AccountId: 011433970860
ContactId: ec0c1f7f-af94-4637-8539-2b84ea3e26c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1664689 ms
Total Talk Time (AGENT): 554854 ms
Total Talk Time (CUSTOMER): 670650 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/ec0c1f7f-af94-4637-8539-2b84ea3e26c8_20250319T15:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I have, um, I was calling about, uh, some of the, uh, some of the claims I have that I sent some information back in February about it, but I haven't heard anything about it and I keep getting things saying that it's y'all need more information and I'm not sure what I need what I need to get for you so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, I'm happy to check on a claim. Let's take a look. What's the policy number? Do you have that by chance?
[CUSTOMER][NEUTRAL] Yes, I have that it's 00769779.
[AGENT][POSITIVE] All right, thank you so much. Let me pull this up.
[AGENT][NEUTRAL] All right. And then if I could get your, uh, one of the insured's names and date of birth, please.
[CUSTOMER][NEUTRAL] Uh, my, uh, date of birth is [PII].
[CUSTOMER][NEUTRAL] And do you want like do my other, my other insurance, is that what you're asking for?
[AGENT][NEUTRAL] No, no, no, just your first and last name just to confirm the policy info.
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then if I could verify your address and email, please.
[CUSTOMER][NEUTRAL] Hey, it's [PII] and my email is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is the claim under your name?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Let's see here.
[CUSTOMER][NEUTRAL] There's quite a few. I've been going through chemo for the last 4 months.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] And that's the thing is they sent me one for the biopsy they asked me to send the um the pathology report, which I did. I sent it back in February, um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And I just wanted to make sure y'all got it uh because I haven't heard anything about that.
[AGENT][NEUTRAL] OK, so do you by chance have the claim number in the February time frame where you had sent that?
[CUSTOMER][NEUTRAL] Well, I mean, the client, the client goes back to October, um, let's see, but I, but I think I got something on it in February. Let me see if I can find that one on the I've got several here. Let me look and see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which one it is um.
[CUSTOMER][NEUTRAL] OK, let's see. Well, I have, I have one on a PET scan.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, for [PII] where they said that I needed to, they received the primary explanation of benefits, so I sent them what I have and it does have what the what what what amounts replied to deductible copay or co-insurance that is on what I sent them. I don't know if that's enough or not, but I sent that. I think that went in on the pet imaging that was on [PII]. Let me see when that biopsy is.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Well, let's see, I know I gotta get in here somewhere.
[AGENT][NEUTRAL] OK. Let me.
[CUSTOMER][NEUTRAL] I want a copy of it. I made a copy of all that that that was on the back it was on the back, so probably, OK, yes, OK, this, this one is, uh, this is something that I got. You want the claim number on it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, 3555, so 3 and 35993.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that was for a surgery benefit and that was for [PII]/11 is when I had the biopsy.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And they just tell me I need to send them the pathology report which I sent that back in February because I got this on like the, the check date on this was [PII]27 so I probably didn't get it till like January early February.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you sent the pathology for that. So let's see.
[AGENT][NEUTRAL] Yeah, cause that one said in order to give consideration, we needed the pathology report.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then it looks like you
[CUSTOMER][NEUTRAL] And I'm
[AGENT][NEGATIVE] Did send an EOB with that one. It says the EOB we received does not show the amounts applied towards deductible, co-pay or co-insurance. That was the other denial.
[CUSTOMER][NEUTRAL] Yes, that's right. Well, I mean, so I sent them my claim detail copy of my claim detail which does show that, but it's, it's not like broken out, you know, it's not real detailed, it just has like, you know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] Let me check that.
[AGENT][NEUTRAL] And then that was that you said.
[CUSTOMER][NEUTRAL] It just has that, it just has like surgery.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then it breaks it out and then there's one that has a, you know, hospital visit on it so, but they don't break it out. I don't know if they want something more broken out than that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] But they, you know, like I said, it's on I sent them the um.
[CUSTOMER][NEUTRAL] Sent them that a copy of that which does show you know what the what my Blue Cross paid and then what my part of it what the co-insurance part was and what I paid that was on there so.
[AGENT][NEUTRAL] OK, let me look. I do see something that we got first part of February for this, so let me look at that and see because it still has a denial on it so let me see.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Maybe it does need to be more detailed here. Um, let's see.
[CUSTOMER][NEUTRAL] If I so if I need, so if I need to call the Blue Cross, I need to know what to tell them, you know, they need to send.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do see the pathology report cause you wrote on their pathology report, it looks like attached.
[AGENT][NEUTRAL] You scroll through, yeah.
[CUSTOMER][NEUTRAL] Yes, I did.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII]ore, give me a moment. Let me go back and look at, so I see the pathology report. Let me go back and look at
[AGENT][NEUTRAL] The EOB to see what that looks like because it looks like it's still requesting more detailed information, so I need to look at.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What we have on here, let's see.
[AGENT][NEUTRAL] OK, so on the original claim for this one, I do see the um
[AGENT][NEUTRAL] It looks like it was it looks like it's from a provider, a bill, and it shows Blue Cross Blue Shield as your primary and what was done for like 1011, 24. What we need.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, that was the day before.
[AGENT][NEUTRAL] Right, what we need from Blue Cross Blue Shield is we need to see on their explanation of benefits what they paid.
[AGENT][NEUTRAL] And what was applied towards the deductible, the co-pay, or the co-insurance. This just shows.
[CUSTOMER][NEUTRAL] Was that
[CUSTOMER][NEUTRAL] Well I mean when I sent y'all sent y'all a copy of what I had that shows that, but it's just like this surgery it's not detailed out as far as I don't know if y'all are looking at specific parts of the surgery or or what, but what I sent y'all a copy of was my explanation of benefits and it said on there let me see find that.
[CUSTOMER][NEUTRAL] I can find it, uh.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] It said that um let's see that's lab services.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's got the
[CUSTOMER][NEUTRAL] OK, uh for surgery.
[CUSTOMER][NEUTRAL] It says amount charged and it says 280 and then it has a member discount.
[CUSTOMER][NEUTRAL] And then it says the Pen paid 8828.
[CUSTOMER][NEUTRAL] And then I'd already met my deductible, so there was 0 applied to the deductible.
[CUSTOMER][NEUTRAL] And then the co-insurance was like 981 or something, so I mean so y'all need more than that uh because I mailed a copy of that to y'all.
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] OK, let me check the claim before cause I don't even see that what you're talking about on this one.
[CUSTOMER][NEUTRAL] Well, it was, it was sent along with the pathology report.
[AGENT][NEUTRAL] So, with the pathology report, it looks like what was sent, that was 9 pages total. When I scroll through that, I don't see any explanation of benefits, but let me, I'll check the next couple after that.
[CUSTOMER][NEUTRAL] Well, I don't know because I'm that that uh wasn't 9 pages I don't think the, the pathology report, but I actually attached along with that this, uh, you know what I got for explanation of benefits I sent those as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] I sent it in 3. I sent in 3 different, there were 3 different, I sent in 3 different envelopes. It was 3 different things, but uh for that I'm pretty sure, yeah.
[AGENT][NEUTRAL] Right, I see this.
[AGENT][NEUTRAL] I see the 2nd 1 now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] OK, um, I think maybe Martha, what the best thing to do would be because you have a lot of denied claims, and I usually will tell people if they can get a provider to do the claims for you, it's way easier because it is so much information.
[AGENT][NEUTRAL] Um, I think I need to have a claims examiner reach out to you and go over these with you and try and help you get all these straightened out because I'm in for I'm not a claims examiner. I don't process claims.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So with so many, you know, because I do see like the explanation of benefits and then, you know, I see what you're saying that it was sent 3 different things and I, I see the 3.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Received, you know, documents and uh it's still saying, you know, uh we've received an EOB but
[CUSTOMER][NEUTRAL] Yeah, right.
[AGENT][MIXED] But I see the amount applied towards the deductible co-pay or co-insurance. So I think that, you know, they're gonna be able to give you exactly what is missing and then that way you're not going back and forth so much because that can definitely be frustrating.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, yes, because I mean I said that's all, that's all that I have is, you know, if that's what I said like I sent on this and uh, and I know they turn in, they turn in everything whether because they don't know whether it's gonna be, you know, paid. I know there's certain things that aren't paid under this policy, but you give them your card, they turn in everything to you. The other thing is I've seen nothing. I've had 6 chemo treatments and I've seen nothing. I've got no claims on those. Do they wait till you get finished? How do they handle that?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I mean, if you're um if you're asking them to do those, they may be waiting until you're completely finished. I know that, you know, there are people that will file the claims on their own behalf and some will just do it once a month.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but again, it can be sometimes overwhelming to do it yourself, just because it can be sometimes a lot of information.
[CUSTOMER][NEGATIVE] Well, and especially when you're not in the best shape to do it.
[AGENT][POSITIVE] Exactly, exactly, um.
[CUSTOMER][POSITIVE] So, so I have actually over the last 4 months, I completed my last um completed my last, uh, the 6th treatment, um, a couple of weeks ago. So I'm completely finished with those. So hope, so hopefully I should get something. Here's another question I have for you. Uh, this is actually my 4th cancer that I've done with y'all over the last 8 years.
[AGENT][NEUTRAL] Oh, well,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so I'm getting ready to retire in June and so currently my, uh, you know, my payment to y'all is deducted from my check and so I, once I retire I'm gonna have to deal with y'all directly on that. However, since I have had gone through so much, I know y'all have a limitation on how much you pay for, you know, like chemo or radiation, I've had all of that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I don't know if there was, so I I need to find out if it's feasible feasible for me to continue this policy or not, especially this time. I mean last time, the I've been very pleased with y'all the last few times y'all paid very well on it, but I've just practically I think I got maybe one check the whole, you know, this whole time on first I can't remember because I'd have to go back and look it up but you know it just so I don't know if I'm reaching the limit on my policy and how would I get that information as far as.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know how much of it I used, how much I have left to see if it's even feasible once I retire for me to continue to keep this policy.
[AGENT][NEUTRAL] Yeah, so I definitely think that you could continue the policy on. Most times when people um will retire or if they leave a place of employment, um, we'll send you a letter, you know, um, advising on continuing out the policy and then you can just pay for it however you decide. Let me see.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Um, I'm pulling up the policy certificate here to see.
[CUSTOMER][NEUTRAL] But but it goes back I think 2018.
[CUSTOMER][POSITIVE] Uh, it's probably the first time I used it. I have had it for years, but 2018 was the first time I used it and I had breast cancer that time and that was just radiation, which all paid extremely well on that.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I had um a skin lymphoma on my foot, which, which was also radiated.
[CUSTOMER][NEUTRAL] And then um
[CUSTOMER][NEUTRAL] 6 years ago, I had Hodgkin's lymphoma, so I had the chemo and the radiation. And then I currently have non-Hodgkin's, which has just been chemo and um a lot of other drugs in addition to that, but.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] So like I said, I'm, I've, I've really used it the last 8 years. So I know there are, they have some like lifetime limits on some of the different.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, things like the chemo and radiation and stuff and like I said, I just need to make sure that uh if I continue to, you know, keep the policy that I still have, hopefully I won't need it again, but.
[AGENT][NEUTRAL] Right, yeah. No, yeah.
[CUSTOMER][NEUTRAL] You know, but again, it's just it's like they're, I mean my doctors are like we never have seen but it has 4 unrelated cancers.
[AGENT][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] So I don't know where, I don't know where it's coming from because it's not, I don't have a family history. I don't have a family history of it. So who knows.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Wow, right? That's, yeah, definitely interesting. OK, let's see. So I know the intensive care portion, like once you hit, you know, age 70, that does decrease.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So I'm set I'll be 72 this summer.
[AGENT][NEUTRAL] So I do know that.
[CUSTOMER][NEUTRAL] OK, what was it you said decreases at at age 70?
[AGENT][NEUTRAL] You have an intensive care, um, hospital intensive care writer on here. So benefits decrease by 50% at the age of 70. Um, it looks like
[CUSTOMER][NEUTRAL] Rider.
[AGENT][NEUTRAL] That does change.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause I was looking for, let's see.
[AGENT][NEUTRAL] So I do see, I mean, there are the radiation chemotherapy, immunotherapy benefit limits in a twelve-month period. Let, let me scroll, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which I mean like it's been 6 years since I've, I've used it so should be starting over for a new period for that. That should that should not be an issue.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Just looking to see if I see any other sort of.
[AGENT][NEUTRAL] Limitations.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] I mean, I'm not, I don't see any other limitations listed. Do you, um, have you ever gotten a copy of the policy or do you want a copy? OK.
[CUSTOMER][NEUTRAL] Yes, I have. Yes, probably just need a copy. I mean, I have one, but it's probably from years and years, you know, when I originally got when I got the policy, which has been quite um, so I mean things may have changed. I probably need an update update updated whatever y'all got.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, OK, I can definitely get that to you. Do you want it sent to your email or do you want it sent in the US postal mail?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You can you can email it to me that's fine.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] To get it quicker
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Takes forever, it takes forever in the mail now.
[AGENT][NEUTRAL] No, yeah, for sure. So the email we have on here is [PII] Kilgore.com. Is that still a good email or?
[CUSTOMER][NEUTRAL] At least, yeah.
[CUSTOMER][POSITIVE] That's, that's, that's still that's still a good email.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] Um, so in regards to the claims, I think what the best thing to do is for I'm gonna, I'll put in a request to have a claims examiner reach out to you and uh go over your concerns as far as these denied claims and try and help you get this all straightened out. So, um, is the [PII]9-0828, is that a good callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] That's a good call back number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so
[CUSTOMER][NEUTRAL] And, and, go ahead.
[AGENT][NEUTRAL] Go ahead. No, no, no, go ahead.
[CUSTOMER][NEUTRAL] I was just gonna say, I was just gonna say is there any way that you could put a note in there for them to send me a letter about me picking up the insurance, you know, for me paying it.
[CUSTOMER][NEUTRAL] That I'm making a probably making a change as of, you know, like June I think it's [PII] 4th, uh, so other words they would still take that out of my May check, um, but I don't know that they will take it out of, you know, that, that'll probably be it. So I mean so if I'm gonna have, if I'm gonna have continue continue coverage I need to go ahead and.
[CUSTOMER][NEUTRAL] And uh do whatever paperwork I need to do so I don't have a, you know, roll or like like you know like in there so if they can just send me, you know that I'm currently the payroll deduction that y'all are getting it, but when I retire and right now [PII] 4th would be my retirement date so we get paid like on the [PII]th of the month. So probably May check would be the last one that that would take a deduction out.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] So I would need to go ahead and go because I because I when I talked to my retirement person yesterday, she said, have you reached out to them yet? And I said, no, I'm just getting the ball rolling here, just getting the ball rolling here. So she said, well, so they expect me to, they expect me to handle that. They're not gonna do that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, OK, so yeah, I will definitely put in the request that you're uh wanting information about continuing on the policy also and that you're planning on retiring in June, um, and I'll just let him know that, yeah, these all these recent claims that you've submitted that you've, you know, submitted additional paperwork and just need help kind of ciphering through it, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right, exactly. So I mean because I don't know what if I call Blue Cross, I don't know what I would tell them they needed to send, you know.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, OK. Um, yeah, so I will create the request, have somebody reach out to you, um, and give you a call back at that number. And, um, in the meantime, I mean, feel free, if you have any other concerns or questions, of course, we're always happy to help. Hopefully we can get this squared away and get these paid so it's not such a headache.
[CUSTOMER][POSITIVE] OK, that sounds good.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes, yes, yes, I was just like go ahead and I know there's also a time limitation on it too, I think it's 180 days or something, so you gotta, you can't, you can't just wait around.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And daily [PII]lly, I got you. Well, is there anything else that I could check on for you today, Miss [PII]lgore?
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][POSITIVE] I think that was the main thing, yeah, I think that those were the main things. I was just wanted to, you know, first of all make sure y'all received what I had sent you back in February since I had not, you know, really seen anything and still getting, still getting that thing it was not enough. So what else I need to do, but I think that's probably the best thing and I appreciate your help.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][POSITIVE] My pleasure. You take care and somebody will be giving you a call from the claims department.
[CUSTOMER][POSITIVE] OK. OK, thank you. I appreciate it.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] Bye bye.