AccountId: 011433970860
ContactId: d54695bc-6062-4b9e-8a0c-f42c3d130ed7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 591659 ms
Total Talk Time (AGENT): 250469 ms
Total Talk Time (CUSTOMER): 225837 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/d54695bc-6062-4b9e-8a0c-f42c3d130ed7_20250121T21:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, good evening. This is [PII]. Um, I was calling to just see, I'm not really sure if I've done stuff correctly. I did see where my claim was denied, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I don't know if I have done the proper work or what I need to do moving forward, um, do you need a policy number?
[AGENT][NEUTRAL] OK, so we just need clarification on that claim?
[CUSTOMER][NEUTRAL] Yeah and see how I can rectify it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, yeah, we can take a look at that um and I'm sorry, you did say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII], I have a policy number and a reference number here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, I will take that policy number.
[CUSTOMER][NEUTRAL] And a claim number.
[CUSTOMER][NEUTRAL] Uh, it's 015.
[CUSTOMER][NEUTRAL] 90903
[AGENT][POSITIVE] OK thank you and then uh before anything else can I also get a good call back number from you please in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Alright thank you and I'm just gonna verify some information really quick [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. The last thing I need is the email address we've got on file for you. uh, looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] It should be [PII] I think.
[CUSTOMER][NEGATIVE] I don't think it's my work one.
[AGENT][NEUTRAL] That's it, yes ma'am. All right, thank you for verifying that. OK, um, and then you did say you had a claim number correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'll go ahead and take that, please.
[CUSTOMER][NEUTRAL] 3551262
[AGENT][POSITIVE] All right. Thank you. One moment, please.
[CUSTOMER][NEUTRAL] And I'm sure some of these are accurate because I've already called y'all once because I didn't really know.
[CUSTOMER][NEUTRAL] How to fill out the claim form and I was a little anesthesia heavy afterwards when I tried to do it. Um, so I probably filled it out incorrectly initially um and that's why I called and spoke, I spoke to somebody.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Last week or the week before, I honestly don't remember when that was, and she just said wait to hear from it and you guys would tell me if you needed more info, um.
[AGENT][NEUTRAL] Right, so it does look like uh.
[CUSTOMER][NEGATIVE] But this looks like it's been denied.
[AGENT][NEUTRAL] Well it will come back as denied even if it is missing information that's where it can be a little bit misleading um and so in this case what I'm looking at is yes we are missing uh information so for most of these items it is stating that we need the fully itemized bill that includes procedure codes and diagnosis codes and you can get that from wherever you.
[AGENT][NEUTRAL] receive treatment.
[CUSTOMER][NEUTRAL] So can you look I may not have uploaded that I uploaded something once it came to me um before I got this letter I just got this letter I think today I don't know if you're able to access what I've uploaded to see if that is what y'all need. I don't remember now.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh, you updated it um I'm sorry.
[AGENT][NEUTRAL] So you uploaded this additional information um after this claim was already received is that right?
[CUSTOMER][NEUTRAL] Yes, but I didn't know if I had to fill out another like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Claim form or I just uploaded it because that's what when I, the girl that I talked to the first time was like, you don't file another claim form every time you just keep uploading.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Your documentation.
[AGENT][NEUTRAL] Right, right, OK, so I do see that we received some claim information from you, uh, looks like on the [PII], and it is still being processed, so it can take about 7 to 10 business days, uh, for claim information to process. So if you'd like to just kind of wait on that, we'll see if that information was sufficient, um, and then of course we'll let you know if anything additional is needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that may not have been, now that I think about it, that may have been the surgical pathology. It may not have been the itemized. I don't really remember. I can log on though and look and see what I uploaded. The other thing is um.
[AGENT][NEUTRAL] That's OK. Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the transportation and lodging benefit, it's saying it's not like 50 miles away from my home, but it's like it's extremely far from my home, so I don't really know what you all need for that to, I mean you already have my home address and then you've got the address I put the address in there to [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] See, let me take a look at that one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it does state that it has to be at least 50 miles away from your home.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh yes, it's 5 hours away.
[AGENT][NEUTRAL] Let's see on your recent claim it appears there was no coverage treatment received therefore, transportation and lodging is not covered for this state of service. OK, so that is not correct, right?
[CUSTOMER][NEUTRAL] Right now I know that like when I first filled it out that's where I thought I filled it out wrong because I think I filled it out starting with like the first time we went and I know that it's only covered for like surgery and chemo.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And immunotherapy and radiation or whatever, so I'm, I probably filled that part out incorrectly on there but I figured at least it would be for the surgery on the [PII] and then I had surgery again on the [PII], and then I'll start chemo next Monday so um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And I wanted to get that part rectified.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let's do this [PII] just to kinda you know give us both a better idea um if you don't mind I'm gonna put you on a brief hold and reach out to our claims specialist so that they can actually review that information again just to make sure that that is correct if it was something as simple as um you know maybe putting incorrect information on the claim form um they'll be able to see that uh so we can at least you know be able to cross that off and see what else might need to be done.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, give me just a moment. I'm just gonna put you on a brief hold, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] [PII], this is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hey [PII], it's [PII] over on the care team again.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] Hi, all right, I've got another insured on the line, um, so she filed a cancer claim with us and, um, for the most part it looks like we're missing, uh, out of my statements with the diagnosis and procedure codes, but she, there is a couple for the transportation. She said she thinks she might have put incorrect information on the claim form.
[AGENT][NEUTRAL] Um, and so she's not sure and just kinda wanted to review what was submitted because she did assure me that she did receive treatment and it was over 5 hours away.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What's the policy number?
[AGENT][NEUTRAL] It is 01590903.
[AGENT][NEUTRAL] And it is for part one. I do have that claim number?
[CUSTOMER][NEUTRAL] Is is the most recent one?
[AGENT][NEUTRAL] Uh, the one ending in 262, yeah, because I think there's one that's processing. She did say that she that information again she's not quite sure what it was, so she doesn't know if that was the supported documents that we needed or not, um, but I did tell her, you know, you could just kind of wait and let it process and we'll be able to let her know but she's really curious about the transportation aspect.
[CUSTOMER][POSITIVE] OK, I got it pulled up. Thank you.
[AGENT][POSITIVE] Alrighty thank you bye bye.
[CUSTOMER][NEUTRAL] Bye.