AccountId: 011433970860
ContactId: c72d10a0-c6ff-4c2b-805d-5a6fb698391c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522460 ms
Total Talk Time (AGENT): 253875 ms
Total Talk Time (CUSTOMER): 214898 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/c72d10a0-c6ff-4c2b-805d-5a6fb698391c_20250403T13:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am. My name is [PII]. Uh, my policy number is 02079181.
[AGENT][NEUTRAL] May I have a
[CUSTOMER][NEUTRAL] And I'm looking at the EOB. I'm sorry?
[AGENT][NEUTRAL] Uh-huh, go ahead. No, go ahead.
[CUSTOMER][NEUTRAL] Sorry, I'm looking at the EOB and I had a question about number 5 on claim number um 358377777.
[AGENT][NEUTRAL] OK, um, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's uh my cell number is [PII].
[AGENT][NEUTRAL] OK. Um, may I have your date of birth?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] OK, thank you. And I need to verify the mailing address and email address on file for verification.
[CUSTOMER][NEUTRAL] Uh, mailing address is [PII] and my email is [PII].
[AGENT][POSITIVE] Perfect, thank you. Alright, let me go ahead and pull the image of that explanation of benefits that you're looking at. OK, one moment.
[AGENT][NEUTRAL] OK, so this is a claim for [PII]. OK.
[AGENT][NEUTRAL] And it's OK, so you said that you have a
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For the chemo, that'll be the remarks 5. OK.
[AGENT][NEUTRAL] Alright, OK, so on the number 5, which is the chemo.
[AGENT][NEUTRAL] Chemotherapy, um, we cover based on the major medicals because we pay, um, actual charges. So we just need a copy of the explanation of benefits from your uh primary insurance.
[CUSTOMER][NEUTRAL] OK, it said an itemized billing for the chemotherapy too, so I was like, um, that's what they sent me, so I didn't know what else it was, so you've got the itemized billing we just need the you just need the EOB OK and so do I just, I can just contact my insurance company and they'll send me that EOB.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it's gonna be.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, yes. Mhm.
[AGENT][NEUTRAL] Mhm, yes, more than likely you can just go ahead and let them know that you're just looking for the chemo charges for that date of service or for that range of service and they can send you a copy or tell you how to get a copy if you have online access. mhm.
[CUSTOMER][NEUTRAL] I guess
[CUSTOMER][POSITIVE] OK awesome hon OK um.
[CUSTOMER][NEUTRAL] And then let me see if there's anything else on that one that I didn't understand. I think that was the only one, but.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mom got you on the phone. I make double sure.
[AGENT][NEUTRAL] Mhm. Sure, yes, yes.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] And blood work is not covered. Number 4, blood work is not covered.
[AGENT][NEUTRAL] Let me check. OK, let me look at the benefits really quick.
[AGENT][NEUTRAL] No. Mm mm. Labs, um, labs are not covered, lab tests are not covered. Mhm.
[CUSTOMER][NEUTRAL] OK and um.
[CUSTOMER][NEUTRAL] I'm still waiting on from the place where he gets his infusions.
[CUSTOMER][NEUTRAL] Um, they keep, I, I don't know.
[CUSTOMER][NEGATIVE] They just keep sending me stuff that doesn't look like what y'all requested um.
[CUSTOMER][NEUTRAL] Is there
[CUSTOMER][NEGATIVE] They send me this just this list of this is we provide this medicine on the state and it doesn't have those numbers that y'all require. Um, is, what am I asking for? Maybe I'm asking for the wrong thing.
[AGENT][NEUTRAL] OK, uh, so there's several ways of asking for an itemized bill with these codes, um, which the first one will be a fully itemized bill with diagnosis codes and procedure codes. Um, that's just a simple, a simple terminology whenever you want to ask for um.
[CUSTOMER][NEUTRAL] Diagnosis codes, diagnosis codes and what?
[AGENT][NEUTRAL] With diagnosis code and procedures code.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Procedures. OK. And
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm. So it's just a fully itemized bill. Mhm.
[CUSTOMER][NEUTRAL] OK. And that's an itemized.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The other one will be like a um.
[AGENT][NEUTRAL] Superville.
[CUSTOMER][NEUTRAL] A what?
[AGENT][NEUTRAL] With super bill.
[CUSTOMER][NEUTRAL] Supervi, OK, because they, you keep cutting out. I apologize.
[AGENT][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] No, it's OK. No, don't worry. Yes. Mhm. And then um the other one will be, um,
[CUSTOMER][POSITIVE] The super bill OK.
[AGENT][NEUTRAL] Let's see, OK, well, depending on the place of service, it could be a UBO4 or a 1500 form, so those are more like.
[CUSTOMER][NEUTRAL] UBO4 or
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Or 1500, 1500 form.
[CUSTOMER][NEUTRAL] Or what?
[CUSTOMER][NEUTRAL] For 15.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Form, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] OK. That, I don't know why they're so, I mean, they've sent me 3 different things and none of them look like they don't have codes or, you know, those little.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Like the ones in this one did, so, uh, you know.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] She's looking to see, but that, they're driving me crazy.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] OK, hon, uh, and then what if I can, can I send the EOB on those?
[CUSTOMER][NEUTRAL] Or do you have to have that also from the doctor?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] We ask for the itemized bills because the itemized bills are gonna explain a little bit more than the explanation of benefits. Um, the explanation of benefits is usually just used for the chemotherapy because of the actual charges. Um, that's the only reason we ask for the explanation of benefits, but in this case whenever it's like a cancer, mhm, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I wonder if the insurance they.
[CUSTOMER][POSITIVE] Go ahead, go ahead, I'm sorry, there's a delay, so I keep overriding you. I apologize.
[AGENT][NEUTRAL] No, no, go ahead, go ahead. No, go ahead.
[AGENT][NEUTRAL] No, it's fine.
[CUSTOMER][NEUTRAL] I, I'm just wondering if my, if our insurance company, if Blue Cross Blue Shield can, they had to have gotten the itemized bill to pay it. I wonder if they could give it to me. I don't know. But I could guess I could call them and ask them.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, uh, mm.
[AGENT][NEUTRAL] Yeah, usually they don't send those. You're welcome. But you, yeah, you know, if you have Blue Cross Blue Shield, uh, they do have the diagnosis code on their paperwork. So if you wanna send that whatever they're sending you with the explanation of benefits from Blue Cross Blue Shield.
[CUSTOMER][POSITIVE] OK, well you've been very helpful.
[AGENT][NEGATIVE] Go ahead and try that because Blue Cross Blue Shield does have diagnosis calls and procedure codes on their explanation of benefits. They're one of them little company like.
[AGENT][NEUTRAL] Mm, you know, the ones that do, yeah, a few, I'm sorry, yeah, that's it, that's the word I was looking for a few that do have all the information that we need on the AOB. So yeah, if you wanna send that one, we, we can probably work work with that, yes, because that one does have that information.
[CUSTOMER][NEUTRAL] One of the few that do that.
[CUSTOMER][NEUTRAL] OK, well,
[CUSTOMER][NEUTRAL] Well, we'll try it.
[CUSTOMER][NEGATIVE] We'll try it cause Texas Oncology is not being very cooperative.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Yes, oh yes.
[CUSTOMER][NEUTRAL] They're, I mean they're not saying it right or something. OK, and thank you very much and I'll get this taken care of.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, you're welcome and thank you for calling APL. You have a good day, Ms. [PII]
[CUSTOMER][NEUTRAL] You too hon bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.