AccountId: 011433970860
ContactId: d2c214ee-9b07-48e9-bf78-47c26b26b730
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 752270 ms
Total Talk Time (AGENT): 286248 ms
Total Talk Time (CUSTOMER): 296049 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/d2c214ee-9b07-48e9-bf78-47c26b26b730_20250320T18:48_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] And how may I assist you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Well, what was that?
[AGENT][POSITIVE] How may I help you today?
[CUSTOMER][NEUTRAL] Well, I had uh
[CUSTOMER][NEUTRAL] I had a few, a couple of claims out there and I see that where they had paid uh.
[CUSTOMER][NEUTRAL] Let's see on claim number 35769997.
[CUSTOMER][NEUTRAL] They had an amount paid at $2600 which just recently, probably on the [PII] it looks like.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So my question is, and I download, I also downloaded the uh.
[CUSTOMER][NEUTRAL] I guess there were 3 pages of documents here, some of it had some notes and all kind of stuff in it. uh, I'm just checking to see if there's if, if there was something else, uh, that was needed, other information that was needed or if all the claims that I had put in, you know, all the, all the bills that uh I had put in for consideration, uh, were.
[CUSTOMER][NEUTRAL] Take what you know we're we're process. I mean this or there was something else that they were needing to consider on another one of the invoices.
[AGENT][NEUTRAL] OK, I can check on that, um, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And um may I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] [PII]. Address is [PII].
[AGENT][NEUTRAL] OK and the email address on file?
[CUSTOMER][NEUTRAL] Um, should be, I think it's gonna be [PII].
[AGENT][NEUTRAL] Um, we have your work email.
[CUSTOMER][NEUTRAL] Yeah, OK, so it's, it's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] All right, um, let me check this information really quick. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm on I'm I'm on the website so if you need any kind of confirmation numbers or claim numbers or anything I I have all that in front of me.
[AGENT][POSITIVE] No, it's OK. I got it. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let
[AGENT][NEUTRAL] OK, so basically for the surgery with Southern Neurology, uh, we need a fully itemized bills to continue the processing of that claim. Uh, the fully itemized bill needs to include procedure codes and diagnosis codes.
[CUSTOMER][NEUTRAL] So, OK, so that one, alright, let me make sure I got the right one that you're talking about. Let's see.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] That's gonna be for.
[CUSTOMER][NEUTRAL] Was that the invoice for 712-7374?
[AGENT][NEUTRAL] OK, the, the way that I see it here is gonna be a lot different from what you see in your end. Um, what I'm looking at is the surgery charges and the facility charges for [PII].
[CUSTOMER][NEUTRAL] Yes, that's gotta be, uh, OK, that's probably the, that's when I went in to do the the biopsy and they charged me, uh, the 1273 74 and it was an anesthesiologist charge of 7 of 250. That's gotta that's, that's the day of the uh, that of the surgery biopsy if you wanna call it that, so, um.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So you need an itemized um an itemized bill for that.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] And that was on that was on 123, correct?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, I'll I'll need to contact the uh.
[CUSTOMER][NEGATIVE] The, uh, the, the business and have to see if they can get that sent to me, uh, yeah, because I know that what I sent was was was really not an itemized bill. That's all that's all that they sent me and I didn't get anything else in the mail or anything so and that's, that's all y'all needing for that right and there's nothing else that that's it after that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] So far that's all I have seen that they need um the two denials, um which is for the two same date of service, [PII], is indicating that we just need fully itemized bill from the hospital facility or the doctors with um itemized um diagnosis codes and procedure codes. Um, let me see this one right here, and there's another chart here. Let me see what they need on this [PII] moment.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It doesn't, it does it, does it show you what those, I mean, I know I told you, but I mean, does it show you which ones in particular is it is the ones I was telling you about the 1273 and the the 250 is that's the one that you need an itemized one on?
[AGENT][NEUTRAL] Mm, I'll have to open the whole claiming order to me for me to see um charge amounts because what we go is by the date of service and the name of the provider.
[AGENT][NEUTRAL] In the procedure. Mhm. So that's what I have in front of me that I can see. So, um,
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, yeah, if you, if you, if you're saying 12, 3 in the surgery, that's, that's, that's gotta be what I'm looking at right here so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'll have to get that uh I can get that and then I can just upload those files, you know, just go back and sign back in and just upload those files and send them.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, upload it as a new claim and we'll go ahead and put it together with what we got already so you can just send it in as a new claim. Um, we also need a fully itemized bill for your CT scan on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] [PII]?
[AGENT][NEUTRAL] Mhm. Yeah, there's a charge on [PII] for a CT.
[CUSTOMER][NEUTRAL] [PII] at [PII].
[AGENT][NEUTRAL] It's also for Southern neurology.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm gonna have to dig that up.
[CUSTOMER][NEUTRAL] Why would, why would I, why would I, why would I have said that for [PII] when it was really uh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It could have been just mixed, yeah, it could have been mixed on the information that you send if you send like a history file or something like that, it could have been all mixed in there and it's just pulled that day, but it is reflecting that day. That's why we're asking for information on that one.
[CUSTOMER][NEUTRAL] I mean everything was last year so.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well, it was a CT scan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There was a CT scan on 125/25.
[AGENT][NEUTRAL] 125.
[CUSTOMER][NEUTRAL] Um, and then that was the that was the one where I had, that was for, uh.
[CUSTOMER][NEUTRAL] Uh, 5:50.
[CUSTOMER][NEUTRAL] And then um.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] There was a, there was a, uh, uh, a CT pelvic scan. I wanna say I'm trying to remember the date. I got the uh the orders or something. It's got the uh
[CUSTOMER][NEUTRAL] Oh Lord, [PII], I ask for some details.
[AGENT][NEUTRAL] If you're looking at the explanation of benefits, it's, it's really like it's self-explanatory in the, in the beginning. If you, I'm, I'm not sure if you have a way of looking at the explanation of benefits that we send um you did provide me with the claim number, the 357 mhm.
[CUSTOMER][NEUTRAL] Well, actually I do. I, I am looking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do have the explanation of benefits in front of me here. There's a whole bunch of notes on there's 3 different pages, so one of them has a whole bunch of notes on it, so.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, we're gonna look at page one.
[CUSTOMER][NEUTRAL] Just trying to see which which.
[CUSTOMER][NEUTRAL] OK, I got page one.
[AGENT][NEUTRAL] OK. So on page one, there is
[AGENT][NEUTRAL] OK, um, Southern Urology, there's 123 charges right there. Um, the, the
[CUSTOMER][NEGATIVE] But they're showing 0, but they're showing zero amount. That's what I was confused at.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] 0, yeah, 0 amount because we still need information to process those. That's why it hasn't paid.
[AGENT][NEUTRAL] So basically anything from Southern urology, we need itemized bill. Even if it's the hospital bill, the facility charges, the surgery charges, any medical imaging, anything that you have done in Southern urology, we're gonna need itemized bills.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so there's probably there's probably a couple of them. OK, alright, I can, I can probably get, get start sending some emails out and get to make some phone call and get some um.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Get them to get the, get that for me.
[AGENT][NEUTRAL] Mhm. And those are the days that um on the first page you will see the dates that we're asking for. So you will just go by that day and you can call Southern Urology, let them know, hey, I, I need itemized bills for date of service [PII] and [PII]. Um, I need the, you know, the itemized bill for the surgery, the hospital facility, or any other um charges that I have there outstanding that I need to send payment for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so, so just as, uh, uh, uh, uh, maybe a silly question, the last, the last note.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That they have on page one where it says internal cancer.
[CUSTOMER][NEUTRAL] For rider 2500.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, uh, uh, what is that, what is that covering?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let me go ahead and pull that up.
[AGENT][NEUTRAL] Let me look at the benefits, one moment.
[AGENT][NEUTRAL] OK, here's your certificate.
[AGENT][NEUTRAL] And I believe that's gonna be the lump sum. Yeah, that's the internal cancer first occurrence lump sum benefit.
[CUSTOMER][NEUTRAL] So, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, well, let me see what I can, uh,
[CUSTOMER][POSITIVE] But I can get you guys
[AGENT][NEUTRAL] OK. Sure, but once we get that information, we'll go ahead and reprocess your claim, OK? So it's not completely denied, it's just waiting for that information.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Got it. OK, no problem.
[AGENT][NEUTRAL] Mhm. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, that'll do it for now.
[AGENT][POSITIVE] OK. Well, thank you for calling APL. Have a good afternoon.
[CUSTOMER][POSITIVE] Yeah, you too. Thank you.
[AGENT][POSITIVE] Thank you. You're welcome bye bye.