AccountId: 011433970860
ContactId: d90f8ae0-47a0-4ae9-809b-cc4720da6ee2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1213400 ms
Total Talk Time (AGENT): 295395 ms
Total Talk Time (CUSTOMER): 295661 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/d90f8ae0-47a0-4ae9-809b-cc4720da6ee2_20250514T16:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, this is [PII]. I have a cancer policy under my husband [PII].
[CUSTOMER][NEUTRAL] Uh, my policy number is 980110335.
[CUSTOMER][POSITIVE] And I got in an explanation of benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For MD [PII] on [PII] it's for my chemotherapy, y'all paid everything else except that one and on the back it says that you'll need an explanation of benefits from my primary insurance carrier. Well, back in [PII] I sent that in.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me check on that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] All right. And let me look that up for you. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I want to make sure that I got the policy number right. It's 980.
[AGENT][NEUTRAL] 110.
[CUSTOMER][NEUTRAL] 98
[AGENT][NEUTRAL] 0 9A. OK.
[CUSTOMER][NEUTRAL] 98
[CUSTOMER][NEUTRAL] Yeah, 0110335.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Give me one moment.
[AGENT][POSITIVE] Thank you so much for clarifying that for me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. You're welcome.
[AGENT][NEUTRAL] And can I go ahead and get you to verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your mailing address and phone number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm using my my husband's phone because uh mine has SOS on it so uh but my phone number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and can I get you to verify your email just real quick?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And is there a claim number on this?
[CUSTOMER][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] If not, we can look it up by the date of service, whichever one is easier for you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Claim number 359-862-8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment while I look that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we did receive that claim on [PII] and it was processed.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Let me see what is going on.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Right, I am showing that that is denied, but let me see what's going on here.
[CUSTOMER][NEUTRAL] It on the back it said that I need uh copies of my explanation of benefits from my primary insurance carrier.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I sent that back way way back when uh [PII]. I've been sending out a bunch of papers, so she may have.
[AGENT][NEUTRAL] You said you sent it in on [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Let me see what's going on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna put you on a brief hold while I look that up, is that OK?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh my God. I can barely hear this woman.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Policy number 79186.
[AGENT][NEUTRAL] Policy number.
[AGENT][NEUTRAL] 79.
[AGENT][NEUTRAL] 318
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 98.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, no, I'm not seeing any OB.
[AGENT][NEUTRAL] Wait, yes, ma'am.
[AGENT][NEUTRAL] I'm not seeing it actually.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Research in the actual.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, doke.
[AGENT][NEUTRAL] I guess that's what I will do.
[AGENT][NEUTRAL] What's her name?
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I am going to send you to our claim support. Would you like me to transfer you or can I call you back?
[CUSTOMER][NEUTRAL] Um, you can transfer me to them.
[AGENT][NEUTRAL] OK, give me one moment. Oh, yes, ma'am.
[CUSTOMER][NEUTRAL] Or you can
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so you, I can, I have to explain it all to him again or you can just explain it to him?
[AGENT][NEUTRAL] Um, I'll, I'll do that before I get, before I transfer you. I'll talk to them first.
[CUSTOMER][NEUTRAL] Yeah, that's
[AGENT][NEUTRAL] Right
[CUSTOMER][POSITIVE] That's fine. Thank you.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Calling APL, this is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, this is [PII] with the care team at APL. I have a Dolores Monso on the line. She said that she is getting um a claims denial because she didn't fax in the EOB from the from the primary insurance, but I'm seeing that on my end. Is it all right if I transfer her over to you?
[CUSTOMER][NEUTRAL] Let me take a look, do you have the policy number?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Yes, ma'am, I do. Uh, let me get you a new policy number 79318.
[AGENT][NEUTRAL] And let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] And that was 79318?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And I verified her it is [PII].
[CUSTOMER][NEUTRAL] OK, what, what participant is it for?
[AGENT][NEUTRAL] Part two.
[CUSTOMER][NEUTRAL] And what claim number is it?
[AGENT][NEUTRAL] 359-862-8.
[CUSTOMER][NEUTRAL] And you said she said she sent us the EOB?
[AGENT][NEUTRAL] When I looked in OnBase, I saw one that was from Blue Cross Blue Shield with the procedure codes, um, but I didn't know if there's something that I'm just missing on my, on my end.
[CUSTOMER][NEUTRAL] Let me see if I can see what we got in for that date.
[AGENT][NEUTRAL] Yeah, she said she sent it back on the [PII].
[CUSTOMER][NEUTRAL] And what piece of mail are you looking at? Is it because I don't see no EOB under that claim number that you gave me. I just see the UV.
[AGENT][NEUTRAL] Maybe it's, maybe it's the UB.
[CUSTOMER][NEUTRAL] Are you seeing that mail under a different an EOB under a different piece of mail?
[AGENT][NEUTRAL] No, I saw it under ill. Can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] If you're saying something, I can't hear you. All I hear is static now.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] How about now?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Are you still there?
[AGENT][NEUTRAL] Can you hear me, ma'am?
[CUSTOMER][NEUTRAL] If you're talking, I can't hear anything you're saying. All I hear is static.
[AGENT][NEUTRAL] I'm just gonna go ahead and
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII], I'm going to have them call you back. Uh, it looks like there was some technical difficulties in that call. So is it alright if I have them call you back?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and is this number still all right? [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alright, and I'll have them call you right back, OK? It may take up to 24 hours. Is that all right?
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] Oh [PII], OK, can you answer me a question?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I also had uh explanation of benefits, um, and it says on there what is what is a.
[CUSTOMER][NEUTRAL] Chemical substance unless a cancer resol or chemical sub is administered on the same day.
[AGENT][NEUTRAL] Are you seeing that on your.
[CUSTOMER][NEUTRAL] Is that like um.
[AGENT][NEUTRAL] Policy certificate? Are you seeing that on your policy?
[CUSTOMER][NEUTRAL] Yes, well, some of my
[CUSTOMER][NEUTRAL] On my exclamation benefit that they didn't pay, is that whenever I get my chemo?
[AGENT][NEUTRAL] Let me look into that for you real quick.
[CUSTOMER][NEGATIVE] Cancer residual chemical substance.
[AGENT][NEUTRAL] You said you saw that on your.
[CUSTOMER][NEUTRAL] One of my benefits. It says charges submitted for routine lab, which I understand. Office visit and or non-canceridial chemical substance are not paid unless a cancer residual chemical substance is administered on the same day.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, I was just wondering.
[CUSTOMER][NEUTRAL] Uh, what that means.
[AGENT][POSITIVE] Mm let me see if I can help answer that for you.
[CUSTOMER][NEUTRAL] Because these are the
[CUSTOMER][NEUTRAL] Yeah, cause these are the days I did get chemo.
[CUSTOMER][NEUTRAL] I don't know and I didn't understand what that was.
[AGENT][NEUTRAL] Let me pull up your policy certificate and see if I can help.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And you were wanting to know about the benefit that says
[CUSTOMER][NEUTRAL] Um, and it, it says on there that um,
[CUSTOMER][NEUTRAL] Nothing's paid unless a cancer residual.
[CUSTOMER][NEUTRAL] Chemical substance is administered administered on the same day.
[CUSTOMER][NEGATIVE] So they didn't pay for nothing, but these are the dates that I had did my chemo.
[CUSTOMER][NEUTRAL] It's it's says position referral.
[AGENT][NEUTRAL] Let me look that up for you real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I am unsure about that. Let me try and transfer you one more time before I ask them to call you back, OK? Because I am unsure about that and I don't want to give you the wrong information. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][POSITIVE] Thank you for calling IPL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] with the care team at APL. I have a [PII] on the phone and she is needing assistance with her claim denial, um, and she has a few questions that I am unable to answer. I was wondering if I could transfer her to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, what's that policy number?
[AGENT][NEUTRAL] Her policy number is
[AGENT][NEUTRAL] 79318.
[AGENT][NEUTRAL] And it is for part 2?
[CUSTOMER][NEUTRAL] OK and
[CUSTOMER][NEUTRAL] OK, and what's the claim number?
[AGENT][NEUTRAL] It is 359.
[AGENT][NEUTRAL] 862 8.
[CUSTOMER][NEUTRAL] OK, give me just one second to get that pulled up.
[AGENT][NEUTRAL] And I know it was showing that it needed a primary um explanation of benefits, but she's needing more clarification on that and then she has some questions about the actual claim itself.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you ready for me to
[CUSTOMER][NEUTRAL] I have it pulled up.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Alright, I am transferring you to [PII] from claim support OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] [PII], I'll fix me some water in my cup.
[CUSTOMER][NEUTRAL] Ms [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hey, this is [PII] with the clients team. How are you today?
[CUSTOMER][POSITIVE] I'm good and you?
[CUSTOMER][POSITIVE] I'm doing well, um, so Miss.