AccountId: 011433970860
ContactId: 7f3a6305-3a78-489e-b143-f715032d72f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1354719 ms
Total Talk Time (AGENT): 599591 ms
Total Talk Time (CUSTOMER): 576847 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/7f3a6305-3a78-489e-b143-f715032d72f6_20250421T21:25_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] Hi [PII], this is uh [PII]. I'm gonna try to take you off there we go. I was trying to register online and um I had an error come up says oops, there's a problem. Call customer service exercise option 4. apparently it doesn't like my member ID number.
[AGENT][NEUTRAL] OK, um, well, I can definitely help you with the sign up. Um, may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[CUSTOMER][NEUTRAL] Let me look up and get my policy number for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 248-4224842.
[AGENT][NEUTRAL] 24842. OK, hold on one moment.
[AGENT][NEUTRAL] That may be your group number. Hold on one second.
[CUSTOMER][NEUTRAL] It does say policy number on my certificate schedule.
[AGENT][NEUTRAL] Does, do you see anywhere that says policy certificate number?
[CUSTOMER][NEUTRAL] You want the certificate number?
[AGENT][NEUTRAL] Yes, please, that's your policy number.
[CUSTOMER][NEUTRAL] OK, it's [PII]. I put that in there as my member ID and it wouldn't take it.
[AGENT][NEUTRAL] Wait, wait, say that one more time. 0253.
[CUSTOMER][NEUTRAL] 0202532534
[AGENT][NEUTRAL] 25
[CUSTOMER][NEUTRAL] It's a group policy with my school.
[CUSTOMER][NEGATIVE] Proper ISD.
[AGENT][NEUTRAL] OK, hold on one moment, 2534. Alright, so I have you here and I just need you to verify your date of birth, your mailing, and email address on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My mailing address is [PII], and I don't know, I, I, do you have [PII] or [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 20 yeah, that's my preferred one. And what else was the other thing you asked me?
[AGENT][NEUTRAL] Your date of birth.
[CUSTOMER][NEUTRAL] Oh, I'm old. [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. OK, so when that message pops up, it just means something being entered isn't matching what we have on file. So, um, I'm gonna go to where you are so we can do it together. At the bottom left, do you see a cancel button?
[CUSTOMER][NEUTRAL] Let me go down.
[AGENT][NEUTRAL] In the box that you're um in like with the username and everything.
[CUSTOMER][NEUTRAL] Yeah, I, I just, I just hit cancel, OK.
[AGENT][NEUTRAL] Alright, so for step one, we're going to click I'm an individual.
[AGENT][NEUTRAL] After you click new user.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] A new user I'm an individual. OK, next.
[AGENT][NEUTRAL] All right, so it's asking for your last name, where it says Social Security number or member ID, not the policy number, you're going to put your full social there because we only have policy numbers and socials.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Oh, I hate doing that.
[AGENT][NEUTRAL] OK, well, um, unfortunately, that's the only way to sign.
[CUSTOMER][NEUTRAL] I, I just
[CUSTOMER][NEUTRAL] I just did it. I had my identity assumed years ago. I'm try, I try to be real careful on giving that out.
[CUSTOMER][NEUTRAL] So let me uh let me fill this out while I put you on hold OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna hit next now see if it'll go.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Create your account username, password, email, and all that stuff.
[AGENT][NEUTRAL] Yes, so as long as you got the step 3, then you, you're past that. So once you create your username and password,
[AGENT][NEUTRAL] Um, it's gonna ask you for your phone number and then your cell phone number or a text message phone. Um, it's going to send you a verification and then, um, once you finish the verification, you'll have access to your dashboard.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The policy is for my wife and I, and on [PII], my wife was diagnosed via colonoscopy that she had a colorectal cancer. She's already had surgery, she's met with the doctors and stuff. And one a while back, uh, one of the persons told me that on your company said that just go ahead and start filing stuff right away.
[CUSTOMER][NEUTRAL] Everything I did just start submitting it or do you is that right? or should I just wait until we have more definitive information like she's gonna start chemo on the [PII] assuming she's healed real well from the surgery. Should I wait to file stuff or should I just go ahead as things come, you know, turn it in.
[AGENT][NEUTRAL] Well, so to be honest with you, you have two options. So either when you go to like the doctor's office or the hospital, um, any, any thing that that's going to use insurance, you can provide them with this policy number and our phone number, so that when they bill your um other insurances, they can go ahead and bill us as well, um, or you can file the claims on your own. It, it depends on what you'd like to do.
[CUSTOMER][NEUTRAL] OK, I didn't know that. So, like my wife has two follow-up visits tomorrow with the uh the, the, like a class to learn how she has a port put in to learn how to do the chemo and stuff, and then she has a, a meeting with the oncologist. So, uh, well I can give her the information, uh, like we, I just put in there my, what, what is she gonna need my certificate number and uh what does she need to give the doctor?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, just the certificate number and then our phone number, um, in case they want to verify benefits, we'll also give them the information on how to file a claim, but actually I would, well, you said it was tomorrow, if she, she can, she can do it tomorrow and then that way whatever has already been done, they can, because I'm sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If anything, they probably only filed it with primary if they filed already. So you may still have time for them to file with us too.
[CUSTOMER][NEGATIVE] Yeah I haven't turned anything.
[CUSTOMER][NEUTRAL] I didn't know we were. I thought this was a supplemental that after my primary paid then I filed, but you're basically educating me and telling me I can file at the same time we file with the primary insurance, so we haven't done that.
[AGENT][NEUTRAL] Right, so, um, well, you know what, let me, let me take a look. Um, do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure, that's fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, thank you so much for holding. So yes, this is, I just want to check on the policy type. So yes, um, this is like a supplemental cancer policy. So they're gonna bill your primary first, if you have Medicare, if you have other insurance, major insurance, they'll bill all of that. Then once they get everything back from them, they'll then bill us. So hopefully you won't receive a bill.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so we, we, so when tomorrow she goes, she gives the certificate number and the phone number uh and just put and the company is APL correct?
[AGENT][NEUTRAL] Yes, sir, and she'll just say I have a um
[AGENT][NEUTRAL] She can say additional, I have a supplemental, however she wants to word it, but I have a cancer policy and this is my policy number and this is the number to verify benefits.
[CUSTOMER][NEUTRAL] OK, the policy number is.
[CUSTOMER][NEUTRAL] My certificate number?
[AGENT][NEUTRAL] Yes, sir, the 253, mhm.
[CUSTOMER][NEUTRAL] Wait a minute. No, no.
[CUSTOMER][NEUTRAL] The certificate number is 0253. She gives them that and she gives them the policy number.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So what's listed?
[CUSTOMER][NEUTRAL] And you said the phone number?
[AGENT][NEUTRAL] What's listed on that card as um policy number is the group number. That 253 number is your policy number and then just the phone number.
[CUSTOMER][NEUTRAL] OK, the certificate number is the policy number.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the uh
[CUSTOMER][NEUTRAL] The group number is is what?
[AGENT][NEUTRAL] Hold on, let me see.
[CUSTOMER][NEUTRAL] Group number 24842.
[AGENT][NEUTRAL] That's 24, 24842 is your group number.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So we give them the group number, the policy number.
[CUSTOMER][NEUTRAL] And then you said the phone number, what's the best phone number to give them?
[AGENT][NEUTRAL] Um, our phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Just those 3 things.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. Now, in the course of the last month or so, she's had a, a CT scan, an MRI, uh, she's had a hospital, she's had surgery at the hospital, follow up with the doctor. So what do I do? Just, uh, those bills that I get from.
[CUSTOMER][NEUTRAL] The doctors just uh sent them in through this dashboard that I'm going to sign up I'm signing up for now.
[AGENT][NEUTRAL] You can or um if you do receive a bill because
[AGENT][NEUTRAL] How long ago did she have like the CAT scan and everything?
[CUSTOMER][NEUTRAL] She got diagnosed on the [PII] and I think the CAT scan was the following week.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then an MRI and the week after.
[AGENT][NEUTRAL] So depending on
[CUSTOMER][NEUTRAL] So it's been.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] It's been since [PII]. It hasn't been a very long.
[AGENT][NEUTRAL] OK, the pin.
[CUSTOMER][NEUTRAL] About 1 month 5 weeks.
[AGENT][NEUTRAL] So depending on how the billing department there, how fast they are, they may have already filed with your other insurances. So, tomorrow,
[CUSTOMER][NEGATIVE] They probably did because I had to pay, I had to pay deductibles though, like every time I see the uh the doctor, uh, the professional doctor for [PII], it's $35. The hospital was $335.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] The CT scans and the MRI's were 250 each that we paid for. So they, we've already paid for some of this stuff, uh, the doctor's visits and that, and then the primary gets built. I guess I have an advantage plan, so it's a cost plus type thing, you know, I pay my my down payment or whatever and they, they cover the rest of it. So we're already out, you know.
[CUSTOMER][NEUTRAL] Like the CT scan and the MRI's are been 500 and the hospital's been 335, so that's uh 835, and then we're probably a little less than 1000 that we've paid out already to doctors, specialists in care.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, so.
[AGENT][NEUTRAL] Tomorrow when she goes to the appointment, I would just check and see because [PII]t because you pay doesn't mean they filed already. They can file at any time. So, well, primary, most of the time has a has a timely filing limit, so that might, there may be a deadline there, but I would check tomorrow and see if they have filed any claims for any of her her her previous um services since February.
[AGENT][NEUTRAL] And give them this policy number and phone number to call, and then if they have already filed, they can go ahead and file with us. If they haven't filed, then they're gonna file with primary and everything, and then that's already on file, they'll just go ahead and file with us after.
[CUSTOMER][NEUTRAL] Um, so basically what you're saying is that, um, my, uh, the supplemental cancer policy I have for my wife and I with your company, uh, it will reimburse us for the MRI and the, and the CT scans and the hospital visit. So, how do, how do we get that? How do I file for that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's not really a reimbursement, so let me pull up your benefits, um, but that's what we're, the filing would be if you give them our information, the doctor is going to file unless you want to file.
[CUSTOMER][NEUTRAL] Well, they filed for the, the majority of it, but we had to pay, you know, the, they wouldn't do anything unless we paid the copays.
[AGENT][NEUTRAL] Right, so when I say
[CUSTOMER][NEUTRAL] So we usually have a choice.
[AGENT][NEUTRAL] Right, so when I say file, just because, so just because you're paying your co-pays and your deductible does not mean that the billing department has actually filed a claim. There
[AGENT][NEUTRAL] Filed a claim yet. I mean, they could file a claim at the end of the year for today. So there's no time frame. So what I'm saying is if when she goes tomorrow, she needs to see if other claims have been filed. If they have, then when she gives them our policy number and phone number.
[AGENT][NEUTRAL] They can then just automatically bill us because they've already built the other people, other policies. If they have not, then they're going to build the other policies and then she'll give them the information tomorrow. They'll have that and when the other um decisions come in, they'll already have this on file to go ahead and process for a bill.
[CUSTOMER][NEUTRAL] OK, so you're saying before any payments might be reimbursed us they need the billing needs to go to you directly somewhere you need to see the billing correct?
[AGENT][NEUTRAL] Mhm. So reimbursement, filing, all of that's the same, it's just different words. So,
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The reimbursement happens because the claim was filed. So all I'm saying is when she goes in tomorrow, she needs to see if from all the previous, from February till today, if they have actually sent the claims to the to your other insurance companies. If they have, then tomorrow when she gives them her insurance information.
[AGENT][NEUTRAL] They can just bill us if there's a remaining balance. If they have not filed with your other insurance companies, then they'll go ahead and file with them and tomorrow she's going to give them this policy, so they'll have that to file as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I understand that you want the filing is important but I don't see how that helps us.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] With the reimbursement?
[CUSTOMER][NEUTRAL] Yeah, because, uh, I'm looking at the information and the policy on the schedule of benefits, there's definitely reimbursements for like the chemotherapy and stuff I have to pull it back up, but.
[AGENT][NEUTRAL] Right, so that's how you use these benefits, filing a claim. So, filing reimbursement is the same thing, we're we're just using different terms. So the only way to get these benefits is to have a claim on file.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] kind of
[AGENT][NEUTRAL] Whether they send it or you.
[CUSTOMER][NEUTRAL] OK, when the claim is on file and you, when the claim is on file and you see that we've paid that APLCs that we paid the uh the the deductibles, what happens then is it, uh, they send me a check or something or how, how is, how do, how does that help us?
[AGENT][NEUTRAL] So deductibles and all of that, that's for your primary insurance. This policy here, once we receive a claim, um, it will pay up to $20,000 per 12-month period for radiation, chemo, or immunotherapy. So basically there's, there's like a list of benefits here and the dollar amount that will be paid for it. So when we get the billing, we can say, oh, she's had such and such, that's this amount. She already paid this.
[AGENT][NEUTRAL] So it just depends on the paperwork. The paperwork is filing the claim, that's what we need so that we can pay you or reimburse you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so in, in the, in the event, well, tomorrow she's only go tomorrow she sees somebody new for the chemo, you know, we're going online filling out all the questions, the whole book that you have to fill out for they want to know. So she's saying somebody new tomorrow that we could start off with the certificate number, policy number, and phone number, but for the, for the, I don't know that she'll go back for an MRI or a CT scan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So how do we, how do I approach that? That's already, that's already been taken care of. I don't expect what when I get an EOB or something from my uh primary, I send the EOB to you maybe put it on my dashboard.
[CUSTOMER][NEGATIVE] Because I don't think we'll go back there. I think we're done with them.
[AGENT][NEUTRAL] Well, you don't have to go back there. You can give them a call and let them know that you have this insurance so that they can bill it. But if you want to bill, if you want to file a claim, yes, you would just send the explanation of benefits and then the um itemized bill, well, first, you're going to need the pathology report.
[AGENT][NEUTRAL] The pathology report is going to show the the um positive diagnosis and then from there you can start um sending in like her billing for the chemo and the treatment that she's receiving.
[CUSTOMER][POSITIVE] That's easy.
[AGENT][NEUTRAL] It's the same thing. Either you can give them.
[CUSTOMER][NEUTRAL] And I also send
[CUSTOMER][NEUTRAL] And I send in the receipts that we have where we paid for the CT scan and the MRI and then um you can follow through with that APL will or is it on my shoulders to do that?
[AGENT][NEUTRAL] Well, no, that's why I'm trying to push for you to give them the policy number so you don't have to do any of this.
[AGENT][NEUTRAL] If you give them
[CUSTOMER][NEUTRAL] Or I can call them and say, look, we have, I, I can call them and I say, look, my wife had the CT scan date on this date and she had the MRI with you on this date. We have a supplemental cancer policy. Here's the information. We can go ahead and tell them tell them to go ahead and file it with you all.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Mhm. Here's my um secondary policy information or policy number and their phone number for you to call and verify benefits and bill, and then that's it.
[CUSTOMER][NEUTRAL] Verified benefit that's again I need to remember verify benefits and you know.
[CUSTOMER][NEUTRAL] OK, I can call them.
[AGENT][NEUTRAL] Now, I will say for her, for this policy, you all do have a first occurrence benefit, which is a lump sum payment that the policy will pay out directly to you all because there was a positive diagnosis and it's $5000. Now that one I would, I would encourage you to file because that money is for that goes to you or to her.
[CUSTOMER][NEUTRAL] That shouldn't be a problem.
[CUSTOMER][NEUTRAL] OK, so what, what that, when I go on the dashboard that you helped me set up, I go ahead and uh so there's a way in there to download and or scan and upload the path I have two pathology reports for some reason.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I can just upload those on the dashboard and that way that's under the uh not the wellness but the uh other other form I saw.
[AGENT][NEUTRAL] Yes, the cancer claim form. So you'll submit the cancer claim form, the pathology report, and any billing if you have it for the same date as the pathology report, and then you'll upload that onto the online service center, which is the portal we just did. And then um as it's processing, you'll see it there and then once the, once it's finished, you'll see the decision there first because that's linked to our system.
[CUSTOMER][NEUTRAL] There are two forms.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, how late are you guys open until, uh, are you guys just there at the [PII] central time?
[AGENT][NEUTRAL] Um, we're here until [PII] central time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well I'll start doing this if I have any questions I just wanted to know how late I could call back.
[AGENT][POSITIVE] Oh, yes, sir, you definitely can, and we're open at [PII] So if you need anything, definitely uh give us a call. We'll be more than happy to help.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about Saturdays and Sundays you guys or is anybody there?
[AGENT][NEUTRAL] No, sir, we don't work on the weekends.
[CUSTOMER][POSITIVE] Oh that's good for y'all, OK.
[CUSTOMER][POSITIVE] All right. Well, thank you very much for your help and I'll start, start filling this stuff out too. Appreciate it very much. Thank you.
[AGENT][POSITIVE] You're very welcome and thank you for calling APL. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, do you make home visits? No, I'm good.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] I'm good. Thank you very much. I appreciate it. OK.
[AGENT][POSITIVE] All right. You're welcome. Have a good evening.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] All right, you too, bye.