AccountId: 011433970860
ContactId: ce8bef1a-5ade-4847-b97f-ca1442c7fa1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1361459 ms
Total Talk Time (AGENT): 473044 ms
Total Talk Time (CUSTOMER): 448731 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/ce8bef1a-5ade-4847-b97f-ca1442c7fa1d_20250219T22:15_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and um, I received, uh, uh, a check from you all, I think it was last week, and I'm sorry I'm just getting back to you, and there were a couple of things that were, um, that were not paid, um, and gave the reasons for them and I was gonna see if you could help me out with that.
[AGENT][NEUTRAL] OK, yeah, let's definitely take a look at it. Do you by chance have the claim number itself um that was partially paid?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, it is 3551739.
[AGENT][POSITIVE] All right, thank you so much let me pull this up here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Some of them I understood and one of them that I really was uh trying to figure out what to do about um.
[CUSTOMER][NEUTRAL] I think it's the very first one, and I don't know if it's in, I thought, for some reason I was thinking it was in reference to my biopsy, maybe.
[CUSTOMER][NEUTRAL] Uh, you all couldn't tell where it was.
[CUSTOMER][NEUTRAL] Performed
[AGENT][NEUTRAL] OK, yeah, let's see here um.
[CUSTOMER][POSITIVE] I think the number one thing.
[AGENT][NEUTRAL] For security, can you just give me [PII] please your date of birth and address?
[CUSTOMER][NEUTRAL] Sure, [PII] and it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, there were, yeah, there were a couple of line items and looks like there was quite a few stuff in this claim, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] With some of it, I understand that there was just, I think it was number one.
[CUSTOMER][NEUTRAL] Um, I live in [PII], and I was going to MD [PII], which is 380 miles from here.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And so, um.
[CUSTOMER][NEUTRAL] The procedure was
[AGENT][NEUTRAL] So on the
[AGENT][NEUTRAL] On the transportation I see that it says it needs physical address.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] But can I give you the physical address or does it need to be on something besides the MD Anderson?
[CUSTOMER][NEUTRAL] Um, paperwork I sent you.
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] I wonder
[CUSTOMER][NEUTRAL] It was done at their location in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I don't know, um, that.
[CUSTOMER][NEUTRAL] It's listed on the paperwork that I sent you from start the MD Anderson sent to me. I didn't.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Look at that.
[AGENT][NEUTRAL] Yeah, that's what I was gonna try and pull up kind of what was like sent and then I was gonna look back at the claim form again and see what they say.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] How much
[AGENT][POSITIVE] I appreciate your patience on this, [PII]. I'm just waiting for the
[CUSTOMER][NEUTRAL] Oh, no problem, no, huh.
[AGENT][NEUTRAL] pages to load that you kinda sent over to us, OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so the only thing that I didn't see and everything that you had submitted to us and it was just the actual like claim form on the claim form it has a section that has the date for the transportation. It does ask for method of travel, street, city, state, and zip.
[AGENT][NEUTRAL] And then it does ask for like receipts for transportation, it looks like um.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So it says we need an itemized invoice or itemized receipt to be submitted for any sort of travel or lodging expenses.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So I don't know if I kept gas receipts don't count. It would just be my mileage.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, OK, so mainly need to see my mileage and then we stayed with my daughter, so we didn't have any lodging expense. Thankfully she lives in [PII]. We were able just to drive back and forth from there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I need to do that and I guess I, I need to fill out that claim form um another time whenever I get.
[CUSTOMER][NEUTRAL] Uh, what I need for the radiation therapy I had done in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm happy just to email it to you [PII] if that's better for you that way you have it.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, thank you. I appreciate that and I'll fill that out. I, that was my fault. I, I did not, um, fill that out.
[CUSTOMER][NEUTRAL] And, and so.
[AGENT][NEUTRAL] No, that's
[AGENT][POSITIVE] Totally fine.
[CUSTOMER][NEUTRAL] I will be just putting um
[CUSTOMER][NEUTRAL] So really that uh.
[CUSTOMER][NEUTRAL] The travel, the mileage is only gonna count for the biopsy. It won't count for when I had the, um, let's see, they call it a fitting or uh assimilation when they make the mold for your radiation. That doesn't count, does it?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] That was, I had like 5 trips to [PII] and like.
[CUSTOMER][NEUTRAL] A couple of months, but um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I knew that it would work on the, on the biopsy, but I wasn't sure about all the other testing and all the stuff leading up to the
[CUSTOMER][NEUTRAL] Biopsy and um the radiation.
[AGENT][NEUTRAL] Yeah, um.
[AGENT][NEGATIVE] Yeah, it looks like some of them were non-covered under the policy unfortunately.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I, I knew that there were gonna be some things that wouldn't be.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then I had.
[CUSTOMER][NEUTRAL] All of my radiation was done in the month of January, and for that you need um do you need like an itemized bill from MD [PII], uh.
[CUSTOMER][NEUTRAL] And then need to fill out this claim form.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Yeah, so whenever you're filing a claim for services such as radiation, it looks like we request itemized medical bill from provider and then explanation of benefits from your other medical carrier if you have one showing the amounts paid for the services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so you need like I go from MD [PII] you need um my ELB from Blue Cross.
[AGENT][NEUTRAL] Mhm, yeah. And
[CUSTOMER][NEUTRAL] OK, mhm.
[AGENT][NEUTRAL] The email I'm sending you, [PII], um, with a claim form if you want to try and save it, um, page one is also gonna be um a breakdown as far as when filing a claim kind of what you need so it's a good point of reference to um.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh good. OK. uh-huh.
[AGENT][NEUTRAL] Yeah, yeah, it'll tell you like if you're doing a pathology or if it's for chemo or radiation, um, it kind of breaks it down with bullet points for what you need if it's a claim for those things.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][POSITIVE] All right, perfect. I will do that. Now, on the radiation, so I got to stay with my daughter again in [PII], but I drove into [PII], uh, every day for 15 treatment.
[CUSTOMER][NEUTRAL] So would I be able to count the mileage?
[CUSTOMER][NEUTRAL] Well, I should say from there to the treatment center in Bath, does that count or only my travel from [PII] to [PII] where I got the treatment one time.
[AGENT][NEUTRAL] I wonder, let's see if it says here in the policy what the stipulations are on the travel.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because on the claim form it just says um.
[AGENT][NEUTRAL] An itemized receipt should include um the dates charge amounts address location um.
[AGENT][NEUTRAL] But let me see if it it probably states in the policy specifics on the transportation.
[AGENT][NEUTRAL] So let's see, it says.
[AGENT][NEUTRAL] OK. So,
[AGENT][NEUTRAL] OK, so it says we will pay for one adult family member to um near covered person. Oh, that's if somebody was traveling to you.
[AGENT][NEUTRAL] So, we'll pay the amount shown on the scheduled benefits for transportation for a covered person who's been diagnosed as having cancer to receive radiation with chemotherapy that's at least 50 miles away from the covered person's residence using the most direct route.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Travel must be must be scheduled by bus, plane, train, or car within the [PII]. Travel by car will be paid at the stated rate shown on the scheduled benefits page per mile. Benefits for travel will be paid for up to 12 round trips per calendar year. Benefits will be provided for only one mode of transportation per round trip.
[AGENT][NEUTRAL] Must be within the [PII].
[AGENT][NEUTRAL] That's all it really states about.
[AGENT][NEUTRAL] Doesn't really say like, so I would say it would cover the mileage from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, home to the facility, facility, and back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then the, the time in between, probably not. I don't, I don't, I know it wasn't 50 miles from my daughter's house to where I had the treatment.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, OK, well, I'll just put the home to the facility and then back.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] I just wasn't sure about that since I went every every day that would count or not.
[AGENT][NEUTRAL] Yeah, and it looks like it's 40 cents a mile and it's up to 1000 miles per round trip.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, here you can.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Well that sounds like great help and I think.
[CUSTOMER][NEUTRAL] I think that was all. I think the rest of those things were pretty self-explanatory and
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That very last one, number 7 says benefits have been determined based on the CPT procedure code listed. I, I didn't know for sure what that was but.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Exportation.
[AGENT][NEUTRAL] Yeah, the last line item that I saw on the claim, does it say CPA diagnostic and prevention benefit?
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] I see here.
[CUSTOMER][NEUTRAL] Who
[CUSTOMER][NEUTRAL] I don't see the rest of my little.
[CUSTOMER][NEUTRAL] My, uh, explanation of benefits from you guys. I, I don't know if my husband put it somewhere.
[CUSTOMER][NEUTRAL] I'm not seeing anything but that very last one. I don't know what he did with the rest of it, but.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Anyway, I just I'm not sure what what that was, but it's probably just something that's not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I mean the other let's see, so the transportation just needed more documentation.
[AGENT][NEUTRAL] Um, it looks like.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This was what I'm looking at is on page 2.
[CUSTOMER][NEUTRAL] And that very last one that is listed.
[AGENT][NEUTRAL] On page 2, OK, let me go to page 2. I'm gonna, I pulled up the EOB hopefully you're looking at, so maybe that'll, let me see here.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Is it the number for the D1E2116?
[CUSTOMER][NEUTRAL] Uh, no, it's the very last one it's a 7.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] And P1E0700.
[AGENT][NEUTRAL] Oh OK, let's see what that one is.
[AGENT][NEUTRAL] OK, so it says benefits have been determined based off of the CPT procedure code listed on the facility bill.
[AGENT][NEUTRAL] So it doesn't look like anything was paid towards that. It's saying in order to determine if additional benefits are due, please provide us with an itemized surgeon bill listing the CPT procedure code for this surgery. If this information, this information can be obtained from the sur surgeon's office.
[CUSTOMER][NEUTRAL] OK, I don't even know what a CPT is.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, it's a code they use for billing basically, but um if you say CPT code to them, they'll they'll know what you're talking about.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the surgeon still. OK.
[CUSTOMER][NEUTRAL] Alright, I don't know if that's coming from [PII]. I think it might be coming from MD [PII] because that's where he works.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I can ask about that.
[AGENT][NEUTRAL] So it looks like that was like a
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] One that was needing it looks like some additional information on that line item.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I'll see if I can get something from MD [PII] regarding that.
[CUSTOMER][NEUTRAL] And then I'll check and see if I.
[AGENT][NEUTRAL] Yeah, because
[AGENT][NEUTRAL] There's a couple different surgery charges that were, it looks like submitted with procedure codes, but there wasn't, you did get a small benefit payment on them, but it wasn't a whole lot, so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So like the first one that was, it looks like asking for [PII]ore information.
[AGENT][NEUTRAL] Um, was
[AGENT][NEUTRAL] The charge came over to uh to us it looks like.
[AGENT][NEUTRAL] As $2,786 but we only paid $84.30 based off of the procedure code, so that's why we need the CPT code.
[CUSTOMER][NEUTRAL] OK, OK, I'm calling to see if I can get that and.
[CUSTOMER][NEUTRAL] Get that uploaded for you.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] And then I'll fix this um method of travel, and I'll check with them and see if they have the radiation bill ready yet. I don't know if they do or not. It was my last treatment was the [PII]. That's probably rushing them.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, possibly a little bit, so.
[CUSTOMER][NEUTRAL] OK that.
[CUSTOMER][NEUTRAL] Um, I'll try to finish up this boxy type thing first and then work on the radiation one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And they'll get that ready pretty soon.
[CUSTOMER][POSITIVE] All right, well, [PII], thank you so much for your um patience and explaining all this to me where I can understand it and I will work on getting those forms for you and get those uploaded on the site.
[AGENT][POSITIVE] Yeah, absolutely, [PII] and if you have any other questions or concerns feel free to call. We're here to help always.
[CUSTOMER][POSITIVE] All right, [PII], well, thank you and you stay warm.
[AGENT][POSITIVE] All right. You too. Take care.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Bye bye