AccountId: 011433970860
ContactId: 5114a57a-ab08-4220-a896-b33cb990ca36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1067959 ms
Total Talk Time (AGENT): 486678 ms
Total Talk Time (CUSTOMER): 351676 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/5114a57a-ab08-4220-a896-b33cb990ca36_20250324T17:46_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII], and I was calling about uh seeing what to do about filing claims on my mother's cancer policy.
[AGENT][NEUTRAL] OK, um, well, I can definitely help you with filing a claim. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, this number [PII] is fine.
[AGENT][NEUTRAL] Thank you for that. And may I have um your mother's policy number?
[CUSTOMER][NEUTRAL] 1593301
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was 1593301?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, that's pulling up another member. um, I can search it with her social if you like.
[CUSTOMER][NEUTRAL] It it's not pulling up [PII].
[AGENT][NEUTRAL] No, but I can search it with her name also. It's a different member and a different, it's not a cancer policy.
[AGENT][NEUTRAL] Hold on, let me try with her name.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] [PII]? I'm sorry.
[CUSTOMER][NEUTRAL] Well, I just had a
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh [PII], OK.
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEGATIVE] Well, sorry, you asked me for something else.
[AGENT][NEUTRAL] I didn't hear you.
[CUSTOMER][NEUTRAL] I, I, I thought you had asked me for something else and I'm, I'm, I don't know, I'm.
[AGENT][NEUTRAL] Oh, I was asking
[CUSTOMER][NEUTRAL] Oh, I'm not thinking.
[AGENT][NEUTRAL] It's OK. I was asking, um, I was saying I can look her the policy with her social or her name, but I'm going to try with her first and last name first.
[CUSTOMER][NEUTRAL] OK, yeah, [PII].
[AGENT][NEUTRAL] And you said her first
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to populate. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I believe I just found that it's coming up now.
[AGENT][NEUTRAL] OK, um, uh.
[AGENT][NEUTRAL] So here's the thing, she doesn't have anyone.
[AGENT][NEUTRAL] Authorized on her policy. What can you verify her date of birth and they'll tell me if it's the right person.
[CUSTOMER][NEUTRAL] [PII] is her date of birth.
[AGENT][NEUTRAL] See
[CUSTOMER][NEUTRAL] She um
[AGENT][NEUTRAL] OK, no.
[CUSTOMER][NEGATIVE] Now she has passed away.
[AGENT][POSITIVE] OK. Well, I'm definitely sorry to hear that. Um,
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] That changes things. So hold on one second, let me try. So there were two policies that we had with her name. The one that I just pulled up, had a different date of birth. So I'm gonna try the other one and see if that's if that matches her date of birth.
[CUSTOMER][NEUTRAL] Uh-huh. [PII].
[AGENT][NEUTRAL] OK, this is her. Wait.
[AGENT][NEUTRAL] OK. Um, so the, I just noticed that the, the, um,
[AGENT][NEUTRAL] Second person on this policy is the same as the other, but it had a different date of birth for your mom. I'll go back and look at that. But for this um policy, I did find her date of birth. Um, when did she pass?
[CUSTOMER][NEUTRAL] Uh, she passed [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] And hold on
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Let me see the.
[AGENT][NEUTRAL] A copy of paper. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, and you're needing to file claims for your mom for while the policy was active, right?
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK, so I can just give you general information. I don't have to give you like specific to the policy. So you just need to know how to file a claim?
[CUSTOMER][NEUTRAL] Uh, yes, yes, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you can
[CUSTOMER][NEUTRAL] What do I need to do.
[AGENT][NEUTRAL] OK, so you can you can either mail it in or fax it to us on our website. There is, um, and our website is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As soon as the page populates there to the top right, you'll see um claim, claim forms.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, you'll click on that and then you're looking for the cancer claim form. Are you trying to file for like, um, treatment or this like wellness or both?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, so you're gonna um use the cancer claim form.
[CUSTOMER][NEUTRAL] Well, I went.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Sorry, go ahead.
[CUSTOMER][NEUTRAL] By wellness by wellness did you mean like and things?
[AGENT][NEGATIVE] Wait, the phone's breaking up really bad. I couldn't hear that.
[CUSTOMER][NEUTRAL] I'm sorry. I just said by uh by wellness, did you mean like her mammograms and
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Things like that, EGDs or something.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, so you're gonna, if you're filing for that, you're going to need both the um cancer claim form and the wellness claim form. So those will all be under wellness and it has the different um types of tests that you can, you know, check off there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For whatever you're trying to file for. And then um you'll fill that out, you'll need the, if it's for treatment or anything, you'll use the cancer claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you'll need the itemized billing, and on the first page of each of the claim forms is a list of instructions. So depending on what you're sending in, it'll show you what you need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we'll need itemized billing.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] From that company?
[AGENT][NEUTRAL] Yes, from whoever the provider was, if it was a hospital or a doctor's office, wherever she went for the service.
[CUSTOMER][NEUTRAL] OK, can you, can, um, can we use like the Medicare forms?
[CUSTOMER][NEUTRAL] That she would that was sent to her or?
[AGENT][NEUTRAL] The Medicare in terms of like the for the billing?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So the billing has to come from the provider.
[AGENT][NEUTRAL] Um, Medicare would be more of like the explanation of benefits, but, um, just because they're the insurance company too.
[CUSTOMER][NEUTRAL] From provider, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Need itemized billing from the provider, OK?
[AGENT][NEUTRAL] Mhm. And then if you, if there is um another insurance, um, let me go to the
[AGENT][NEUTRAL] You'll need like the explanation of benefits.
[AGENT][NEUTRAL] If you're using like for the mammogram and.
[CUSTOMER][NEUTRAL] Like her Medicare and her Blue Cross Blue Shield, is that what you're talking about?
[AGENT][NEUTRAL] Right, it would be, um, you can submit both of them. We're not really in conjunction with Medicare, um, but
[AGENT][NEUTRAL] It sounds like Blue Cross. Well, if she has both Blue Cross, Blue Cross is probably second to Medicare. So I will submit them both.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then depending on um what you're filing the claim for, um, just look on that first page and then it'll tell you any other documents that's needed, but for the most part, it's always the um bill and the
[AGENT][NEUTRAL] Um, any documents, explanation of benefits or documents you're trying to send in.
[CUSTOMER][NEUTRAL] OK, well let me pull that up real quick you said.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] A like apple.
[CUSTOMER][POSITIVE] Good forms.
[AGENT][NEGATIVE] Uh oh, it's breaking up again.
[CUSTOMER][NEUTRAL] Am I able to.
[CUSTOMER][NEUTRAL] Sorry, I moved again. I came back to my computer. Can you hear me?
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Yes, I can hear you.
[CUSTOMER][NEUTRAL] Uh, I go to claims and forms.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then click on.
[AGENT][NEUTRAL] Well, you're gonna scroll all the way down on that. Once you click claims and forms, um, scroll all the way down until you see claim forms and policy change documents.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And so the cancer claim form is probably there on that first page because it's an alphabetical order.
[AGENT][NEUTRAL] And then the wellness claim might be that 2nd page or the 3rd. You see, you see down, you might have to scroll a little bit, but you'll see a 123.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes, yes, and so, and then once I click on the cancer claim form, it brings up instructions for insured or patient, so I just follow those instructions.
[AGENT][NEUTRAL] Mhm. And then, yes.
[CUSTOMER][NEUTRAL] And fill out the cancer claim form. Am I able to fill these out online?
[AGENT][NEUTRAL] Um, you can't fill them out online, but once you download it, you can like save it to your computer and fill it out and then upload, well, you can't upload it because it's um it's no longer active. It would just be fax or mail.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So just fill that out and fax or mail. OK.
[AGENT][NEUTRAL] And then our, and our fax, our um mailing address is at the bottom of the claim form and the fax number.
[AGENT][POSITIVE] But I can give it to you. You got it.
[CUSTOMER][NEUTRAL] OK, very good. And, and do you know what her dates are?
[AGENT][NEUTRAL] In terms of the services?
[CUSTOMER][NEUTRAL] Uh-huh, like when, like when the service started, I, I had um.
[CUSTOMER][NEUTRAL] What do I have?
[CUSTOMER][NEUTRAL] I have too many papers on this.
[AGENT][POSITIVE] Oh, take your time.
[CUSTOMER][NEUTRAL] Um, I've already forgotten, um, good grief.
[AGENT][NEUTRAL] You were asking me if the um
[CUSTOMER][NEUTRAL] I mean, I think she's had this policy since [PII] or a long time.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] So you're wanting to know how long the policy has been active?
[CUSTOMER][NEUTRAL] Oh yeah like the dates I can submit claims for.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Well, now, this policy says effective [PII], there's that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I mean, she wasn't diagnosed with cancer until [PII], or at least, um, so.
[AGENT][NEUTRAL] So I can't give account specific. Wait, let me ask you, well, go ahead.
[CUSTOMER][NEUTRAL] But, but
[CUSTOMER][NEUTRAL] Oh, well, I was just thinking, so like her mammograms before [PII], do I submit those as wellness?
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Before she was diagnosed with cancer.
[AGENT][NEUTRAL] You said can you submit it with wellness?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] 00, OK.
[AGENT][NEUTRAL] If you let me make sure I understand. You just want to know if the policy was active, can you file a claim for wellness?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Is that what you're asking me?
[CUSTOMER][NEUTRAL] Uh, well, I mean, I, I was just wondering um you know, from like, like I have an effective date of uh [PII], so I can file all mammograms after that. I mean, I, I don't know where they all are, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The ones I find, I can file all of those.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm, you can, and also, um,
[AGENT][NEUTRAL] If you haven't already, I will send a copy of the death certificate to our care team so that we, with your name and all of your information like your relation, you know, you're her daughter and uh contact information so that we can put you on the policy and be able to help you file, you know, speak more specifically.
[CUSTOMER][NEUTRAL] OK, OK, yeah, because I mean we um she didn't have anything that went through 8.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] The phone went in and out. I, I didn't hear your question. I'm sorry.
[CUSTOMER][NEUTRAL] I'm sorry, but uh she didn't have anything, have anything that went through probate, um.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] So, I mean, I mean, there was no estate, like to make the checks out to an estate.
[AGENT][NEUTRAL] Right, so once we get the, so that's what
[AGENT][NEUTRAL] So once we get the death certificate and we place that on file, um, actually I can get a customer service rep on the line to let you know how the next steps work once we get that will be and how the payments would go out, but most likely it would, it would go to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, now.
[AGENT][NEUTRAL] Because you're her next of kin.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now where do I send the death certificate? Do I just send it with the claim forms or?
[AGENT][NEUTRAL] So the claim forms
[CUSTOMER][NEUTRAL] To a specific
[AGENT][NEUTRAL] The claim forms you can only mail or fax, but let me give you our care team email so that you can send the um er the certificate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][POSITIVE] Oh, I'm ready.
[AGENT][NEUTRAL] OK. Um, sorry, email is [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII],
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, very good, yes, I can do that.
[AGENT][POSITIVE] Alrighty, and then I'll go ahead and note the policy for you. And was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, you, you said, so do you think that other, you said you found one with the date of birth that was not the same? Do you think that's mom's policy? And what was that policy for?
[AGENT][NEUTRAL] Um, it's still a it was a cancer policy as well. Let me go back to that. Hold on one second.
[CUSTOMER][NEUTRAL] Do you think that one
[CUSTOMER][NEUTRAL] Well, now I know when um I.
[CUSTOMER][NEUTRAL] I know at one point she had a cancer policy on my dad too, but I'm not sure if it was through you all or through a different company. I don't remember it.
[CUSTOMER][NEUTRAL] So that, that could have been
[AGENT][NEUTRAL] Yeah, this is hers. The date of the date of birth is incorrect. We can correct that once we put you on the file, but this is a policy that she had prior to the active or prior to the one that became effective in what was it, [PII]?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Oh, OK, so she had a cancer policy with you prior to [PII] and then the one that started in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, now that makes sense.
[CUSTOMER][NEUTRAL] Uh, this is all a lot and so confusing, so I apologize for this.
[AGENT][POSITIVE] Well, there is no need to apologize. If you have any questions or need any help, that's what we're here for. Um, I'm the only [PII] here, but anyone will be more than happy to assist you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, alright, so I will send the death certificate and then print, print the claim forms and see about getting billing and.
[CUSTOMER][NEUTRAL] And, and do that, so.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And anything else I need to know?
[AGENT][NEUTRAL] Oh
[AGENT][NEGATIVE] Um, no. After we received, well, no, there's nothing else.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, well thank you so much [PII] you have been very helpful.
[AGENT][POSITIVE] You're very welcome, [PII]. Well, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.