AccountId: 011433970860
ContactId: 4e12db37-2af9-49d0-aa4e-479db812feb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 825039 ms
Total Talk Time (AGENT): 358272 ms
Total Talk Time (CUSTOMER): 319962 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/4e12db37-2af9-49d0-aa4e-479db812feb9_20250417T13:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes and I have a quick question. My husband, we've been trying to file a claim on just initial diagnosis, so I'm not sure if we're doing that correctly.
[CUSTOMER][NEUTRAL] Um, or what, how do we even do this? This is obviously a first time for us.
[AGENT][NEUTRAL] OK, so you're, you're needing help with filing a claim?
[CUSTOMER][NEUTRAL] Right, so I know we do like initial diagnosis, so I sent that in along with that claim form, but it says like this is not covered, so how do I, what do I need to be able to do that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, 1st may I have your name and a good contact number and then I'll pull up the policy and see what type of policy you have and I can go from there.
[CUSTOMER][NEUTRAL] OK, so my name is [PII], but this is my husband, so it's [PII].
[AGENT][NEUTRAL] And you said your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and um, [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Sure 956.
[CUSTOMER][NEUTRAL] 459-572-6
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Is 253.
[CUSTOMER][NEUTRAL] 5080.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, so there's two things. Um, is Mr. [PII] available for me to get permission to speak with you and then I'm also gonna send you all the authorization form so we can get that filled out so that you can call and be able to talk because it looks like, um, yeah, you, yes, ma'am.
[CUSTOMER][NEUTRAL] Got it on his behalf. OK, let me get him can I get him on the phone?
[AGENT][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] Yeah, give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello. Hey, I have the cancer plan online so um she's gonna just need to talk to you to get permission.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hi, Mr. [PII], this is [PII] with APL. How are you?
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] It is fine, you know.
[AGENT][NEUTRAL] I'm doing well. I just need you to verify your
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry, go ahead, yes, I can hear you.
[AGENT][NEUTRAL] OK, um, I just need you to verify your date of birth, your mailing and email address, and um just let me know if I have permission to speak with Mrs. [PII] on your behalf.
[CUSTOMER][NEUTRAL] Yes, it's gonna be [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] And my email is gonna be [PII].
[AGENT][NEUTRAL] Thank you for that. And do I have permission to speak to Mrs. [PII] on your behalf?
[CUSTOMER][POSITIVE] Yes, my wife will be able to talk to you, ma'am. Yes, ma'am.
[AGENT][NEUTRAL] Alright, and I'm also going to send um to your email address as third party authorization form for HIPAA, um, so that you all can fill it out and she'll be able to call and she won't have to uh get the verification or permission anymore. We can just talk to her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much OK?
[AGENT][POSITIVE] You're very welcome. Well, thank you for um for helping us with this, and I hope you have a good day.
[CUSTOMER][POSITIVE] Yeah you too thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] OK, alright, honey, I'll call you later.
[CUSTOMER][POSITIVE] OK thanks bye bye.
[CUSTOMER][NEUTRAL] OK, sorry, it's like let me get him. I just don't know like.
[AGENT][NEUTRAL] All right, so you're trying to file for, oh, I'm sorry.
[CUSTOMER][NEUTRAL] Initial, like I guess initial diagnosis?
[CUSTOMER][NEUTRAL] Do I need to do that or? because I know that's part of the benefit or not?
[AGENT][NEUTRAL] Yes, so initial, so you're just saying there's been a positive diagnosis and you're trying to file the first occurrence for that.
[CUSTOMER][NEUTRAL] Right, so I, well, and that's the only thing I have is that report that I've uploaded.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Which shows consistent with malignancy. I don't know if that's enough or we need.
[CUSTOMER][NEUTRAL] Something else.
[AGENT][NEUTRAL] OK, let me see what this is saying.
[CUSTOMER][NEUTRAL] Because he's being referred to MD [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] The OK, wait a minute.
[AGENT][NEUTRAL] OK, so, uh, let me see what this is. There's a CT that was sent in and then
[AGENT][NEUTRAL] Hold on, I'm just trying to get caught up and then these, OK.
[CUSTOMER][NEUTRAL] Yeah, because initially I thought like I just needed to.
[CUSTOMER][NEUTRAL] So I'm, I probably messed up I'm sure, but my husband doesn't like this is all just a big shock to all of us, but luckily we had a cancer plan, you know.
[AGENT][NEUTRAL] Yes. So this is what you need. The CT scan isn't, so what you're needing is the pathology report.
[AGENT][NEUTRAL] So, um, you'll need the pathology report, you'll need the itemized bill from the um hospital or doctor's office that he went to, and you'll need, um,
[CUSTOMER][POSITIVE] Got it OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Make sure for the billing, um,
[AGENT][NEUTRAL] It has the procedure codes and the dates of service and the charge amounts on it.
[CUSTOMER][NEUTRAL] So, pathology.
[CUSTOMER][NEUTRAL] Report, but does that come from a CT scan or does that have to come from an actual needle biopsy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The CT scan.
[AGENT][NEUTRAL] How can I say that?
[AGENT][NEUTRAL] The pathology report comes after the imaging, that's where they show the diagnosis. So it's, it's a different document.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Then the CT write up.
[CUSTOMER][NEUTRAL] Got it, but it could be from from this CT write up, right? Or from this from this imaging that he did.
[AGENT][NEUTRAL] From that imaging they were able to determine.
[AGENT][NEUTRAL] The diagnosis, but we need that pathology report versus the imaging.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Got it
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it. OK, so pathology report with you said codes.
[AGENT][NEUTRAL] Mhm. So the pathology report, um, and then the itemized bill, um, we should have the procedure codes, the dates of service, and then the charge, you know, all the charges for.
[CUSTOMER][NEUTRAL] Or no that's the itemized bill.
[AGENT][NEUTRAL] What they did that day.
[AGENT][NEUTRAL] And then the first occurrence benefit for this policy is $2500. So once we receive the pathology report which shows the diagnosis, then we'll be able to pay out and that is uh one per lifetime per person.
[AGENT][NEUTRAL] Well, this is an individual policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] So that's the first step, correct? Now we they've sent us to [PII], so that's like a 7 hour drive for us.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] What's my next step there? like we already have an appointment for [PII]. What do I do? What would be my next step?
[AGENT][NEUTRAL] Well, to be honest, outside of the first occurrence benefit, and the only reason I'm saying this is because the first occurrence benefit, that's for y'all like that goes to you, that's for him. But all the other like treatments and everything else, I would just give them the policy number, them being the, you know, like when they ask you for your insurance. Give them this policy number and let them know that you have a cancer policy, that way you don't really have to do all this, they do.
[CUSTOMER][NEUTRAL] Or do I wait till.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Oh my gosh, that is, and I saw.
[AGENT][NEUTRAL] I didn't want to say it like that, but, but it's true.
[CUSTOMER][NEUTRAL] But it's true, absolutely. OK, so then I will, so there's a way right to print our ID cards from here or no?
[AGENT][NEUTRAL] Well, OK, so for the cancer policies, we, so we only offer ID cards for, for medical and dental, um, but that policy number that you gave me, uh, and then if now if they need to, I will give them the policy number and our phone number. So that way they can call us, verify the benefits, know all his coverage, and then we'll help them with like um the ways that they can file the claim.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] I just give them the policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just in case they want to do that.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it. So, so this pathology report, I will initially do that or can the doctor's office do that still?
[AGENT][NEUTRAL] Well, honestly, it's up to you, but for me, I tell my patients to to do the first occurrence on their own because that's coming directly to them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And then everything else, I would just let the provider handle.
[CUSTOMER][POSITIVE] Alrighty, this is good to know.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] I will do that. Well, I really appreciate you, [PII]. You've been a lot of help. I'm just like I've uploaded twice and I'm like I don't know. I'm sure I'm doing something wrong or and I saw that it said pathology report and I thought I don't, this is not a pathology report like.
[CUSTOMER][POSITIVE] So I was right. OK, I will call the doctor's office and get one.
[AGENT][NEUTRAL] Alrighty. Well, was there anything else I can help you with today, [PII]? Oh, and I'm gonna email the authorization form to that to the email on file so that um you can just call and do what you need to do.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][POSITIVE] Perfect and the phone number that I call is the phone number I will give the doctor when we start uh treatment, correct?
[AGENT][NEUTRAL] The [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], is that what you said?
[AGENT][NEUTRAL] Oh, no, so it's [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII] that's what I would give the doctor's office along with the policy number.
[AGENT][NEUTRAL] Uh, if they need to, yes, if they need to call and verify benefits, all that.
[CUSTOMER][NEUTRAL] OK, for verify.
[CUSTOMER][POSITIVE] Good. All right. Well, I appreciate you so much and
[CUSTOMER][NEUTRAL] I guess hold on here's one more ridiculous question. So when I tell them I we have a cancer plan, we give them that policy number they apply whatever to to our bill correct? or are they sending that to us?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Wait, say that one more time. I, I don't, say that one more time.
[CUSTOMER][NEUTRAL] To pay the bill.
[CUSTOMER][NEUTRAL] So like, so like I go to, we go to the doctor, we're gonna go to [PII] on [PII]. They're gonna ask us for our insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They're gonna ask us and then we'll tell them we also have a cancer plan. Here's the policy number here's the phone number when they do that, let's say they bill us right is part of that cancer plan that will kick in and help pay some of that bill? Is that going directly to them to pay the bill? Got it. Not it's not gonna come to us. The only thing coming to us is the 2500.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Well, no, so that's not necessary, so it depends. Um, you should not receive any bills until all the insurances have been billed and we answered, you know, and they have the explanation of benefits and then there, if there's anything left over after all the insurances have been billed and processed, then a bill could come to you. But um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So depending on what's being filed, it could be something left over to them or it could be something that we pay out to you all. It just depends on what's being filed and what the benefit is. Like if it's treatment, it would go to them, but if it's something like lodging or mileage, that's to y'all.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got you and then those we file separately lodging and traveling.
[AGENT][POSITIVE] It's up to you. I, I would do anything that's coming to me, I'll do it by myself because I want to.
[CUSTOMER][NEUTRAL] We do that.
[AGENT][NEUTRAL] I want to make sure I get mine.
[CUSTOMER][NEUTRAL] Yeah right. Make sure yeah and that's what I wanna know because like so we have to wait till after the travel date to be able to submit that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Got it. OK, I appreciate you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that was it. You answered my questions.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL, Mrs. [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.