AccountId: 011433970860
ContactId: 452aa9a2-564b-463c-8f9e-54db948d95b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1780859 ms
Total Talk Time (AGENT): 546990 ms
Total Talk Time (CUSTOMER): 309252 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/452aa9a2-564b-463c-8f9e-54db948d95b4_20250512T20:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon and thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi. Um, I just have some questions about, um, our policy. Um, my husband was diagnosed with cancer late last year, and I am just trying to understand how this policy fits into
[CUSTOMER][NEUTRAL] The insurance and all of that stuff that's happening. So I'm wondering if you could explain that to me a little bit.
[AGENT][NEUTRAL] OK, I can try to explain the policy. Um, may I have your name?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] So it's [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. Thank you. And do you have the policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] I have the, um, I have the policy in front of me and I have the application for coverage. We applied for this back in [PII], so it's an old policy. I have the policy number here. You need that?
[AGENT][NEUTRAL] Go ahead, yes, mhm.
[CUSTOMER][NEUTRAL] It's 9 A as in Adam, J as in John 291438.
[CUSTOMER][NEUTRAL] And then there's a reference number after that but I don't.
[AGENT][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] Let me try again.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] May I have um his date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] Sure. The mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And may I have your date of birth for security?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, I'm waiting on the paperwork. Bear with me just a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I don't have any specific questions. I have general questions right now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I'm still waiting on the paperwork, OK? It's gonna be a minute.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, go ahead with your questions and I can go ahead and see if I can get an answer for each one of them.
[CUSTOMER][NEUTRAL] OK. So, my questions are
[CUSTOMER][NEUTRAL] Um, what I need to figure out is, should I be just, uh, filing the information that he was diagnosed with cancer and when it happened, is there any benefit to doing that now? Right as of now, everything has been paid in full by Medicare and our Blue Cross supplement. Um, so it's
[CUSTOMER][NEUTRAL] I guess I'm trying to understand if you pay anything in addition to them paying the entire thing, you know what I'm saying? So are there any additional payments that you would make to us.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] That's what I don't get. So.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, um, I have a few questions. Uh, so, so far, what type of service has been rendered?
[CUSTOMER][NEUTRAL] He has had, um, he has had chemo, he's had radiation, he's had a ton of X-rays, he's had some hospitalizations, um, but again, so far, everything has been paid.
[AGENT][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] And that currently, he's in rehab.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, OK. Um, yeah, this particular policy is besides any other policy you have. This is just for cancer. So even though you, even if you have a major medical or any like Medicare or anything like that, this one is besides any other.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Insurance. So this won't pay an amount even if it was fully paid by the other insurance, um, because this is your cancer policy, OK? Um, you do have benefits for chemo radiation therapy. Um, let me check and see if I can find the amount for that one.
[AGENT][NEUTRAL] It's not really telling me that this is an old policy, so let me see if I can find that information, OK? Um.
[CUSTOMER][POSITIVE] OK, sure. So in other words, we would submit all of that information and we would get paid money that we just get to keep, OK.
[AGENT][NEUTRAL] Directly.
[AGENT][NEUTRAL] Uh, correct. You will submit your own claims for reimbursements. That's, that's what you need to do, just, um, submit claims for reimbursements. We cannot guarantee any payments over the phone until we receive the claim and verify the claim and see if they pay service, but yeah, um, let me see, uh, let's see one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right, right.
[AGENT][NEUTRAL] I don't know if I'm gonna have anything here.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Do you mind holding for me? I'm just gonna go ahead and see if I can get some information about this policy. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, sorry.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] And thanks for calling APM.
[AGENT][NEUTRAL] Hey, [PII], can you hear me?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hello? Oh no, let me call you like this.
[AGENT][NEUTRAL] Hey, can you hear me better now?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I know, and I heard you just like hit it and then it just I didn't hear nothing else and I'm like what's going on? So I guess it's my phone. The teams is working but the other line is just I don't know what's going on with that line, but yeah, I had two calls that I cannot hear them they cannot hear me so I don't know.
[AGENT][NEUTRAL] Um, so anyway, so I'm sorry, I have this policy that is so old. I cannot feel like it has the chemo on the PIPFT but it's 99999. What does it mean? It means that we pay any. I don't know.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh, uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] This is the first time I run to this type of policy, the first time ever in my 8 years. I'm like, what is this?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You know,
[AGENT][NEUTRAL] Just the Ibispiel. OK. Any other benefits that is not listed on that PABFT that I'm not seeing?
[AGENT][NEUTRAL] Or it's just chemo?
[AGENT][NEUTRAL] I, I try to find it, but I don't know if I just see, tell me how I get there because I'm in the Shared Point like, um, under the libraries, I think it is, like, where am I? I don't know where I am.
[AGENT][NEUTRAL] Uh huh, OK, I'm in claims department.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK, let me see, because I, OK, I'm in claims department and it has the library. So do I go in information by product?
[AGENT][NEUTRAL] Or.
[AGENT][NEUTRAL] OK, yep.
[AGENT][NEUTRAL] OK, let me make this bigger.
[AGENT][NEUTRAL] I know when you see me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Skim, oh, OK, yeah, the part that I was.
[AGENT][NEUTRAL] I always miss that scan policy thing you, OK.
[AGENT][NEUTRAL] I look everywhere.
[AGENT][NEUTRAL] OK, so group.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm sorry, I'm just writing this down really quick.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Scan policies always go to scan.
[AGENT][NEUTRAL] OK, here we go. OK, so do do do do, uh, it's gonna.
[AGENT][NEUTRAL] The 1st 10, yes, I see. OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] This is surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Page 5. OK, let me.
[AGENT][NEUTRAL] 45, this one.
[AGENT][NEUTRAL] Oh, OK, so attendance.
[AGENT][NEUTRAL] Oh, OK. Oh, this one is so different. Oh my goodness, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh wow. And they also have the transportation and ambulance and all that. OK, so everything listed here. OK. And I think she has paper because she's like I can see some of the benefits now. OK.
[AGENT][NEUTRAL] All right. OK, so let me just go over this and see exactly. OK, I just needed to know like how much was for the um for that chemo and she said, well, they pay fully by the major medical, well this is a separate be a separate policy. This is a cancer policy.
[AGENT][NEUTRAL] So she's like, oh, OK, so just the itemized bills, no EOBs, correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] In the claim form, OK dokey then thank you so much.
[AGENT][NEUTRAL] OK. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye.
[CUSTOMER][NEUTRAL] I know I have it, you know, what do we do.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I'm so sorry it took so long, but we had to get the paperwork and we had to find it. Um, but it looks like um under the chemotherapy and that's why I was a little confused because it's totally different from the new ones right now. This one is unlimited, so meaning that we'll pay uh whatever is in the charges from the doctor, the bill charges. So what we're gonna need is an itemized bill for the chemo or radiation therapy.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so even though all that stuff has been paid by insurance, you will pay uh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You'll pay us again. OK. All right, so now tell me what, so that's for the chemo, the radiation, are those anything else that you would pay?
[AGENT][NEUTRAL] Mhm, yes, yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, we pay for hospital stay, I don't know if he has been hospitalized for surgery.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Not for surgery.
[AGENT][NEUTRAL] No surgery. Um, so he has not had any surgery?
[CUSTOMER][NEUTRAL] Well, they did do, um, you know, like, um, biopsies and stuff like that. So he was.
[CUSTOMER][NEUTRAL] Uh, but he had, he had an aneurysm, but that's not cancer related, so.
[AGENT][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Oh it's not cancer. OK. OK. No, yeah, it has to be positive for cancer. OK. So basically you have benefits for hospitalization if it's um cancer surgery, any kind of cancer surgery. Um, you also have for attending physician while he's hospitalized every time the doctor just went in to see him, those charges are covered as well.
[CUSTOMER][NEUTRAL] That doesn't count.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, on that one there, like there is some benefits, there are separate benefits. I will say, um, just whatever you have, just send it and let us look at it, uh, and see if it's a pay benefit, and we can go ahead and go over the benefits and see what we can pay, but, but there's many, many benefits, including skin cancer, anesthesia, um, you have uh X-ray.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right. So we had um
[CUSTOMER][NEUTRAL] He had some complications during his chemotherapy, uh, which he was hospitalized for. So, um, tell me exactly what documentation I need to send you, and it's gonna be a ton of documentation. I was thinking I could do it online, but I'm now thinking that it might be better if I mailed it would
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's your best suggestion for that?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] If, if you're sending a big package, a big package is like 20 pages or more, uh, it's best to send it by mail. Um, so, um, all you need to do is send copies, just make sure you keep the originals just in case. We never know what happens with the mail. So, um, just send us copies and let us look into it. What you're gonna need is itemized bill for everything you're just gonna need itemized bills. Um, so the itemized.
[CUSTOMER][POSITIVE] Oh yeah, definitely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so like, uh, a Medicare.
[CUSTOMER][NEUTRAL] Uh, Medicare, EOB would not be sufficient. Is that correct? Do you need the bill from the actual doctor or the hospital? OK. OK.
[AGENT][POSITIVE] Um correct.
[AGENT][NEUTRAL] Correct. Correct. Correct. Yes. Mhm. Yeah, we don't pay based on the primary or any other insurance, we just pay based on the benefits of the policy, and we're just gonna need itemized bills with diagnosis codes, procedure codes, large amounts, just a fully itemized bill and um.
[CUSTOMER][NEUTRAL] All right. All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and then we have a claim form. On the claim form you can find it on our website at [PII]. Um, it's gonna be the cancer claim form that you can add to that paperwork we're gonna need for authorization, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK, so basically your best advice is to gather just everything that's happened to him and send it to you and then you guys decide what's payable and what's not.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. Yes. That, that will be the best thing, yes. Whenever it is a policy that has a lot of benefits, it's best to send everything. Mhm.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and is the address that this needs to be sent to online or is it?
[AGENT][NEUTRAL] Yes, it's online, and it's also on the claim form, the claim form in the bottom on the first page, you're gonna see instructions and you're gonna see um the address and the fax number and the website, all the information is in the claim form.
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][POSITIVE] OK, great. All right, well thank you very much for all your help.
[AGENT][NEUTRAL] You're welcome, Miss [PII]. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Oh, I'm sure there is, but I can't think of it, so we'll, uh, we'll deal with that when it comes to it.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Well, whenever you think about it, yeah, you can always call us back. Sure, no problem, Ms. [PII]. OK, hi, good afternoon. You're welcome, and I'm sorry for that delay. I know it took a long time to get all that information, but yes, you have a good day. Good afternoon. Thank you. You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. All right, thanks for your help.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's fine. Thank you.
[CUSTOMER][NEUTRAL] Bye bye.