AccountId: 011433970860
ContactId: e0f0b818-7a18-4f54-976d-c77b0df7de0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 469500 ms
Total Talk Time (AGENT): 196587 ms
Total Talk Time (CUSTOMER): 240585 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/e0f0b818-7a18-4f54-976d-c77b0df7de0f_20250521T19:07_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I spoke with someone named [PII] the other day and she said that I could probably just call back and you could see the notes that she had made.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My question concerning um submitting these bills for my husband. He has bladder cancer and um let me give you his date of birth or whatever you need from me for him.
[AGENT][NEUTRAL] OK, um, may I first, OK, go ahead.
[CUSTOMER][NEUTRAL] No, I'm sorry, what?
[AGENT][NEUTRAL] Uh, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]. The last name is [PII], [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, hold on just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the cancer policy number is 748041.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right, now I have you here, Ms. [PII]. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] My date of birth or my husband's. The insurance.
[AGENT][NEUTRAL] Yours, just to verify.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] And my address is [PII].
[AGENT][POSITIVE] Thank you for that. And your email?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. OK, so what questions did you have about the um filing the claim?
[CUSTOMER][NEUTRAL] OK. She told me and I knew that I would need uh the equivalent of an itemized bill, or EOB and a procedure code. OK, I have the EOB in front of me, one of them. I got a bunch. And it tells you scope, bladder removal of tumors, medium, then it has a code 52235.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It has where it was done Saint Francis Medical Center a claim number and what my share was, is that gonna be sufficient? And then I also have the Visa bill that was printed out it says paid. Uh, is that gonna be sufficient or am I gonna need a.
[AGENT][NEUTRAL] So the
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] The explanation of benefits, yes, that's fine. In terms of the bill, um, the receipt won't be good. They're going that may be denied, um, but what you'll need to do is, uh, I don't know if it was a doctor's office or a hospital, we're just trying to get their copy of the itemized bill, which will have all the coding and all the charges.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] OK, so this EO from my insurance company is not gonna be enough.
[AGENT][NEUTRAL] not to, not if you're wanting to do coding. The coding that's on there is procedure codes. We need diagnosis to show why those procedures or treatments were given. So the explanation of benefits is used to see what was billed, what was paid by insurance and what's left over, so we know what to contribute to.
[AGENT][NEUTRAL] So yes, it's needed, but not for the coding.
[CUSTOMER][NEUTRAL] OK, it's not gonna take the place of the code.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so you should have the procedure code on it, right?
[AGENT][NEUTRAL] Right, that code that you called out, that's a procedure code. Procedure code is just telling us the treatment that was done.
[CUSTOMER][NEUTRAL] OK, now let me ask you one more thing. Um, the visa, every time I paid with the visa, it says where I paid it like if it was to [PII] or if it was to Doctor [PII], so it it corresponds.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] With this EOB and not only does it show my share, but it shows that I paid my share. So I would think that would be.
[CUSTOMER][NEUTRAL] Important to accompany each one of these since I have them, wouldn't it?
[AGENT][NEUTRAL] No, because the explanation of benefits already gives that information. That's more of a receipt with the visa on it. The receipt and itemized billing is not really, it's not the same thing. We're asking for.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I thought you
[CUSTOMER][NEUTRAL] I see, uh, but my understanding was I thought you needed to see where I paid what my share was.
[CUSTOMER][NEUTRAL] You don't need that.
[AGENT][NEUTRAL] Right, so what I'm saying is the explanation of benefits shows what you pay, shows what the insurance paid, and shows what's left over. So that takes care of your portion. What you're trying to submit. OK, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] But it does
[CUSTOMER][NEUTRAL] It does
[CUSTOMER][NEGATIVE] It shows what I'm charged with, but it doesn't show that I've paid it. The ELB does not show paid.
[CUSTOMER][NEUTRAL] The EOB shows.
[AGENT][NEUTRAL] The EOB
[AGENT][NEUTRAL] You can submit the Visa card if you like, but you will still need to get the itemized billing from the provider.
[CUSTOMER][NEUTRAL] But do you see what I'm saying, or, and correct me if I'm wrong, but this EOB shows what I'm responsible for, but it does not show that I've paid it and I have paid it. That would be the difference in just submitting the EOB and submitting the EOB with the Visa bill that is marked paid. So that's why, that's why I was asking you.
[AGENT][NEUTRAL] Well, I understand what you're saying it's just not sufficient enough, where you can submit the visa if you like, but for medical documentation, we're going to need the itemized bill from the provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I understand that. I was just asking you if, if I send the itemized bill and the EOB and the procedure code if you would need the bill so yes she did pay for this.
[CUSTOMER][NEUTRAL] Uh, it's a it's a paid receipt. I don't know.
[CUSTOMER][POSITIVE] Anyway, uh, OK, well, you've answered my question. I appreciate it.
[CUSTOMER][NEUTRAL] And um,
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Not unless you want to go to all these places and get an itemized bill.
[AGENT][NEUTRAL] Oh, I wish I could for you because I know it's a headache, but you know what, to be honest with you, you shouldn't really, unless you want to do this in terms of filing the claims, you don't have to. If you want to give you the easiest thing to do is to give your the doctors, hospital, anything that's in relation to this um policy, give them our policy number and our phone number.
[AGENT][NEUTRAL] You know, when they ask you for your insurance, just give it whenever you give your regular insurance, just go ahead and write our policy number down and our phone number down too, so that they can call us to verify benefits and they'll, they're supposed to file the claims on your behalf, so you don't, unless you want to, you don't have to do all this.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I've never, I've never had them willingly pay a supplemental policy, quite frankly.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] You know what I'm saying? So, uh.
[AGENT][NEUTRAL] Yeah, and each place is different, so they might not do it.
[CUSTOMER][NEUTRAL] They submit everything to Blue Cross Blue Shield, but when you tell them you have a supplementary policy, they look like you out the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Wagon, so I think the fastest way would be for me to go and get, get all of this, but I'll, I'll get it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much and you said your name was?
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] [PII], yes, ma'am.
[CUSTOMER][POSITIVE] OK well thank you I appreciate it bye bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.