AccountId: 011433970860
ContactId: 6e2714c0-4e66-4045-91f1-c167f91e94b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 610719 ms
Total Talk Time (AGENT): 176982 ms
Total Talk Time (CUSTOMER): 321493 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/6e2714c0-4e66-4045-91f1-c167f91e94b6_20250204T14:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling Apel's [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. I have uh my cancer plan with you.
[CUSTOMER][NEGATIVE] And I went, I submitted some claims and um then you came back and said you needed more information and I sent the information back and now last night when I checked it said it was pending so now I'm I'm still off today so I wanted to know if you needed more information today at least have the day to try to get whatever information you need.
[AGENT][POSITIVE] OK, I can go and help you with that. Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] Can I get your policy number?
[CUSTOMER][NEUTRAL] I don't have um I don't have that with in front of me, ma'am.
[AGENT][NEUTRAL] OK. Give me 1 2nd.
[AGENT][NEUTRAL] Can I get your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] The flu is going around where you're at too?
[AGENT][NEUTRAL] Yeah, well, just my allergies.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um, can you verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And lastly, your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], thank you for that. So you have a question about um the claim that's pending?
[CUSTOMER][NEUTRAL] Yes ma'am, it said it was pending last night.
[AGENT][NEUTRAL] OK, give me 1 2nd.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, it looks like um it's pending so we sent over um for medical review. So as of right now, you're not, um, we're not needing anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you know how long that usually takes?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It's more likely it would probably be maybe a few days and we might get the information back um this week, um.
[AGENT][NEUTRAL] But I mean it can vary so I mean if you wanna maybe check back in a couple of days, I mean, or you can look on the the website as well, um, but like I said, that is what what that pending code means.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[CUSTOMER][NEUTRAL] But if it needed anything.
[CUSTOMER][NEUTRAL] How would I tell if you needed anything?
[CUSTOMER][NEUTRAL] Because I, I don't know how y'all can figure all that stuff out, that you, you wanted the itemized bill when that itemized bill came back in the pathology report.
[CUSTOMER][NEUTRAL] You know, I looked at both of them and I couldn't figure out not one beans of either one of them. So I just sent it over to y'all and figured y'all know better than I do.
[AGENT][NEUTRAL] Yeah, so like I said we um received that information, um, what you sent them back on the [PII], and so, um.
[AGENT][NEUTRAL] The rep was working on the claim yesterday and um and like I said, when she was reviewing the information, she determined that it needed further review, further medical review. So she sent that over to them and that's basically looks like it was a path report um and.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, God bless you. God bless you because.
[AGENT][NEUTRAL] And so, like I said, that's why, so when we get these information and, and we need further review other than our review, we send it over um for medical review.
[AGENT][NEUTRAL] Um, and selected it, um, it's normally we'll get a response back in a couple of days.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Now do you send it to is your medical review inside with you or over to Moffet?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, it's, it's within um.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, because Moffet, you know, they, they're usually pretty quick about it. OK, now also, the second thing I wanted to ask you, um.
[CUSTOMER][NEUTRAL] When I met with the surgeon, after the surgery, I met with the surgeon, she said that there was no evidence of disease. After they took everything out, no evidence of disease.
[CUSTOMER][NEUTRAL] And then she said you're cancer free.
[CUSTOMER][NEGATIVE] And I said, I don't understand. She's like, well, I figured you'd be, you know, excited and everything else. And I said, I don't understand what this means. And she says, What don't you understand? And I said, so tomorrow, am I gonna have my hands, my feet and my legs? Is everything gonna be back to normal? She said, No. She said in 2 weeks you have to start radiation. And I said, you said there's no evidence of disease.
[CUSTOMER][NEUTRAL] And she says, there's no evidence of a large disease. She said, but there's still little particles in there that you must have radiation to kill those pieces and then yes, there won't be no evidence of disease. And I said, well you told me there's no evidence of disease. So I have to have radiation. She said if you don't have radiation, you'll have cancer back by May.
[CUSTOMER][NEUTRAL] So now my question to you is that thing, that pathology reports there's no evidence of disease. So are you not gonna pay for the radiology that I start in 2 weeks?
[CUSTOMER][NEUTRAL] How does that work?
[AGENT][NEUTRAL] So let me see what the.
[AGENT][NEUTRAL] Let me look
[CUSTOMER][NEUTRAL] That might be the reason why they're questioning it because it says no evidence of disease.
[CUSTOMER][NEGATIVE] But I still have to have radiology, if not my cancer will come back.
[CUSTOMER][NEGATIVE] I, I don't understand this whole cancer thing and I know that you're not the one.
[CUSTOMER][NEUTRAL] But I'm trying real hard.
[AGENT][NEUTRAL] Yes ma'am, I totally understand. I'm just, let me just look on here, um, let me see, hold on one second.
[CUSTOMER][NEUTRAL] Because my, my insurance with you says it does cover radiology, uh radiation.
[CUSTOMER][NEGATIVE] You know, I thought the worst was over when they poured those millions of dollars' worth of poison in me. And now I have to go in 2 weeks and they're gonna shoot me with beams of something that's gonna take my body back down again for 7 weeks.
[AGENT][NEUTRAL] So I mean, I mean I really can't say because I'm thinking, I mean that could be why she sent it over to have review um but I can't say yes or no. I mean until we get that review back, um.
[CUSTOMER][NEUTRAL] OK. No, I'm saying.
[AGENT][NEUTRAL] So, I mean, I would just.
[CUSTOMER][NEUTRAL] My, my radiation, am I going to still submit like I've been submitting my chemo to you for my radiation?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] All right, well, that's at least a little bit of a saving grace if I'm gonna have to do this, and it's not, you know, it's through a different company because it's 11 seconds on the right side of where the tumor was and 11 seconds on the left side of where the tumor was. So I don't know how much it's gonna cost, how much I'm gonna have to pay out of pocket. I don't know anything yet.
[CUSTOMER][NEUTRAL] And I don't like the unknown, you know, I, I, I wish there was a, a folder, you know, that you could pick up and say, OK, you know, if you have cancer, here's what to expect, here's what all this stuff means.
[CUSTOMER][NEGATIVE] You know, she says no evidence of disease and I'm cancer free, but yet every 3 months for the next 2 years, I have to go back down and I have to have CAT scans and I have to have mammograms, and I have to have biopsies and I have to have all of this other stuff. How can you say no evidence of disease if for the next 2 years, I'm still going to be put through all of this other stuff?
[AGENT][NEUTRAL] Yes, ma'am, that's just, I mean, that's just the norm. I mean, just um
[CUSTOMER][NEGATIVE] You know, I, I just don't understand.
[AGENT][NEUTRAL] Like like other members and um that's just, they just do that um to make sure. I think it's, it's for the next couple of years, they do that to make sure um it's not there. Um and then after the couple of years, then if they don't see anything, then um the timeframe to get checked is, it's, it'll be longer instead of you doing it like every, every year. That's normally how, how it, how it goes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I still, you know, every time I get all these things, I still submit them to you and
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, so y'all are familiar with all of this stuff?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh OK, so it's not out of the norm for a cancer patient.
[AGENT][NEGATIVE] No, ma'am, that's not at all.
[CUSTOMER][POSITIVE] OK, alright, I'm sorry ma'am to bother you.
[AGENT][NEUTRAL] Oh, that's OK, that's what we're here for, um.
[AGENT][NEUTRAL] I'm gonna stop. Did you have any other questions? Like I said, as far as the um medical review, I mean, I would give it a few days, um, and we should have a response back then as far as that, um, and you, and then um we can go from there.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you very much, ma'am. Have a good day. God bless.
[AGENT][POSITIVE] You, Ms. [PII] thanks for calling APO.
[CUSTOMER][POSITIVE] Alright, God bless bye