AccountId: 011433970860
ContactId: 7b398982-04d6-423e-9adb-85b7a8e5c484
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1504150 ms
Total Talk Time (AGENT): 466606 ms
Total Talk Time (CUSTOMER): 695535 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/7b398982-04d6-423e-9adb-85b7a8e5c484_20250609T18:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] This is [PII]. Um, I am trying to fill out some claim forms and I need my, um, policy numbers. I have an intensive care and I also have a cancer policy.
[AGENT][NEUTRAL] OK. Um, you said your last name was [PII]. Is that [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let me get that pulled up.
[CUSTOMER][NEUTRAL] It just it pay.
[CUSTOMER][NEUTRAL] What did you pay for hospital stay.
[AGENT][NEUTRAL] And first name was [PII], is that right?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let me get that, uh, your policy number pulled up and verify a few pieces of information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is your address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then lastly your email address.
[CUSTOMER][NEUTRAL] Um, probably you may have my husband's, it's [PII].
[AGENT][NEUTRAL] Uh, it looks like we might have a work email, possibly.
[CUSTOMER][NEUTRAL] OK, that would be [PII].
[CUSTOMER][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Do you want to keep that email the same or do you wanna change that?
[CUSTOMER][NEUTRAL] No, that's fine. That's fine. You have, you have both emails, don't you, [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, we just have that one email, the school email.
[CUSTOMER][NEUTRAL] OK, OK, that's fine. I would need to change it on.
[AGENT][NEUTRAL] OK, and then
[AGENT][NEUTRAL] Um, I can change it for you if you'd like, or.
[CUSTOMER][NEUTRAL] Just ask her if you need to change it. Does it I have on these cancer forms that I filled out. I have my husband's email because they were wanting here it's a claim for him and it was for his um.
[CUSTOMER][NEUTRAL] Cell phone number and his email.
[AGENT][NEUTRAL] OK, main thing is the policy number.
[CUSTOMER][NEUTRAL] But I'm policy.
[CUSTOMER][NEUTRAL] Ma'am?
[AGENT][NEUTRAL] Uh, the main thing, what, what we will look at is the actual policy number that you put on the claim form, so that other information is fine to keep it that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And then let me give you the claim, uh, so this is for your
[AGENT][NEUTRAL] Um, intensive care, um, coronary care policy. Are you ready for that number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, that number is 528.
[AGENT][NEUTRAL] 453.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then let me get the other policy.
[AGENT][NEUTRAL] OK, and then your cancer policy?
[AGENT][NEUTRAL] That number is 592.
[AGENT][NEUTRAL] 141.
[CUSTOMER][NEUTRAL] OK, on this intensive care, you said coronary care, what does that cover?
[AGENT][NEUTRAL] Um, so let me see.
[CUSTOMER][NEUTRAL] Does it cover cataracts?
[CUSTOMER][NEUTRAL] it would be hard to find out and going to a heart doctor.
[AGENT][NEUTRAL] Yeah, it would be like if, if you're in like a heart um intensive care unit, so something related to heart.
[CUSTOMER][NEUTRAL] But if you have heart surgery like valve replacement.
[AGENT][NEUTRAL] Um, let me see what it pays.
[AGENT][NEUTRAL] If you were in the CCU, then were you in the CCU for that or was he?
[CUSTOMER][NEUTRAL] No, but he's, he's going to be, he's gotta have a valve replaced.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] He's got a lazy
[AGENT][NEUTRAL] So it looks like for your policy, um, which is not a guarantee of payment, it's a basic outline of your policy.
[AGENT][NEUTRAL] For your benefits, days 1 through 30, it pays $600 per day. That's if you're in intensive care or coronary care unit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well, see, I submitted all the intensive care forms and they didn't cover.
[CUSTOMER][NEGATIVE] Didn't cover it at all.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And so I'm trying to redo.
[CUSTOMER][NEUTRAL] That was I said I told it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, another lady, I don't know if she works for, um,
[CUSTOMER][NEUTRAL] The company or what, but she said they coded it wrong so I've got.
[CUSTOMER][NEUTRAL] The um actual notes on the floor that says hopefully it says I hadn't run them off yet that he was in intensive care.
[AGENT][NEUTRAL] OK, was that from this year or what, what year was that from?
[CUSTOMER][NEUTRAL] It was from, I, I sent it in probably this last year but it was from [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, and then you said you submitted something again, um, because the last thing we have on file was our denial back from [PII].
[AGENT][NEUTRAL] So did you say you recently?
[CUSTOMER][NEUTRAL] Yeah, I see
[CUSTOMER][POSITIVE] No, I'm, I'm going to I'm working on it, a couple of friends of mine and I are helping.
[CUSTOMER][NEGATIVE] Helping me refile because I'm, I, I couldn't believe they didn't pay anything and he was in intensive care for several weeks plus, how long have I been.
[CUSTOMER][NEUTRAL] Or had this insurance probably 40 years.
[AGENT][NEUTRAL] Uh, looks.
[CUSTOMER][NEUTRAL] I mean, I've paid on
[CUSTOMER][NEUTRAL] I haven't just
[AGENT][NEUTRAL] We make sure what we received and make sure we don't need anything else before you gather that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, trust me, I know that.
[CUSTOMER][NEUTRAL] I mean like right now she's looking now.
[CUSTOMER][POSITIVE] Maybe she find that somebody that that's what they do and a lot of it is who you talk to that's how helpful.
[AGENT][NEUTRAL] So, the information that you submitted, it doesn't say on their ICU. Do you have, it does, yes, it says critical care services. So that, that was why we weren't able to reimburse. Do you, do you have some other type of documentation that shows he was in the ICU?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Like intensive care
[CUSTOMER][NEUTRAL] That's what we're fixing.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, I have gotten in touch with the hospital and they, they sent it to my husband's email. So we're gonna try to run that off and send with it because I think it's the actual um
[CUSTOMER][NEUTRAL] Notes from
[CUSTOMER][NEUTRAL] His stay. I mean, maybe it's nurses notes. I haven't looked at it yet, but
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, she told me it would say it said intensive care.
[AGENT][NEUTRAL] OK, well, that, that's why we had denied the claim, um, because nothing in here indicated intensive care unit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, my other question is, um,
[CUSTOMER][NEGATIVE] I've just got denial on his cancer, uh.
[CUSTOMER][NEUTRAL] On the cancer policy for him.
[CUSTOMER][NEUTRAL] Oh you need to get that cancer claim.
[AGENT][NEUTRAL] Uh, let me look up that one.
[CUSTOMER][NEUTRAL] I've got the cancer policy number. Oh, OK, you had that, yeah, oh no, she gave it to me.
[CUSTOMER][NEUTRAL] 00, she gave you. Oh, OK.
[AGENT][NEUTRAL] Hold on just a second.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][POSITIVE] You are fast on that computer, girl.
[AGENT][POSITIVE] Yeah, it's pretty, I've been typing my whole career.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I still kind of hunt and peck.
[AGENT][NEUTRAL] OK, let's get the other account pulled up. We'll see what's going on there.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Travel back and forth all over the country. Mhm.
[CUSTOMER][NEUTRAL] OK, here it says transportation on here.
[CUSTOMER][NEUTRAL] OK, I see it's got how much.
[CUSTOMER][NEUTRAL] How was I met
[CUSTOMER][NEUTRAL] I feel all that out because I I.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Oh is that treatment.
[AGENT][NEUTRAL] OK, yeah, it looks like we recently got some claims. Let me see what's going on with those. Let's see.
[AGENT][NEUTRAL] It looks like we need the pathology report that shows that diagnosis of cancer when it was first diagnosed.
[CUSTOMER][NEUTRAL] I thought I sent that.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] Has he had more than
[CUSTOMER][NEUTRAL] You said 3, so he needs 3 different pathology reports. Well, the first one would be have the 2 that were on the kidney. He had 2 different types of kidney, uh.
[CUSTOMER][NEUTRAL] Cancer on one kidney, so he has a whole kidney removed. And then he's had the cancer in the lining of the black.
[CUSTOMER][NEUTRAL] And I thought was I sent the pets out for. Are there any?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma, let me make sure I'm sending the right forms. Are there any new like uh critical care forms or cancer claim forms? I may be using an old form, but I, someone told me they thought that would be OK.
[AGENT][NEUTRAL] Yeah, that, that would be fine. Um, it's, it's not the forms, it's the documentation that we received. Let me make sure what else. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh girl, you've been so helpful.
[AGENT][POSITIVE] Oh, I'm glad to help. Uh, that's what we're here for. Definitely don't want this to be frustrating.
[AGENT][NEUTRAL] Or overwhelming
[CUSTOMER][NEUTRAL] Hey, can I, can I, can I ask for you next time I have a question?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Yeah, I mean, I'm gonna write that down, girl.
[AGENT][NEUTRAL] Yeah, I'm not. OK, so this is all from [PII] and [PII], it looks like, is that right?
[CUSTOMER][NEUTRAL] Yes, ma'am. And I'll have some from [PII] probably, but maybe not this time. I wanna get this much submitted.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] He can get the other from MD [PII]. He's gone to MD [PII] for all of it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see. Pulling up what we received to make sure we didn't just miss that pathology report.
[AGENT][NEUTRAL] I'll make sure we didn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But not because it was there and I found it to shoot that dog so she didn't.
[CUSTOMER][POSITIVE] Thank you so much and how much.
[CUSTOMER][NEUTRAL] Is in the back and.
[CUSTOMER][NEUTRAL] She, no, she just left the phone somewhere but he.
[CUSTOMER][NEUTRAL] you know and she's been there and of course [PII] would go out there.
[CUSTOMER][NEUTRAL] And it finally should let him in the house. She lets him out and he doesn't want, he goes to the backroom and she wants, he wants to come back in.
[CUSTOMER][NEGATIVE] And she needs to start crying in the house and she's wrong because the locking is so.
[AGENT][NEUTRAL] But do you know who what provider the pathology report would have been from? Would that be from MD [PII] or would it be a different provider?
[CUSTOMER][MIXED] Um, I think from I could be wrong. The great clinic one probably wouldn't do it, but the doctor the German.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] I've got one here that I think from the bladder.
[CUSTOMER][NEUTRAL] Yeah, it's a surgical interpretation.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Uh, this one is from.
[CUSTOMER][NEUTRAL] This is renal cell carcinoma.
[CUSTOMER][NEUTRAL] On this it's a, yeah, it says at the top pathology surgical interpretation details.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this was in [PII] under a [PII] [PII].
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] There's also one thing.
[CUSTOMER][NEUTRAL] Yeah, that's got the diagnosis um.
[CUSTOMER][NEUTRAL] [PII], we've got another one. Yeah, we've got another one for [PII]. This one is 12-2920.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is 21.
[AGENT][NEUTRAL] Yeah, I'm, I'm looking through all of these documentations. We received 44 pages.
[AGENT][NEUTRAL] Um, I'm not seeing the pathology report, so is that something that you would be able to send to us again?
[CUSTOMER][NEUTRAL] Ask her if this that uh this is probably not what they're wanting. As she's got the pathology surgical interpretation, but you need the actual report correct?
[AGENT][NEUTRAL] Yes, the one, so when they had the suspicion of cancer and then they went to do the um tissue sample and do a biopsy, that's what we're looking for is when the biopsy was performed and then it came back as cancer.
[CUSTOMER][NEUTRAL] Well, I think that's what so this is just telling, this is just explaining, I think this interpretation details. I think this is just explaining to the patient what it is. I don't think this is the actual biopsy, uh, because this one says the two tumors are just my mouth is dry different, but there were two tumors on one kidney and this tells what it was. Would that not be it?
[CUSTOMER][NEUTRAL] They were the 2 centimeter tumor.
[CUSTOMER][NEUTRAL] In the interpolar region shows a more papillary architecture.
[AGENT][NEUTRAL] Yeah, we
[AGENT][NEUTRAL] I think so that's after the, that's after the surgery, correct?
[CUSTOMER][NEUTRAL] You have this
[AGENT][NEUTRAL] Or is that before the surgery?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah they probably after they need to pass off.
[AGENT][NEUTRAL] OK, now, we need
[AGENT][NEUTRAL] Correct, yeah, pathology report, yeah.
[CUSTOMER][NEUTRAL] is there a different, I wonder, department from [PII] [PII] because all this came from medical records, I'm sure.
[AGENT][NEUTRAL] So is [PII] [PII] who diagnosed him or was it like a doctor in your city or close to your city?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm thinking that they diagnosed it at [PII] [PII].
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And they can get more, I may need to get more specific and see if there was somebody. I don't know, can't remember of him going to anybody else.
[CUSTOMER][NEUTRAL] Except the second time when he had it in his bladder.
[CUSTOMER][NEUTRAL] The first time he had 2 tumors on one kidney.
[CUSTOMER][NEUTRAL] And I have that report that just describes it.
[CUSTOMER][NEUTRAL] And then um the other one, I think that other one is for uh doctor um.
[CUSTOMER][NEUTRAL] Doctor [PII] sent the tissue off. That would be the pathology report then that that's on one of them. I wasn't, we'll, we can call and get that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, that it's whoever whoever took the tissue and sent it off that's, that's who should have it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, and that's all you need. That's why they didn't, they denied the cancer was because there was not a pathology report, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah yeah is is that.
[CUSTOMER][NEUTRAL] Policy, um, pay for the hospital stays like when you have 3.
[CUSTOMER][NEUTRAL] So if even if it's not to you does it pay or
[CUSTOMER][NEUTRAL] Any of that kind of stuff.
[AGENT][NEUTRAL] Um, let me see what it pays for.
[CUSTOMER][NEUTRAL] Is there any way I can get a copy of my policies mailed to me?
[AGENT][POSITIVE] Yeah, absolutely. I can put that request in.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, so this policy, um, this is not a guarantee of payment, basic outline of the policy.
[AGENT][NEUTRAL] So, it looks like for this policy on the cancer policy.
[AGENT][NEUTRAL] That pays if you're confined to the hospital, pays $100 per day, and then there's a benefit of $10,000.
[AGENT][NEUTRAL] Um, for chemo radiation.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] What if he had some kind of um immunotherapy or it's not chemo or radiation, would they cover that?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] It's got a whole list of different areas of the body and what it pays. Let me see if there's immunotherapy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Now for the immunotherapy, are they administering
[AGENT][NEUTRAL] Um, is that by like IV? Is that a drug, the immunotherapy?
[CUSTOMER][NEUTRAL] I think so. I think it was uh by the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't see immunotherapy outlined under the policy. It does have a drug and medicine benefit if you're confined. Um, so if you're inpatient, it just pays up to $250. Immunotherapy is not listed under this, um,
[AGENT][NEUTRAL] Under your scheduled benefits, um, so I don't see that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm saying that's what it's called. I don't know I've got some other terminology, but.
[CUSTOMER][NEUTRAL] I'll look for that or.
[CUSTOMER][NEUTRAL] When I submit the resubmit these claims, does it pay anything for actual surgery done?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so there is under the scheduled benefits. So you said it was kidney and bladder, correct?
[CUSTOMER][MIXED] correct, but they removed the kidney.
[AGENT][NEUTRAL] OK, um, for a nephrectomy, which is the removal of kidney that pays 1080.
[AGENT][NEUTRAL] And then, what about the bladder? Was that kept or was there a partial removal or?
[CUSTOMER][NEUTRAL] I'm thinking it is.
[CUSTOMER][NEUTRAL] No, not yet, you know, he's been receiving for that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] There's also um a benefit for biopsy of the kidney and the bladder. So there's a benefit of $100 for the bladder, $150 for the kidney.
[AGENT][NEUTRAL] So that would be, you'd be able to be reimbursed for that with the proper documentation. Um, let's see.
[AGENT][POSITIVE] And then there is a benefit to of the dollar amounts I mentioned for the kidney and bladder cancer or bladder surgeries, it pays 25%.
[AGENT][NEUTRAL] of that charge for anesthesia.
[AGENT][NEUTRAL] So, for example, for the kidney, it pays $1080 for the surgery.
[AGENT][NEUTRAL] And then 25% of that dollar amount.
[AGENT][NEUTRAL] would be paid for the anesthesia charge.
[CUSTOMER][NEUTRAL] OK, now let me um.
[CUSTOMER][NEUTRAL] What about like travel? We live in [PII] and
[CUSTOMER][NEUTRAL] We have to travel to [PII] to [PII], and sometimes it includes an overnight stay and I included that on the um
[CUSTOMER][NEUTRAL] On the forms that I submitted earlier.
[CUSTOMER][NEUTRAL] But um,
[CUSTOMER][NEUTRAL] Is there any coverage for that? I thought there was.
[AGENT][NEUTRAL] There is, um, for meals, uh, transportation, meals and lodging, actual charges up to $30 per day for lodging.
[AGENT][NEUTRAL] Um, $20 per day for meals, and then round round trip, um, is 40 cents per mile, it's more than 100 miles from your residence.
[CUSTOMER][NEUTRAL] OK, that would add up, but they have to live day by day and the days that they went and the number of miles and everything.
[AGENT][NEUTRAL] Yes, that's correct. We just need to, you know, the address of your, the residence with the address of the location you went to, and then um the dates that you did that, and then
[CUSTOMER][NEUTRAL] Yeah, but do they have to receive treatment like for chemo chemo or radiation or something like that or, or, or if it's just a visit like a checkup?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Does that make a difference?
[AGENT][NEUTRAL] Just said, no, it doesn't. Just getting any type of services regarding this cancer, that's what it would reimburse for.
[CUSTOMER][NEUTRAL] They only reimburse $30 a day for lodging.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] They hadn't stayed anywhere for like there nothing I guess.
[AGENT][NEUTRAL] Yeah, I know.
[CUSTOMER][POSITIVE] OK, I don't have to see if my girls have any other questions. I think we got it in my right.
[CUSTOMER][NEUTRAL] Get it sent in to you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] We'll, we'll send you the policy, um, I'll send you the policy certificates for both of these so you can look through those, um, and then if you have any questions at all, please don't hesitate to give us a call back.
[CUSTOMER][NEUTRAL] I will and I'm gonna ask for [PII].
[AGENT][POSITIVE] Well, it was a pleasure talking to you today, Ms. [PII]. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Y'all have any other? No, ma'am, thank you, but enjoy the rest of your day.
[AGENT][POSITIVE] All right. Thank you for calling APL. I hope you enjoy the rest of your day too.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you. Goodbye.