AccountId: 011433970860
ContactId: 1674d369-a958-4c47-8830-56157e3ade9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 686059 ms
Total Talk Time (AGENT): 235164 ms
Total Talk Time (CUSTOMER): 401114 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/1674d369-a958-4c47-8830-56157e3ade9d_20250402T14:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, this is [PII], and I, um, I'm trying to file a claim.
[CUSTOMER][NEUTRAL] Uh, for my husband and I have some questions about
[CUSTOMER][NEUTRAL] Um, some things.
[AGENT][POSITIVE] OK. I'm happy to help, [PII]. Uh, do you have a policy number?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's 769-816.
[AGENT][NEUTRAL] OK. Let me pull that up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. And then just for security, can I please verify [PII] your date of birth and address?
[CUSTOMER][NEUTRAL] Uh, it's [PII] [PII].
[AGENT][NEUTRAL] OK. And what kind of questions or concerns did you have?
[CUSTOMER][NEUTRAL] OK. My husband um has been treated for cancer and he underwent a CAT cell transplant, spent, uh, I think almost 15 days in the hospital. I have the, um,
[CUSTOMER][NEUTRAL] I have the itemized
[CUSTOMER][NEUTRAL] Bills from the hospital, um, with all that information. He's also had, um, he, while he was there, he had to have um transfusions. He had to have, um, platelets, he had to have blood. And I noticed in looking at my schedule of benefits, it does talk about, um,
[CUSTOMER][NEUTRAL] Blood products or whatever.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] That is all in that's all in those records. I mean this is like massive. I have page after page after page is somebody gonna go through all of that?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And look for all that stuff or do I need to?
[CUSTOMER][NEUTRAL] Point that out or what?
[AGENT][NEUTRAL] No, I mean, they're gonna go through that and, and look for that. I mean, that's, that's their job as far as processing the claim and, and all of that. I know it's um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The, the cancer ones are some of the most overwhelming ones because there is so much information. Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, there it is, it's just page after page after page and just.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] The stuff that I don't even know what this stuff is. And I'm thinking, I hope somebody that's looking at it knows exactly what, exactly what that is. Also, um, our, it talks about medical imaging under here, our PET scans and CTs and things like that also included.
[AGENT][NEUTRAL] Uh, I hear you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Under the coverage
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so they're also in these records, do I have to have the actual report?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] From when he had the PET scans or when he had the CT cause I don't, I don't have all that. I mean, I have, I have one. I have the first PET scan he ever had. I do have the report from that.
[AGENT][NEUTRAL] OK, let me see what it says on here.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Excellent.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] really.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it does show on the scheduled benefits that it looks like it's a maximum of 2 per calendar year.
[AGENT][NEUTRAL] So, I would, for the benefits, you would need um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The date of service for that imaging and the itemized bill for it. Yeah, if you wanted to claim that. Now, if it's like you said, a lot, um, if there was more than 2 in a year, um, I would just go with 2 cause, yeah, that's all the benefit is on it, so.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Do, do I need to highlight them on when I send them? I guess this is, this is my question is there's so much of this stuff and I mean, I don't know, I know somebody's gonna go through all this.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Uh, but you know, I want to make sure that we get.
[CUSTOMER][NEUTRAL] That we get everything that we.
[CUSTOMER][NEUTRAL] Or, um, that we qualify for.
[AGENT][NEUTRAL] Right, right, yeah.
[CUSTOMER][NEUTRAL] And like I said, I, I have the actual report from the first, very first PET scan he had, but he's had, he had, and he's had 3 or 4, and he had um
[CUSTOMER][NEUTRAL] He had a couple when he was in, was he when he was in the hospital in [PII] and uh he had a couple at another place.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But they're in the rack they're in they're documented in these records.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Honestly, somebody will go through it. It's gonna take some time if you're sending it all at once for, you know, the for it to be processed. If you wanna take the time to, to highlight what you, you know needs to be pointed out that you're certain on, I mean, you can do that, but it's not a requirement. It's not something that we ask for.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Right, oh yeah.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Uh let's see, uh, let me make sure. I'm trying to, I'm trying to, trying to look at this to see if there's anything else. Uh, the chemotherapy, we've got all that.
[AGENT][POSITIVE] No, no problem.
[CUSTOMER][NEUTRAL] Um, the, the, the, um.
[CUSTOMER][NEUTRAL] I know that they don't. I know that they don't pay for like the, when his, when his T cells were harvested, but I, but I do have that information so that they can, so that they will know that he, that those were harvested when he was in the hospital, that that's what he was, that that's why he was in there.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, yeah, perfect.
[CUSTOMER][NEUTRAL] What he was in there for.
[AGENT][NEUTRAL] Yeah, yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Cause the hospital stay would still be something that you could get a benefit for.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yes, um, let's see.
[CUSTOMER][NEUTRAL] Here I'm trying to see.
[CUSTOMER][NEUTRAL] Uh, I mean, I have
[CUSTOMER][NEUTRAL] I have like the uh the.
[CUSTOMER][NEUTRAL] Not only the hospital bill, but the bills from the doctors, but I don't know that, that those, I mean, what something says attending physician benefit. I don't know if that's something.
[AGENT][NEUTRAL] Let me see here. Yeah, let me see.
[CUSTOMER][NEUTRAL] Different.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] $40 per day while hospital confined. So that would just be while in the hospital. That would be for like a physician in the hospital.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, so I need to send those in also.
[AGENT][NEUTRAL] If you have, yeah, I mean.
[CUSTOMER][NEUTRAL] Because I, because what they did.
[CUSTOMER][NEUTRAL] Yeah, what they printed out for me is there's two separate things. They printed out the hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Charges and everything and then they printed out the the ones for the physician so I have.
[CUSTOMER][NEUTRAL] I have separate stuff like I said this is just.
[AGENT][POSITIVE] Yeah, yeah, yeah, yeah. So I would definitely, yeah, you can definitely do both then. Mhm.
[CUSTOMER][NEUTRAL] I'll just, I'll probably just send everything I got and somebody can.
[CUSTOMER][POSITIVE] Go through it and hopefully.
[CUSTOMER][NEUTRAL] Figure out
[AGENT][NEUTRAL] Usually that's, yeah, that's what I usually say. It's better to send more than not enough, you know, so just send everything you got.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know, because, um, there's a lot. Yeah, he saw doctors every, every he saw a doctor every day. Sometimes he saw more than well course they would come in as a, as a, a group, you know, it wasn't like, like he saw 3 different doctors at 3 different times. He might see 3 doctors all at once, but anyway, they always had a lead doctor. Uh, OK, let's see, uh, I'm looking at this, um.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I've, I've been kind of putting off doing all this because there's so much and trying to gather everything.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm OK and probably what I'm gonna do is just send.
[CUSTOMER][NEUTRAL] Everything I have and then.
[CUSTOMER][NEUTRAL] Somebody can go through it and I guess, I guess if if at any point there's any questions about anything, they'll y'all will contact, y'all will contact me or if I have some questions at the end.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like, like at the end when um when it's all been processed and everything, is there, is there a breakdown of like so many dollars for this, so many for this, so many for this, so you can kind of see exactly what was paid or is it just, just one just one check and no explanation.
[AGENT][NEUTRAL] No, you'll get an explanation. Yeah, I know you'll get an explanation of benefits, so it should show um you know, approvals and as far as like what the date of service was and then a denial, it would say like if the maximum benefit was paid it would say, you know, for this date of service maximum benefits been paid so then you would, yeah, you would definitely know OK well that day I got everything I could and.
[CUSTOMER][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Um, yeah, you'll definitely get that, mhm.
[CUSTOMER][NEUTRAL] OK, that that's what that's what I was wondering because um.
[CUSTOMER][NEGATIVE] You know, I thought, well, if I just get, if I just get a check and there's no, there's no uh.
[CUSTOMER][NEUTRAL] Explanation it's like well what did this, what did this pay for what did this cover? OK.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Right, right, right. No. And then if you, you know, um, once you know, everything's processed, if you had any questions or concerns, you can always call us and we can have a claims examiner go over it with you if um you had questions or didn't understand something. We're happy to do that. So, yeah, we can absolutely, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that sounds good. I, I think that you've answered my, I think basically what I'm gonna do is I'm just gonna make copies of all of this and send all of this stuff and then um.
[CUSTOMER][NEGATIVE] Let somebody let let somebody spend for the uh, oh goodness [PII]. I hate that.
[AGENT][NEUTRAL] I, I hear you. I hear you, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Well, listen, thank you so much. I appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.