AccountId: 011433970860
ContactId: 551ab0e4-4f40-43cd-933e-8c0a9124d51f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1038938 ms
Total Talk Time (AGENT): 724202 ms
Total Talk Time (CUSTOMER): 297550 ms
Interruptions: 13
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/551ab0e4-4f40-43cd-933e-8c0a9124d51f_20250506T15:20_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], uh, my name is [PII], and I am just trying to figure out how to get this whole business started, and I do have the online thing, uh, I just, I just never done any insurance claims and I'm at my wits end.
[AGENT][NEUTRAL] OK, so your name Ms. [PII], you're wanting to find out how to go about filing a claim. Is that correct?
[CUSTOMER][NEUTRAL] Of what
[CUSTOMER][NEUTRAL] That and how I get all this information that you need and.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, yes, ma'am. Well, I can try and help you with this. So first off, what is a good callback number for you, please?
[CUSTOMER][POSITIVE] A good what?
[AGENT][NEUTRAL] Call that number.
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] I have no idea.
[AGENT][NEUTRAL] OK, and the policy is in your name, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what is your full social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to locate your information and then once I do, I will have to verify several things with you first for security and also any information that I provide for you today would be a verification of benefits and not a guarantee of payment. So first off, um, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you and lastly your email address and the email that we have on file for you does appear to be your work email.
[CUSTOMER][NEUTRAL] OK, um, do you want me to get, can I give you both of them or do you want just the work one?
[AGENT][NEUTRAL] OK, so I need for you to verify the work one first.
[CUSTOMER][NEUTRAL] OK, OK, [PII].
[AGENT][NEUTRAL] OK, thank you. Now I can update if you would want it changed to your personal email for for you to be able to set up your portal, um, your profile on the online service center. Now I do wanna make you aware that because of how we receive enrollments for your group, if we receive a file that has your work email on it, it will override my change that I make.
[AGENT][NEUTRAL] But I can change it so that you can set up your profile if you would like for me to do that. I just don't want you to call back at some point and say, oh, we changed that.
[AGENT][NEUTRAL] Because we are, we can, but there is a possibility it will go back to your work.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, that's fine. Keep the work, yeah, if, if you're gonna need paperwork from my, so anything that my school sends you, that will change it back to their email that email, is that what you're saying?
[AGENT][NEUTRAL] Well, it's not that they're gonna be emailing us anything. It's the enrollment information that we received for your employer for your district comes, comes to us on an electronic file and on that file, if it has your work email, the system will automatically change from your personal to that whatever's on that file that we receive. So I just don't want you to think that I didn't change it.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Yeah, we can just be there.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] So it's whatever you want to do.
[CUSTOMER][NEUTRAL] Yeah, no, no, we'll leave.
[CUSTOMER][NEUTRAL] We'll just leave it.
[AGENT][NEUTRAL] OK. All right. So, that's all of the information I need to verify with you at the moment. So this is your cancer policy that you have with APL. So have you created your profile yet, Miss, Miss [PII], or were you in the process of trying to set that up?
[CUSTOMER][NEGATIVE] No, I don't think so. I don't think I've done anything. I, I am so overwhelmed, it's not funny.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, so first off I will email you a user guide that not only explains how to set up that portal but it also gives you additional information on the different things that you can do in the portal, locating your policy information, how to upload claims in there, it explains all of that so I will send that to you once we get off of our call.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that email that I will send to you so that you'll know what to look for it's gonna come from care team.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I will put [PII]. Mhm.
[CUSTOMER][POSITIVE] Oh, just like [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, Aub, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] [PII]. OK, oh.
[AGENT][NEUTRAL] Mhm. And then the subject line, I will put APL so that that's, you know, easily recognizable for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you're, OK, so I can also include a claim form.
[AGENT][NEUTRAL] If you would like.
[AGENT][NEUTRAL] In that email
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sorry, I have a dog scared of the thunderstorms jumping on it.
[AGENT][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] Oh my bad. OK.
[AGENT][NEUTRAL] So would you like for me to include a claim form as well?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Sure. I mean, anything that will be helpful.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because on the claim form.
[AGENT][POSITIVE] Miss Guy, it does give you the first page gives you instructions.
[AGENT][NEUTRAL] On all of the.
[CUSTOMER][NEUTRAL] OK, I think that, is that what I'm
[CUSTOMER][NEUTRAL] I might be looking at that on the on your site. I don't know that.
[AGENT][NEUTRAL] It would say cancer claim form.
[AGENT][NEUTRAL] It says cancer claim form at the top.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK. So have, OK, so you have you been diagnosed with cancer, Miss Guy?
[CUSTOMER][NEUTRAL] I don't have it.
[CUSTOMER][NEUTRAL] Yes, I've been in the hospital, in and out of the hospital since [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, the form that you're gonna need specifically states cancer claim form at the top of it and the first page has all of the instructions for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Deleting the form and the additional documentation that you will need to provide, OK? Um, so I recommend using that as your checklist.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so all the things that I need to provide because I'm looking at this one.
[CUSTOMER][NEUTRAL] Like pathology report first diagnosis, uh, do, do doctors give you all that? Like I haven't gotten a bill in because they bill my insurance company, so I have to go to my doctors and they will give me, they'll be able to give me all of these these itemized bills. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Correct. So it's
[AGENT][NEUTRAL] Yes. So you will need to contact your doctor. You, if you've been in the hospital, you will also need to get that information from the facility.
[AGENT][NEUTRAL] Um, from each medical provider that you've had.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Dealings with related to this.
[AGENT][NEUTRAL] OK, so hospitalizations, surgery, all of that will have to have those itemized bills.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So like
[CUSTOMER][NEGATIVE] So that's where I, that's where I get into trouble because I don't know who the doctors were that did the biopsies.
[AGENT][NEUTRAL] If that was done just at the hos OK, so did you see a doctor who then ordered those things for you?
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Yeah, I have an oncologist and I was under his care.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, I'm listening.
[AGENT][NEUTRAL] So you would contact.
[AGENT][NEUTRAL] That doctor, they should have. The, the doctor who ordered it should have in your records there, your pathology reports that confirms the positive diagnosis of cancer.
[CUSTOMER][NEUTRAL] OK, so they just need, you just need to report, OK, OK, alright.
[AGENT][NEUTRAL] Yes. And then when you were hospitalized, the hospital itemized bill and everything should have
[AGENT][NEUTRAL] Uh, anything related to your hospitalization, including the surgery and all of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, and so then, OK, perfect.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so then once you have once you have all of your information together again this user guide that I'm gonna send you will explain, do you have access to a computer?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and I'm asking you that because currently the portal does not support mobile uploads.
[AGENT][NEUTRAL] We're working on some upgrades, but at this time you do have to upload from a computer. So you would just scan everything in, save it on your computer. The user guide will tell you the maximum size of a file and the different types of files that it will accept.
[CUSTOMER][NEUTRAL] Oh no, no, I have, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Should in the event that you have to upload, you know, multiple uploads for your claim, don't worry about that because the system will know to tie everything together.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If for any reason.
[CUSTOMER][NEUTRAL] So just upload everything.
[AGENT][NEUTRAL] Right, and if for any reason, once we have reviewed the information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If there is some additional information that we're in need of that was not included.
[AGENT][NEUTRAL] Then your explanation of benefits will let you know that.
[AGENT][NEUTRAL] So for example, maybe.
[AGENT][NEUTRAL] Maybe, uh,
[AGENT][NEUTRAL] Part of the itemized bill wasn't included, OK, or a code that we needed.
[AGENT][NEUTRAL] Once you get that missing piece of information, then you would just upload that into your portal for our review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again the system would know hey we were we we needed that and so here it is and and we would review it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Again that user guide's gonna be very helpful in explaining all of that now should we need some additional information for a claim that we've already, you know, looked at.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you go to upload the missing piece of information. There's not a way, Miss Guy, for you to attach it to that claim number that we've already issued, so you're just gonna still, like I said, upload it like it's gonna appear kind of like you're uploading a new claim.
[AGENT][NEUTRAL] But don't worry about that because the system again will recognize that hey this was missing on this claim, so OK, we're gonna review it under.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The proper claim number. Does that make sense?
[CUSTOMER][NEUTRAL] Yes, but it's not, it's gonna be OK if I make a phone call and say I'm confused.
[AGENT][POSITIVE] Absolutely. Oh yes, absolutely. We just cannot accept, you can either upload your information to the portal, which is the fastest and most effective route. Mhm.
[CUSTOMER][NEUTRAL] OK. All right. OK.
[CUSTOMER][NEUTRAL] So, so I will have a
[CUSTOMER][NEUTRAL] Right, so I'll have a portal, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the claim number, but if you need extra information I can just upload it to the portal even though it's not going to a claim. They just don't put a claim number down.
[AGENT][NEUTRAL] Right, because, right, your options are gonna be like, I think it says upload files or file new claim in the portal and some people get, they think, oh this is not a new claim, you know, and it just says upload files. I wanna, you know, this is for claim number 1234567.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And that's fine. We get calls about that all the time. You just you just click upload files and upload your document and then when it's reviewed, like I said, we'll be able to tell that this was something that was missing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that data service that we've already reviewed.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] Uh, you can add in and again the user guide's gonna explain this, but in the portal you can opt in for text notification alerts so when we do review a claim you'll get a text. Now you may not be able to instantly log into your portal and see the status because it would have to go through our overnight processing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the EOB to be viewable to you, but you could call us and we could give you the status.
[AGENT][NEUTRAL] OK, cause you'll get that text alert before it goes through our overnight process.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you can also add in direct deposit information.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] So that if we are able to pay benefits to you, they could be electronically deposited instead of us having to mail you a paper check. But again, that is your preference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Sounds good.
[AGENT][NEUTRAL] So I will email that user guide and I will also include the cancer claim form.
[AGENT][NEUTRAL] And again, the information on page one is, it's all instructions.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The total claim is 4 pages and page 1 is instructions.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, sounds good so I could so I can fill it out on the paper and then and then just copy that into the portal.
[AGENT][NEUTRAL] Yes, you can just.
[CUSTOMER][NEUTRAL] That it for me if that's OK.
[AGENT][NEUTRAL] Right, you can just, you, you can print that out if you want to um it should be a fillable document but if not you can print it out and then you could just image it back in with all of your other.
[CUSTOMER][POSITIVE] OK, sounds good. Like I.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Documents that you're gonna have to submit.
[CUSTOMER][POSITIVE] OK, or I'll just, I'll print it out, fill it out, and then type it in just so I have it all information, yeah, OK, sounds good.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure. Mhm. Yes, ma'am.
[CUSTOMER][POSITIVE] All right. OK, sounds good.
[AGENT][NEUTRAL] Um, and I can go ahead and give you your policy number. Now, when you sign into your portal, Ms [PII], you're gonna see previous policies, OK, because, you know,
[CUSTOMER][NEUTRAL] Um, all right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You've had this policy number that I'm gonna give you is your active policy that went into effect [PII].
[AGENT][NEUTRAL] But you have had other policies through your same employer. It's just maybe there was a little change in the benefit or something previously. So you'll see two other ones that show as lapsed, and then you're gonna have one that's showing as active. And that policy number that's active is 253.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 53
[AGENT][NEUTRAL] 2418.
[CUSTOMER][NEUTRAL] 253
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2418.
[AGENT][NEUTRAL] 2418. Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Oh, you've been so helpful, thank you.
[AGENT][POSITIVE] Oh, well, you're very welcome. Yes, ma'am. Is there anything else, Miss Guy that I could help you with at the moment?
[CUSTOMER][NEUTRAL] Uh, not right now. I, I'm sure I will call back. I don't know if I'll get to talk to you, but, um, yes, thank you. That's very.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Well, any of us here would be.
[AGENT][POSITIVE] Well, you're welcome. And any of us would be very happy to help you. If you have any questions, you know, yes, ma'am, do not hesitate to give us a call. Uh, we're here Monday through Friday from [PII] Central time.
[CUSTOMER][NEUTRAL] [PII] Central.
[AGENT][NEUTRAL] Yes, ma'am. [PII] Central time, Monday through Friday.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you so much and I will look forward to your email.
[AGENT][POSITIVE] Well, you are very welcome.
[AGENT][NEUTRAL] Yes, ma'am. I'll be sending it in just literally a couple of minutes. So if you don't see it in your inbox very soon, uh, check your junk or spam folder. I really don't think it will go there. But if you haven't seen this email, literally, in just a couple of minutes, then yes, please check one of those folders.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, I will. Thank you so much and have a great day.
[AGENT][POSITIVE] OK. Well, you, I hope you do too, Ms. Guy, and again, it was my pleasure in speaking with you today and thank you for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am.