AccountId: 011433970860
ContactId: e62ac802-250d-47ab-b698-86b30b51ed3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 901200 ms
Total Talk Time (AGENT): 439736 ms
Total Talk Time (CUSTOMER): 319095 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/e62ac802-250d-47ab-b698-86b30b51ed3d_20250219T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. How are you doing today?
[AGENT][POSITIVE] I'm doing well [PII] thank you how are you?
[CUSTOMER][NEUTRAL] I'm doing fine, thank you. I have policy number 79318.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Don't make me say the last name cause I forgot how she said Mo [PII].
[CUSTOMER][NEUTRAL] I believe
[AGENT][NEUTRAL] Wednesday Friday OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Anyway, um, she is calling me, she was trying to look at her claim. She couldn't get the claim, uh, that we just processed pulled up on the line, so I explained to her that sometimes it does take a little.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, up to 24 hours to be able to view in the OSC.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so we're going over the claim information. She couldn't remember a date of service of [PII].
[CUSTOMER][NEUTRAL] And when I pulled the documents up I don't see that data service in those claim documents.
[CUSTOMER][NEUTRAL] You know, unless I'm just overlooking it. I don't know. But then she um was stating that the
[CUSTOMER][NEUTRAL] Her um treatment location is over 200 miles. It's from [PII] to [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Then I was telling her that we need the itemized bills with procedure codes and um diagnosis codes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] She just needs further information regarding this, no, no benefits being paid.
[CUSTOMER][NEUTRAL] I tried to go over everything with her, but
[AGENT][NEUTRAL] OK, yeah, it looks like.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like that's what we're requesting is the itemization for um there's a surgery and also some inpatient uh care. Um.
[CUSTOMER][NEUTRAL] Surgery.
[CUSTOMER][NEUTRAL] And then she's questioning now I told her that the lodging does have to be over 50 miles um to the.
[CUSTOMER][NEUTRAL] Place of ser the service location and it has to be for a covered treatment or surgery procedure. And she said it is for her cancer. And so she's asking about the lodging as well.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] And obviously she's been verified.
[CUSTOMER][NEUTRAL] Oh yeah, I verified all of her stuff.
[AGENT][NEUTRAL] And I'm not seeing the [PII] either, so I'm not sure where.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] I know it's hard for these cancer people to.
[CUSTOMER][NEGATIVE] You know, being going through treatment and trying to get all this stuff in. I know it's hard.
[AGENT][NEUTRAL] Right, and that's her phone number listed there the contact?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it looks like there's some notes here, OK, um, and you said she was verified, right [PII]? Sorry.
[CUSTOMER][NEUTRAL] Yes ma'am, she is.
[AGENT][NEUTRAL] OK, I'll speak with her.
[CUSTOMER][POSITIVE] All right, thank you [PII] let me get her on the line.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Miss [PII], thank you for your patience. I have [PII] on the line she's going to look at this claim further for you, OK? OK, thank you and thank you for calling APL you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello, is it [PII]? How do you say your name? I'm sorry, [PII]. OK, [PII], alright, great, thank you. My name's [PII]. I'm in the claims department so I'm taking a look at uh the information that was sent in to us for your claim and it does look like we are requesting some additional information so I'm just kind of reviewing right now uh the notes in the uh in the claim and what exactly is uh needed.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Um, now, [PII] had said that we had some dates there that we weren't sure about as far as the surgery. Um, looks like it was [PII]. Is that an incorrect date?
[CUSTOMER][NEUTRAL] Uh, she said [PII], but I think that's whenever I went and did, uh.
[CUSTOMER][NEUTRAL] A scope for my stomach, so.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, to check and see if I had some cancer in the stomach, but uh.
[CUSTOMER][NEUTRAL] That's the only thing I could see that would be at Achner in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me just uh.
[CUSTOMER][NEUTRAL] But I don't remember sending anything in for that claim, I mean, you know, for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just looking over what was uh sent in so it looks like we got a couple of things here that are um we're requesting some additional information so it looks like for um.
[AGENT][NEUTRAL] Let me just verify this information.
[AGENT][NEUTRAL] I'm kind of going over what documents were submitted so it looks like we are needing that itemization of charges for for the hospital stay.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and it does.
[CUSTOMER][NEUTRAL] But that's for the biopsy uh uh [PII].
[AGENT][NEUTRAL] Yes, so let me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like we had two charges for transportation that was on uh [PII] and then again on [PII] um and what uh the information that I'm seeing here, the transportation was less than 50 miles when they um, they do a calculation of the miles based on uh the address and the uh location.
[AGENT][NEUTRAL] So, um, it does say it needs to be at least 50 miles from your residence, um, in order to, uh, qualify for that portion of the benefit for the transportation. Um, now, it, it does appear for, again, the hospitalization on the [PII], it looks like the [PII] and the [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, we're requesting an itemization of charges from the hospital for those dates, uh, of confinement.
[AGENT][NEUTRAL] And then we're also needing a, a surgery uh bill for the surgery charges because it looks like what was received under this claim, um, let's see.
[AGENT][NEUTRAL] Uh, and then also the biopsy on 115, we're requesting an itemization.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I have that I have that but the other dates I don't know where you're getting all these dates from because the only time I went in, you know, is for my biopsy other than.
[CUSTOMER][NEUTRAL] I don't know where I don't know. I don't know where you're getting maybe the uh ELB explanation of benefits that's where you're getting everything.
[AGENT][NEUTRAL] Well, I do see, OK, so we did.
[AGENT][NEUTRAL] I'm looking over those documents and it just, I have some notes here and it just states that um
[CUSTOMER][NEUTRAL] So y'all gonna send me a a thing what y'all need?
[AGENT][NEUTRAL] Yes, you should receive an explanation of benefits um and I understand that you were looking, uh, Miss [PII] said that you were looking online and you you're not able to view it as of yet, so it does take a little bit of time in order to or to uh be able to be viewed in the online service portal, um, but you will receive an explanation of benefits, um, in regards to, you know, what's needed for the claim.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What else is needed? OK.
[AGENT][NEUTRAL] Yeah, so it does look like, like, go ahead.
[CUSTOMER][NEUTRAL] Now let me ask
[CUSTOMER][NEUTRAL] Now, um,
[CUSTOMER][NEUTRAL] On the traveling wise from my house to [PII].
[CUSTOMER][NEUTRAL] Is 195 miles one way.
[CUSTOMER][NEUTRAL] And 195 miles another way so that's well over 50 miles.
[CUSTOMER][NEUTRAL] Because I do all of my treatments and stuff in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it does appear that.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] It does appear that the documents that were sent to us as far as the um and it looks like and that was on the um the dates that were written on the claim form, the [PII] and [PII].
[CUSTOMER][NEUTRAL] And then I had another paper.
[CUSTOMER][NEUTRAL] That would, uh, no, that's the one for [PII], but I had another paper, uh, stapled with all of that saying, you know, every time we went to [PII] in [PII].
[CUSTOMER][NEUTRAL] There was no more room to put my traveling, so I added a piece of paper.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and that's what um.
[AGENT][NEUTRAL] I was on the 4650 so.
[AGENT][NEUTRAL] Just bear with me for one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Because it looks like the attachment that was uh.
[AGENT][NEUTRAL] Included here and you said that that you would attach the paper?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do see it says [PII] on the bill that was submitted um.
[CUSTOMER][NEUTRAL] Yeah, the [PII].
[CUSTOMER][NEUTRAL] I have their address.
[CUSTOMER][NEUTRAL] [PII]. I know it by heart, girl.
[AGENT][NEUTRAL] Yeah, I can understand.
[AGENT][NEUTRAL] Because it doesn't show.
[CUSTOMER][NEUTRAL] My first time I went was uh [PII].
[CUSTOMER][NEUTRAL] And then my first treatment was [PII].
[CUSTOMER][NEUTRAL] And the second treatment was [PII].
[AGENT][NEUTRAL] OK, and I am seeing that information here.
[AGENT][NEUTRAL] Um, however, on the papers that were provided by the University of Texas MD Anderson, it doesn't give us an address, um, on the paper. It has your address and then it has like the itemization of services, but it doesn't tell us, uh, the location.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yes, ma'am, it does.
[CUSTOMER][NEUTRAL] Because I, I, I wrote it out just like on the claim form, the date.
[AGENT][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] And um the um place that I went to.
[AGENT][NEUTRAL] Yeah, I see that.
[AGENT][NEUTRAL] Right, I see that on the claim form where the address was written, but I think that it was reviewed based on what uh billing was received so let me um if I can, if you don't mind um can I uh give you a call back? What I'm gonna do is I'm gonna reach out to the.
[AGENT][NEUTRAL] Um, adjuster that process your claim and just get some more clarity as far as like those dates and what is exactly is needed and I'm also going to um review that address that you wrote on the claim form and let her know that that's where the treatment um took place was in [PII] and um if it's OK with you, I can just give you a call back once I speak with uh her directly, is that OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah, now she said something about lodging, but I was told the other day that the only way I'll pay on lodging is if I'm in the hospital and I have a hotel for my husband, is that right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That is correct now u[PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Is that something that you, you can provide to us? It's not OK, OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, because, uh, I mean, I was never, I was in the
[CUSTOMER][NEUTRAL] I was at [PII] for treatment like my chemo and immunotherapy, but that's not considered a hospital to y'all, right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Well, if, if you're not inpatient, like if you stayed uh or you just went for the treatment and then were discharged, it was kind of like a outpatient treatment, correct? Yeah. So that's where it would, it would have to uh meet that uh criteria for being inpatient confined to the hospital.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, right, OK.
[CUSTOMER][NEUTRAL] Right, right, right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so in that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] These all these little bitty stipulations, it's unreal.
[AGENT][POSITIVE] Uh, and I apologize. I know it can be frustrating, especially when you're dealing with all you're dealing with. I understand. Um.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[AGENT][NEUTRAL] So, um, that contact number for you I have is [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so, um, if you'll give me a little bit of time, like I said, I'm gonna reach out and, uh, have her review this claim with me and just make sure that um we are requesting the correct information and like I said, I wanna check on some of those dates and then also like I said I'll bring it to her attention that it uh the address written on the claim form is actually where you went for the treatment and that was in [PII] and I see the [PII], right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so I either I will call you back, Ms. [PII], or, or it will be the adjuster and again my name is [PII], but I'll call you back shortly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[AGENT][POSITIVE] You're welcome, thank you, thank you for your patience.
[CUSTOMER][POSITIVE] Bye bye thank you bye bye.
[AGENT][NEUTRAL] Bye.