AccountId: 011433970860
ContactId: 755153e1-f531-4c44-98f7-519e977a6cdf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 581700 ms
Total Talk Time (AGENT): 312931 ms
Total Talk Time (CUSTOMER): 276513 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/755153e1-f531-4c44-98f7-519e977a6cdf_20250225T18:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking? How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me give you my account number. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's a good call back number for you, Miss [PII], in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you for that information and how may I help you today?
[CUSTOMER][NEUTRAL] Well, I am fixing to send you guys um information. Hang on just a second.
[CUSTOMER][NEUTRAL] I had um on my insurance.
[CUSTOMER][NEGATIVE] a ICU, I get, they're calling it a rider. Uh, my husband had cancer and he was in, had to go into the ICU July, I think it's the [PII], and he passed away [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I have all of his medical records for the last two weeks of being in the ICU and I was going to FedEx them over and I wanted to make sure that I am sending the right form.
[CUSTOMER][NEUTRAL] Uh, with it, because I looked at the cancer form, and the cancer form is just like a to it just asks to your travel. It doesn't ask, it's not anything else. So I, I just need to make sure that this is the right one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] OK, well, let me get you to verify uh your date of birth and your, your mailing address please.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII].
[CUSTOMER][NEUTRAL] And the mailing address is [PII].
[AGENT][POSITIVE] Thank you. And what's your email address?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][POSITIVE] Thank you for verifying that information for me, Miss [PII]. So I'll be able to assist you with uh the claim form that you have in hand and uh just a moment. I wanna make sure. Did you report, uh, well, first of all, I'll please accept our condolences for your loss and you're welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just checking the notes to make sure that um you called in and reported he had passed away. Let's see here.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Did you uh send in a death certificate?
[CUSTOMER][NEUTRAL] I'm sending the death certificate along with all of the information I have.
[AGENT][NEUTRAL] OK, great. OK, so we'll just go from there. Um, so, so what you, that, that cancer claim form would be the correct form because the ICU is a writer on this policy. So it's a writer on the cancer policy. All right? So what you need is that cancer form. In addition to that cancer form, you need um an itemized bill from the facility where he was admitted to ICU with procedure codes, dates of service and charge amounts for review.
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK, I have.
[AGENT][NEUTRAL] And we need to admit and discharge summary as well.
[CUSTOMER][NEUTRAL] An admin and discharge you mean where they say that he is, he died?
[AGENT][NEUTRAL] No, admission and discharge summary. Mhm. Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK, I think that's in all of their notes because there's over.
[AGENT][NEUTRAL] Yeah, it, it's more than likely it is. Mhm.
[CUSTOMER][NEUTRAL] OK, and I, I'll be very honest, I have no idea where these medical bills could be, um.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I, I don't know. Um, I've just got 540 pages of the last two weeks of his life.
[CUSTOMER][NEUTRAL] In ICU
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if it's just, uh, just FYI to you if that's just notes and it's not an itemized bill, an itemized bill would show a procedure code, a data service and a charge amount.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um, that's something that you probably would have to request from them, uh, because they, they normally don't just automatically put that in medical records. So, um, if you send in those pages and we don't have that itemized bill, then that's gonna hold the claim up and we're gonna request it because that's something that we have to have. That's how we determine, uh, where was he truly charged for an ICU room, OK? So, um.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm you can ask that facility for a copy of their UBO4 which is what they bill to the insurance company, which will show all that information we need.
[CUSTOMER][NEUTRAL] OK, and also send the medical records that I have because I had them on a thumb drive and I just got them printed off.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Um, you know, um, you can submit those for review because I'm seeing that looks like some things have been requested like they requested a pathology report. Was it ever, uh, let me take a look at his history and see, um.
[CUSTOMER][NEGATIVE] I've had an awful lot of issues, um, when he had had cancer. Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it seemed like
[CUSTOMER][NEUTRAL] The company wanted more and more and more information from.
[CUSTOMER][NEGATIVE] Uh, the, um, from the hospital, from the doctor, I mean, from everybody. And we, we never got, uh, they never would pay anything and I've had the policy for over 20 years.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] So, and I, I understand that, but it was because we never received the pathology report. And unfortunately, uh, when you have a cancer policy, you have the burden of proof. You have to prove that you or the dependent had cancer. We don't just file, pay out benefits without proof that this person was diagnosed with cancer. So we never received proof. We never received the pathology report. So hopefully, it's in those medical records that you're sending over.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, you had.
[CUSTOMER][NEUTRAL] I press it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, I can tell you I did send those and it just got more seriously, I did send those and it it was so much paper.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That I can remember.
[CUSTOMER][NEGATIVE] We, my husband and I just gave up after a while cause it just, it, it was everything we had, everything the hospital gave us.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And still nothing.
[CUSTOMER][NEUTRAL] So I'm, I'm not.
[CUSTOMER][POSITIVE] You know I don't want to complain to you because that's like in the past right now this I'm dealing with this right now.
[AGENT][NEUTRAL] Right, but I do want you to receive all of your benefits and while I do know APL requests a lot of information.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Um, once we have that information, we do make the, we do make the payment according to your benefits. So, you know, I would hate for you to just throw your hands up cause I see he was receiving immunotherapy and we, unfortunately, um, that cancer claim form that you're talking about, it should have been 2 pages and the very first page tells you what we need on there for you to have a clean claim for your claim to be processed and not be held up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So I would hate for you to just, you know, um, give up on that. Uh, I would say, you know, but that's totally to your discretion and hopefully some of this information, I would assume that it's gonna be in that 500 pages that you're gonna send over. Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, I
[CUSTOMER][NEUTRAL] I would think so too. It's the doctor's not. I mean, it's every single thing they did to him.
[AGENT][NEUTRAL] Yeah, so the only
[AGENT][NEUTRAL] Right, so the only thing I, I'm afraid that's not gonna be in there is an itemized bill. So like I said, I would just reach out to the facility and ask them for uh a itemized uh their itemized bill and you can ask them for a UBO4. That's what they bill on a copy of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then once I, once I get that I can just submit all of this in?
[AGENT][POSITIVE] Yes, you can.
[CUSTOMER][NEUTRAL] Because I'm sure, I'm sure somewhere it's there. It's just, you know, I, um
[CUSTOMER][NEUTRAL] I've never, I never put it this way, my husband did it all.
[AGENT][NEUTRAL] Oh, I understand.
[CUSTOMER][NEUTRAL] So I never did anything. And it's just been a very big learning curve, being a widow. So I am
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] I appreciate your compassion on this because not many people I've talked with in this company has been compassionate. But um I will, I will definitely get this information. It's somewhere either at home or I'll just call the hospital because they were there so.
[AGENT][POSITIVE] And you're welcome.
[AGENT][POSITIVE] Oh, I'm so sorry, Ms. [PII].
[AGENT][NEUTRAL] You know what, Ms. [PII], when you get it, when you get it, if you have any other questions, you can ask to speak to [PII]. I'm in the cancer department. So, um, we're, I'm one of the ones that I don't know if I will get your husband's uh case, but when it's a
[AGENT][NEUTRAL] Sign it may be assigned to me or it may be assigned to one of my uh co-workers, but if you have any questions, you and you you wanna ask something or you wanna call and say hey I submitted that in, you can ask for [PII] and that way you don't have to deal with anybody else, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] I honestly appreciate it. I really, really do.
[AGENT][POSITIVE] You're quite welcome. Yes, ma'am.
[CUSTOMER][POSITIVE] I'll get this to you. Thank you so much.
[AGENT][POSITIVE] OK. You take care of yourself. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] I will.
[CUSTOMER][POSITIVE] No, that's it. Thank you again.
[AGENT][POSITIVE] All right. Thank you for calling APL. You're welcome, Ms. [PII]. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Goodbye.