AccountId: 011433970860
ContactId: dfd5d4bb-d42b-4438-81b6-2478e071463e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 832289 ms
Total Talk Time (AGENT): 378588 ms
Total Talk Time (CUSTOMER): 364940 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/dfd5d4bb-d42b-4438-81b6-2478e071463e_20250121T22:38_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I spoke with someone back on the [PII]. Her name was [PII], and I was wondering if I could speak with her again.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I can definitely see if she is available. Let's see, um, the first, if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Alright, thank you. And was this for your individual policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have that policy number?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Do you want me to give it to you?
[AGENT][NEUTRAL] OK. Yes, please.
[CUSTOMER][NEUTRAL] 2 OK 242-858-9.
[AGENT][POSITIVE] All right. Thank you. One moment, please.
[AGENT][NEUTRAL] Sorry, what is so slow today. Alright, I'm just gonna verify some information really quickly. Can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Uh-huh, [PII].
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] Perfect. Last thing I need is the email address we've got on file for you. uh, looks like it is through your employer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I have 3 different ideas of possibilities. So does it start with Doctor, Doctor [PII], or does it start with [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Uh huh, at RISD.
[CUSTOMER][NEUTRAL] [PII]. US.
[AGENT][POSITIVE] Yes ma'am. OK, thank you so much for verifying that. All right, give me just a moment here and I appreciate you verifying your information. Let me see if [PII] is available. I think she has already left for the day, um, but let me check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so she is gone for the daily, um, she will be back tomorrow uh was there anything I could help you with?
[CUSTOMER][NEUTRAL] Well, maybe what I'm needing, they, I sent in some paperwork and I wasn't given all the information. I had thought I was, but um [PII] told me that we needed a UB40 from the hospital cancer center where I had my treatment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I got it and I was wondering because instead of telling me, you know, a lot of them are saying chemotherapy, lab, pharmacy, this one just has the numbers on it and I just wondered if, if it would be possible for y'all to tell me, is that what I'm needing or do, uh, could I give you the number and see if you can look it up in your system?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, just so that
[CUSTOMER][NEUTRAL] Because it's a treatment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so just so that I understand um this is the form that they gave you and it only has numbers on it there's no, uh, it doesn't state like what the treatments were.
[AGENT][NEUTRAL] It's just the numbers?
[CUSTOMER][NEUTRAL] Right, and I, I know what it is I feel because I, I'm receiving immunotherapy and it's very expensive. So the most expensive things on here, I feel like are the, the actual um medications.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And but it doesn't say the name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It just has a number so I have other things that say laboratory immunology, um, pharmacy, but this just has a letter of N and then it has numbers after that.
[AGENT][NEUTRAL] OK, um, you could try giving one of those to me um it would be a bit uh normally I would say to go ahead and just send it to us because it's a little difficult to verify one way or another just over the phone without being able to actually see it um but if you could give me one we can at least give it a shot.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, I appreciate that.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Are you wanting to give it to you now or do you need to pull something up or?
[AGENT][NEUTRAL] Oh sure, you could go ahead and just give me one of them, um, and that way I'll be able to see if that's a, uh, procedure code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so they're very similar to one another, but it starts with the letter N.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 455-513
[CUSTOMER][NEUTRAL] 013
[CUSTOMER][NEUTRAL] 201 and then the letters U and the letter N 1.2.
[AGENT][NEUTRAL] OK. That's a bit long for a procedure code, but um let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] And then I'm so sorry just again to make sure that I understand correctly when you asked them for the UB40 this is what they gave you?
[CUSTOMER][NEGATIVE] Yes, and so it was surprised me and I was concerned that if I just send it in that maybe y'all would tell me no that's not gonna work.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] It's the actual name of the medication.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, [PII], if you don't mind, um, I'm going to put you on a brief hold. I'm going to, uh, I did make a note of this code. I'm gonna reach out to our claims specialist, uh, see if that's something that they recognize at all, um, again what I'm thinking is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Might just need to submit it just to make sure I know that's could be a bit time consuming um and it may very well not be what we need um but let's just try this for good measures see if it's something that they recognize.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I give you something very quickly? The name, this is a medication and the name of it is [PII], which is [PII]
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and so I believe that's the number for that.
[AGENT][POSITIVE] [PII] OK.
[AGENT][NEUTRAL] OK, OK, alright, um does it have the date of service on there at all? Is there a date?
[CUSTOMER][NEUTRAL] Yes, yes, it does. I'm looking, I walked over to find the name of the medication, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Both of them.
[CUSTOMER][NEUTRAL] Well this one that I I may have, yeah, the one I gave you is 5:30 and the one the other one that's almost exactly like it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it's off, it may be June, but anyway, yes, that one is 5:30.
[AGENT][NEUTRAL] That's OK. We could just focus on this one, just to be able to identify if this is a correct document or not, um, and that was 5:30 of 24, correct?
[CUSTOMER][POSITIVE] Yes, yes, yes.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, alright, [PII], give me just a moment. I'm just gonna put you on a brief hold um while I see what I can do for you I'll get right back with you OK?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Alright, yes ma'am thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Know benefit.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Uh
[AGENT][NEGATIVE] Oh jeez.
[AGENT][NEUTRAL] Right, nope.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Sing
[CUSTOMER][NEUTRAL] For calling APL, this is [PII]. How may I assist you today?
[AGENT][NEUTRAL] [PII], it is [PII] on the care team again. I'm getting all the cancer calls today.
[AGENT][NEUTRAL] I'm telling you, um, I've got a weird one, it's an individual and I guess she's been talking to several people. She asked her that you be uh [PII] and she said that she got a paper that has nothing but.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Codes like numbers and such and she wanted to make sure if this was correct um and I told her really there's no way of knowing without seeing it so to go ahead and upload it but she gave me this code and it's very long. I don't know if it's something that you would recognize like it begins with an N.
[AGENT][NEUTRAL] And has UN 1.2 at the end, does that sound like anything that we would need?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, what is she doing this for surgery or something?
[AGENT][NEUTRAL] It's, well, she did say she thinks this was for a medication. Um, I, but there, she said there's no text on this. This is what they gave her. Yes.
[CUSTOMER][NEUTRAL] A cancer?
[CUSTOMER][NEUTRAL] A cancer drug, a chemo drug?
[AGENT][NEUTRAL] Yeah. Yeah. Kinti is what she told me. She spelled it for me, but.
[CUSTOMER][NEUTRAL] It would be, it would be a J code.
[AGENT][NEUTRAL] It starts with this one starts with an N.
[CUSTOMER][NEUTRAL] Mm mm. No, that wouldn't, mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So she needs to get back with the provider, this isn't what we need?
[CUSTOMER][NEUTRAL] Um, from what, I mean, just, I can't say for sure cause just like you're saying, you, you know, you, you don't, you can't say, but the chemo drugs, um, normally start with a J.
[AGENT][NEUTRAL] That's what I'm saying, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK interesting yeah this was all completely foreign to me. I'm getting all the curveballs, so should I just have her go ahead and upload it and we'll just kind of go from there?
[CUSTOMER][NEUTRAL] That's, yes, um, but you can also let her know that that in code does not, you know, sound familiar, but maybe if the drug name is on there, then that would help also cause we can um definitely look it up by name and know, but um, but just if it's a code and no name, then no, that probably wouldn't be it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK all right I appreciate your help again thank you.
[CUSTOMER][POSITIVE] You're welcome. Mhm, bye-bye.
[AGENT][NEUTRAL] Alright bye.
[AGENT][NEUTRAL] Alright, [PII], sorry about that wait are you still with me?
[CUSTOMER][NEUTRAL] I'm here.
[AGENT][NEUTRAL] OK, so I did run that code by our claim specialist and it was very unfamiliar to her as well um she said typically was this, I know you did say it was a medication was this uh like a chemo medication?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it, it's not a chemo, it's an immunotherapy.
[AGENT][NEUTRAL] For immunotherapy, OK, um.
[CUSTOMER][NEUTRAL] But it's very I mean it I it's given the same way it's just a different agent.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I did chemo as well, but this is just the immunotherapy.
[AGENT][NEUTRAL] Got you. OK, um, and then you said that you believe it was for this drug that you gave me, but there's nothing on there that has the name of this drug, right? The congenT?
[CUSTOMER][NEUTRAL] Right, and it has something called an HCPCS.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Beside it, which has a Q 5117. I don't know if that's more.
[CUSTOMER][NEUTRAL] Helpful or not?
[AGENT][NEUTRAL] Well, what I, I told her, uh, when she told me, um, is the same thing that I was thinking is to go ahead and upload what you were given and we will go through to see it's, you know, neither nobody wants to tell you one way or the other until we can actually see it um but I will say that code that you gave me does sound it's very unfamiliar to me and to her as well um but we will review it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm sorry, it might be a bit, you know, obvious it can take about 7 to 10 business days for claim information to process, but that's really gonna be the only surefire way that we're gonna know if that's the correct information or not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. Sure. Uh-huh.
[CUSTOMER][NEUTRAL] Mhm. OK. Well, it's just a very large number because it's like $43,000 just for that treatment. It's crazy. Um, so that's why I know it has to be that medication, but they may need to resend it. I don't know to me and I don't know how they can do it, but.
[AGENT][NEUTRAL] Dang, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Anyway,
[AGENT][POSITIVE] Well, right, so if you just send us this information again we'll review it if there's anything specifically that we see on there um maybe just missing a couple of things or something like that we'll be able to let you know and then hopefully the provider will be able to give you that information without any issues.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sure, OK, well I appreciate your help and can you tell me your name one more time?
[AGENT][NEUTRAL] Yeah, sorry, there wasn't more I could do to help. Uh, yeah, it's [PII]
[CUSTOMER][POSITIVE] Right, very good. Well, I will go ahead and get this sent in tomorrow.
[AGENT][POSITIVE] OK, sounds good we'll sure do our best to get it done quick for you. I'm sorry there wasn't more I could do to help.
[CUSTOMER][POSITIVE] Well, no, I understand. It just surprised me too, so we'll just see what happens when y'all look at it. OK, thank you so much. That's it.
[AGENT][POSITIVE] Fingers crossed, yes ma'am. Did you have any other questions for me?
[AGENT][POSITIVE] All right well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you bye bye.