AccountId: 011433970860
ContactId: 70ee18f3-1ee9-48db-b779-39894231ed8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 815140 ms
Total Talk Time (AGENT): 327538 ms
Total Talk Time (CUSTOMER): 377591 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/70ee18f3-1ee9-48db-b779-39894231ed8b_20250414T20:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, uh, [PII], uh, my name is [PII], and on Friday afternoon, I was speaking to one of your representatives, and she told me she had to go and talk to, uh, someone, and she was gonna call me back with the information, but I never did receive a call and she did not call back today. So I was wondering if you could look up my claim and see if you could help me uh with this.
[AGENT][POSITIVE] I sure can. Um and I'm definitely sorry you have not received the call back, um, but I'll be more than happy to help you, Ms. [PII]. May I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] OK. Uh, it would be uh [PII].
[CUSTOMER][NEUTRAL] OK, you ready for the policy number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 022450007
[AGENT][NEUTRAL] OK, thank you for that. Hold on one moment.
[AGENT][NEUTRAL] Here we go. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII] and what else you needed?
[AGENT][NEUTRAL] Um, your email address?
[CUSTOMER][NEUTRAL] My email address, right. It's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And hold on one moment.
[AGENT][NEUTRAL] And this is for your cancer policy?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The reason I'm asking, hold on one moment.
[AGENT][NEUTRAL] Because I don't see anything in here since [PII]. Hold on one second.
[AGENT][NEUTRAL] OK, so what's supposed to be what's happening, um, so there was a claim that was processed.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, but can I explain to you what's, what's happening, um,
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so my husband passed away in [PII].
[CUSTOMER][NEUTRAL] Uh, [PII], uh, it was cancer. But last, when we started with the cancer, I was working and he had cancer and I was trying to get into treatments and it was just too much. So I, I had filed something really quickly in the process when it first started and then I just never sent anything else in. So now I'm starting to send
[CUSTOMER][NEUTRAL] Then we want to start to send in all of the cancer, uh, claims that uh cancer bills that we have. And so I started looking at all of this, and he's had a lot of, he had a lot of treatment from [PII] until he died in December. So when I, and I, I didn't write the person's name down. I feel like I should have done that, but I didn't. So what I explained to her.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I printed out the cancer forms from online.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so I made a whole bunch of them. But then when I started looking at it, it's like, it's very overwhelming. So I was wondering, my first question to her was, could I put, like, let's say we went to [PII] [PII], and he had 3 things done in one day, maybe blood tests, maybe a CAT scan. Could I put that on one form or do I have to do an individual form for every single procedure he's had?
[AGENT][POSITIVE] Oh no. OK, so, um you can group it together. So I would just do everything that's the same. So if he had like treat like uh I'm just using this because it's one of the benefits I remember. If they have like, if he's had chemo or radiation treatments that you're wanting to file for, I'll put all those together, all the tests and get, you know, and just use that form.
[AGENT][NEUTRAL] Because it'll be different submissions. So I would just use that one form for all of that group, not each. No, no, no, you don't have to do anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, and then on the itemized bill, I would need to find that and highlighted on the itemized bill from the hospital.
[AGENT][NEUTRAL] On the itemized bill from the
[CUSTOMER][NEUTRAL] To attach
[CUSTOMER][NEUTRAL] Yeah, because you know I received.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Y'all would look at the item line. So this is, this is OK, [PII], uh, like I'm overwhelmed, [PII], over here, you know, I'm dealing with his loss. I'm dealing with trying to get all this paperwork done and I'm just like, I'm overwhelmed, OK? And I'm trying my very best to do it. So what I was wondering,
[CUSTOMER][NEUTRAL] Is there a way that I could just send all my itemized bills in to y'all since we already have an open claim and y'all could just go through it and see what would be covered or do I have to do individual for everything?
[AGENT][NEUTRAL] So here's the thing, to be honest, because you got, you all have had cancer policies with us since [PII], but they are different policies.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, what the easiest thing to do is I can give you the policy numbers and the dates that the policies were effective.
[AGENT][NEUTRAL] And terminate it. From there, you can look at the dates of service that you have to first see which which policy we would even be filing under because on that claim form you're going to have to put the policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so what do you mean Terminated? Like a they terminated him when he died, but that should be the only thing that's terminated, huh?
[AGENT][NEUTRAL] No, I'm just saying, so like from [PII] now you've had 12345 policies, so terminated one ended and another one began.
[CUSTOMER][NEUTRAL] 00 OK alright OK so and I need to have the like the policy number from that particular year.
[AGENT][NEUTRAL] Right, because you can file the claim at any time as long as the policy was active on the date of service. So depending on the dates of service determines which cancer policy you'd be filing under.
[CUSTOMER][NEUTRAL] All right, so could you give that to me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Alright, so policy number 159.
[AGENT][NEUTRAL] 8500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] was active from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment, 985.
[AGENT][NEUTRAL] I just, as I'm doing this, I also want to make sure that
[AGENT][NEUTRAL] Was he on all the yeah, he's on all the policies. OK. So then the next one is 224.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 5007.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was effective from [PII].
[AGENT][NEUTRAL] To [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then 237-2086.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] was um processed, I'm sorry, was active from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, policy 252.
[AGENT][NEUTRAL] 2743.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] was active from [PII].
[AGENT][NEUTRAL] To [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the active policy you have now is 2582063, and that this has been active since [PII].
[CUSTOMER][NEUTRAL] OK. So, all right, so in your opinion,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I would have to look at like,
[CUSTOMER][NEUTRAL] So is there any way I could just send the itemized bills for these dates and, and y'all would just go through it or do I have to do all those claim forms?
[AGENT][NEUTRAL] Um, oh.
[AGENT][NEGATIVE] See, because if you send it in and it goes to the active one, it's just going to be denied because the the policy wasn't active on the data service.
[CUSTOMER][NEUTRAL] I know, but if I would take the itemized bills and like make sure that I just submit the 224500-007, for example, uh when we first found out he had cancer, anything that he had from the date we found out he had cancer through [PII], if I send that in.
[CUSTOMER][NEUTRAL] And do I have to do separate claim forms for each one of those, or can I just like, so like let's say on [PII], he had a blood test, he had uh MRI. So could I just send that in or do I have to do a separate claim form and check off MRI, check off whatever?
[AGENT][NEUTRAL] Uh, well, technically, yes, you're supposed to do a claim, not for each one, the one claim form can hold multiple.
[AGENT][NEUTRAL] can have multiple things um with it. So you can send a claim form.
[AGENT][NEUTRAL] I don't want to tell you no, because I know it's probably a lot, but at the same time, I just don't want to say yes and then you send it in and it's denied because it's one versus one account versus the other. You see what I'm saying?
[CUSTOMER][NEUTRAL] Oh, OK, but I know what you're talking about. Like I would be careful to send in like a whole stack of itemized bills, but I would, I would be careful to send in like for example, [PII], but
[CUSTOMER][NEUTRAL] It's like all those claim forms, you realize, you realize how many claim forms I'm gonna have to do.
[AGENT][NEUTRAL] [PII] under that one.
[CUSTOMER][NEUTRAL] You know, he's had like PSA tests. He had blood tests. He had MRIs, he had CAT scans, he had PET scans. So that's what I'm saying. Do I have to send in for each thing that he had? Do I send a
[AGENT][NEUTRAL] So let me ask
[AGENT][NEUTRAL] Let me ask you this. Is the provider saying that that is like the hospital, are they not willing to file these claims for you? Cause honestly, you're not supposed to have to do this. The hospital or the doctor's offices, that would be way easier for you. Are, are they like saying that they're not filing anymore or something?
[AGENT][NEGATIVE] I just, cause you can call them right now and tell them, hey, I have these cancer, I received these bills, I have this can these cancer policies. Can you bill my insurance?
[CUSTOMER][NEUTRAL] No, wait.
[CUSTOMER][NEUTRAL] And they would do it?
[AGENT][NEUTRAL] Yeah, because we don't have a timely filing and
[AGENT][NEUTRAL] Like this money is owed to them or you're trying to be reimbursed?
[CUSTOMER][NEUTRAL] No, it's all owed to me. I don't owe anybody. I'm gonna just do it myself, but alright, so I'm gonna just do it.
[AGENT][POSITIVE] OK, then yes, I would.
[AGENT][NEUTRAL] Uh, you, you can submit them.
[AGENT][NEUTRAL] Ah
[AGENT][NEGATIVE] I don't want to say to submit them, however, you know, you see fit, because then when we get it, if they don't go through it and it's denied.
[AGENT][NEUTRAL] versus just
[CUSTOMER][NEUTRAL] Yeah, yeah, I'm gonna, I'm gonna just do, I'm gonna just do it, um, but I'm glad you gave me the information about the different policy numbers. I, I didn't have any idea about that.
[AGENT][NEUTRAL] Yes, ma'am. So if you have stuff from.
[CUSTOMER][NEUTRAL] You know that I had all these different policies.
[AGENT][NEUTRAL] Mhm, and even for you.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Like if you have your, like your mammograms and things like that, um for your, if you have the wellness benefit, you can go back to [PII] too.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I don't think you might want to with all the work you have to do for your husband, but I'm just letting you know you have that option.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][POSITIVE] OK, well thank you so much, [PII]. I appreciate it. OK, thank you. Alright, I'll, uh, oh, no, no, that's it. So thank you so much. OK, bye bye.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Was there anything else I can help with?
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.