AccountId: 011433970860
ContactId: 6d402fdb-dc66-45b5-8963-0063bc706b11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1036618 ms
Total Talk Time (AGENT): 621447 ms
Total Talk Time (CUSTOMER): 262770 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/6d402fdb-dc66-45b5-8963-0063bc706b11_20250128T18:23_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and we have had this policy, a cancer policy for many, many, many years and have never used it. Actually kind of forgot about it, even though we pay for it monthly. And my husband recently, uh, had surgery, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I just, we haven't done anything about it and I just wondered.
[CUSTOMER][NEUTRAL] What we can do.
[CUSTOMER][NEUTRAL] Uh, is it too late cause he, he, uh, had prostate surgery last
[CUSTOMER][NEUTRAL] March, it's been almost a year.
[AGENT][NEUTRAL] OK, yeah, let's look into that for you, Ms. [PII]. Do you have that policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I do not. I, I don't have any paperwork in front of me.
[CUSTOMER][NEUTRAL] Uh except something that looks like it might have been dated in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But it doesn't have a policy number on it. I can give a social number. I can tell you who it's through, what insurance agency we have it through.
[AGENT][NEUTRAL] Yeah absolutely so I can look that up for you with the social. Are you the subscriber on the account?
[CUSTOMER][NEUTRAL] Uh, I am one of them, my husband and myself. Well, it's a, it's a, uh, employee and spouse account. So I'm assuming my name is also on it.
[AGENT][NEUTRAL] OK, yeah, um, would you have been the employee at the time or would it have been your husband?
[CUSTOMER][NEUTRAL] It would have been my husband.
[AGENT][NEUTRAL] OK, I can look it up. I would just need his social security number or I can search with uh [PII]'s names instead.
[CUSTOMER][NEUTRAL] OK. No, I, I have his. Uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If I can remember it. [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Wonderful.
[CUSTOMER][NEUTRAL] I believe.
[AGENT][NEUTRAL] And I was
[CUSTOMER][NEUTRAL] Sometimes I get his mixed up with mine.
[AGENT][POSITIVE] No, it was perfect. I, I was able to find you. Ms. [PII], would you be able to verify for me, please, your date of birth?
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Yes, mine is [PII].
[AGENT][POSITIVE] Wonderful, and I'm just gonna have you verify some additional information that mailing address if you can.
[CUSTOMER][NEUTRAL] Yes, uh, [PII].
[AGENT][NEUTRAL] Wonderful and then lastly if you're able to and it's OK if not but the email address on file.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm, I, I will go with his because I'm not sure. I can give you mine. His is might be OK [PII].
[AGENT][POSITIVE] That was it. Thank you very much.
[AGENT][POSITIVE] All right. So, first off, I wanna let you know I'm really sorry to hear about the health complications your husband's had to go through. I'm sure that was a really tumultuous time for you all as a family.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][MIXED] It was not great, but everything is fine now.
[AGENT][NEUTRAL] I'm very glad that you're on the other side of it and things are fine now um so a couple things right off the bat um as a company we do not have a timely filing limit so you are welcome to submit any claims for anything that has happened since you've been active with us. It looks like you guys have had this policy since [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][POSITIVE] So, um, you are definitely as far as submitting something from a year ago, no worries.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I am pulling up your policy documents, and what I can do is I can actually, um,
[AGENT][POSITIVE] Look at some of the benefits you all have.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] To see if there's anything that.
[AGENT][NEUTRAL] Could help you um as far as.
[AGENT][NEUTRAL] Submitting a claim, the very first thing we'll need is on that claim form and I feel like I'm gonna give you a lot of information, um, but it's.
[CUSTOMER][NEUTRAL] OK. I'm, I've got a pen. I'm writing it.
[AGENT][POSITIVE] OK, cool.
[AGENT][NEUTRAL] I don't want to stress you out with too much, um.
[AGENT][NEUTRAL] Let me pull up the cancer claim form because I have it listed on it exactly everything that's needed and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, the first time you're submitting a uh an initial diagnosis or a new diagnosis, um, we're gonna need that pathology report. Um, and so that is for the positive diagnosis of cancer. So you'll wanna make sure you, you have a copy of your pathology report.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if you are filing a claim for services for services such as hospitalization, surgery, chemotherapy, immunotherapy, radiation, hormone therapy, etc. um, you're gonna want to include itemized bills from each medical provider along with your explanation of benefits from your medical carrier, um, so your primary insurance, showing the amounts that were allowed and paid for for each service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, he did not have to, uh, so far at this point, uh, go through any chemo, radiation, or anything like that. They got it out of there and then right now, he is cancer-free.
[AGENT][POSITIVE] That is the most wonderful thing to hear. So then you'll just want to, for those surgery bills, um, you'll want to make sure you're getting that itemized medical bill for that and the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Surgery and explanation, OK.
[AGENT][NEUTRAL] Um, you might need to get, um, if, and they, they might ask this, you can write it down if you want, but an operative report may be required if you're filing a claim for multiple surgeries performed on the same date. So I don't know if that would be something that you've had to go through or if you've had multiple surgeries on the same date, but if that is the case, you might need an operative report.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I mm.
[CUSTOMER][NEUTRAL] I don't, I, I believe there were, they considered it like two surgeries. So, OK.
[CUSTOMER][NEUTRAL] Surgery or surgeries.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Alright, OK.
[AGENT][NEUTRAL] The very first step I would say I mean honestly you can do this however you wanna do it if you want to gather all the information and send it all in at once you can if you wanna start sending the information little by little as you get it you can um whichever works best for you um we will always just process once we have the complete information.
[AGENT][NEUTRAL] Um, to make a decision.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I'm going to, to that email, the OK [PII]. I'm gonna send out some information to you. Um, are you
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you feel comfortable like with the computer at all?
[CUSTOMER][NEUTRAL] Yes, but that's his, that is his email. Can you include my email?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you want me to send it to you instead, my friend?
[CUSTOMER][NEUTRAL] That would, if you can include mine.
[AGENT][NEUTRAL] Yeah, I can send it to him and then I can also address it to you if you'd like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what's a good email address for you?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and then your last name [PII], [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][POSITIVE] Wonderful.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] So what I'm gonna do is I attached in this email the cancer claim form and so that claim form is going to the first page of it honestly I would use it like a checklist it's gonna have everything I just told you it's gonna say complete these sections and you can just like check that off. I completed it.
[AGENT][NEUTRAL] Um, it's gonna say get your documentation, your pathology report, and you can just check it off like, yes, I've got this pathology report and I would use that top of that first page on that claim form like a checklist to help you gather any of the documents you will need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then you would just fill out that form and submit it with any of the documents so we have an online portal and that I'm also gonna send you information on. It's our, um, user guide, but it tells you how to set up the portal, how to submit claims and do everything, but it is honestly the quickest, easiest way to get information to us, um, so what you can do is you can just like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Download it all to your computer you can download your EOBs um or any of your medical documentation from like your health portals through, you know, perhaps your like physician's office, anything like that but you can just upload them to us um and it's secured and then otherwise we do accept um any claim and medical information via fax or mail but it's just not as quick like mail especially it seems to take forever so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I highly recommend using that online portal and I can send you the user guide to how to set that up um it will need to be set up though with [PII]'s information because he is the policy holder on this account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Um, from there,
[AGENT][NEUTRAL] Anything that you submit if we need more information we're always we'll send you out a letter but if you have that online portal you can always just check it there too and you'll see like it'll say hey we're requesting.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Medical records or we need we have your bill but we need something with the diagnosis code whatever the case might be any time that they need more information they'll send a request for it to you through mail or you can check it through your online service center um and we won't ever just not cross like once we get that information we will continue the processing of the claim so it might say like it might say.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A D next to it which is a denial code and but it's just pending more information so don't hesitate to just send us that information. It looks like it's missing and once we receive that we're always gonna continue forward with the processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That sounds good.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And then,
[AGENT][NEUTRAL] As far as your particular benefits go, I do have a policy document, but I can only mail that to the email address on file, um, your husband's, um, but that one does talk about all of your benefits, um, the, you know, if you are confined to a hospital, your surgical benefits, um, any outpatient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Um, surgical benefits, anesthesia, anything like that. So it has all of your benefits listed in it. Um, it's gonna tell you your exclusions and it's, it's a lot of pages, but it really helps you understand kind of, um, exactly what benefits you have available to you. And if you like, that's something, I can send out to your husband's email address.
[CUSTOMER][NEUTRAL] That would be great. I have one sheet of benefit for low option plan, but I don't know how old this is, and I don't know if anything has changed. Um, so it'd probably be best for us to have what you have.
[AGENT][NEUTRAL] Perfect so what I will do is I'll get that sent out to you or to him um but the claim form and that user guide I'll send out to the both of you, um, and then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if you set up that online portal with your husband, um, you're, you'll also be able to view all of your policy documents online as well. So if you ever lose the email we send, um, yeah, I don't know if he can add you or if he would share his username and password with you that would be I can't.
[CUSTOMER][NEUTRAL] OK, he can add me.
[CUSTOMER][NEUTRAL] Somehow.
[CUSTOMER][NEUTRAL] 00, OK.
[AGENT][NEUTRAL] You know what I mean, but, um, but the policy documents are all available online too once you have that portal set up, but I will email them to his email address as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that would be great thank you.
[AGENT][POSITIVE] Absolutely, um, I know I've given you a lot of information. Is there anything you particularly have questions on that I can go over?
[CUSTOMER][NEUTRAL] I don't think anything that you've told me. Um, I do have like a question, which I'm sure will be answered with the massive amount of paper that we'll be printing, but
[CUSTOMER][NEUTRAL] Is, does, uh, like a mammogram or a colonoscopy, does that count because it's preventative? Or is it just basically, if we've had, if the cancer was there and they had to be taken care of?
[AGENT][POSITIVE] That is a fabulous question. Let me look at your particular benefits and I'll let you know if you have any of those preventative ones.
[CUSTOMER][NEUTRAL] It's since we're low option I just didn't think that it would be something preventative but.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][POSITIVE] Yeah, let's take a look. It certainly does not hurt.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm not seeing in here any of the wellness benefits uh for the mammograms or the routine testing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] No, that's fine. I mean,
[CUSTOMER][NEUTRAL] Again, we've kind of forgot about this.
[CUSTOMER][POSITIVE] So we'll be happy with whatever happens.
[AGENT][NEUTRAL] But and then.
[AGENT][NEUTRAL] Let's see, um, any other questions you have?
[CUSTOMER][NEUTRAL] I don't think so, not, not until we get the paperwork and look through it and see what we have to do.
[AGENT][NEUTRAL] OK, I'm gonna send on that first one and I just wanna [PII] Stindle, your last name [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm sorry, I guess I typed it. I'm really glad I actually asked about that because I typed it with a second L on accident.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That's not [PII].
[AGENT][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Alright, I'm gonna send on that first one that's gonna be coming to you and then I am sending those policy documents out to your husband.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][POSITIVE] If you look it over and you have additional questions, please don't hesitate to reach out to us and let us know um we'll be happy to like dive deep into something with you or just answer any questions you might have.
[CUSTOMER][POSITIVE] Got it. Uh, don't worry.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Alrighty ma'am, so keep an eye out on your.
[AGENT][NEUTRAL] Keep an eye out on your email, um, all that should be coming y'all's way and then.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] I don't think so. Did you say your name was [PII]?
[AGENT][NEUTRAL] Yes, I did. [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for all your help, [PII].
[AGENT][POSITIVE] Oh, it's my pleasure. Thank you so much for calling APL. I just hope you have a fabulous day.
[CUSTOMER][POSITIVE] Thank you so much. Bye-bye.
[AGENT][POSITIVE] My pleasure bye bye.