AccountId: 011433970860
ContactId: 571595a1-bd9a-486c-838f-89eac968938f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1133300 ms
Total Talk Time (AGENT): 436084 ms
Total Talk Time (CUSTOMER): 505270 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/571595a1-bd9a-486c-838f-89eac968938f_20250324T15:56_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] Hi [PII], this is [PII], and I have a policy with you guys, and I am trying to do, um, a wellness, uh, claim for my husband who should also be on there.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so you need help filing a claim or something like you got an error or something?
[AGENT][NEUTRAL] Or you just need help?
[CUSTOMER][NEUTRAL] Well, it doesn't have him listed. It only has me.
[AGENT][NEUTRAL] Oh, OK. So the, your husband should be on here, but you don't see him. OK, I can check for you. I'm sorry that you don't see him. I can definitely look into the policy. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Oh gosh. Uh, let me see what it is. It is.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Let me see if I can find it. I printed off all my stuff yesterday, um.
[CUSTOMER][NEUTRAL] I have uh I think this is it certificate number.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh no, 26626677 policy number.
[AGENT][NEUTRAL] Mhm. What's the certificate number?
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 67676.
[AGENT][NEUTRAL] OK, that's your policy number. The other one is your group number.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEGATIVE] That's that, that's not the way they have this listed on this paperwork.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So I have you here. I pulled up the policy and Ms. [PII], can I just need to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, 220 of 64. My address is [PII] and the email address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So if you don't mind, I'm gonna place you on a brief hold. It looks like
[AGENT][NEUTRAL] Um, it looks like they just didn't, um, add him at some point there was a lapse and you all were added or yeah, you all were added, but they, they didn't add your husband back. So let me get them to fix this and
[CUSTOMER][NEGATIVE] Yeah, this is, this is a mess. I'm just gonna tell you.
[AGENT][NEGATIVE] You said it's a mess?
[AGENT][NEUTRAL] Well, OK.
[CUSTOMER][NEGATIVE] It has been a mess.
[AGENT][NEUTRAL] So that's
[CUSTOMER][NEGATIVE] They didn't send me the bill.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So that's what all happened and then they were putting everything back and they input Mr. [PII]. OK, that makes perfect sense. Let me call, um, it's just a click of a button, I believe, but I'm still gonna be on the phone with you. I'm just gonna call them on the other line, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and then I have another question after we take care of that part part.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Good afternoon thank you for calling APL. This is [PII] in the customer service department. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII] on the care team. How are you?
[CUSTOMER][POSITIVE] I'm doing well. How about yourself?
[AGENT][NEUTRAL] I'm doing good. Um, can you help me with this policy? It looks like they were lapsed at one point and then the part two was never added back.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Um, it's 256-767-6.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Uh, it's not letting me do it hang on.
[CUSTOMER][NEUTRAL] 256-767-6
[CUSTOMER][NEUTRAL] OK, I fixed it.
[AGENT][POSITIVE] You too. Thank you.
[CUSTOMER][NEUTRAL] Alright, and let me know if you need anything else.
[AGENT][POSITIVE] All right, thank you. All right, have a good day.
[CUSTOMER][POSITIVE] You're welcome. Have a good day. You too. Bye.
[AGENT][NEUTRAL] All right, bye bye.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for the wait. So, um, customer service just fixed it for us, so, um, Mr. [PII] is now um active on the policy.
[AGENT][NEUTRAL] And what was your second question?
[CUSTOMER][NEUTRAL] OK, my second question is I've tried twice to do direct deposit for you guys. I put in my routing number and my account number, and it will not change to JPMorgan Chase Bank. It only puts in Bank one.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] As long as your routing number and your account number are correct.
[AGENT][NEUTRAL] Um, Chase may have brought out that bank and it's just not in the system, but if your routing number and your account number is correct, that's specific to your bank and your and your account number, so you can still enter it.
[CUSTOMER][NEUTRAL] OK, I can still enter that. OK, uh, let me, um, I've got one other.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hang on just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But sometimes when you get these, you're like, huh.
[CUSTOMER][NEUTRAL] How did that happen?
[AGENT][NEUTRAL] How does that, right?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, when I'm filing for um.
[CUSTOMER][POSITIVE] My wellness claim even for myself.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Do I have to attach anything to it?
[AGENT][NEUTRAL] Um, with the wellness claim, it's usually just the itemized bill, um, just make sure it has all the coding.
[AGENT][NEUTRAL] Like the diagnosis code, the procedure code, and the charges. As long as you have that itemized bill and then um if you do have a, like a major insurance company, their explanation of benefits.
[AGENT][NEUTRAL] Um, and that's it, that the cancer claim form.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] But just those three.
[CUSTOMER][NEUTRAL] OK, so let me.
[CUSTOMER][NEGATIVE] Let me get this one my signature is not very good on this.
[CUSTOMER][NEUTRAL] OK, even on the wellness.
[CUSTOMER][NEUTRAL] Same.
[CUSTOMER][NEGATIVE] It doesn't ask for you to attach anything. That's what's broke.
[CUSTOMER][NEGATIVE] Really weird to me.
[AGENT][NEUTRAL] Um, hold on one second.
[AGENT][NEUTRAL] Let me pull up the.
[CUSTOMER][NEUTRAL] I think you guys, the last time y'all said I have to attach anything y'all just checked with my doctor.
[AGENT][NEUTRAL] Um, I mean, I've seen it both ways. Um, I just tell everyone to send it in because I'd rather you send it and we not need it than to get denied and then you have to send everything in. So I just, it's up to you. You don't have to submit it if you don't, if it doesn't listed there, but sometimes they do ask for the billing and then pay out, so that's up to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. I'm gonna see if [PII]'s, there's [PII], yep, OK, he's on there now. Yup. I just wanted to make sure of that.
[AGENT][NEUTRAL] You see him? OK, good.
[CUSTOMER][NEUTRAL] Yes, and so um.
[CUSTOMER][NEUTRAL] With that being said, so.
[CUSTOMER][NEUTRAL] We just um.
[CUSTOMER][NEUTRAL] [PII] center.
[CUSTOMER][NEUTRAL] Cancer
[CUSTOMER][NEUTRAL] For the last few years, well, for 5 years now. And so,
[CUSTOMER][NEUTRAL] We're about to send in the [PII] information that we've got now ready and then he started a new treatment in [PII].
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And so I don't know if, with that being said, uh because he's doing an immunotherapy treatment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And do we need to update, do we need to send his Medicare stuff in plus I don't know what all we need to send in on that stuff.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So for that, all you'll have to, the easiest thing to do is when, you know how they ask you for your insurance information, just give them this policy number and our phone number, so that they can call us and verify benefits and then after they bill your primary, they'll automatically bill us so you don't have to do all of this leg work. Um, that's probably the easiest thing, but if you're going to file the claim then
[AGENT][NEUTRAL] Um, with the, the different therapies, I'm pulling up his benefits now so I can see what the max is. But now for that, you would just use the cancer claim form and submit the billing and we'll go ahead and pay out um up into that calendar year [PII] I'm waiting for it to come up so I can see it.
[CUSTOMER][NEUTRAL] OK, because what, what happens is they bill Medicare, then they build our bill our supplement and then we turn around and just make a claim to you guys.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that's fine to make a claim with us.
[CUSTOMER][NEUTRAL] And so
[AGENT][NEUTRAL] It's just if you would rather, because I mean it is a lot to get the paperwork together. I was just like you know you have another, they usually bill us, so I mean you can if you want to, it's just I just know it's a lot of work.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I just get his insurance stuff confused with what I've got going on through me and so by.
[AGENT][NEUTRAL] A lot going on. It's a bunch of everything. OK, it's all mixed together.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Insurance is not fun. I don't know why you even work in an insurance.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] To be honest, OK, so, well, it is very confusing. This is just a part of my degree. I've used my job to show me the different sides of my degree, so now I'm looking at how secondary insurance works. So that's why I'm here.
[CUSTOMER][NEUTRAL] That for years.
[CUSTOMER][MIXED] Good for you because it's a pain in the butt as we age.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] I'm just telling you, it's not friendly, not at all.
[AGENT][POSITIVE] Well, hopefully I can help you change, I can help change that a little bit, just a little though.
[CUSTOMER][POSITIVE] Well, you have been a blessing so far, trust me. So I'm gonna do sta.
[AGENT][POSITIVE] Well, thank you.
[CUSTOMER][NEUTRAL] Now, when I'm filing for [PII]'s wellness claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Then with that wellness claim.
[CUSTOMER][NEUTRAL] After I do the submission, I can go back and add the attachment, is that correct?
[AGENT][POSITIVE] Yes, ma'am, you can.
[AGENT][NEUTRAL] It'll just now when you add it, it'll look like it's a new claim. Every time you add something on the online service and it's gonna look like a new claim, but it's OK, we can just, we can tell that it belongs to, you know, something that was previously submitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because I have, uh, I just did mine and I can attach my information and then I'll do [PII]'s and attach his information and then we'll do his cancer stuff and girl, it's been a lot.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I know it has. On the, um, I did look up the immunotherapy for you, so the max is $10,000 per 12, so per year per 12-month period.
[AGENT][NEUTRAL] And um so you'll just send in those bills and the claim form and we'll pay, you know, as long as everything's there, we'll pay up to that $10,000 a year.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK, what if we, uh, let me ask you this, so what if we never receive an actual bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But he's receiving this treatment.
[AGENT][NEUTRAL] Oh, so then you'll just reach out to the billing department of where um wherever the facility is and just ask them for whatever, you know, the date of service that he's that you're filing for, just ask them for an itemized bill for that date of service. Just stress to them that you're not asking for the patient bill. You want the itemized bill or the universal bill from the hospital. We want their version because it has all the coding on it. The patient version is just going to show the treatment and what you paid.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Bill or itemized bill or what was it?
[AGENT][NEUTRAL] Universal bill.
[CUSTOMER][NEUTRAL] Universal bill.
[CUSTOMER][NEUTRAL] OK, not the patient bill.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Because I'm like, we tried this once before and it never did, and we cannot figure it out. So I was like, just forget it, just forget it.
[AGENT][NEUTRAL] Mhm. And y'all have had this policy since [PII], so you can, even if you had claims from back then, you can file for that too. I mean, I don't know.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Um, if you have other claims, but.
[CUSTOMER][NEUTRAL] He didn't have
[CUSTOMER][NEUTRAL] [PII], but he does have treatments this year, so he went out, he went without treatment for a year and a half. Thank gosh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but we actually had it before then. I retired with Mansfield ISD. I had it when I worked for Mansfield ISD.
[AGENT][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] Oh, yes, ma'am. You've had it since [PII].
[CUSTOMER][NEUTRAL] But we never
[AGENT][NEUTRAL] You've been with us for a while.
[CUSTOMER][NEGATIVE] Yeah, cause we never could get.
[CUSTOMER][NEGATIVE] We never could get the right documentation.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To do uh the claim. I don't know why but it just never worked, but now that you said itemized bill or universal bill, we will get that and we'll make that claim.
[CUSTOMER][NEUTRAL] Cause these, uh, I think some of these treatments are like $20,000 every time I go, so.
[AGENT][NEUTRAL] Oh, and then if they, if they happen to like um
[CUSTOMER][NEUTRAL] Anyway, but.
[AGENT][NEUTRAL] Say that you need to sign something to release the information. Let them know you're not asking for the medical records. You need the itemized bill cause that's, we've been running into that sometimes too. So, just let them know you're not trying to send the medical records. You just need a copy of your bill so the claim can be processed.
[CUSTOMER][NEUTRAL] OK, alright, claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well, let me see what we can figure out on that. In the meantime, I'm gonna go ahead and do our wellness claims and um then I'll do the [PII] where we found out the new cancer was.
[CUSTOMER][POSITIVE] Where he had the biopsy done. And then in [PII], he had a biopsy and now the treatment. So, yeah, it's been, it's been fun.
[AGENT][POSITIVE] Well, I know, I, I, I'm praying for you. I know it's probably a lot with your husband, so.
[AGENT][POSITIVE] I'm glad he has you because you're doing all you can, so just make sure you give yourself some grace and get some rest.
[CUSTOMER][NEUTRAL] Well, we just got
[CUSTOMER][POSITIVE] Yeah, we just gotta keep going, but we appreciate your help and
[AGENT][NEUTRAL] Keep on, keeping on.
[CUSTOMER][NEUTRAL] And what was your name again, sweetheart?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] [PII], [PII], oh, well, [PII], you have been a pleasure to speak with and everything, and I'm glad I called today because I was like, I really don't wanna do this insurance stuff but it's blessing. Not many do this, trust me.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Well, I am very glad I got to speak with you today and help you. I hope you feel a little better, just a little bit about insurance, but I am the only [PII] here, so if you ever need help, just let us know. Any of us will be more than happy to help you, but I'm the only [PII].
[CUSTOMER][POSITIVE] All right, thank you so much [PII] I appreciate you.
[AGENT][NEUTRAL] You're welcome. Was there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, I think that's it. So, um, when I go back on here after I do this wellness claim, I can attach the document to those wellness claims, correct?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Wait a minute, so has the wellness, so have you submitted the wellness claims already because if not,
[AGENT][NEUTRAL] So do you have?
[CUSTOMER][NEUTRAL] I did for me.
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] But I didn't attach the document yet.
[AGENT][NEUTRAL] OK, so then yes ma'am, you can attach it.
[CUSTOMER][NEUTRAL] OK, alright and then um.
[CUSTOMER][NEUTRAL] And then for [PII] he's got his already uploaded for me on a flash drive so I can attach that automatically so.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] And then all the other cancer stuff that we deal with, so but if I have any questions, [PII], I'm calling you back.
[AGENT][POSITIVE] OK. That's totally fine.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right thank you so much for your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII], and thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] All right, bye-bye.