AccountId: 011433970860
ContactId: 7fcc3fa6-5fd9-4a82-9e79-d608f602d704
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1219119 ms
Total Talk Time (AGENT): 574443 ms
Total Talk Time (CUSTOMER): 657463 ms
Interruptions: 20
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/7fcc3fa6-5fd9-4a82-9e79-d608f602d704_20250423T13:17_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling AP. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm sorry, did you say [PII]?
[AGENT][NEUTRAL] Yes, ma'am, I do.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], um, and my husband's name is [PII], and this particular claim was on he, um, for him. He's, um, fighting cancer at MD [PII].
[CUSTOMER][NEUTRAL] And I had some questions if if you've got a minute.
[CUSTOMER][NEUTRAL] In regards to a recent client.
[AGENT][NEUTRAL] OK, Ms. [PII], so you're calling with regarding your husband's claim?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can try and help you with this, Ms. Bro, um.
[CUSTOMER][NEUTRAL] I think it
[AGENT][NEUTRAL] First off, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, it is [PII]. And the last name is actually [PII] and I do have a policy number if you need it.
[AGENT][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] OK, Ms. [PII]. Thank you. And what is that, what is that policy number, please?
[CUSTOMER][NEUTRAL] It is 996576.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you. So give me a moment please to get that information pulled up.
[CUSTOMER][NEUTRAL] Sure, sure, go right ahead.
[AGENT][NEUTRAL] OK, and Miss [PII], I will need to verify several things with you first for security purposes and
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So any information that is provided would be a a guarantee of payment. So first off, if you could please verify.
[AGENT][NEUTRAL] Your date of birth and then your husband's date of birth.
[CUSTOMER][NEUTRAL] I can do that. My birthday is [PII] and [PII]'s birthday is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. Thank you, Ms. [PII] and also the home mailing address for you all.
[CUSTOMER][NEUTRAL] OK doke, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And the phone number that we have on file is the same as the one that you gave me, so that is your best contact number. Is that correct? that we should have?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am. That's my number.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right. And lastly, your email address, please.
[CUSTOMER][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. All right, Ms. [PII], so yes, ma'am, I do see that.
[AGENT][NEUTRAL] It was just a claim that was processed on yesterday.
[CUSTOMER][NEUTRAL] Oh, you cut out a little bit there.
[CUSTOMER][NEUTRAL] Yes, ma'am. I, I had a question on that.
[AGENT][NEUTRAL] So, yes, ma'am.
[AGENT][NEUTRAL] OK. So, yes, ma'am. How can I help you with that?
[CUSTOMER][NEUTRAL] So yes ma'am, it shows that there's no amount paid so I'm a little bit confused um about why.
[AGENT][NEUTRAL] It shows that according to the remark on this information, medical records received by APL but not requested by APL.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, I don't know what that means.
[CUSTOMER][NEUTRAL] It was.
[AGENT][NEUTRAL] So we received some medical records for some reason but had requested that.
[CUSTOMER][NEUTRAL] You reckon.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But it didn't show where I was making a claim.
[AGENT][NEUTRAL] So that is what that was for.
[AGENT][NEUTRAL] No, ma'am. It just shows medical records received.
[CUSTOMER][NEUTRAL] OK, now first off, let's let's.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you received medical records.
[CUSTOMER][NEUTRAL] But you don't really know why you received them, is it because there wasn't a claim form with it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] Uh, yes, ma'am. We don't know what we were supposed to be reviewing. Yes, ma'am. Now, I'll be happy to connect you over with one of the examiners, but yes, ma'am, uh, there wasn't any indication as to what these medical records were for.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] It was only the
[CUSTOMER][NEUTRAL] Oh well.
[CUSTOMER][NEUTRAL] Yeah, maybe I should talk to him because.
[AGENT][NEUTRAL] Medical records, not a claim form, not.
[CUSTOMER][NEUTRAL] OK, well, let, and you know you might be able to help me here and it could be that necessarily I need to talk to the lady because see MD [PII], who is where we're having all of our treatments and things done, they are the.
[AGENT][NEUTRAL] Right. Yes, ma'am.
[CUSTOMER][NEUTRAL] One that told me they could file on our cancer policy for us we just needed that to give them the specific dates because he's got so much going on we didn't wanna file a whole bunch of stuff at one time and so I gave him the dates for you um to send to you any medical records between I think it was the [PII].
[CUSTOMER][NEUTRAL] Through the [PII] or [PII], [PII], and the reason I went back to the [PII] was because when they originally sent, when we originally sent in the first thing.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There were some, there were some things they did y'all didn't get from from us that you needed some coding numbers so I asked her to please send those and include those.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so,
[CUSTOMER][NEGATIVE] Maybe I should be doing this myself instead of them.
[AGENT][NEUTRAL] OK, because there are, so you're saying some of this information was for the previous claim?
[CUSTOMER][NEUTRAL] OK, the very first claim we made and the only claim so far was the initial, the initial pathology report diagnosing what [PII] has.
[AGENT][NEUTRAL] Uh-huh, OK.
[CUSTOMER][NEUTRAL] And so and we did receive that but in that there was also.
[CUSTOMER][NEUTRAL] Excuse me, um, some biopsy that was done, maybe some outpatient that day. It was on the [PII], but they, excuse me, I'm, my voice is cutting out now.
[CUSTOMER][NEGATIVE] They couldn't pay on some of those things. They couldn't pay on some of those things because they didn't have the, you didn't have the correct coding. I don't know if you see the information on the very first claim.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] Well, I can see, um, one of them for your date for a dirty service at [PII]. We were asking for a fully itemized bill.
[AGENT][NEUTRAL] Uh, fully authorized surgery bill that includes the procedure code and diagnosis code. So that is something we were needing, needing on that other claim.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That was on the very first one, right?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Where you paid out the 5000 along with uh some gas.
[AGENT][NEUTRAL] Yes, ma'am, not this one that we just, hm.
[CUSTOMER][NEGATIVE] I think it was some travel money you spent those two things, but you never, you did not receive that.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am. It was 5,0078.
[CUSTOMER][NEGATIVE] Yeah, um, but you have yet to receive.
[AGENT][NEGATIVE] No, we did not receive the itemized.
[CUSTOMER][NEUTRAL] OK, well that's what they were supposed to be sending you along with anything up to that had been done for Troy up to I wanna say it was the [PII] or [PII] um this this next one.
[CUSTOMER][NEGATIVE] So basically they really didn't send you anything?
[AGENT][NEUTRAL] Well, no, I mean, they sent us medical records, but it doesn't appear that based on this, based on this note,
[AGENT][NEUTRAL] That itemized bills with were received with that.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Because that does state.
[CUSTOMER][NEUTRAL] OK, well,
[CUSTOMER][NEUTRAL] Yes, well, I can understand why you would need those.
[AGENT][NEUTRAL] Cause we had to have the charges.
[AGENT][NEUTRAL] And all of that. Mhm.
[CUSTOMER][NEUTRAL] Sure, of course, of course, um, OK, well, we have to be headed to [PII] today.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I was going to request the next date for them to do but instead of that perhaps I need to be requesting all of that from them and then me actually to make the claim we're just not that computer literate and so when they said they could do it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's true. I understand. There's a whole lot.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] There is, there is a lot and so when they said they could do it for us, I would have thought they knew exactly what they needed to send you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, they sent us, according to this, again, they sent us medical records.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] OK, I'm writing down what you're telling me.
[AGENT][NEUTRAL] But that doesn't have the itemized bills with [PII]. Now, if you can access your portal, Ms. [PII].
[AGENT][NEUTRAL] From your cell phone and pull up that. OK, so not.
[CUSTOMER][POSITIVE] Yes, and I can.
[AGENT][NEUTRAL] OK, so if you were looking at it, it would be, let me go back to the screen. I'm so sorry, just.
[CUSTOMER][NEUTRAL] Sure, sure, that's OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] It would be under claim number 357.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 9668.
[AGENT][NEUTRAL] That is the claim that was reviewed back at the end of March where we paid that benefit that you were just discussing.
[AGENT][NEUTRAL] At 5000
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so that
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That, that claim number has additional remarks as far as what other information we were needing, and that's all on page two of your explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I think, yes, and I think.
[CUSTOMER][NEUTRAL] I think I.
[CUSTOMER][POSITIVE] I think I read that too because that's how I knew what you needed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But when she said she could handle it.
[CUSTOMER][NEGATIVE] It really wasn't handled like I thought it was being done.
[CUSTOMER][NEUTRAL] So, um,
[AGENT][NEUTRAL] Yes, because that's more than likely gonna have to come from the billing department instead of medical records.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] OK. OK. Thank you for that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Department, OK, what I'm going to do and I'll probably have to have some help, um, but I'm going to go this morning when we get there and see if I can't find out exactly what I need to collect and get it from them.
[CUSTOMER][NEUTRAL] Um, do you need the medical records as well?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, we already have those. I mean, we've received medical records.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But you mean I get it. So I'm talking more in line of future.
[AGENT][NEUTRAL] At
[AGENT][NEUTRAL] You know, up to this point.
[AGENT][NEUTRAL] Yes, the eas, I think the easiest thing, Ms. [PII], is that, I'm gonna go ahead, you can pull our claim form up for the cancer claim from our main website, OK, but I'm gonna go ahead and just email that to you right now because the
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Page one of that claim form, it tells you about completing the claim form itself and it also gives you bullet points as far as using for a checklist.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On what type of documents you need to submit with your claims.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, that makes sense. um, um, I think for the future.
[AGENT][NEUTRAL] OK, so that might make it easier that you.
[CUSTOMER][NEUTRAL] Yeah, but I guess now I'm just gonna ask this a dumb question over again. So when I, when I send, when I send this to you, of course I'm gonna be sending you the stuff that you need from the billing department of codes and charges and all that kind of stuff, but am I also going to include the medical record part of that as well?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I know question is dumb.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or will the bill the information.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, ma'am. That should be, yes. We don't have to have the medical records every time. If, again, when you
[CUSTOMER][NEUTRAL] Be enough.
[AGENT][NEUTRAL] Get the um claims when they, you get the claim.
[CUSTOMER][NEUTRAL] You cut out there are you.
[AGENT][NEUTRAL] I am and I'm so sorry there's something internally with our my system and it does that. Can you hear me OK, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] I can, I can now yes ma'am.
[AGENT][NEUTRAL] OK. So, for example, on one of the bullet points on the cancer claim form, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If, for example, he were going for, when a claim is, it's, it specifically reads this, when filing a claim for services such as hospitalizations, surgery, chemotherapy, immunotherapy,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Radiation therapy, hormone therapy, and they
[CUSTOMER][NEUTRAL] Oh, we cut out again. It got you. Uh-huh.
[AGENT][NEUTRAL] Anesthesia, etc.
[AGENT][NEUTRAL] Itemized medical bill from each medical provider.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Your explanation of benefits from your other medical carrier showing the amounts allowed and paid for each service.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Those, that is specifically listed on the claim form. So it's easy to use that is to say, OK, well let me just.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Its cut out again, cut out.
[AGENT][NEUTRAL] Just check this off, you know, example, if you have traveling.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, I, I, I'm just so sorry. I don't know why it's doing that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That's OK. That's OK. I got the just of that.
[AGENT][NEUTRAL] Um, but it, it will give you.
[AGENT][NEUTRAL] Right. So anytime if we were to have surgery, we would have to have, you know, like the operative report, if it's for prescriptions, a copy of the prescription.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, like, you know, when it's related to his chemo, if he's taking chemo or hormone therapy, pain, and anti-nausea applied through a pharmacy, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But not the entire medical record. You don't have to request that every time.
[AGENT][NEUTRAL] And if there's, if there is additional information that we need. So hypothetically, you submit stuff like you did before, we were missing some stuff, then you just need to provide us with that specific missing stuff that we need.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, OK. Well, that helps me out a lot to know what we're gonna try to handle this ourselves instead of giving it to them because basically it's been a waste of time.
[CUSTOMER][NEGATIVE] Um, another thing we've done on our own, we did something wrong that we shouldn't have done.
[AGENT][NEUTRAL] Mm, well, I mean,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the, um, last night.
[CUSTOMER][NEUTRAL] See, I went back I had requested because I've had this policy forever and I've made very, very few claims on it and the young lady that I talked to the very first time, she told me kind of went through some processes sort of like what you did here, but she also said that we had to do it on the computer we couldn't do it on the iPad.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And well, but we had a problem with the computer last night when I was trying to download some past stuff for me, uh, like from [PII] up to present like mammograms and things like that. Well, he, I'm with him on.
[AGENT][NEUTRAL] Uh oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] the bus because he said you email that to them that'll be fine. No, no, I got an email back saying you can't do that because it, it opens your stuff up and so I said, well, um we won't do that again.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Oh, don't do that.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, we can't accept, we can't accept emails via email, uh, we can't accept claims via email due to security purposes, so the portal is very secure and then the second you could fax it to our.
[CUSTOMER][NEUTRAL] So we'll, we'll.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what it said.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I did see that too you said that in the email to me.
[AGENT][NEUTRAL] Secured fax line which is on the bottom. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, yeah, I got that information too.
[AGENT][NEUTRAL] And then there's one, or, or mailing it, which is obviously the slowest. So, yes, ma'am. Um.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Right now, I will tell you some people.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Technically, Ms. [PII], that is correct, is being able to upload.
[CUSTOMER][NEUTRAL] Oops, you said that.
[AGENT][NEUTRAL] From your cell phone or a tablet. Now, I have spoken to people who tell me they have been able to update or excuse me, upload things from the portal or to the portal from their mobile device.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that, according to IT that really should not be a, but you could try it. It'd be worth a try and see if you could do it, but.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I can always try.
[CUSTOMER][POSITIVE] Yeah, well, we'll, we, we can get access to another computer. We just, it was his company one and he was having some trouble with it getting on so um we'll probably just get let somebody straighten that out for us and and do all of this ourselves so OK well you've given me some to dos today and I appreciate your time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Well, you're welcome, and I'm going to send this email to you in just a moment, Ms. [PII], and again, it will come from care team.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] [PII]. I will put APL um in the subject line and cancer claim form just so that you'll have that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can see what, what you need, OK?
[CUSTOMER][POSITIVE] Thank you so very much.
[AGENT][NEUTRAL] For
[CUSTOMER][POSITIVE] OK, thank you again I appreciate it.
[AGENT][NEUTRAL] You're very
[AGENT][POSITIVE] Yes, ma'am. You're welcome. And again, anything else I can help you with today?
[CUSTOMER][NEUTRAL] That that.
[CUSTOMER][NEUTRAL] Nope, I think that'll do it.
[AGENT][POSITIVE] All right. Well, thank you.
[AGENT][POSITIVE] OK, well, thank you so much for calling APL. I hope you have a nice day and a safe trip back and forth.
[CUSTOMER][POSITIVE] Thank you. Thank you so much. I appreciate it. Bye-bye.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. Bye-bye.