AccountId: 011433970860
ContactId: 2a162e9b-5422-4b9f-bf4a-aacfe6402fab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 733330 ms
Total Talk Time (AGENT): 290605 ms
Total Talk Time (CUSTOMER): 241044 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/2a162e9b-5422-4b9f-bf4a-aacfe6402fab_20250312T14:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I'm giving you my account number. My name is [PII]. It's 6.
[CUSTOMER][NEUTRAL] I'm sorry, it's 256.
[CUSTOMER][NEUTRAL] 6030
[AGENT][NEUTRAL] OK, let me pull this up here. Give me just one second.
[AGENT][NEUTRAL] All right, and if I can get your first last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, [PII], thank you for that. And then the address we should have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] How can I help today, [PII]?
[CUSTOMER][NEUTRAL] Oh, what's y'all need more paperwork for me to send over?
[AGENT][NEUTRAL] You're wanting to check to see if we need any additional information on the claim?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] 84.
[AGENT][NEUTRAL] OK, so it looks like [PII] on the most recent claim.
[AGENT][NEUTRAL] Um, it looks like there was one submitted [PII]. That's the last that I see under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So it looks like there were a few items that were
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, what was not covered?
[AGENT][NEGATIVE] So it looks like office visits are not covered. It says the policy does not provide benefits for office visits.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I took care of that myself, and what's the next one, ma'am?
[AGENT][NEUTRAL] Uh, laboratory tests are not covered under this policy.
[CUSTOMER][POSITIVE] That's good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then one of them says, based on the effective date of coverage, it's necessary to obtain past medical history to determine if this is a pre-existing condition.
[AGENT][NEUTRAL] Please complete the enclosed form and return. So this claim was processed on the [PII], and so that paperwork would have just been sent out to you to fill out and get back to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On one, OK, you're talking about the one for the doctor thing?
[AGENT][NEUTRAL] Yeah, it looks like they're needing more information just to make sure that it's not preexisting.
[CUSTOMER][NEUTRAL] OK, I got the one, so I'm gonna fax it back, but the two doctors I see.
[CUSTOMER][NEUTRAL] Is my uh cancer doctor, Doctor [PII]. I got his number and everything down his name and Doctor [PII] is my primary doctor that's for like my medication and stuff like that. That's it.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] In the pain I've been having my arthritis in my knees and stuff. That's doctor. Yeah, that's my primary doctor and then rest on the specialist, my cancer doctors, and that's it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. OK. So, yeah, I mean, it looks like we did send something out to be completed. Um, but that was the only thing. I mean, everything else was pretty like laboratory tests weren't covered. The office visit wasn't covered pretty cut and dry.
[CUSTOMER][NEUTRAL] OK, now, uh, on the other one, y'all got back here [PII]. That was when I did my, uh, it showed my biopsy. It showed, uh, like you said, you know, when I went to have it, it was $2000. I paid $500 down.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I've been making a payment range and then also was in there was uh
[CUSTOMER][NEUTRAL] Showing him with a head cast.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That was since y'all do y'all, do y'all used to have that for the [PII].
[AGENT][NEUTRAL] Let me pull this one up here. Yeah, I see another claim here.
[AGENT][NEUTRAL] OK, so let's see what this one.
[CUSTOMER][NEUTRAL] So do y'all cover like the medical bills that I do?
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Like when I had my biopsy and I did the uh.
[CUSTOMER][NEUTRAL] The bone scan and stuff like that.
[AGENT][NEUTRAL] Yeah, so this one from the [PII].
[AGENT][NEUTRAL] Did say that it needed an itemized surgery bill with procedure and diagnosis codes.
[CUSTOMER][NEUTRAL] OK, I sent that to y'all. That was included with that one on the uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The [PII], yeah, so y'all got that itemized bill for the [PII].
[AGENT][NEUTRAL] So there were a couple that
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Charges submitted are not payable because services were rendered prior to the policy's effective date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] So which one of those?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEGATIVE] Doesn't show me the charge. I could pull the claim, but there were two line items that were not covered. The date of service was [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEGATIVE] So that wasn't covered because there was no active coverage at the time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Yeah, so it looks like the only other thing that was needed was just this form to be submitted.
[AGENT][NEUTRAL] Um, determining whether or not it's a preexisting condition, so it looks like we sent out the form and closed and just what needed it returned to our office just so we can determine.
[AGENT][NEUTRAL] Whether or not it was preexisting or not.
[CUSTOMER][NEUTRAL] So this is the one with the doctor's name and address and phone numbers and stuff.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's the one I'm faxing back out to you today.
[AGENT][NEUTRAL] OK, so once we get that then just give it a little time to get processed on our side.
[CUSTOMER][NEUTRAL] So be about the first of about somewhere in April before I help me out on this one. I send it to y'all.
[AGENT][NEUTRAL] OK, yeah, so if you get that one sent to us, that's that should be all we need.
[CUSTOMER][NEUTRAL] OK, now the one I'm gonna try to get this man name that's what I do my radio stream name, uh.
[CUSTOMER][NEUTRAL] I know you got recording his name was Doctor [PII] have the address and phone number, everything on there. I got my primary doctor.
[CUSTOMER][NEUTRAL] Doctor [PII] on his address and phone number to our medical clinic and then I got Doctor He is the one that uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] He's doing all the rest of stuff he does, he, he's the one that he did my biopsy. He's going to found the cancer. He's the one I got to go see on the [PII] again. So I should put that down again, the [PII], when I go see him.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, I mean, I would definitely put as much information as you can, you know, um, it's better to have more than not enough, that's for sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So just remember I says my physical doctor and the ones who's doing my treat me for my cancer. Those are the only one cause Doctor [PII] is my primary doctor.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The rest of them are just my specialists.
[CUSTOMER][NEUTRAL] OK, let me get this down on here then, put his name back on here then and uh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Y'all can know, you'll see it'd be on hand away, but I just put the date down on him when I get to go see him again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which would be the [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would that, would that be fine?
[AGENT][NEUTRAL] Yeah, that should be fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you, ma'am. So whenever all this get done, what happens after that?
[AGENT][NEUTRAL] So once we get all the paperwork and everything, then we would determine, you know, if what the benefit amount would be and then that would be remitted to you. Um, it looks and it would be sent in a paper check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will read a paper check, just, uh, uh, the whole, everything that I
[CUSTOMER][NEUTRAL] Just for the billing you have to pay the bills with the cancer insurance policy, I mean, pay the cancer insurance doctors with.
[AGENT][NEUTRAL] Right, exactly. So we will send out a paper check and then you can use that to reimburse your physicians. Um, if you want to do direct deposit, that's something that is set up online if you wanted all of the claim money to be direct deposited.
[CUSTOMER][POSITIVE] Yes, I would have it done. Could you, uh, send me something I can do that, just put it in and send it back to y'all.
[AGENT][NEUTRAL] Yeah, I think it's, let's see here.
[CUSTOMER][NEUTRAL] Cause you can't take it over the phone. I know that much.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, once if, if it's like a check they sent, you don't know the amount.
[AGENT][NEUTRAL] Uh-huh, yeah, well you should be able to give you the amount and everything and um.
[AGENT][NEUTRAL] So, yeah, I can email you the form for the direct deposit. Is that all right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes, man, that's fine.
[AGENT][NEUTRAL] OK. So.
[CUSTOMER][NEUTRAL] I told my yeah.
[AGENT][NEUTRAL] I'll use the
[CUSTOMER][NEUTRAL] So what all is done by April, I hear something from you by April.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Yeah, for sure, for sure. Once we get all the information, it should just take a few days to uh to process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that's all like I said I got this filled out already with their names on there.
[CUSTOMER][NEUTRAL] Well, like I said, when I got to go today and see Doctor [PII] to do my full body scan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh so you have Doctor [PII].
[CUSTOMER][NEUTRAL] Doctor [PII] and Doctor [PII].
[CUSTOMER][NEUTRAL] Those are the cancer specialists. That was it. Everybody else like Doctor, uh Doctor [PII], if he wasn't there, if I need a pain shot or something like that there, he, the nurse gave it to me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That was about it, but everything was so when you see the doctor today has nothing to do with my cancer, he used the one that was checking my pH level.
[CUSTOMER][NEUTRAL] Keep an eye on it.
[CUSTOMER][NEUTRAL] And that's when he sent me over to him in January to get this stuff done.
[CUSTOMER][NEUTRAL] Cause y'all got that file that was sent to y'all on the [PII].
[AGENT][POSITIVE] OK. All right, sounds good, [PII]. Well, that direct deposit form is on its way to you. Is there anything else that I can help with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, no, so I just, I just wait and call y'all back next month then I guess.
[AGENT][POSITIVE] OK, sounds good thank you for calling [PII]. I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] You too, ma'am.
[AGENT][NEUTRAL] Uh bye-bye.