AccountId: 011433970860
ContactId: 66d473e4-6d60-4aae-8d8c-a5e64e65d584
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 930659 ms
Total Talk Time (AGENT): 462079 ms
Total Talk Time (CUSTOMER): 212980 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/66d473e4-6d60-4aae-8d8c-a5e64e65d584_20250519T18:26_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] I have the cancer insurance on my hus on both of us, my husband and myself and we received a payment um a while back ago and then it said that other things are under.
[CUSTOMER][NEUTRAL] Like, like under investigation or pending.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I wanted to check on that.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] OK, sure, I can assist you with claims. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the better call back number is my cell. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, I don't.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I can tell you where I work and.
[AGENT][NEUTRAL] OK, I can do.
[CUSTOMER][NEUTRAL] My social.
[AGENT][NEUTRAL] I'm gonna try and name search if I cannot find you then we can try the social.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And you said the last name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] No [PII] in the end.
[CUSTOMER][NEUTRAL] There is an [PII] in the end.
[AGENT][NEUTRAL] There is, OK, so [PII] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, I found you. Let me have your date of birth and the email address on file for verification.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the email on file I'm assuming is my work email [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect, yes. All right.
[AGENT][NEUTRAL] Let me see where we are with your claim.
[AGENT][NEUTRAL] OK, I don't have anything on this one. Let me go to the old policy one moment.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] Oh, I can, he's been ongoing with non-Hodgkin's.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like it's gonna be the policy prior.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We waited out the wait period on it and then.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] To me it was like they were what I can remember is y'all were looking at his infusions.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So far what I found was the payment we made back in [PII], which I don't is that the one that.
[AGENT][NEUTRAL] The $500 payment or is it a recent payment that we send out?
[CUSTOMER][NEUTRAL] There's not, it was way back in [PII]. That's why I'm calling is because I just realized that, you know, there was a letter attached that the others were under review.
[AGENT][NEUTRAL] OK, so it will be this.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And we pay the CT scan.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And there's another one here.
[AGENT][NEUTRAL] OK, so, uh, see this was for [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I went ahead and pull that one prior to that one as well. It looks like we pay chemotherapy till [PII]. Um, are you trying to get benefits for [PII] for the chemo?
[CUSTOMER][NEUTRAL] Yeah, and he's still receiving infusions. I need to submit another claim.
[AGENT][NEUTRAL] Yeah, it looks like uh for [PII], I don't see one. I see that we were asking for additional information back when we received the one for the three years which it was [PII], [PII], [PII], and [PII]. We were asking for additional information back then. I don't see anything recent, but I don't see any claim submissions for [PII] or [PII] for chemo.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So if you're trying to submit that, um, we're just, we're gonna need the itemized bill and we also need the copy of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] So EOBs.
[AGENT][NEUTRAL] You'll be from the primary insurance and itemized bills.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] From the doctor.
[CUSTOMER][NEUTRAL] OK, because I didn't send EOBs the first time, I don't think.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, OK, yeah.
[CUSTOMER][NEUTRAL] I had to send his.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What's it called pathology report.
[AGENT][NEUTRAL] Yeah, that was for the first time because that, that this was the first claim we paid in all together. So, that's why we're asking for pathology report. Right now, if it's just for the chemo radiation therapy or immuno immunotherapy, those three, the only thing we require for you to send is the claim form, the itemized bill, and the explanation of benefits from the primary insurance. Those are the 3 documents we need for any of those services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what, how much you get paid on immunotherapy?
[AGENT][NEUTRAL] OK, looks like it's going to be 1500. Let me double check. It looks like that's what we've been paying in the past. Let me check the, the other policy because you had a different policy back for [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Is that a single year or is that per unit?
[AGENT][NEUTRAL] Mm, let me check.
[AGENT][NEUTRAL] Looks like that was per year, but let me double check.
[AGENT][NEUTRAL] one.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, it's gonna be I'll have to pull the documents on this one for [PII].
[AGENT][NEUTRAL] OK. So let's see, for the [PII] period, um, it changed. Um, so from [PII], the benefit changed to 20,000 per 12 month period. So that is the benefit you started back in [PII], so it did change.
[CUSTOMER][NEUTRAL] It was how much again?
[AGENT][NEUTRAL] It's 20,000 per 12 month period.
[AGENT][NEUTRAL] No, we pay uh actual charges.
[AGENT][NEUTRAL] So we don't pay more than what the major medical insurance benefits, but um we do pay up to 20,000 for 12 months.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, because I mean he's still.
[CUSTOMER][NEUTRAL] Doing that today.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, he's actually.
[AGENT][NEUTRAL] OK, and let.
[CUSTOMER][NEUTRAL] Getting the treatment today.
[AGENT][NEUTRAL] Oh, OK. Um, let me check the new benefits because that was back again, that's from [PII]. So let me check the benefits from 23 to 24 and then let me check the most recent because it looks like the policy changed a couple of times, OK? So it's different policy numbers, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me just make sure that amount didn't change any.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And the information given is just a verification of coverage, not a guaranteed payment, OK? All right, let's see so for this one which is 23 to 24.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] He.
[AGENT][NEUTRAL] And if it is 20,000, so this one stays the same, and let me look at the most recent one.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] But this one, the most recent one is still the same benefits. So it's still the um 20,000 for 12 month period, OK?
[CUSTOMER][NEUTRAL] And we're talking about per or for the immunotherapy.
[AGENT][NEUTRAL] Including that's all combined together, radiation, chemotherapy, and immunotherapy. Those three are combined. So the total benefit amount is 20,000 per 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like it costs
[CUSTOMER][NEUTRAL] I think about 18,000 a month.
[CUSTOMER][NEUTRAL] Does that sound right or per session?
[AGENT][NEUTRAL] It really depends where he goes, yeah, it can be more or less. Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, it's, it's definitely not cheap. I was really shocked.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so I need to get the EOBs.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] He only has one insurance, so.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] So get the EOBs and get the itemized bills from Texas Oncology.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And then fill out another claim form for 22232324.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And up to now.
[AGENT][NEUTRAL] Well, we pay already for the 22 unless he had anything after it's starting [PII]. So [PII] is when the new policy started with that amount of 20,000. So that's when um you can go ahead and start submitting claims. So [PII] until present.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, that sounds great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I will do that. I appreciate it.
[AGENT][POSITIVE] OK. You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, I mean he gets PET scans and all that, so that will be covered, right? or whatever.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, he had scans. He has one, a benefit for um medical imaging, um, 11 per year. The medical imaging is $500.
[AGENT][NEUTRAL] And this is one per year. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And he also have benefits for surgery. If he has had any surgeries, we also pay for surgeries. Um, for the surgeries, we do ask for the pathology report before the surgery, you know, the one they do before the surgery and then itemized bills. So those, if you have any, you can submit those as well and that's the information. But if you go to our website at [PII] and get the claim form.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim form in the first page is gonna give you instructions based on what you're trying to submit the claim for so the first page is gonna give you instructions.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And that was [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today, Miss [PII]?
[CUSTOMER][NEGATIVE] Nope, I just gotta do all this for him. He's just too, he, he's just not well enough to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm yeah.
[CUSTOMER][NEUTRAL] Even care that's what and I'm like well I need itemized bills. I knew I was gonna need that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But um I didn't realize the OBs, so I will get all that together.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, yeah, we don't have timely filing limits and just, yeah, [PII].
[CUSTOMER][NEUTRAL] Starting at [PII].
[AGENT][NEUTRAL] So take your time. We we don't have timely filing limits, OK?
[CUSTOMER][NEUTRAL] OK, will do.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][POSITIVE] You're welcome. Have a good day, Mr. [PII].
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye.