AccountId: 011433970860 ContactId: 11d88407-8761-4ef3-b275-d8411b4f86ad Channel: VOICE LanguageCode: en-US Total Conversation Duration: 1845000 ms Total Talk Time (AGENT): 734674 ms Total Talk Time (CUSTOMER): 443160 ms Interruptions: 5 Overall Sentiment: AGENT=0.4, CUSTOMER=0.4 Redaction Types: PII Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/11d88407-8761-4ef3-b275-d8411b4f86ad_20250227T15:09_UTC.wav -------------------------------------------- [AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you? [CUSTOMER][NEUTRAL] Yes, I was calling in regards about my policy and my number is. [CUSTOMER][NEUTRAL] [PII] [AGENT][NEUTRAL] OK, and who am I speaking with, please? [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] OK. And Ms. [PII], what is a good callback number for you? [CUSTOMER][NEUTRAL] [PII] [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] I'm sorry, [PII]. [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] OK, thank you. And how can I help you today, Ms. First of all, your information is pulling up. [CUSTOMER][NEUTRAL] OK, I was calling about the uh my previous claim that. [CUSTOMER][NEUTRAL] Uh sign in on the [PII]. [CUSTOMER][NEUTRAL] And I just had a few questions. [AGENT][NEUTRAL] OK, so you're needing some information regarding a claim that was submitted that you submitted to us, is that correct? [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Yes, ma'am. [AGENT][NEUTRAL] Yes ma'am, I can help you with that. And so first off, Miss [PII], any information that I provide for you today will be a verification of benefits and not a guarantee of payment. I will also need to verify several things with you first for security purposes. So first off, if you could please verify your date of birth. [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] Thank you and your home mailing address? [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] Thank you. The phone number that we have for you is the same as the one you gave me, so again, that is your best contact number, is that correct? [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] OK, thank you. And lastly your email address and this does appear to be your work email. [CUSTOMER][NEUTRAL] [PII]. [AGENT][POSITIVE] OK, thank you. [AGENT][NEUTRAL] OK, so on. [AGENT][NEUTRAL] You're calling in regards to the claim that went through our processing yesterday or last night? [CUSTOMER][NEUTRAL] Mhm. Yes, mhm. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] OK, so yes, ma'am, I can see that there was a benefit paid in the amount of $939 on this claim. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And that claim is, uh-huh, go ahead. I was just gonna say, and that claim shows that that will be a direct deposit. [CUSTOMER][NEUTRAL] So, [CUSTOMER][NEUTRAL] OK, so you say y'all need copies, the copies of the explanation of benefits from my primary insurance carrier. [AGENT][NEUTRAL] OK, so let me pull up the remarks. [AGENT][NEUTRAL] Give me just a moment, please. [AGENT][NEUTRAL] OK, so let's see. So, yes, ma'am, um, for your chemo, I do see that that does state that for data service 1213 to please provide copies of your explanation of benefits from your primary insurance carrier. Mhm. And that's also [CUSTOMER][NEUTRAL] For which day? [AGENT][NEUTRAL] Um, this shows for data service 12:13. [CUSTOMER][NEUTRAL] 1213? OK. [AGENT][NEUTRAL] Uh-huh. [AGENT][NEUTRAL] And then there's also the same remark for an immunotherapy for [PII]. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] And of course, you, you should have be able to access your explanation of benefits. Are you able to yet since it just went through our nightly processing, it may take a little time for you to be able to see that, but are you able to see your explanation of benefits, Ms. [PII]? [CUSTOMER][NEUTRAL] Uh, no, they're working on it, so it's not, it's not open yet, uh, longer than usual. [AGENT][NEUTRAL] Oh, OK. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] So those are the two things that it shows that we are needing information on. [CUSTOMER][NEUTRAL] Um [CUSTOMER][NEUTRAL] OK, and there was one other thing I was gonna ask you. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] OK. Transportation benefit. My daughter came with me that day, so she did not pay for her mileage? [AGENT][NEUTRAL] Uh-huh. [AGENT][NEUTRAL] There was a transportation, there was a transportation benefit paid on [PII] and [PII]. [AGENT][NEUTRAL] Let's see. [CUSTOMER][NEUTRAL] Was that for me or for my [AGENT][NEUTRAL] That was [AGENT][NEUTRAL] It shows that there was again for [AGENT][NEUTRAL] Um, it shows that it was 9450 that was paid twice. [AGENT][NEUTRAL] For the travel. [CUSTOMER][NEUTRAL] OK, but [CUSTOMER][NEGATIVE] I submitted one for my daughter coming to, to be with me and there was no benefit paid for it, so. [AGENT][NEUTRAL] OK. Give me just a moment to look at your [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] It's just taking a moment this first to load some of the information that I'm wanting to look at. [CUSTOMER][NEUTRAL] Oh [CUSTOMER][NEUTRAL] OK, I have one other question. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] OK, so what I'll do, um, once I, I'm finished, I can't see that information regarding what you submitted for your daughter, you said? [CUSTOMER][NEUTRAL] Mhm. [AGENT][POSITIVE] But I can connect you with someone in a different division who can take a look at that for you. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] OK. So did you, you said that you did have another question though? [CUSTOMER][NEUTRAL] I [AGENT][NEUTRAL] OK. So how can I help you? [CUSTOMER][NEUTRAL] With me, with me following, uh, my immunotherapy and my treatments like that. [CUSTOMER][POSITIVE] Does it, is there's so much benefit that goes. [CUSTOMER][NEUTRAL] So. [AGENT][NEUTRAL] I'm sorry your voice went out, Ms. [PII]. I did not hear all of your questions. [CUSTOMER][NEUTRAL] OK, uh, whenever I file from the immunotherapy, the treatment. [CUSTOMER][NEUTRAL] Do I follow them for so long and then the benefits just the money run out for it or how does that go? [AGENT][NEUTRAL] Mhm. [AGENT][NEUTRAL] So, on your radi for any radiation therapy, chemotherapy, or immunotherapy, the maximum per covered person for a 12-month period is 15,000. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And that starts the date from the first treatment for the next 12 months. It's not a calendar year. It's a 12-month period. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK, so. [CUSTOMER][NEUTRAL] Does it show how much they paid so far online or it doesn't show? [AGENT][NEUTRAL] This is one of the line items that it does show we need the primary insurance explanation of benefits. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] For review on that. Yes, ma'am. But again, um, I will be happy to connect you regarding the transportation portion since you said that you had submitted that. Mhm. Now when I transfer you, you will not have to re-verify any of your information. I will let them know that that has been done and provide them your policy number. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][POSITIVE] That'll be fine. Thank [CUSTOMER][POSITIVE] OK, thank you. [AGENT][POSITIVE] Well, you're very welcome. So is there anything else that I could help you with before I do connect you? [CUSTOMER][NEUTRAL] No, ma'am, that's it. [AGENT][POSITIVE] OK, well thank you for calling APL and I hope that you have a wonderful day. [CUSTOMER][POSITIVE] Thank you. [AGENT][NEUTRAL] Yes, ma'am. One moment, please. [CUSTOMER][NEUTRAL] Transferring. [AGENT][NEUTRAL] Oh [AGENT][NEUTRAL] Uh [CUSTOMER][NEUTRAL] Hey thank you for calling APL. This is [PII]. How can I help you? [CUSTOMER][NEUTRAL] Hello? [AGENT][NEUTRAL] Hey [PII]. [PII], it's [PII]. Hey. [CUSTOMER][NEUTRAL] Hey. [AGENT][NEUTRAL] I'm sorry, my phone was on mute. I'm sorry. How are you today? [CUSTOMER][POSITIVE] I'm good. How about you? [AGENT][NEUTRAL] I'm good, thank you. I have an insured on the line um with policy number 02525111, Ms. [PII]. [AGENT][NEUTRAL] And she, she and I just went over the claim that was processed yesterday, claim 356-865-3, and she's gonna be getting the explanation of benefits that we need. However, on the transportation, we did pay her, but she says that she also submitted information for her family member that traveled with her, her daughter. [AGENT][NEGATIVE] But there was no reference to that. [CUSTOMER][NEUTRAL] Let me [CUSTOMER][NEUTRAL] Get it pulled up here let's see. [AGENT][NEUTRAL] OK. [AGENT][POSITIVE] Real sweet lady too. [CUSTOMER][NEUTRAL] You said she submitted like receipts for the daughter? [AGENT][NEUTRAL] She says she submitted for her daughter as well. [CUSTOMER][NEUTRAL] Hm, let's see. [CUSTOMER][NEUTRAL] Still looking here to see if I see any. [CUSTOMER][NEUTRAL] I'm not seeing any receipts. [CUSTOMER][NEUTRAL] I see we got the itemized bill and then like she sent. [CUSTOMER][NEUTRAL] Let's see what it is. [CUSTOMER][NEUTRAL] It's a bill. [CUSTOMER][NEUTRAL] And then she was like she sent the the GPS, the Google Map is the rest of it. [CUSTOMER][NEUTRAL] The directions to the facility. I don't see any receipts in this. [CUSTOMER][NEUTRAL] Let me see, is there any other policy out here to make sure ain't nothing under something else. [AGENT][NEUTRAL] Yeah [CUSTOMER][NEGATIVE] Yeah, I'm not seeing any receipts in this new mail. I don't see anything um. [CUSTOMER][NEGATIVE] Yeah, there's no receipts in this information. [AGENT][NEUTRAL] Because I can see, yeah, we paid for her for the [PII] and [PII]. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Yeah, I don't see anything regarding family receipts or anything in here. [CUSTOMER][NEUTRAL] All I see is itemized billing and then the directions to the facility. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] OK, so, [CUSTOMER][NEUTRAL] So if she has it, she can submit it to us. I don't show that we received it. [AGENT][NEUTRAL] What is [AGENT][NEUTRAL] OK, so, um, [AGENT][NEUTRAL] OK. So hypothetically, let me ask you this. If they stayed in the same hotel room, how do you submit for the family member? [CUSTOMER][NEUTRAL] Well, under this policy, let me glance at the, make sure it has the family lodging. [AGENT][NEUTRAL] I'm just saying, I mean. [AGENT][NEUTRAL] She's just been on hold a while. [CUSTOMER][NEUTRAL] The family lodging benefit, let's see. [AGENT][NEUTRAL] It does. [CUSTOMER][NEUTRAL] So it has to be during the time that they've actually received treatment. [CUSTOMER][NEUTRAL] So, [AGENT][NEUTRAL] Mhm. She says she [CUSTOMER][NEUTRAL] It all depends on that as well during that time frame. [AGENT][NEUTRAL] OK, so what do I need to tell her before I end up just having to release her? [CUSTOMER][NEUTRAL] Yeah, we haven't just let her know that we, I don't, we don't, I wouldn't, we didn't receive any um billing related to the um family lodging, so we'll need that, the, the billing for the lodging. [AGENT][NEUTRAL] So receipts for the lodging? [CUSTOMER][NEUTRAL] Yeah, it actually had to be the, yeah, receipt and or um the, the statement from that particular facility as well so it can provide us with the dates and all that information. [AGENT][NEUTRAL] Yeah. [CUSTOMER][NEUTRAL] For wherever they did the lodging at the hotel, the hotel lodging, if for example if it was there, then we will need the, the billing from the hotel that shows us the dates and that information. [AGENT][NEUTRAL] OK, but we have that for her. We just don't have that for the daughter. [CUSTOMER][NEUTRAL] Um, no, I don't. We have the bill where she received treatment, so they pay the transportation benefit based off the treatment she received from the hospital. [AGENT][NEUTRAL] Yeah. [AGENT][NEUTRAL] OK. So, [CUSTOMER][NEUTRAL] That's how they paid her. [AGENT][NEUTRAL] OK. And then how do they pay the family member? That's where I'm not understanding. I'm sorry, [PII]. [CUSTOMER][NEUTRAL] So if they can submit the receipts along with if it's a hotel, that billing from the hotel, which provides the dates that they were lodging at that hotel, for example. [AGENT][NEUTRAL] All right. [AGENT][NEUTRAL] The receipts from the hotel. [AGENT][NEUTRAL] OK. And what else? [CUSTOMER][NEUTRAL] And that bill from the. [CUSTOMER][NEUTRAL] From that hotel. [CUSTOMER][NEUTRAL] So wherever they receive, where, wherever they have lodging at, we'll need the receipt in. [AGENT][NEUTRAL] That's fine. [AGENT][NEUTRAL] Just receipts from the, where they were lodging. [CUSTOMER][NEUTRAL] Not, not just the receipt, not like if they paid it and there's a receipt. We wouldn't, so if for example the Holiday Inn, you know how they give you the statement when you check out, it shows the dates and all that information, we would need the actual statement from if they, for example, went to Holiday Inn, we will need that that provides the dates and that information. [AGENT][NEUTRAL] OK. So a detailed, you know, receipt from the hotel showing dates and chart. OK. And what else? Anything else? [CUSTOMER][POSITIVE] Yes, mhm, correct. [CUSTOMER][NEUTRAL] Yes. [CUSTOMER][NEUTRAL] And that's it. [AGENT][NEUTRAL] Nothing from the facility. When you say when you said facility, I was thinking like the treatment center or whatever, but just the hos OK. [CUSTOMER][NEUTRAL] No, no, no, no. So we would compare it to the dates that she was receiving treatment. So whatever dates that that's submitted as far as their lodging, it will have to coincide with when she was receiving treatment. Cause if it's outside of her treatment dates, then it wouldn't be, you know. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] OK, alright, well let me see if I can provide her that information if she has any other questions, I'll, I'll just connect her. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] OK, sure. [AGENT][POSITIVE] OK, alright, thank you, [PII]. [CUSTOMER][POSITIVE] You're welcome bye. [AGENT][NEUTRAL] All right, bye bye. [AGENT][NEUTRAL] Ms. [PII], thank you so much for the, um, extended hold. I do apologize about that. This is still [PII]. So, um, I have one of the, I spoke with one of the examiners, and she does not see any information that was received showing the information regarding the transportation. [AGENT][NEUTRAL] For your daughter? [CUSTOMER][NEUTRAL] I, it was attached right right behind mine was hers cause I have it all stapled together. [AGENT][NEUTRAL] Yes, ma'am. She looked through all of the documents but did not see that. [CUSTOMER][NEUTRAL] OK, so she needs me to repack it to her? [AGENT][NEUTRAL] You can or you can upload it into your portal, that would be the quickest way to get it. Um, and they said that it would just need to be the detailed receipt from the hotel or wherever your lodging was that shows. [CUSTOMER][NEUTRAL] No, we didn't say. She didn't, we didn't stay. She just came to be with me that day. [AGENT][NEUTRAL] OK, so yes ma'am, then let me try and transfer you because I'm not sure um under the transportation for so for the mileage is what you're. [AGENT][NEUTRAL] Questioning, I was thinking it was lodging. OK, so one moment and I will try to get you connected. OK. [CUSTOMER][NEUTRAL] Yeah, mhm. [CUSTOMER][NEUTRAL] No, ma'am. [CUSTOMER][NEUTRAL] OK. [CUSTOMER][NEUTRAL] Transferring. [CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you? [AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you? [CUSTOMER][POSITIVE] Yes fine thanks how are you? [AGENT][NEUTRAL] I'm OK, thank you. So I have an insured on the line that we've gone over her claim and everything. I actually spoke to [PII] briefly, but, um, the policy number, [PII] is 252-511-1 for Miss [PII]. [AGENT][NEUTRAL] And it's on claim 356-865-3. [CUSTOMER][NEUTRAL] OK. [AGENT][NEUTRAL] So we've gone, again, we've gone over the remarks and everything. She's gonna get the other information that we're needing. But she says that her daughter traveled with her for her treatment. [AGENT][NEUTRAL] And she says that she included the information for her daughter. We paid the insured, it looks like. We paid her benefit, but we did not pay for the family. [AGENT][NEUTRAL] Transportation. [CUSTOMER][NEUTRAL] OK, uh, let me see here. [AGENT][NEUTRAL] And there was no lodging, it was just a, you know. [AGENT][NEUTRAL] The mileage. [CUSTOMER][NEUTRAL] OK, so I'm looking on the claim form under family member lodging, she didn't indicate anything there. [AGENT][NEUTRAL] She said she put up the information behind hers when she sent it. [CUSTOMER][NEUTRAL] Um, [AGENT][NEUTRAL] I that [AGENT][NEUTRAL] Yeah, cause see there's, it wasn't any lodging. [CUSTOMER][NEUTRAL] Was for transportation and lodging. [CUSTOMER][NEUTRAL] On the form [AGENT][NEUTRAL] Yeah, well, uh, see where it is section C is non-local transportation, and then the next section says family member lodging. [CUSTOMER][NEUTRAL] Um, [CUSTOMER][NEUTRAL] Right, so it looks like she didn't indicate anything on those. [AGENT][NEUTRAL] But we paid her for her travel. [CUSTOMER][NEUTRAL] Um, [CUSTOMER][NEUTRAL] Right, because we would automatically, if we, we will automatically look for transportation, but there's no way for us to know that a family member went with you without you indicating it. [CUSTOMER][NEUTRAL] Um, [CUSTOMER][NEUTRAL] I don't see. [CUSTOMER][NEUTRAL] Where she says where the family member went. I mean, I do see several different like Google Maps. [AGENT][NEUTRAL] OK. So then for her, for the transportation, the mileage benefit, she just needs to fill out section C. [AGENT][NEUTRAL] On page one. [CUSTOMER][NEUTRAL] Correct and then she can indicate on there that it was a family member like somewhere on the line and yeah and fill out that line of that information. [AGENT][MIXED] OK, but nothing under the lodging one. [CUSTOMER][NEUTRAL] Right, if they didn't do lodging then they wouldn't need the lodging. [AGENT][NEUTRAL] Because [AGENT][NEUTRAL] OK, so under section C, it has a begin date of travel, method of travel, the address, and then she can just write somewhere. [CUSTOMER][NEUTRAL] Yeah, let's put a little line and say daughter. [AGENT][NEUTRAL] Somewhere in that state for daughter and does it need to include the daughter's name? [CUSTOMER][NEUTRAL] Yeah. Mhm. [CUSTOMER][NEUTRAL] Uh, no, I mean, cause it's not gonna, but yeah, so just see. [AGENT][NEUTRAL] No, OK, OK. [AGENT][NEUTRAL] And then sign it and then have her and then the insured sign it and date it. [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] And just submit that one form, page 2. [CUSTOMER][NEUTRAL] Uh, yes, yes, because it'll be important to have the date to serve as long as it was, you know, for the covered treatment, we'll be able to review it. [CUSTOMER][NEUTRAL] So if we pay for her for the same date then yes it should be payable. [AGENT][NEUTRAL] OK, so [AGENT][NEUTRAL] OK, so just, just, I just wanna make sure to tell her correct as far as to what she needs to submit. So it's just to complete that section C and make sure she finds it and dates it and then she can upload just that one page. Is that right? [CUSTOMER][NEUTRAL] Yes. [AGENT][NEUTRAL] OK. All right. Well, obviously, to fill in the top section, but, you know, I mean, section A, she needs to fill that in. [AGENT][NEUTRAL] Uh, [AGENT][NEUTRAL] Basically A through C and sign it. Is that right? [CUSTOMER][NEUTRAL] Yes, that's fine. [AGENT][POSITIVE] OK, perfect. OK, [PII], thank you so much. [CUSTOMER][POSITIVE] Sure, you're welcome. [AGENT][NEUTRAL] OK. All right, bye-bye. [CUSTOMER][NEUTRAL] Bye-bye. [AGENT][NEUTRAL] OK, Ms. [PII], thank you again so much for holding for me. OK. So what you need to, they looked again, they do not see that. So, what you would need to do is on the claim form. [AGENT][NEUTRAL] The cancer claim form. [AGENT][NEUTRAL] You know, page one of the claim form is the one that has all the instructions. The second page is the statement of the insured. So you would just complete section A, B, and then C is the non-local transportation. [CUSTOMER][NEUTRAL] Uh-huh. [AGENT][NEUTRAL] And you would just complete those sections and they said you can write in just daughter somewhere in that section. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Mhm. [AGENT][NEUTRAL] And then you would, there wouldn't be anything in the family lodging since you all did not stay out, you know, there wasn't any of that. [AGENT][NEUTRAL] And then make sure to sign it and date it and then you can just upload that one page into your portal. [CUSTOMER][NEUTRAL] Just uh the one page. [AGENT][NEUTRAL] Of that claim form, because that's the section for the non, for the transportation. [CUSTOMER][NEUTRAL] So I don't need to send all of those pages with where the to and from and all that. [AGENT][NEUTRAL] No. [AGENT][NEUTRAL] No, ma'am, because they already have that just because you're on the section C on this page that you're gonna complete. It has the begin date of travel, the method of travel, then the street address, city, state, and zip for your treating location. [CUSTOMER][NEUTRAL] Ah [AGENT][NEUTRAL] And just somewhere in that extra space that you're gonna have in there, you can just write, you know, daughter. [CUSTOMER][NEUTRAL] Uh-huh. [AGENT][NEUTRAL] went with me to treatment, something to that effect. You don't even have to put, you know, her name. [CUSTOMER][NEUTRAL] And I can just [CUSTOMER][POSITIVE] I can upload that really from my phone, right? [AGENT][NEUTRAL] Well, you may or may not. Some people are able to upload, some people are not. Technically, [AGENT][NEGATIVE] At this point, the online service center is not supposed to. [AGENT][NEUTRAL] Be mobile, you know, friendly as far as uploading all uploads we've been told for. [CUSTOMER][NEUTRAL] Exit I can. [AGENT][NEUTRAL] But some people that I've spoken to are able to do it from their phones. So yes, ma'am, if you're able to upload that, by all means, that would be just fine. [CUSTOMER][NEUTRAL] Uh-huh [CUSTOMER][POSITIVE] OK. Sounds good and I'll do that. [AGENT][POSITIVE] OK, and again, thank you so much for holding for so long, Ms. [PII], while I was checking on this stuff for you. [CUSTOMER][POSITIVE] OK, thank you. [AGENT][POSITIVE] Well, you're welcome. And again, is there anything else I can help you with this morning? [CUSTOMER][NEUTRAL] And that's it. [AGENT][POSITIVE] OK, well, thank you again for calling APL and I hope you have a great day. [CUSTOMER][POSITIVE] Thank you. Bye bye. [AGENT][NEUTRAL] Yes, ma'am. Bye-bye. [CUSTOMER][NEUTRAL] Bye bye.