AccountId: 011433970860
ContactId: d2f745b6-91b7-4669-bd4e-1649b0b555fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 614599 ms
Total Talk Time (AGENT): 338669 ms
Total Talk Time (CUSTOMER): 300421 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/d2f745b6-91b7-4669-bd4e-1649b0b555fd_20250228T20:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking and how may I help you?
[CUSTOMER][NEUTRAL] Hi again [PII], this is [PII] on the care team. How's it going?
[AGENT][POSITIVE] I'm good and you?
[CUSTOMER][POSITIVE] Doing all right thank you um I've got a member on the line that uh she had submitted a cancer claim and we needed quite a bit of uh additional information she believes she has it all um OSC isn't working for her, so she's gonna mail it but she wants to make sure that she does in fact have everything that she needs and wanted to talk to y'all.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, well, well, we don't review claims over the phone. I can just give her a list which is what's on that, yeah, which is the instructions on the page, yeah. What's, what's her, uh, what's her name and her policy number?
[CUSTOMER][NEUTRAL] No, the, the denial, um, that for this particular claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, her name is [PII]. Uh, policy number is 636-574.
[AGENT][NEUTRAL] OK, and what's her callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, alright. I'll just go, I mean, is this gonna be the same information that was on there, and is this regarding of, of in particular claim that she's she's calling about?
[CUSTOMER][NEUTRAL] Pretty much, um.
[CUSTOMER][NEUTRAL] Yeah, it's, yes it is for her um and it's the last time that we've received it's uh 355-762-5.
[AGENT][NEUTRAL] OK, go ahead and send her over. Mhm.
[CUSTOMER][NEUTRAL] Also, really quick, um, I don't know if you'll know the answer to this because I was trying to help her, of course upload that information just to OSC um, she said it wasn't working but but she wasn't able to see the claim number on OSC and.
[AGENT][NEUTRAL] We will, you will never see a claim number. A claim number is not assigned until we process a claim.
[CUSTOMER][NEUTRAL] That's what I thought.
[CUSTOMER][POSITIVE] Well, we do have this particular claim number but that's what I was thinking but that she thinks that's why it wasn't working so OK that makes I wanted to make sure that all right I appreciate your help.
[AGENT][NEUTRAL] And we don't attach.
[AGENT][NEUTRAL] Mm, no. Yeah. Yeah, we, we don't, yeah. OK, all right, go ahead and send her over.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for calling APL. Is this Ms. [PII]?
[CUSTOMER][NEUTRAL] It is, it is.
[AGENT][NEUTRAL] OK, and I understand that your name, date of birth, uh, physical address and email has been verified, is that correct?
[CUSTOMER][NEUTRAL] Yes she did.
[AGENT][NEUTRAL] OK, and you're calling in today because uh you tried to upload some information on the uh the online service center and you think you got an error, is that what you're thinking?
[CUSTOMER][NEGATIVE] Well, I didn't get an error. It just won't go through. I don't have a claim number.
[AGENT][NEUTRAL] You will never get a claim number. You're never gonna get a claim number. A claim number will be assigned when we process your claim.
[CUSTOMER][NEUTRAL] It doesn't show up on my.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, that's funny because I, I part of the claim has been processed and and.
[AGENT][NEUTRAL] So in it
[AGENT][NEUTRAL] Right, and we don't attach to it wouldn't automatically attached to that claim. It's gonna get a different, it's gonna be assigned a mail number once you upload it and then once someone is assigned to your piece of mail that you're trying that you just uploaded, they'll begin to process it and it's gonna get a new claim number it's not gonna be the previous claim number it never will be.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] That's, that's good to know because that's not what someone there at APL told me last time they said we don't understand why you can't see your claim number on the right hand side of your dashboard and I said because it's not there so this will not.
[AGENT][POSITIVE] Oh, I'm so sorry they told you that. Mhm.
[CUSTOMER][NEUTRAL] This will not be part of the original claim. I, I actually have, well, I have transportation and then I have, I think it's 11 infusion and chemo claims or 9 infusion claims and 2 hospitalizations.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'll have that many different claim numbers is what you're saying.
[AGENT][NEUTRAL] No. Whenever you submit a document like you're just submitting one just a little while ago.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] When that comes in when it comes in through our, our mail room to scan it and upload it to your system, you will never see a claim number until it's assigned to someone and it's processed. If all of that what you just name is up under that one document, whether it's 13 pages of 55 pages, everything that's under that document is gonna be under that new claim number once they process that claim.
[CUSTOMER][NEUTRAL] Yeah, I couldn't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh well, it will not allow me to upload this many pages. It only allow me to upload 20 megabytes if I could even get one megabyte uploaded, but I can't.
[AGENT][NEUTRAL] OK, well, my suggestion is you just will have to separate it out then because I'm not sure why it's not allowing you to do that, but we've had people submit 500 or 1000 pages at one time and we're not having any issues with the OSC that I know of, so I would just suggest that you just submit it, you would have to do it separately and once that mail comes in who's ever assigned mhm.
[CUSTOMER][NEUTRAL] And I've
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] And if it won't allow I'm just going to have to mail it in, right?
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Or you could fax it
[CUSTOMER][NEUTRAL] I don't have a fax.
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] I don't have a
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's very, very, very confusing that I've, I've submitted claims before and they've gone right through. So I don't understand what's happening.
[CUSTOMER][NEUTRAL] But I guess my other question to you is, so I'm submitting for chemo and immunotherapy, but I had no out of pocket expenses that, so do I even need to submit that?
[AGENT][NEUTRAL] So let's take a look at what the benefits state on your policy certificate for that give me one moment.
[AGENT][NEUTRAL] So you are in the state of [PII] and that policy because uh you are in the state of [PII], it states that we have to have your primary explanation of benefits, which tells us what your patient responsibility was. So um now, according to your policy, we'll pay actual charges, actual charges is what the insurance company paid on your behalf.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] For that chemo or immuno uh uh immunotherapy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Plus your patient, plus your your patient responsibility, but if you didn't have any responsibility and you're at 100%, let's just say you're at 100%. That's why it might have been why you didn't have any responsibility. Um, if they paid, if the doctor billed $10,000 but the provider paid the network amount to them of $300 that means we would consider $300.
[CUSTOMER][NEUTRAL] But that's as I
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You 300, OK, and it's up to 10,000, right?
[AGENT][POSITIVE] Yes, that is correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then on the travel, it's
[AGENT][NEUTRAL] I'm sorry, you're going in and out, oh.
[CUSTOMER][NEUTRAL] Oh, I'm on the travel it's, it's so many miles at.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] It has to be more than 50 miles one way.
[CUSTOMER][NEUTRAL] What, what?
[AGENT][NEUTRAL] If it's not more than 50 miles one way, OK, well, if it's more than 50 miles one way, we need the physical address so that we can do the calculation.
[CUSTOMER][NEUTRAL] OK, it is.
[CUSTOMER][POSITIVE] Yeah, I'm, I'm giving, I'm giving you that.
[AGENT][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Gonna be worth my trying to get it to you somehow. Yeah, it's actually 55 9 miles one way.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] To the um
[CUSTOMER][NEUTRAL] To the cancer center in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, well, I am, I try to figure out a way to get because it, I, I just didn't wanna go to all this is.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] You know you weren't gonna pay it anyway.
[AGENT][NEUTRAL] Yeah, I understand, but it's like I said it's it's actual charge so it's gonna be uh what they paid on your behalf plus your patient responsibility. So just because you don't have any patient responsibility, uh, whatever they pay on your behalf, then we would consider that. Now if that EOB says 000 all the way across 0 pay to the provider, then that's what you would be like, well no that's that, that wouldn't be considered because nothing was paid. Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] They what
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, it's
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Right I I understand.
[AGENT][NEGATIVE] No power.
[AGENT][NEUTRAL] Alright, and is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Understand all that. Alright, I think I'm just gonna try to get this in the because I don't think it's gonna work any other way, darn it.
[AGENT][NEUTRAL] OK, so what happened when you submitted it because I know you told the previous rep that you were having some problems with the online service center.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, it just um.
[CUSTOMER][NEUTRAL] It just sits there with a little red circle with a line through it.
[CUSTOMER][NEGATIVE] And doesn't ever go anywhere. I mean, really it can sit there 30 minutes for a 10 megabit file.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So have you tried, have you tried closing that web browser and refreshing it and coming back, signing in all over again?
[CUSTOMER][NEUTRAL] I'm still not.
[CUSTOMER][NEUTRAL] Uh uh.
[CUSTOMER][NEUTRAL] I have done all of that.
[AGENT][NEUTRAL] Mm. OK. Well, it may come through. And the thing about it, not, not, files don't all the way, all the time come through to us instantaneously, OK? So you can either, you can check back in the morning if you would like, first thing in the morning and see if that file just happened to go through.
[CUSTOMER][NEUTRAL] It's just
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Oh, OK, I didn't. Alright, well I will go ahead and keep trying to submit it and we'll just see what happens.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, well, alright, well thank you for calling APL Miss [PII]. You have an awesome rest of your, uh, day and a great weekend and take care.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][POSITIVE] Well, thank you. APL has been very uh nice to me. This is my 4th cancer.
[AGENT][POSITIVE] Well, awesome. Oh, well, that's OK. Well, well, I'm glad that your benefits have been great to you, awesome to you. And um you know, hopefully, you know, um I wish you all the best and hopefully this will be your last bout with that.
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] This
[CUSTOMER][POSITIVE] Well, we do hope, thank you.
[AGENT][POSITIVE] Yes, yes, ma'am. All right. Well, have a great one.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] OK, bye-bye. Thank you.
[CUSTOMER][NEUTRAL] OK.