AccountId: 011433970860
ContactId: 8c5e59bf-c9de-4639-8b43-fe5326e00e36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667890 ms
Total Talk Time (AGENT): 205497 ms
Total Talk Time (CUSTOMER): 307201 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/8c5e59bf-c9de-4639-8b43-fe5326e00e36_20250409T22:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I was calling because I had, uh, started a claim here for my policy, and I was just reading some of the notes, um, on it, and so I just want to make sure I kind of communicated some of back to you guys and what they were asking me to do before I get some of that in the mail.
[AGENT][NEUTRAL] OK, sure. Um, do you have your policy number?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It is 0254.
[CUSTOMER][NEUTRAL] 021 9
[AGENT][POSITIVE] OK, thank you, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and what was your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and then I just need a few pieces of information. Um, could you give me a good callback number just in case the call gets dropped?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK. And what is your birth date?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and last thing is your email address.
[CUSTOMER][NEUTRAL] Uh yes, [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, and um was it on a claim that we had previously requested more information?
[CUSTOMER][NEUTRAL] Yeah, I just opened one last week. Um, I just completed a mammogram and ultrasound, and then went in for a biopsy. And so once I got the results of that biopsy back, I went ahead and opened up a claim after talking to one of my, one of y'all's reps last week too. Um, so,
[CUSTOMER][NEUTRAL] She told me to go online and fill out just to start the process, uh, the initial claim, uh, a claim form, so I did. And part of it was asking like, did I have to stay in a hotel or reimbursement for transportation and stuff. Um, which I even asked them. I was like, well, none of that is applicable, because I didn't go more than 50 miles and I didn't need to stay in a hotel and all of that. And she's like, no, that's just standard. But that's one of the remarks that they have on here was,
[CUSTOMER][NEUTRAL] Um, we're not able to do anything about transportation. I'm like, well, I know that's why I didn't fill it out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But for the
[CUSTOMER][NEUTRAL] Um, mammogram and ultrasound.
[CUSTOMER][NEUTRAL] I submitted what they gave me because I said, you know, I need it to be the detailed bill along with like the billing codes, which is what they gave me, so that's what I submitted but.
[CUSTOMER][NEGATIVE] They're saying something about needing something for anesthesia and stuff, and I didn't submit anything about anesthesia. Like, that's why I think they're having confusion.
[AGENT][NEUTRAL] OK, let me see what's going on. Let me pull up what we received.
[AGENT][NEUTRAL] See if I can
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So have you been diagnosed with cancer?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then so did all, have you had treatment?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, just the initial process of the diagnosis and biopsy, etc. Is that what's transpired so far? OK, OK.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK, let's see. Um.
[AGENT][NEUTRAL] OK, so I see what we received.
[AGENT][NEUTRAL] This is the pathology results.
[AGENT][POSITIVE] Um, which that's definitely something that we need, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Looking through here. Just give me one moment.
[CUSTOMER][POSITIVE] You're good.
[AGENT][NEUTRAL] So, and the biopsy was, that was just an outpatient procedure at the hospital, correct?
[CUSTOMER][NEUTRAL] Correct. Um, and I was getting, I like, I didn't submit a bill for that. Like I'm not, I was, I only did the biopsy there.
[CUSTOMER][NEUTRAL] Um, I just submitted only the bill for the ultrasound and mammogram.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From uh Touchstone.
[AGENT][NEUTRAL] Let
[AGENT][NEUTRAL] Just trying to look, we've received a few things. I'm trying to make sure I'm looking at the right thing here.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, it looks like um
[AGENT][NEUTRAL] Yeah, I'm trying to decipher what, there's a lot of codes on here, so let's see what.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it looks like there is a pre-existing clause on the policy. Did you get that piece of information from us?
[AGENT][NEUTRAL] Asking if you'd been a preexisting condition.
[CUSTOMER][NEUTRAL] There's a note, like, because I did everything online, there's a note that says fill out the enclosed form, but of course, I guess they're sending that in the mail, um, because I can only see two pages that were uploaded back to this on my account online, which just says, um,
[CUSTOMER][NEUTRAL] Like explanation of benefit.
[CUSTOMER][NEUTRAL] To the provider and then it includes all these notes at the bottom so I can't see any other form that they're referencing that I need to fill out.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So I'm assuming it's coming in the mail, but I at least in the meantime, wanted to make sure people knew, like, not asking for hotel transportation and stuff. The only thing I'm, that I was instructed was, if I do get the diagnosis of cancer, um, you know, go in, submit the claim form.
[CUSTOMER][NEUTRAL] Along with that diagnosis, and I can see about getting the ultrasound mammogram.
[CUSTOMER][NEUTRAL] Uh, paid for. I've only, I've paid part of the bill and then.
[CUSTOMER][NEUTRAL] To go from there if I needed reimbursement for what I have paid or how all those benefits work.
[AGENT][NEUTRAL] Right, OK, so yes, I do.
[CUSTOMER][NEUTRAL] That's all I have so far, so.
[AGENT][NEUTRAL] So yes, it looks like they have put in the mail. You should get that any day now. Um, there's a pre-existing form to complete and basically it's wanting to make sure that you've not been seen for this diagnosis in the past or been diagnosed with this prior to the policy effective date.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Um, so that, that should come in the next few working days, um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] I would think that.
[CUSTOMER][NEUTRAL] Yeah, I think they just updated everything on this on the [PII], so it should be here hopefully at this week, but I was like, well, let me just make sure I call because because I know some of these can take time, so I was like, well, let me just try to be as on top of this as I can.
[AGENT][POSITIVE] Yes, it should.
[AGENT][NEUTRAL] Yeah, totally, totally understand. Um, so yes, if you'll wait to receive that form, get that completed, um, yeah, the transportation, I, I don't know why they put that on there because I don't see that you've submitted anything for transportation, so, um.
[CUSTOMER][NEGATIVE] All right. Well, when I asked the lady I talked to you last week, I was like, that's a little odd that that's your initial claim form is about transportation. I was like, I just need somebody to know like, hey, this is where I'm at in the process. What do I do? And I'm like, transportation, that just seems odd. I feel like they would want to know something not just about a hospital stay or whatever, or hotel. I'm like, OK. I was like, great. I already messed this up.
[AGENT][NEUTRAL] Yeah, and
[AGENT][NEUTRAL] Oh no, no, she can't mess it up. Um, there is a transportation benefit, but yeah, I'm not sure why that, um.
[AGENT][POSITIVE] That was on there because like I said, yes, there is that benefit.
[CUSTOMER][NEUTRAL] Yeah, like if I even, even if I just go where it says claims and forms on the website.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It says, well, once you sign in and stuff, uh, downloaded complete the appropriate claim forms, did it by product.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Cause like it says like, disclose information, change and request forms, continuation, direct deposit, miscellaneous tax waivers. I was like, I don't know which one. And she said, just click on where it says Can claim form, download it.
[CUSTOMER][NEUTRAL] And it's 4 pages, because of course, it's not front and back, um, but on page 2, that's where immediately asks about, you know, your policy info, and then non-local transportation and family member lodging. And I'm like,
[CUSTOMER][NEUTRAL] They want that? What? What does that have to do with starting a claim?
[AGENT][NEUTRAL] Yeah, I think what we we try to do is is put everything that you could potentially be claiming a benefit for onto the claim form so that's why that would be on there yeah um so from what I can see right here, the very first thing that we need to determine is that there's no preexisting conditions that you haven't had this in the past.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So if you will, when you get that form, let's if you'll wait for that, wait for the form, complete that form, and then from there we'll be able to start determining what's what we can, um, you know, pay on the policy, but the preexisting piece has to be completed before anything else is done, so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Um, but yeah, you should get that any day now. So, and if you have any questions at all when you get the form, have any questions about how to fill it out, please don't hesitate to give us a call back and we'll, we'll walk you through that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. I appreciate it.
[AGENT][POSITIVE] OK, well, thank you for calling [PII]. I hope you have a good evening.
[CUSTOMER][POSITIVE] Thanks you too.