AccountId: 011433970860
ContactId: 0ff2d87a-cce4-4884-875f-8651a43b229b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 558099 ms
Total Talk Time (AGENT): 274227 ms
Total Talk Time (CUSTOMER): 221391 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/0ff2d87a-cce4-4884-875f-8651a43b229b_20250624T18:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh, hi, [PII]. This is uh [PII].
[CUSTOMER][NEUTRAL] And uh gosh, so I guess I need to know what it is I need to do to file um.
[CUSTOMER][NEUTRAL] I, I don't know what the uh.
[CUSTOMER][NEUTRAL] So like, I've been through cancer screening, uh, 2 blood tests, high PSAs, and I just had a high contrast MRI and I have the cancer insurance with your organization, and I guess I need to know what it is you need for me to fill out to receive the reimbursements.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Claims, OK. Um, do you have your policy number by chance, [PII]?
[CUSTOMER][NEUTRAL] You see, that's the thing. So I have this through Fort Worth Independent School District here in [PII]. And so I don't know that I actually have a policy number.
[AGENT][NEUTRAL] Mm. Mhm.
[CUSTOMER][NEGATIVE] At least not one that I, I, because I've been paying this, I, I guess you call it a writer for I don't know, 14 years or whatever and I've never, of course, ever used it, but uh do you, can you look me up through Fort Worth ISD?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, let's take a look. What is your
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Right, and then if I can just verify to the full address in [PII] and then email that we would have on file.
[CUSTOMER][NEUTRAL] OK, well, the email you have on file should be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what was the other my mailing address?
[AGENT][NEUTRAL] Yeah, the mailing address, uh-huh.
[CUSTOMER][NEUTRAL] OK. Uh, [PII]. No, hold it. [PII].
[AGENT][POSITIVE] All right, thank you. OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Um, claims can be filed 3 different ways. They can be submitted in the mail. They can be faxed, and then we have an online service center. So as far as submitting the claims go, it's really up to you as far as what you feel like is the best, easiest way for you to do that. You have those different options.
[AGENT][NEUTRAL] When filing a claim, you would need first the the claim form. Uh, the claim form can be located on our physical site, which is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They in public.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm. So [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] When you get to the website, there's a link up at the top you'll see it says claims and forms, and if you click on that,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It'll take you down to the claim forms. They're all in alphabetical order, so.
[AGENT][NEUTRAL] Now, as far as what you need with the claim form, it would just depend on what you're actually filing it for. Um, if you're just filing for the screening benefit.
[AGENT][NEUTRAL] Um, you know, or, you know,
[AGENT][NEUTRAL] It kind of breaks it down exactly as far as depending on what you're filing for what you would need with the claim.
[CUSTOMER][NEUTRAL] OK, and that's on the actual claims form?
[AGENT][NEUTRAL] Yeah, that's on the actual claim form itself. Um, if it's just gonna be like, are you just filing for the imaging because that's just like a wellness benefit that you have on the plan or
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, uh, so I've had, I, I don't know, I've had two sets of labs. I believe the cost for after the TRS Blue Cross Blue Shield Insurance, uh, and I don't know that that has anything to do with you, but I've had two screenings.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the, the contrast MRI was actually yesterday.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then my cost for that that I paid at that time was 1, I don't know, $29 I believe and so I think there's a benefit that comes back so you would need a receipt along with the uh form and also with the screenings, um, uh, the blood testing and then also I don't know if it has anything to do with the cost of the doctor's visits or not.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So, the plan itself really just pays uh kind of like a set amount depending upon, you know, if it's, so for the screening, diagnostic testing, it's a flat $50. So there's no sort of receipt needed. Any follow-up diagnostic testing pays $100. So really, we just need um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The test that was done and the date that it was done. So if that's what you're gonna be filing for, don't actually do that cancer claim format. Go to page 3 and just do the wellness screening benefit claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause it's just a screening benefit, which is a little bit, is different. And so all that's gonna ask for is your name, all your information, and then it asks for the type of exam or imaging that you had done, um, and then it's gonna ask for the dates, and then you just have to sign it, send it to us, and put the physician's name.
[CUSTOMER][POSITIVE] OK. I can, I can handle that now.
[CUSTOMER][NEUTRAL] With the imaging you said that that is under the wellness benefits.
[AGENT][NEUTRAL] Right, it's under the, the screening wellness benefit. Uh-huh.
[CUSTOMER][NEUTRAL] OK, so it was my understanding there was an imaging benefit payment uh of almost $500. That's not exactly what you're just telling me. You're telling me it would be $50. Is that accurate?
[AGENT][NEUTRAL] Well, there's diagnostic tests. Let me see what's, they fall.
[AGENT][NEUTRAL] OK, so medical imaging, did you have, I apologize, I don't remember what you said, [PII]. So if you had an MRI, a CAT scan, or a PET scan, that is a medical imaging. Did you have any of those?
[CUSTOMER][NEUTRAL] Yes, it's a high contrast MRI.
[AGENT][POSITIVE] OK, so then that one, yes, you wanna send um whatever you have for that because yes that one does have a benefit of $500. I apologize.
[CUSTOMER][NEGATIVE] Oh no, it's OK. I uh I'm just trying to figure all this nonsense out.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So yeah, on
[CUSTOMER][NEUTRAL] OK, last thing, last thing.
[AGENT][NEUTRAL] Go ahead, yeah.
[CUSTOMER][NEUTRAL] No, go ahead. I was gonna just say, do you have my account number available?
[AGENT][NEUTRAL] Mhm. Yeah, I have your policy number here. I can give that to you whenever you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Alright, so that is going to be 252.
[AGENT][NEUTRAL] 7511.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 252-751-1
[AGENT][NEUTRAL] Mhm, yeah, and I was just gonna let you know that um all of these are one per like calendar year, so it would just be exhausted um submitting, you know, um for that one you would not get another one this year. It would not be payable again until next year. That's all I was gonna add in that.
[CUSTOMER][NEUTRAL] Is that a is that a is that a insurance year?
[CUSTOMER][NEUTRAL] Or is that a, a physical year?
[AGENT][NEUTRAL] A physical year.
[CUSTOMER][NEUTRAL] Uh, I guess what I'm asking is insurance, uh, open enrollment starts again for me in July and takes effect [PII]. So when you say per year, are you talking calendar year or enrollment year?
[AGENT][NEUTRAL] I'm talking a calendar year, so from January to December, mhm, yeah.
[CUSTOMER][NEUTRAL] Calendar year, OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Did you have any other questions or concerns, [PII]?
[CUSTOMER][NEUTRAL] I don't think I do. I think you answered them very well. Thank you.
[AGENT][POSITIVE] Yeah, not a problem. If you have anything else, feel free to call, OK?
[CUSTOMER][POSITIVE] I sure will. Thank you so much.
[AGENT][POSITIVE] Uh-huh. Take care.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.