AccountId: 011433970860
ContactId: d5b7f33c-ebf8-4338-9d30-419475b5fb40
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512299 ms
Total Talk Time (AGENT): 313908 ms
Total Talk Time (CUSTOMER): 188479 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/d5b7f33c-ebf8-4338-9d30-419475b5fb40_20250122T22:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APA. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi there, [PII], how are you?
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And I was calling to check on something, a claim that I had filed recently. I got a, a denial for some things in the mail, and then I wanted to match them with the ones that haven't been processed yet, and see what I can figure out that's going on.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] All right. Can you give me your name first?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII] Last name is [PII], [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK. And then, do you have your policy number?
[CUSTOMER][POSITIVE] I can pull it up for you. Hang on just a second.
[AGENT][POSITIVE] And let me have your phone number just in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][POSITIVE] All right, thank you for that information.
[CUSTOMER][NEUTRAL] And then I'm trying to pull it up for you.
[CUSTOMER][POSITIVE] Sorry about that. Just a minute.
[AGENT][POSITIVE] Oh, that's all right. Yeah.
[CUSTOMER][NEUTRAL] Well, I thought it would pull up easily. Can I give you my social instead?
[AGENT][NEUTRAL] Yes, ma'am. Hold on, let me get to that screen.
[AGENT][NEUTRAL] All right. Let me have his social.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, what's your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, give me a second to pull it up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And you said something was processed today for you?
[CUSTOMER][NEUTRAL] No, ma'am. I said, um, I got a letter in the mail yesterday saying that 5 claims had been denied. And then I got another, uh, not, not another claim, but I got a, I've got 5 on there or 4 that haven't processed yet, and I'm trying to see, are those the same claims, or are they different? It's what I'm trying to compare.
[AGENT][NEGATIVE] OK, now, something was processed on [PII]. It was two claims processed. On those claims, it was chemo from uh like 10/23. Uh, you know, your chemo is maxed for the, for the 12 month period. So that was denied. Chemo for 11-18 was denied. Your image benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's what I'm going.
[AGENT][NEUTRAL] Oh, go ahead, go ahead.
[CUSTOMER][NEUTRAL] Hold on, why was the one from [PII] denied?
[AGENT][NEUTRAL] Because they send you uh oh no I'm sorry, no, it's not Mac you need that primary explanation of benefit for that data service with that data service 111 [PII] they only got the bill and for the state of [PII], you have to have the uh.
[CUSTOMER][NEUTRAL] That's my new one.
[AGENT][NEUTRAL] The explanation of benefit, uh-huh, and you must have seen it.
[CUSTOMER][NEUTRAL] The EOB.
[CUSTOMER][NEUTRAL] No, what happened is I dealt with a lady through y'all the other day and she got it for me. We were on the phone for 2 hours. She even went through Blue Cross for me, the lady from your company, and she even went through the hospital, UT Southwestern, and they gave her
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Well, maybe that's, maybe that's one of the claims that's waiting to be processed then, but that's what they were asking for, uh-huh. And then your image benefit is, uh, let me see what that code means for the image benefit CLREM that.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] That one's probably meant for the year, I would think, but.
[AGENT][NEUTRAL] Yeah, it probably is, yeah, it has been met for the year and that date of service, let me go back so I can tell you what that date of service was.
[AGENT][NEUTRAL] That data service was [PII]. Your transportation benefit for [PII] to 1118 wouldn't be paid up because they say they need the physical mailing address, so you need to fax in your physical mailing address. Uh, I don't know if they need the facility they must need the facility. Yeah, they need the facility, they need the facility mailing address.
[CUSTOMER][NEUTRAL] And the day, the day we were on the phone.
[AGENT][NEUTRAL] And on that claim form, you know, on that claim form, it tells you, you know, when the creation, you know, you, you write down the address for the facility, but maybe you didn't write it on your claim form.
[CUSTOMER][NEUTRAL] Right, and it
[CUSTOMER][NEUTRAL] Right, well, I didn't because the lady told me this time I didn't need to do a claim form since I had done one before. And what she told me the other day, uh-huh.
[AGENT][NEUTRAL] Yeah, but it
[AGENT][NEUTRAL] But if we need the address for something, I mean that's why I would always fill out a claim form because like they said they need that address for those places where you went to chemo, University of Texas Southwest, but you don't have to do a claim form. You can write it on a piece of paper. It said, uh uh you can take transportation benefit.
[AGENT][NEUTRAL] A physical address for the provider, whoever they're trying to get it from and just fax that information in. That's what they need they need the physical address for that place to be able to determine if uh transportation benefit is pay up because it has to be 50 miles or more for it to be paid up for and we need the address to be able to do it. And then, um, OK, that's all on that one so that was that one. Let me go to the next one that was the that and see what dates on that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] On the other one, chemo for 1023, this is the same one. So I guess they put all of them together. Physical therapy, for physical therapy from [PII], they need to itemize physical therapy bill.
[CUSTOMER][NEUTRAL] They must have.
[AGENT][NEUTRAL] So if you had physical therapy, you need to send in our physical therapy bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so that's all on those.
[CUSTOMER][NEGATIVE] Yeah, the trouble, the trouble that I'm running into is that the EOBs are not being produced quickly enough. I mean, they, they get the bill paid, but then they don't send us our EOB through Blue Cross. We wait and we wait and we wait. And so, as far as
[AGENT][NEUTRAL] Don't they have a, you, they don't have a website like when I get mine, I get an email, I get an email from Eton you can go and check your claims, you know, information that you can't get on the website and get them that way.
[CUSTOMER][NEUTRAL] Oh, yes, ma'am.
[CUSTOMER][NEUTRAL] Oh yeah, I've done that, but what I'm getting at is like for instance, uh recently on a claim with y'all, they had, they paid the claim and everything, my, my company, but they didn't send out a POB for almost 6 weeks.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And I thought that's crazy that you should have to wait that long on your EOB once the claim has already been filed and paid on, you know.
[AGENT][NEUTRAL] Oh, OK, yeah, that's right, that's right, yeah, OK, and that's why I go on my on the on the website and just print my off if I need something to send them, you know, somebody need my explanation of benefit because that, yeah.
[CUSTOMER][NEUTRAL] But that's kinda how they've been rolling.
[CUSTOMER][NEUTRAL] Oh yeah, well, what it says is I'm in it right now and what it says it says EOB coming soon is all it says.
[AGENT][NEUTRAL] Oh, that's all I was saying, they said, OK, they're, they're a little bit slower. OK. OK, yeah. OK. All right. Yes, ma'am, but that's what they're asking for.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And uh the other claims came in.
[CUSTOMER][NEUTRAL] OK, and on the [PII] that are showing right now that are not processed, are those different kinds?
[AGENT][NEUTRAL] No, ma'am, they came in on the step. They came in on the [PII] and they're in line to be reviewed to be processed. The claims before that came in on the [PII] and [PII]. So that's why they was already processed. Yes, ma'am. All right.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][POSITIVE] OK, alright, well thank you I'll just keep watching then and I'll try to send some more information as I can.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah, and make sure you send that physical address to that place where you had to chemo it down at, OK?
[CUSTOMER][POSITIVE] And you said I could, you said I could even do that like, uh, can I do that email or?
[AGENT][NEUTRAL] Just write it on. No, well, I don't know, we don't accept email. I know the adjusters don't, but if you, if you know if you've been sending it to somebody by email, you can send it, but we don't adjuster can't accept emails. So however you can get that to us by fax, upload it or mail, you can just write down requested, uh, address for transportation benefit to be reviewed and put the name of the company and the address.
[CUSTOMER][NEUTRAL] I'm.
[CUSTOMER][POSITIVE] OK, well thank you very much you have a good evening.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life, and you have a wonderful day. Bye-bye.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I