AccountId: 011433970860
ContactId: ff47671b-19f6-418a-ba7a-1b6f8be193b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 730440 ms
Total Talk Time (AGENT): 264332 ms
Total Talk Time (CUSTOMER): 276878 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/ff47671b-19f6-418a-ba7a-1b6f8be193b1_20250403T14:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. Uh my name is [PII], and I'm calling, uh, let me see if I can figure this out. I talked to someone earlier today about uh my claim, um, what information do you need?
[AGENT][NEUTRAL] Um, may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] OK, um, my current cell number is [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh got it.
[CUSTOMER][NEUTRAL] And my policy number, I'm looking it up because I don't have it memorized.
[AGENT][POSITIVE] Oh, take your time.
[CUSTOMER][NEUTRAL] Is 207-918-1.
[AGENT][NEUTRAL] Thank you, that was 207-918-1?
[CUSTOMER][NEUTRAL] 207-918-1.
[AGENT][NEUTRAL] All right, and I have you here and I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII] uh address is [PII] and my email is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And then, um, so what's going on with the claim?
[CUSTOMER][NEUTRAL] OK, um, I had called about a question because on the recent claim number 5 said I needed to get the EOBs from my insurance company, is what she said when I talked to her this so when I talked to her this morning. Now, um, I'm at Blue Cross Blue Shield, which is our insurance company, but um the medicines, the immunotherapy is processed through a different, um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Not through them but through Express Scripts.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And I, I can't find, I've never received an EOB and I'm on their website, and they don't have EOBs. What do I need to get from them?
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I mean I've got where I'm sorry, go ahead.
[AGENT][NEUTRAL] There are 2 things.
[AGENT][NEUTRAL] So the first person I will reach out to Blue Cross, and the reason I would reach out to Blue Cross, if you don't see it there, I will ask them if, well, do you see an explanation of benefits from Blue Cross though for that data service? I'm trying to see if the um medicine.
[CUSTOMER][NEGATIVE] Not for those medicines.
[AGENT][NEUTRAL] So it's separate billing, that's what I was trying to figure out, it's billed separately.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] It's billed separately and when I go to the the express groups who who's it it's billed to.
[CUSTOMER][NEUTRAL] Um, it's with my TRS, it's with the Blue Cross Blue Shield TRS care, um.
[CUSTOMER][NEUTRAL] It I can get I'm looking what it says.
[AGENT][NEUTRAL] Wait, because I don't want to, hold on one second, because I don't want to confuse myself. I want to make sure I understand. So, Express, Express Script is who provides the medicine. They still would have to bill your insurance.
[CUSTOMER][NEUTRAL] I can get a detail of.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Blue Cross Blue Shield, or are you saying they don't build them at all?
[CUSTOMER][NEUTRAL] OK, no, no, it, it.
[CUSTOMER][NEUTRAL] No, MD [PII] provides the medicine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh, and they apparently have to build Express Scripts, which is a part of our, our insurance company. I guess, I guess they split it up. Blue Cross Blue Shield does one thing and all the medicines are through another thing.
[AGENT][NEUTRAL] Express, OK.
[AGENT][NEUTRAL] Express Group. Mhm. OK.
[AGENT][NEUTRAL] Is there a
[CUSTOMER][NEUTRAL] And I, I
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Is there a number or anything that we can contact Express Groups if that's the case, then we would just need their explanation.
[AGENT][NEUTRAL] Wait a minute, but we're not.
[AGENT][NEUTRAL] Let me, so this is for what what's the claim number that you and so went over? Let me go through the notes because I don't even.
[CUSTOMER][NEUTRAL] Let, let me go through, let me go through back to it.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] So I can just start from the beginning.
[CUSTOMER][NEUTRAL] Claim number
[AGENT][NEUTRAL] Guinea.
[AGENT][NEUTRAL] 358-37777
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And also, I need to be looking under [PII] and not you. That's another reason. OK. So this is for [PII]. OK. It's OK.
[CUSTOMER][POSITIVE] Oh, OK, I'm sorry.
[AGENT][POSITIVE] Now, line 5. No, you're totally fine. Line 5.
[CUSTOMER][NEUTRAL] I thought because it was my policy I sorry.
[AGENT][NEUTRAL] I'm just trying to get caught up so I can help you correctly. Do you mind if I place you on just a brief hold? I'm getting ready to look up the REOB so I can know what we asked for and then I can go from there. I'll be clear. OK, hold on one second.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mrs. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, thank you so much for holding. So here's the thing. So it's asking for two things. It, so from Express Scripts, all you, all you need from them is the bill, the itemized billing, that's it for them.
[AGENT][NEUTRAL] In addition
[CUSTOMER][NEUTRAL] OK, Express Scripts is the insurance company, the part of the insurance company, so.
[AGENT][NEUTRAL] OK, so however you want to, you can, you can say that the itemized bill or the explanation of benefits, but they have something for this data service showing that they paid or denied or what happened with the medicine. They have something for that data service.
[CUSTOMER][NEUTRAL] OK, so what I can see on what they sent me to was the website and what I can see is it says.
[CUSTOMER][NEUTRAL] Um, to me, it kind of, you know, has some of the stuff that an EOB, but it doesn't say EOB. It says the name of the medication. It says that it's accepted, it says the date it was processed. It shows a cost summary, total cost, uh, how much I owe, how much was applied to my deductible, um, prescription details. OK. So that, that.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that's what you're wanting.
[AGENT][NEUTRAL] Mhm. As long
[CUSTOMER][NEUTRAL] Oh, go ahead.
[AGENT][NEUTRAL] As long as it's for, um, oh, sorry, my mouth just got stuck. As long as it's for date of service. I'm trying to get back to the date, I believe it was May.
[AGENT][NEUTRAL] Or was it March? [PII] to
[AGENT][NEUTRAL] Well, [PII] is what that 2nd 1 is for.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So as long as it's from Express Scripts and it has the billing, it sounds like it's all in one. If that's a separate part of the insurance company, they do the billing and the processing for their claim, for the medicine.
[CUSTOMER][NEUTRAL] Yeah, I don't know.
[AGENT][NEUTRAL] Yeah, so whatever um you have for March, and it could be, I hope it's all together, but as long as it shows [PII], that's what we're looking for.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because that's the only other thing you can ask for. Blue Cross, the other side won't have anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because this is a claims history is what it says is what it's telling me and it says it's got a
[CUSTOMER][NEUTRAL] I mean, it's, it's a list, a a long list of all the medications.
[CUSTOMER][NEUTRAL] And it says service date.
[CUSTOMER][NEUTRAL] Uh, total cost you paid, um, and.
[CUSTOMER][NEUTRAL] And then I can also see details which just tells you.
[CUSTOMER][POSITIVE] It's a bigger, I don't know. I'll send this to y'all and y'all can tell me what to do next.
[AGENT][NEUTRAL] And um, you can do that or if you, if you like, um, we can call them. I mean, uh.
[AGENT][NEUTRAL] From what you're explaining though, it sounds like that's what we're looking for. Does it have
[AGENT][NEUTRAL] Do you see any coding on there?
[CUSTOMER][NEUTRAL] Uh, I do not see any coding.
[AGENT][NEUTRAL] Like, does it show procedure?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it just says the vanitlaxin tablets, 2828 pills, 100 mg, 28 day supply, 28 tablets, University of Texas MD Anderson.
[AGENT][NEUTRAL] Yeah, that sounds like it because that's for medicine, yeah.
[CUSTOMER][NEUTRAL] Uh, data service.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I would try it if
[CUSTOMER][NEUTRAL] OK, I will send it to y'all.
[AGENT][NEUTRAL] At the very, at the very, the worst we could say is this isn't it, but we can um definitely that sounds like it to me because it's for medicine.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] I mean, if you'd like, I can definitely, if you want to call them, just ask some questions and make sure that's the correct thing. If you like, I can definitely call them with you, um, or if you want to send it and see what happens is whatever you, whatever you like.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, I'll send it and look at the number and I and include the number with it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then that way,
[CUSTOMER][NEUTRAL] Uh, that way if y'all need it.
[CUSTOMER][NEUTRAL] You've got it
[AGENT][NEUTRAL] OK. Well, I will note the policy so when they do get it, they'll know what's going on.
[CUSTOMER][POSITIVE] thank you hon I appreciate it.
[AGENT][POSITIVE] You're very welcome, Mrs. [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, that takes care of it.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you, you too, hon.
[AGENT][POSITIVE] Thank you. Bye-bye.