AccountId: 011433970860
ContactId: 841da936-212c-4e21-ba04-8f9cba540e50
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 518058 ms
Total Talk Time (AGENT): 225504 ms
Total Talk Time (CUSTOMER): 290757 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/841da936-212c-4e21-ba04-8f9cba540e50_20250314T20:12_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. How are you?
[AGENT][POSITIVE] Hey [PII], I'm good. How are you doing?
[CUSTOMER][NEUTRAL] I am good. I have an insured on the phone. Uh, her husband was diagnosed with a melanoma or something and let's see if that's covered under her policy.
[AGENT][POSITIVE] Good.
[AGENT][NEUTRAL] OK. All right, [PII], um, what's her name and the policy number?
[CUSTOMER][NEUTRAL] OK, uh, the policy number is 699113. Now he was diagnosed before the end of the policy, so.
[CUSTOMER][NEUTRAL] She's just wanting to see if it and if it was all right to to file a claim and her name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Uh huh and she's verified.
[AGENT][NEUTRAL] OK and her number she's calling from is that a good call back number?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][POSITIVE] OK, thank you, [PII], you could go ahead and put her through.
[CUSTOMER][POSITIVE] Alright, thank you [PII]. Alright, here she is.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII]. I'm with the care team.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hello, so I understand you want to file a claim on your husband, is that correct?
[CUSTOMER][NEUTRAL] Yes, if he, if it qualifies, I don't know.
[CUSTOMER][NEUTRAL] You know, I've already retired and was cleaning out papers and ran across this and just happened to
[CUSTOMER][POSITIVE] went through it and see it and I thought, oh my goodness, um, and oh it was.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And [PII] let me know that the service was before um [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am. He was diagnosed um in [PII], right before I retired. It just flat ruined our my retirement. But praise [PII], turned out, it, it really was melanoma, but it turned out not to be what the original diagnosis. It was not as bad as the original diagnosis. And he had to have surgery, but everything's been great. So, you know, we're just
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Oh, no.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][MIXED] So thankful for that, but still, I don't know if it's.
[AGENT][NEUTRAL] Wonder. Yes, ma'am.
[CUSTOMER][NEUTRAL] Covered or not.
[AGENT][NEUTRAL] Well, well, what I'm going to have you do is go ahead and send in the claim because when you mentioned surgery, um,
[AGENT][NEUTRAL] That sparked for me so I'm going to go ahead and have you send in the claim and file a claim on it just to to make sure you know just in case there is something that can be paid on it um let me take you to our website so that you can get the claim form um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's you're gonna go to [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], yes ma'am. Once you get to that website up at the top right hand corner you're gonna click on claims and forms.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you're gonna choose the cancer claim form, which is, if I'm not mistaken, I think it's, it's the 3rd 1 down.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] When you open that page.
[AGENT][NEUTRAL] When you download the claim form.
[AGENT][NEUTRAL] That first
[AGENT][NEUTRAL] The page that is on the claim form is a little cheat sheet that tells you exactly what you need to send with your claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Uh, and the big thing is to make sure you send in the pathology report that had the first diagnosis of cancer.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Along with um the explanation of benefits.
[AGENT][NEUTRAL] The primary insurance if you had it.
[AGENT][NEUTRAL] And the itemized statement from the facility that he was seen at that has the diagnosis of procedure codes.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] I'm right.
[AGENT][NEUTRAL] And then you'll also need um.
[CUSTOMER][NEUTRAL] Diagnosis and procedure.
[AGENT][NEUTRAL] Yes, ma'am. And since he had surgery, you'll need the operative report.
[CUSTOMER][NEUTRAL] OK. Now, the surgery was not until the surgery did not happen until July, but does that matter?
[AGENT][NEUTRAL] From the facility that he had a surgery at.
[CUSTOMER][NEUTRAL] As far as
[CUSTOMER][NEUTRAL] She said something about it had to be before, see.
[AGENT][NEUTRAL] Go ahead
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Yeah, go ahead and send it in, go ahead and send it in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It may not pay, but.
[AGENT][NEUTRAL] It would help if you sent it in to show that he had surgery later on.
[CUSTOMER][NEUTRAL] OK, OK, and see, I thought this was good through [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That was because all my insurance was good through [PII].
[CUSTOMER][NEUTRAL] They didn't consider
[CUSTOMER][NEUTRAL] Well, I don't know how I always considered to be real honest.
[CUSTOMER][NEUTRAL] I just did what they said.
[AGENT][NEUTRAL] We're actually showing, right, we're actually showing that um the last pay to date was [PII].
[CUSTOMER][NEUTRAL] OK. Well, I think maybe that might have been, they do, they did our checks over 12 months, even though I guess my retirement was [PII], but I still got the pay.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They take your 180 days or whatever it is and just divide it over 12 months. So my last check didn't come till August, so that might be why I'm thinking.
[CUSTOMER][NEUTRAL] Whatever it is I'm trying to think.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But OK, but I was still working when all this diagnosis happened and everything because it just ruined. Oh my gosh, it was horrible because, you know, usually melanoma a lot of times is the.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, I'm thanking the Lord that he is good, that he's good now, and you guys have gotten through that.
[CUSTOMER][POSITIVE] Oh listen, it is wonderful, yes.
[CUSTOMER][NEUTRAL] We sure did. And, and the oncologist, it was a dermatologist that diagnosed it, but, and did the biopsy, but um you know, they sent us straight on to an oncologist and um
[CUSTOMER][POSITIVE] He was just marvelous. And, and he was best friends with one of our son's best friends from one of our son's best friends from high school.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] They, the oncologist and our son's friend were best friends in college.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And, and we live in a little town called [PII], 80 miles east of [PII]. He was a, he's in a big hospital facility in [PII]. He was like, oh my [PII], he said, you're from [PII]? I have a good friend from [PII], and we're like, you are kidding. That kid we thought was like our own kid because he was at our house so much. So, and then the thing.
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That doctor was doing surgery and he was our son's age. It was like, whoa.
[CUSTOMER][NEUTRAL] You know, your kids just don't ever really grow up in your mind.
[CUSTOMER][NEUTRAL] Nor do their friends. But no. Well, OK. No, they don't, but, um, OK, so just do what you said and then send all this in and find out what happens, right?
[AGENT][NEGATIVE] No, they don't, they don't. No, they sure don't.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and when I go to look for all this, this, if I can't, if I need help I can call back, right?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes you can and once you send in claim if there's anything missing they'll send you a letter letting you know what's missing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you just send that in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Well, I will get it all sent in and if it does something great, if it doesn't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You know, nothing lost. So I appreciate your.
[AGENT][POSITIVE] Well, we'll just pray that it does.
[CUSTOMER][POSITIVE] Yes, that would be great. I appreciate it so much. Thank you.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful weekend. Is there anything else I can do to help you before we go?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] I can't think of anything. Thank you so much.
[AGENT][POSITIVE] You're welcome. You take care, Ms. [PII], and thank you for calling APL.
[CUSTOMER][POSITIVE] Alright you have a great weekend too.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] You too ma'am thank you bye bye.
[CUSTOMER][NEUTRAL] Uh-huh.