AccountId: 011433970860
ContactId: 8f83f511-6fbf-430d-97eb-9046b04265ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 570840 ms
Total Talk Time (AGENT): 221337 ms
Total Talk Time (CUSTOMER): 309088 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/8f83f511-6fbf-430d-97eb-9046b04265ac_20250219T15:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was wondering if I could speak with someone in the claims department. Would you be able to help me?
[AGENT][NEUTRAL] I can help you um with a claim. Is the claim for yourself or is it for a patient?
[CUSTOMER][NEUTRAL] No ma'am, it's for one of my clients I'm a broker.
[AGENT][NEUTRAL] OK, alright, I can help you with the claim. Can I please get your name and the group number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Last name is [PII]
[CUSTOMER][NEUTRAL] And the group number is 25538.
[AGENT][NEUTRAL] OK, thank you Ms. [PII] and then just in case our call gets disconnected, what is your callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK thank you let me pull that group up real quick.
[CUSTOMER][NEUTRAL] And really my question my claims question is pretty generic, but it is about a specific member with this group.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII], just for security reasons, can you verify the group's physical address for me, please?
[CUSTOMER][NEUTRAL] Yes, it is, uh, let me pull it up.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] OK thank you I appreciate you doing that and what is the name of the member that has the claim?
[CUSTOMER][NEUTRAL] Her, yes, her first name is [PII] Last name is [PII].
[CUSTOMER][NEUTRAL] S M
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Do you know her policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am, I do.
[AGENT][NEUTRAL] OK, what is that please?
[CUSTOMER][NEUTRAL] 2206172
[AGENT][NEUTRAL] OK, let me pull up her policy real quick.
[AGENT][NEUTRAL] OK, I've got her pulled up and you said you just had a general question.
[CUSTOMER][NEUTRAL] Yes, so Ms. [PII] had a cancer diagnosis last year in which she did chemo and and uh radiation treatments and everything and so she was in remission but receiving immunotherapy benefits but then last Tuesday um I received an email from the group that she unfortunately and unexpectedly passed away last Tuesday.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And so I know, bless her heart, she went through all that and, and then ended up passing away and I don't even think it was from the cancer, it must have been from something else. But um anyways.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] Oh, that's so sad.
[CUSTOMER][NEUTRAL] I was wondering if there's a way for us to still file claims against her cancer policy for the immunotherapies that she received from January until last Tuesday. So any, any, can we still file claims basically is my question for any services that she's received while the policy was enforced. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, absolutely, um, there's not a timely filing limit uh with our company, so as long as she was covered on the date of service, you can always file a claim.
[CUSTOMER][NEUTRAL] Now she will not be able to sign for anything if anything needs to be signed for. I think she already has a cancer claim that has paid out, so I think she received some monies back in December so I don't think she would need to sign anything. I believe all I'll need to submit is just EOBs from her.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Major medical and I guess y'all will also need an itemized bill. What, what will y'all need that maybe I could obtain or her husband could obtain to to file these claims?
[AGENT][NEUTRAL] I am going to um refer you to our website because on the claim form itself that first page has a really good cheat sheet that tells you everything that you need to send in so if you go to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then at the top right hand corner um click on claims and forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you would choose the cancer claim form and when you download it that very first page gives you everything that you need to send in with claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, since she has
[AGENT][POSITIVE] I actually use it a lot so that.
[AGENT][POSITIVE] I actually use that cheat sheet a lot when I'm on the phone with, with insureds and they're wanting to know what to send in. I always look at that even myself just because it's such a good cheat sheet.
[CUSTOMER][POSITIVE] Yes, oh yeah, good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Very good. Well, I'll take a look at that. Um, I do know to submit the cancer claim that's already paid out we had to have EOBs and itemized bills, um.
[AGENT][NEUTRAL] And the pathology report.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I have the initial pathology report that we submitted. I don't think that she had any more.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yes, that's, that's what you'll need is the initial first diagnosis.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so we're gonna need to start the claims process all over again just for these immunotherapies or can this be a continuation of the cancer, you know, treatment that she received from our initial cancer claim?
[AGENT][NEUTRAL] I believe it'll be a continuation and you're just filing a new claim for that.
[CUSTOMER][NEUTRAL] OK, that's what I think. OK.
[AGENT][NEUTRAL] First diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Um.
[CUSTOMER][NEUTRAL] Since she has passed, will the checks still come in her name and be direct deposited into her bank account?
[AGENT][NEUTRAL] Uh, let me look and see if she's on direct deposit. She is on direct deposit, so yes, they would be direct deposited to her bank account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a way to in the OSC to uncheck that box or you know decline that so that a paper check comes in the mail?
[AGENT][NEUTRAL] Yes ma'am. um, now the member, yeah they would have to go into the OSC and check that box so they don't get uh direct deposit anymore.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Now she has a future lapse date of [PII], so her policy will lapse on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see, did somebody send in, is there a way that you guys can, um, send in her death certificate when you receive it so we have it on file for her? OK.
[CUSTOMER][NEUTRAL] Yes ma'am, yes ma'am. Once I get it, her husband is working on getting that because I have a life insurance claim I need to file for him as well, um, so I don't have that yet, but yes, I'll make a note, um, send it in.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] And just know that it does not have to be an original copy you guys can email it in to the care team email address that way he doesn't have to use one of his good copies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it can be copy. OK, I'll write that down. Alright, yes, they had her funeral on Monday and so I'm sure I'll probably, you know, get some of this stuff maybe sometime this week or next week. I told them no rush. I said they'll let us file the claim whenever, you know, we get the information.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, absolutely. And I'm sure he's got a lot he's having to take care of right now, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yeah, OK.
[AGENT][POSITIVE] At least that's something that can keep him busy for the moment, you know, keep his mind on other things for the moment. Bless his heart.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I know, I know it. I know it.
[CUSTOMER][POSITIVE] Um, well, this is very good. This really helps a lot. Um, I'm going to see if I can help do some of these things so that he doesn't have to, but if I can get him some, you know, extra money from this policy and, you know, squeeze everything out of it, I think that would be helpful.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, it would be.
[CUSTOMER][POSITIVE] OK. All right, very good. Well, [PII], I certainly appreciate your help. Thank you so much.
[AGENT][POSITIVE] It's not a problem at all. I enjoyed talking with you, Ms. [PII], and I'll keep that family in my prayers. That's tough to go through.
[CUSTOMER][POSITIVE] Yes ma'am, I appreciate that thank you so much well you have a good day, OK?
[AGENT][POSITIVE] Thank you
[AGENT][POSITIVE] You too, Ms. [PII], thank you for calling APL you have a blessed day.
[CUSTOMER][POSITIVE] Yes, ma'am. You too. Bye bye.
[AGENT][NEUTRAL] Bye bye.