AccountId: 011433970860
ContactId: 0c5f300d-8503-4a3a-afc0-0339a5575ecc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1076310 ms
Total Talk Time (AGENT): 563506 ms
Total Talk Time (CUSTOMER): 456385 ms
Interruptions: 11
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/0c5f300d-8503-4a3a-afc0-0339a5575ecc_20250225T20:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I was calling um how far back can you make a claim is what I was wanting to know.
[AGENT][NEUTRAL] Uh, as far back as when your policy was first active, do you want me to get that pulled up and I can get that date for you?
[CUSTOMER][NEUTRAL] Uh, I started in [PII], but they told me I had to wait a year or so, uh, because my husband has cancer to start making claims.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. If it was a recent, yeah.
[AGENT][NEUTRAL] When did, when was he diagnosed?
[CUSTOMER][NEUTRAL] He was diagnosed in, uh, well, [PII].
[CUSTOMER][NEUTRAL] But they told me I couldn't start making claims until I've had, I had it for like a year or so.
[AGENT][NEUTRAL] OK, um, we can go ahead and get that pulled up just to verify that does sound accurate, um, but we can get that pulled up just to make uh 100% sure. I'm so sorry, what did you, what was your name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK. And you said this was for your husband?
[CUSTOMER][NEUTRAL] Yes, and he's under my policy.
[AGENT][NEUTRAL] OK, what was his name?
[AGENT][NEUTRAL] OK, what was his name? [PII], OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] And [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, do you have that policy number?
[CUSTOMER][NEUTRAL] I do not, I don't.
[AGENT][NEUTRAL] Um, that's OK. I could start choosing your social, sure.
[CUSTOMER][NEUTRAL] You need my social? OK. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] What was your last name [PII] I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I think we've got you under a different last name.
[CUSTOMER][NEUTRAL] Um, my maiden name is [PII]
[AGENT][NEUTRAL] OK, that's what we've got here. All right, um, give me just a moment let me try to find, there's the active one.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Alrighty and then I'm just gonna verify some information really quick. Oh there we are. OK, I went to the active one and that one is Costco. I apologize for that confusion.
[CUSTOMER][NEUTRAL] OK. No, you're fine.
[AGENT][NEUTRAL] All right. Uh, can I go ahead and get your uh date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. The last thing I need is the email address we've got on file for you. Uh, it looks like it might be through your employer.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Got it. OK, thank you so much for verifying that information.
[CUSTOMER][NEUTRAL] Big old email.
[AGENT][NEUTRAL] Uh, they usually are with employers. OK, give me just a minute. Let me get this policy pulled up here.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And then just so that I'm, we're on the same page, make sure I understand correctly. So [PII] was diagnosed with cancer in [PII]. Is he still receiving treatment?
[CUSTOMER][NEUTRAL] Yes, ma'am. He receives chemo every 2 weeks and he has for the past 3 years.
[AGENT][NEUTRAL] Got it. OK. And have you all filed any claims with us before?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I haven't, I haven't. I was, I, I always make sure we have it active and everything, but with everything going on with him.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm just like, oh, I need to call them and figure this out because I know I can make claims already, cause it's been past the year.
[CUSTOMER][NEUTRAL] That I've kept it
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Do you, I know this is, uh, I'm sorry, um, do you know exactly what the date was or at least the month that he was diagnosed in [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] We were told he had cancer [PII].
[AGENT][POSITIVE] OK, because if I'm reading this right and I can get some.
[CUSTOMER][NEUTRAL] The [PII]
[AGENT][NEUTRAL] in [PII].
[CUSTOMER][NEUTRAL] It's December it was [PII], and he started, his journey started [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] I see. OK. So the reason I.
[CUSTOMER][NEUTRAL] It was like a week, it was a week, yeah.
[AGENT][NEUTRAL] Sure. The reason I ask is that there is no waiting period, but there is a pre-existing condition period. So if it were late [PII], then that would have been completely different. OK, so pre-existing condition period of 12 months. So if you don't mind, I'm gonna put you on a brief hold again just so I can get some clarification. Um, I'll get right back with you, OK?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[AGENT][NEUTRAL] Hi Miss [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][POSITIVE] I'm doing good. How you doing?
[AGENT][NEUTRAL] I'm doing well, thank you. So I have a question for you regarding a cancer policy. Um, I've not actually run into this before, so for the policy, there's no waiting period, but there is a
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Oh, sure. It's um 2558412.
[CUSTOMER][NEUTRAL] OK. I got it. And this is for Ms. [PII], OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, so her first policy, uh, started in [PII], and I guess her husband was diagnosed with cancer beginning at [PII], so obviously before this policy was active. Um, and I see that's 12 months for the pre-existing. So, after that initial 12 months from the policy being active, so that would have been [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So when, when did the policy lapse? This is a takeover, so they don't have to worry about Prix. If you go to that PINAM screen, anytime you see a Y, that means it's a takeover. Preexisting don't don't affect this policy.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, I didn't know that. Oh, I just pulled up the actual policy.
[CUSTOMER][NEUTRAL] Uh-huh. Yeah.
[CUSTOMER][NEUTRAL] Yeah, and I don't know why you got the new policy or the old policy.
[AGENT][NEUTRAL] The new one.
[CUSTOMER][NEUTRAL] OK, I guess some people that wouldn't be a takeover. So you would have to, anytime you, you question it about whether it's pre-existing and they already have a policy before, always check the PINAM screen. If you see a Y there where it says takeover, TO means takeover and then PWPS mean waiver of uh uh Prix.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That is very good to know. I appreciate I've never heard that but thank you. That is very good to know. OK, so I guess her question and mine as well um is so from that period when can they start? what's the date that they can file claims going back to?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] They can go back to if it's something that they need to file on the old policy, tell her to put the information and put the old policy number on there. If it's something new after [PII], send that information for the new policy. Anything after [PII], she can, you know, file on that policy. Anything before that that was covered on the old policy, just tell her to separate the two so they can know one party for the new policy and one party for the old policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So just after that initial 12 months, right?
[CUSTOMER][NEUTRAL] Well, wasn't no takeover, so it's just starting from [PII], whatever, whatever her old policy was, whatever the effective date was. See if he had already been diagnosed with cancer, then pre-X must have been already ruled out. If it's still related to his cancer that he had in [PII]. Is that correct?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, right, so the first policy was.
[CUSTOMER][NEUTRAL] What's the what's the old policy number? What's the old policy?
[AGENT][NEUTRAL] It's uh 223-1232. And so that one's effective date is [PII]. She said he was formally diagnosed uh January of that year.
[CUSTOMER][NEUTRAL] [PII] yeah, so that, that would have been pre-X. So they look like they must have never filed the claim. She ain't never filed the claim. So she have to go back from [PII].
[AGENT][NEUTRAL] Right, [PII], yes ma'am.
[AGENT][NEUTRAL] Got it. OK, that's.
[CUSTOMER][NEUTRAL] The present, but now, now one of [PII], this policy lapsed. Did you see that she have another policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so she, she has another one in between there, so she's had it since [PII], yes.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK. What's the, what's the other policy number?
[AGENT][NEUTRAL] It's 243-040490.
[CUSTOMER][NEUTRAL] OK, [PII]2.
[CUSTOMER][NEUTRAL] OK, so she ain't that, so now one of 2023. So yeah, so she was, she was after sending the original pathology report?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Cause she never filed a claim, the original pathology report, the itemized itemized surgery bills, any, any bills, uh, hospital bill, any bills she wants to review. Anything that's before 9 or [PII] we go on this policy. Any claims after [PII] would go on a new policy.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Got it.
[AGENT][POSITIVE] OK, I really appreciate you clearing that up. Thank you so much for your help, [PII]. I will let her know.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, you're welcome. Bye bye bye.
[AGENT][POSITIVE] All right thank you bye bye.
[AGENT][POSITIVE] Alright [PII], I sure appreciate your patience. Are you still with me?
[CUSTOMER][NEUTRAL] Yes, ma'am, and I got that date for you. It was [PII] when he got diagnosed.
[AGENT][NEUTRAL] OK, no worries. I wanted to get clarification because, um, so I'm sorry if this is a bit confusing. um I know you've had a cancer policy with us since [PII], but they were actually three separate policies if that makes sense. So there was one that started in [PII], 1 that started in uh [PII], and then one that started last year, [PII]. So essentially we do still need that original pathology report for the first diagnosis of cancer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so you send that to us first thing, uh, we won't be able to file anything until we have that, um, and then after that, so that 12 months, that would be anything from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can those itemized statements um that show any diagnosis and procedure codes and you can get those from wherever it was that he received treatment they'll have that information um does he.
[CUSTOMER][NEUTRAL] The UB 40?
[AGENT][NEUTRAL] Perfect. Yes. Um, and then, uh, let's see, did you say, I'm sorry if you did already. Did he receive any, uh, chemo, radiation or immunotherapy?
[CUSTOMER][NEUTRAL] Before
[CUSTOMER][NEUTRAL] Yes, uh-huh, he receives.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the only thing in addition we need um from that those itemized statements, we would need um the explanation of benefits from the primary insurance um showing whatever they contributed for chemo radiation or immunotherapy.
[CUSTOMER][NEUTRAL] Chemo. Uh-huh.
[CUSTOMER][NEUTRAL] Explanation of benefits, so like we've changed health insurances since [PII], so I would have to contact the previous insurance or?
[AGENT][NEUTRAL] That's fine.
[AGENT][NEUTRAL] That's fine. It
[AGENT][NEUTRAL] No, you shouldn't have to contact them. The provider should have all of that information as long as they contributed um to any of that uh chemo radiation treatment they'll have that information, those explanation of benefits.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So that's not the UB40, that's something different?
[AGENT][NEUTRAL] That is different, yes. But we only need that for the chemo and radiation and immunotherapy if you received that.
[CUSTOMER][NEUTRAL] So I, so, mhm.
[CUSTOMER][NEUTRAL] Right, so like I could go to the, where I go to get the UB40s, like I had to make a claim when he had his surgery or whatever. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Through another insurance that I have, um.
[CUSTOMER][NEUTRAL] I could go to them and tell them I need an explanation of benefits for that month.
[AGENT][NEUTRAL] Yes, absolutely, absolutely, and again, you can file claims all the way back until [PII].
[CUSTOMER][NEUTRAL] Right. OK.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I can give you um both of these policy numbers so whenever you're ready just again I know it's a bit confusing but just kind of eliminate that if you see mismatched numbers and this would be Y and just so that you're aware.
[CUSTOMER][POSITIVE] Perfect. OK.
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] Let me find a pen.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry, I left my office, so cause I work at a school and I was trying to find a quiet place.
[AGENT][POSITIVE] Oh, you're perfectly fine.
[AGENT][NEUTRAL] I don't blame me.
[CUSTOMER][NEUTRAL] You have a pen I could borrow?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You got a sticky note.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A sticky, uh-huh.
[CUSTOMER][NEUTRAL] I'll take one of these either.
[CUSTOMER][NEUTRAL] I'll bring it right back to you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when I make the claims for [PII], it pertains to a certain policy number?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, OK, that's what I'm trying to understand, OK.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] So for the year [PII], what policy number would I put?
[AGENT][NEUTRAL] So that one is 24.
[AGENT][NEUTRAL] 30.
[AGENT][NEUTRAL] 490.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that would be, that's from [PII] until [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then your active policy, which effective date for that one was [PII], that one is 25.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 58.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 412.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I will say
[CUSTOMER][NEUTRAL] And that's [PII] till next year, right?
[AGENT][NEUTRAL] Right, that one is the the active policy, so that's where we're at right now, um, so I will say, um, if I mean it's up to you if you'd rather wait and get the information first, but, um, in order to file claims with us because have you filed any claims with us before?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK, I will say the quickest and easiest way to get claim information to us is going to be through our online portal um uh have you ever created an account with us?
[CUSTOMER][NEUTRAL] Yes, I created the account, uh huh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect. OK, awesome so it does to upload claim information it does have to be accessed through a desktop or a laptop computer it doesn't really have support for mobile devices um and then from there you would just fill out the cancer claim forms and then there's a spot where you can upload uh documents and it gets to us really quick.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And so you said I need the UB 40.
[CUSTOMER][NEUTRAL] You'll be 40, and then what was the other?
[AGENT][NEUTRAL] So across the board, across the board I'd say general rule of thumb is going to be that yeah the UB40 is fine um but just I would always try to keep in the back um because I don't know if he's had multiple different providers uh treatment spots so itemize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, he hasn't.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] He hasn't, it, it's always been at Harrington Cancer Center. He's never moved from that cancer center. Yes.
[AGENT][NEUTRAL] OK. That's, that's really nice. OK, cause I know I can add to the confusion. No kidding. Um, so yeah, in short, it's the itemized statement with the uh diagnosis and procedure codes. And then for chemo, radiation or immunotherapy, we, in addition, we need the primary EOB.
[CUSTOMER][POSITIVE] Yes, thank God.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Primary
[AGENT][POSITIVE] Yeah, the explanation of benefits. Yes, ma'am.
[CUSTOMER][NEUTRAL] Explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they, they should have that. I don't have to contact the previous health insurance.
[AGENT][POSITIVE] Yes, the provider correct.
[CUSTOMER][NEUTRAL] They should have it, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So the UB40 is the itemized, right?
[AGENT][NEUTRAL] Yes, as long as it shows those um codes, those diagnosis and procedure codes, but again, first thing we need before anything else is going to be that original pathology report.
[CUSTOMER][NEUTRAL] For the chemo. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So every time I make a claim, these 3 things have to be included?
[AGENT][NEUTRAL] And also
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Yes, we really only need the uh primary EOB for uh chemo or radiation, um, or immunotherapy. Everything else, uh, the, um the itemized statement with those codes, that should be sufficient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can also through the website you can set up direct deposit as well for claims um otherwise we would just send a paper check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I know that was information overload. Did you have any questions for me, [PII]?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, no, I just can't believe I've waited so long to do this, but I'm like, I know they said a whole year, and then before you know it, another year passed and I'm like, oh my gosh.
[AGENT][NEUTRAL] How you remember, yeah, you're fine and mhm.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][MIXED] But it's just a lot with his uh cancer, so we're just, there's all kinds of stuff going on all the time. But thank [PII] he's still able to work and so we're just like, oh my gosh.
[AGENT][NEUTRAL] I can imagine.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh, definitely, yes.
[CUSTOMER][POSITIVE] Yeah. OK. Well, thank you so much. That was a big help.
[AGENT][POSITIVE] All right. Well, thanks for giving us a call. Of course, yeah. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Uh-huh, bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.