AccountId: 011433970860
ContactId: ea3bbfeb-ad9d-4410-bbed-7036c7b46dbc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 678059 ms
Total Talk Time (AGENT): 396167 ms
Total Talk Time (CUSTOMER): 100540 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/ea3bbfeb-ad9d-4410-bbed-7036c7b46dbc_20250609T17:48_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to um see the status of the claim that I put in. I'm not able to go online, um, it's not allowing me to access anything online.
[AGENT][NEUTRAL] OK, so you.
[AGENT][NEUTRAL] Or trying to check a claim status for yourself, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII]. What is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then your um policy number?
[CUSTOMER][NEUTRAL] It is 587-187.
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] And any information that I do provide for you today, Miss [PII] would be a verification of benefits and not a guarantee of payment. And first off, I will have to verify several things with you for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, also your home mailing address.
[CUSTOMER][NEUTRAL] Um, you either have [PII] McCos or [PII] Mcco. They're the same address. It was changed by the post office, [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, thank you. So the, what is on file here is the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we also have the same phone number on file for you as the one you gave me, so that is your best contact number. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, thank you and then the last thing to verify is your email address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So as far as the portal goes, Ms. [PII], so there was an update recently to the portal last week, so the reason you're not able to just sign in is you will have to create a new profile for the portal and I would be happy to email you the information on how to do that if you would like.
[CUSTOMER][POSITIVE] Oh yes please.
[AGENT][NEUTRAL] Alright, so give me just a moment so I can go ahead and send that to you.
[AGENT][NEUTRAL] You doing OK today?
[CUSTOMER][NEUTRAL] Yes, yeah, how about yourself?
[AGENT][NEUTRAL] 25 thanks.
[AGENT][NEUTRAL] So the email that I'm gonna send to you, Ms. [PII] is coming from care team at [PII]. I did put APL in the subject line for you, and there are going to be two attachments. One is setting it up for setting up the portal and the other one is for using the portal, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so just one moment.
[AGENT][NEUTRAL] OK, so I do see that there is a claim that will go through our nightly processing for you tonight, Ms. [PII].
[AGENT][NEUTRAL] And on this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is scheduled for the benefit to be paid in the amount of $2,373.98.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that a portion is that the com that would complete the.
[CUSTOMER][NEUTRAL] Entire um claim or how does that work?
[AGENT][NEUTRAL] OK, so there's a lot of line items on this claim for you, so there are several things that were denied and there are several things that the benefits were paid on.
[AGENT][NEUTRAL] If you would like, I, but I, I don't, I can go over every remark if you would like for me to do that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I was just curious because I know that you pay up to $7500 for radiation and I had 30 treatments.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Over a six-week period, so I was just curious.
[AGENT][NEUTRAL] OK, so let me see if I can tell that yet. I may not be able to tell that until it goes through the nightly processing um tonight, Ms. [PII].
[AGENT][NEUTRAL] Since it's not fully.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Processed, so just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So yes, ma'am. See, I can't see that yet. I don't have any, it won't populate all of the information for me.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so it doesn't give me any remarks next to your radiation benefit again yet since it has not fully gone and been processed.
[AGENT][NEUTRAL] I can see that back in some because these dates of service range from [PII].
[AGENT][NEUTRAL] And there was
[AGENT][NEGATIVE] An office visit that wasn't covered because that's not, the office visits are not covered by this policy. Now, there was a surgery, it appears in August.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on that remark, it states in order to give consideration to your claim, we will need a fully itemized surgery bill that includes the procedure code and diagnosis code.
[AGENT][NEUTRAL] Please submit this information at your earliest convenience again that was for data service [PII].
[AGENT][NEUTRAL] Uh, there was also another remark for that same data service.
[AGENT][NEUTRAL] The same thing in order to give consideration to the state of service, we will need a fully itemized bill, a facility billing with all charges fully identified.
[AGENT][NEUTRAL] And you will be able to see all of these remarks on your explanation of benefits on the 2nd page, Ms. [PII], and you should be able to see that.
[AGENT][NEUTRAL] Tomorrow afternoon.
[AGENT][NEUTRAL] Now for 6-12-2023.
[AGENT][NEUTRAL] There was a charge for anesthesia, and it states anesthesia benefits are based on the benefits allowable under the surgery benefit. Please send the surgery charges to include the itemized bill listing the procedure codes for this data service so that those benefits can be considered. This bill may be obtained from your surgeon's office.
[AGENT][NEUTRAL] And also for 6:12.
[AGENT][NEUTRAL] It also has the remark in order to give consideration to your claim, we will need a fully itemized bill, including the procedure code and diagnosis code.
[AGENT][NEUTRAL] And then for there was on [PII].
[AGENT][NEUTRAL] There's a transportation.
[AGENT][NEUTRAL] Charge it state's policy provides benefits for transportation to the place of treatment when the distance is at least 50 miles from your legal residence. According to the information on file.
[AGENT][NEUTRAL] Your legal residence is less than 50 miles from the place of your current treatment. Therefore, we will be unable to provide transportation benefits for these dates of treatment.
[CUSTOMER][NEUTRAL] I, I didn't ask for that, so I guess it's just a standard thing. I, I didn't use any type of transportation.
[AGENT][NEUTRAL] Well, if it was
[AGENT][NEUTRAL] OK, if it was part, anything that you submit, we will review in case there's a potential benefit that was missing, so there must have been something included.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well, that all came from a doctor and my sister drove me there so I don't know where that came from. So I, I that's why I said I don't, I wasn't trying to claim anything with that and I got my information, the documents from the doctor's office. They said that they knew exactly what you guys would need, so I have to send it back to them.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So, yes, basically, for those other dates of service, we're in need of your itemized bill, including the diagnosis and procedure codes, and then also for the anesthesia portion for that surgery back in [PII]. Um, the same thing.
[AGENT][NEUTRAL] So that we can look at the anesthesia benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, so do you have any other questions that I can try and help you with at the moment?
[CUSTOMER][NEGATIVE] No, I just, it seems like I need to wait on the package.
[CUSTOMER][NEUTRAL] It's it's a lot going on there, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, well, if there's anything else that you have a question about, uh, please give us a call, and again this should go through our we're we're scheduled to go through our nightly processing tonight.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Well, if that is all then that I could help you with, oh, you're welcome. At the moment, it was my pleasure in speaking to you, Ms. [PII], and I hope that you have a very nice afternoon.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Yes ma'am, you're welcome and thank you as well.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Uh-huh, bye-bye.