AccountId: 011433970860
ContactId: 665debcb-edc5-4580-98af-ce91ed321057
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 890260 ms
Total Talk Time (AGENT): 485818 ms
Total Talk Time (CUSTOMER): 272979 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/665debcb-edc5-4580-98af-ce91ed321057_20250114T16:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I have a policy and I'm trying to figure out how to fill out this claim.
[AGENT][NEUTRAL] OK, I can help you fill out a claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I have the
[AGENT][NEUTRAL] Can I get your
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I get your name and your callback number please just in case the call is disconnected.
[CUSTOMER][NEUTRAL] OK, [PII] again.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you Miss [PII] and what is your policy number?
[CUSTOMER][POSITIVE] Oh, that is a good question, um.
[CUSTOMER][NEUTRAL] I don't know that I have that.
[CUSTOMER][NEUTRAL] I printed out some stuff, but it.
[AGENT][NEUTRAL] I can look it up with your social security number if you'd like to give that to me.
[CUSTOMER][NEUTRAL] OK. Yeah, let's do that. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, let me pull in your policy real quick with your social, it's gonna be just a sec.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], uh, for security reasons I'll need for you to verify some information for me. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and then I'm also going to need for you to verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, Gmail is, uh, [PII].
[AGENT][NEUTRAL] OK, looks
[CUSTOMER][NEUTRAL] And what was the other thing?
[AGENT][NEUTRAL] It looks like I have your um.
[AGENT][NEUTRAL] Your your work email address.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][NEUTRAL] Yes, that's correct. And then the cell phone number or the number that you gave me, if we did get, yes, that's the one that you gave me if we get disconnected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you Ms. [PII]. I appreciate you verifying everything for me.
[AGENT][NEUTRAL] So you're needing help filing a claim?
[CUSTOMER][NEUTRAL] Um, yeah, um, so my husband has lymphoma and he's been going to MD Anderson.
[CUSTOMER][NEUTRAL] Um, for the most part, they've been covering a good bit of it. Um, but there are some things that, you know, every once in a while, they'll send us a bill, say you, you know, you owe $400 or you owe $80. Um, and we don't really know exactly what it's for, we could, you know, the way that they have it broken up, um.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But the way, the way that they work is if you don't pay, if you're not up to date, then they don't see you. So if I don't know how I can fill out the claim.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] With enough time for to submit a claim to you to get the, that y'all to pay them or however it works, um, because it's just like a day by day type thing with us, um, because he's going pretty much every day.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So is this a kind of policy that pays us back or do y'all pay them?
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Either way, uh, it depends on who files the claim. If you file the claim you'll get reimbursed. If the facility files the claim, then they'll be reimbursed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And they'll be paid for the client.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So do I just need to give them your information or how does that work?
[AGENT][NEUTRAL] Yes, you can give them your insurance card.
[AGENT][NEUTRAL] And then let me give you a payer ID number that's for the facility to file the claim electronically for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on, let me
[AGENT][POSITIVE] Are you ready for it? Yes ma'am.
[CUSTOMER][NEUTRAL] No, hold on one sec. OK. uh, what's it called? The facility number?
[AGENT][NEUTRAL] It's the payer ID number.
[CUSTOMER][NEUTRAL] Yeah, cause I don't think I have a card.
[CUSTOMER][NEUTRAL] I don't think I ever got a an actual card.
[AGENT][POSITIVE] OK, I'm gonna order you one.
[AGENT][POSITIVE] Yes, ma'am. I'll order one to be mailed to your home address that you verified for me. I'll take care of that for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] And then also, OK, the pay ID number is 60801.
[CUSTOMER][NEUTRAL] 60801
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And that's so that they can send the claim in electronically and for you we also have an online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That if you sign up for it it's a direct portal to your policy and you can also file claims for yourself if you need to um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The website for that is secured [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll sign up as a new user, uh huh.
[CUSTOMER][POSITIVE] [PII], OK, secured.
[CUSTOMER][NEUTRAL] Secured do what?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Like [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you first go into that website you're gonna sign up as a new user that's gonna be your first option to choose and then the second option is gonna be you are.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] I'm sorry, you cut out. Say that again.
[CUSTOMER][NEUTRAL] [PII], [PII] and then what else? Uh-huh.
[AGENT][NEUTRAL] The second option is.
[AGENT][NEUTRAL] Then you're an individual with the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you just and the rest of it is just like based you know setting up your username and your password and.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if I receive like partial credit.
[AGENT][POSITIVE] And I'm going to order.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If I were, if they pay, if, if Blue Cross pays like, say, say the treatment is 4000 and Blue Cross pays 2000, um, can I get
[CUSTOMER][NEUTRAL] Um, APL to pay the remainder.
[CUSTOMER][NEUTRAL] And then is there like a balance that stays?
[AGENT][NEUTRAL] It depends on what the procedure codes are, um, so when you send in a claim, you have to have the explanation of benefits from your primary, you'll need the pathology report.
[AGENT][NEUTRAL] And you'll also need the itemized statement from the facility that you go to and so all those things combined together are what the claims examiners look at.
[AGENT][NEUTRAL] And depending on the procedure codes and diagnosis codes that are on the itemized statement based how it pays once we receive the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do y'all do any kind of reimbursements, reimbursements for what we've already paid?
[AGENT][NEUTRAL] You can um definitely send in a claim.
[AGENT][NEUTRAL] For anything past as long as your policy was active on the day of service, you can always file a claim and doesn't matter how far back we don't have a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um, because I noticed it's uh 15,000 for uh radiation and chemotherapy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So whatever Blue Cross doesn't hasn't paid on that, then, then ACL will pay on the rest is what I'm getting.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I can't guarantee the payment. I can't tell you like, like it depends on the procedure codes and the diagnosis codes that are on the itemized statement. That's what they look at as far as paying the claim. Um, you can send the claim in.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, I noticed that you had, um,
[AGENT][NEUTRAL] You've had coverage with us.
[AGENT][NEUTRAL] Since
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] So if anything goes back to [PII], as long as you were covered on the date of service, you can send in a claim for that at any time.
[CUSTOMER][NEUTRAL] Oh wow, I didn't, didn't realize I had it that far back. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am, your first original policy with us was your effective date is [PII] and.
[AGENT][NEUTRAL] Let's see. I'm gonna look and see if you had any lapse in coverage at all. I don't see that you've had a lapse in coverage. You've been with us since [PII] and
[AGENT][NEUTRAL] This is the
[CUSTOMER][NEUTRAL] Now is that just me or is that my husband too?
[AGENT][NEUTRAL] Let me see if he's on that first policy.
[CUSTOMER][NEUTRAL] Cause it's the
[CUSTOMER][POSITIVE] Yeah, cause we're, this is all it's gonna be for him.
[AGENT][NEUTRAL] His name is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, he was on your first original policy. Let me check to see about the second one because you we've changed plans. You've changed plans 3 times. So let's make sure that it's OK. It's some of it's us too because we changed um the product ID and when the product ID and I know that's probably jargon to you but it's just the name of the policy, the type when that changes we have to issue new policies.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] So like nothing really changes except for that ID number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me go in and see if he's on your 2nd 1.
[AGENT][NEUTRAL] Yes, he's on your 2nd 1 and he's also on your 3rd 1, so he's on all 3.
[CUSTOMER][POSITIVE] OK, good.
[AGENT][NEUTRAL] Back to [PII]. So any um claims that you have.
[AGENT][NEUTRAL] From [PII] to present.
[AGENT][NEUTRAL] Send in your claim claims for those and see if there's any reimbursement for you for sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I would need like,
[CUSTOMER][NEUTRAL] Like, basically like a receipt from each thing to have to turn in.
[AGENT][NEUTRAL] Right, so from each data service.
[AGENT][NEUTRAL] You'll need a claim form and I'm gonna give you the the website to get the claim form from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you go to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you click on claims and forms on the top right hand corner.
[AGENT][NEUTRAL] You're gonna choose the cancer claim form.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when you download that cancer claim form we have a little cheat sheet on the first page that tells you every single thing that you'll need to send in with your claim.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] So you won't miss anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, that's gonna be a lot of work going back and getting all that.
[AGENT][NEUTRAL] Yes, it is, it is.
[AGENT][NEUTRAL] It's a lot of research and it's a lot of sending in um if you if you send it through the online service center you can upload your um claim form and download all your documents and send it through the online service center if you sign up for that. If not, I'm gonna give you a fax number and a mailing address if you choose to either fax in your claim or mail in your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] The fact no.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, let me, yeah, let me get the mailing address, but I can't do a fax so.
[AGENT][NEUTRAL] OK, that's fine. Nailing it in is.
[CUSTOMER][NEUTRAL] I'll just I'll pro I'll probably use the portal.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Do they have the um are they are they able on the portal like can I take a picture of the document and and upload it or or no?
[AGENT][NEUTRAL] Yes ma'am, you'll be able to take a picture and then upload it. It just has to be very clear for them to be able to see it because it does, you know, you know how sometimes things get distorted when you send it through the computer.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right. Yeah.
[CUSTOMER][NEUTRAL] OK, um, well I'll go ahead and take that uh um ground ground address as well though.
[AGENT][NEUTRAL] OK, yes, ma'am. It's going to be [PII].
[AGENT][NEUTRAL] And that is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII], [PII].
[AGENT][NEUTRAL] And then the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think that's it then.
[AGENT][POSITIVE] Awesome, OK, is there anything, there's nothing else I can help you with while we're on the phone together that you can think of?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] No, I don't think so. I'll just have to do a lot of background work, I think.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, well, Ms. [PII], if you get stuck or you need any further help along the way while you're trying to do all this, please pick up the phone and call us and we'll help you all we can, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. You have a blessed day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.