AccountId: 011433970860
ContactId: d0dba22f-c45f-4acf-af8c-43640148c956
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473329 ms
Total Talk Time (AGENT): 259232 ms
Total Talk Time (CUSTOMER): 158670 ms
Interruptions: 8
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/d0dba22f-c45f-4acf-af8c-43640148c956_20250529T21:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, my friend, how you doing?
[AGENT][POSITIVE] I'm doing good. How are you?
[CUSTOMER][POSITIVE] I'm good, thank you.
[CUSTOMER][NEGATIVE] I reckon I won't be getting you on this, this.
[AGENT][NEUTRAL] Not on this line anyway.
[CUSTOMER][POSITIVE] Get more yay.
[CUSTOMER][POSITIVE] I'm still so excited, girl. Um.
[CUSTOMER][NEUTRAL] I, I, you just don't know.
[CUSTOMER][NEUTRAL] My bud is coming, my buddies. Anyway, OK.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Policy number is 256-919-9.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What we got going on.
[CUSTOMER][NEUTRAL] And I have the insured [PII] on the line.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And she's calling on her husband's claims, [PII], for dates of service 3-13-25 and [PII].
[CUSTOMER][NEGATIVE] And she said that she's been told all she has to do is to send this document in and she sent them in and it's still not, her, the surgeries are still not paid. It was due to his cancer.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And as you know in care team, I can't pull up the documents and look at them because we don't do research.
[AGENT][NEUTRAL] OK, so she's specifically calling out those states.
[CUSTOMER][NEUTRAL] Yeah, it's specifically for those two.
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] So 3:30.
[CUSTOMER][NEUTRAL] She does see where, you know, the other one was paid recently and.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the 321.
[AGENT][NEUTRAL] Diagnostic surgeries.
[CUSTOMER][NEUTRAL] And I see where Roxy sent an email.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this is surgeries that result in a negative diagnosis of cancer are not covered.
[CUSTOMER][NEUTRAL] And she said this is caused from his leukemia.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see if there's any other surgeries that she has.
[AGENT][NEUTRAL] That one is
[AGENT][NEUTRAL] Listed specifically but there's also.
[AGENT][NEUTRAL] DC 301.
[AGENT][NEUTRAL] Path report
[AGENT][NEUTRAL] In order to give consideration to this procedure, please send a path report, but that's a different claim, so we may have already had that like had the bill and this is the path report.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so 3, yeah.
[CUSTOMER][POSITIVE] I know they're going through a lot. Bless them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean,
[AGENT][NEUTRAL] OK, so that's specific.
[CUSTOMER][NEUTRAL] It was an X-ray that was paid.
[AGENT][NEUTRAL] Mhm. And then for 418, for 4:18, all I have is a preventative and it's saying that that's been exhausted, so I'm not 100%.
[CUSTOMER][NEUTRAL] Oh, that was prevented.
[AGENT][NEUTRAL] On the 3rd, 0, you know what? Hang on.
[AGENT][NEUTRAL] Who process these claims. Let me get, let me get these claim numbers. Let me go back. Let me go back a step. OK, so the one where we requested path reports was 3600157 requested pass.
[AGENT][NEUTRAL] Do you know how hard it's gonna be for me to not do this when we have questions come through? I'm just saying.
[CUSTOMER][NEGATIVE] It is so hard. It is so hard because I've came from claims, you know, and doing all that and.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Like I've already told [PII] like.
[CUSTOMER][NEGATIVE] It is so hard.
[AGENT][NEUTRAL] I think the hard part is not going to be passing it along necessarily. The hard part is going to be, but I know the answer.
[CUSTOMER][NEGATIVE] It's so hard.
[AGENT][NEGATIVE] But I know what to do, you know, like why do we have to pass this through another set of hands when I know.
[CUSTOMER][POSITIVE] Exactly, exactly.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEGATIVE] It is so hard. I'm just gonna tell you. That's the hardest part of the job. It's not do what I know I can do.
[AGENT][NEUTRAL] Yeah, um,
[AGENT][NEGATIVE] I am not excited about that.
[AGENT][NEUTRAL] Although,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't know, because are you an admin now?
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Let me let
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I thought so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hang hang on just a second, let me go back to her and just tell her just hang on just another minute while you review this, OK? OK, hang on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So out of curiosity is.
[CUSTOMER][NEUTRAL] So what I don't, and see, I'm pulling this up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead. Go ahead.
[AGENT][NEUTRAL] Oh, I was just gonna talk about the job, so you go ahead because this is actually about the claim.
[CUSTOMER][NEUTRAL] Well, I was just looking at the UBO4 which it shouldn't date, but it does have a cancer diagnosis on it.
[AGENT][NEUTRAL] Yeah, so data service 3:13.
[AGENT][NEUTRAL] Here today for outpatient thoracentesis history of CML and currently taking Sprice.
[CUSTOMER][NEUTRAL] Yeah, that one.
[AGENT][NEUTRAL] Developed
[AGENT][NEUTRAL] serositis, thought to be related to the medication and pleural effusions bilaterally in his lungs.
[AGENT][POSITIVE] We discussed the drainage of those today for diagnostic and therapeutic purposes. He has a good understanding of the risk and benefits.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] OK, I need to know who processed these so that I can see like were they released by somebody?
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] Like, what should this be me.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't see it yet.
[AGENT][NEUTRAL] No, it was not me. OK, cool. I was like, oh God, watch this be something I've looked at and I'm like, I completely overlooked this. That's fantastic. OK.
[CUSTOMER][NEUTRAL] Who's who
[CUSTOMER][NEUTRAL] Have you, what time do you get off? Do you want to call me?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Um, yeah, I don't get off until [PII], so I've.
[CUSTOMER][NEUTRAL] I get off at [PII]. You want, you wanna call me?
[AGENT][NEUTRAL] Yeah, I can.
[CUSTOMER][NEUTRAL] I mean if you want to ask me anything.
[AGENT][POSITIVE] Yeah, I'd love to.
[CUSTOMER][NEUTRAL] OK, you ready?
[AGENT][NEUTRAL] Yep, go ahead.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK dokey, um, ask her if she would be OK with a call back because I'm going to need to look through this and likely reach out to, um, [PII] and or [PII] this one, yeah, um, to make sure that we process all of this accordingly.
[CUSTOMER][NEUTRAL] The original adjuster.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, what's her call back just so I have it.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Perfect. OK, let her know that we're reviewing this and um someone will be in touch with her hopefully by tomorrow with answers. We just need to look through what we have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, and if she gives me a different phone number for tomorrow I'll let you know.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] OK, that sounds good.
[CUSTOMER][POSITIVE] All right, thanks. Appreciate it. All right, thank you. Bye-bye.
[AGENT][POSITIVE] Thank you, ma'am. All right, bye.