-af61-4522-9991-0ffd1d1ccacd_20250520T15:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII]. My name is [PII], and I had sent you some information about uh cancer, breast cancer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, my date of birth is [PII].
[CUSTOMER][NEUTRAL] Can you pull up my account?
[AGENT][NEUTRAL] Yeah, let me take a look. [PII], give me just a second.
[CUSTOMER][POSITIVE] OK, thank you, yes ma'am, thank you.
[AGENT][NEUTRAL] Your last name is spelled [PII] Is that correct?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] And this is the first name [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Alright, so I've got you pulled up here, [PII], so you were calling in regards to a claim that you sent in?
[CUSTOMER][NEGATIVE] Yes, I sent in a claim and they sent me back. I sent up a bunch of, um, my papers and stuff, and they sent me a check for $75. Is that all I will be getting? because I mean I had breasts, I had my breasts removed.
[AGENT][NEUTRAL] Let me see
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I guess I'm with the right person. I don't know.
[AGENT][NEUTRAL] Do you have the check number, [PII]?
[CUSTOMER][NEUTRAL] Uh yes ma'am, 204-1158.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me see.
[AGENT][NEUTRAL] If there is anything on the claim itself.
[AGENT][NEUTRAL] OK. So it looks like on this, um there were some denials, [PII] for, looks like you submitted some um surgery charges, um, but it looks like in order to consider those benefits, we need the procedure code and a pathology report.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, hold on just a second procedure code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, let's see. Can you spell that? My brain just went dead, procedure.
[AGENT][NEUTRAL] Yeah, procedure is P R O C E D U R E.
[AGENT][NEUTRAL] Uh, procedure code and pathology report, and that would be for the surgery charges.
[CUSTOMER][NEUTRAL] Pathology.
[CUSTOMER][NEUTRAL] Report.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That would be for the surgery.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Um, it says, let's see.
[AGENT][NEUTRAL] So part, it looks also part of the denial was on the anesthesia, but it looks like it just says please send.
[AGENT][NEUTRAL] The surgery charges. So if you're able to get an itemized surgery bill with the procedure codes, that'll work for the anesthesia also.
[CUSTOMER][NEUTRAL] OK, and itemized uh surgery code, I mean, itemized what?
[AGENT][NEUTRAL] Bill for the surgery with the procedure codes.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Surgery.
[CUSTOMER][NEUTRAL] We have
[CUSTOMER][NEUTRAL] Cos.
[CUSTOMER][NEUTRAL] OK, so autoized bill for surgery with codes.
[AGENT][NEUTRAL] Mhm. Correct, yeah.
[CUSTOMER][NEUTRAL] That's what you want? OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then.
[AGENT][NEUTRAL] Yeah, so the only other thing that I see was um the pathology report needed.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] It looks like there was a service date on here from like [PII]. Looks like it was a chemo.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The denial on that is stating that we need the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'd have to call my primary insurance and get that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now tell me again what I need from them.
[AGENT][NEUTRAL] So from the primary, you're gonna need the explanation of benefits for the date of service of [PII].
[AGENT][NEUTRAL] The benefit
[CUSTOMER][NEUTRAL] [PII] explanation.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Explain uh perfect explanation of.
[CUSTOMER][NEUTRAL] Service.
[CUSTOMER][NEUTRAL] Rendered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I get that from my insurance.
[AGENT][NEUTRAL] Mhm. From whoever your primary is. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and then the other ones I get from the doctor and um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then, um
[CUSTOMER][NEGATIVE] What about the uh reconstruction? Do y'all pay anything on that?
[AGENT][NEUTRAL] So, like the surgery.
[AGENT][NEGATIVE] The only thing that I saw that was not covered was the biopsy. It looks like the policy doesn't provide a benefit for the biopsy.
[AGENT][NEUTRAL] Um, but for the other surgery submitted, we just need that pathology report.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, for the consideration. So it was initially denied, but once those are submitted, then they'll re-examine that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then who do I send, do I just send it to the same address and put attention to anyone or anything?
[AGENT][NEUTRAL] You can put attention to claims on it.
[AGENT][NEUTRAL] And you can send it to the exact same place and you don't need to resubmit everything that you submitted the first time you can just submit those things that are needed um you don't have to do it all over again and then let me give you the claim number that it's in regards to and you can write it's just if you want in reference to this claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 4099.
[CUSTOMER][NEUTRAL] OK, and I sent it to [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] M
[CUSTOMER][POSITIVE] Alrighty I appreciate your help so much.
[AGENT][POSITIVE] You're welcome, [PII]. If you have any other questions or concerns, feel free to call. We're always happy to help, OK?
[CUSTOMER][POSITIVE] OK thank you mhm thank you.
[AGENT][POSITIVE] Mhm. You're welcome. Bye-bye.