AccountId: 011433970860
ContactId: 9ca2c159-6dc1-4af3-a97e-8584f04954a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 873369 ms
Total Talk Time (AGENT): 439690 ms
Total Talk Time (CUSTOMER): 346998 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/9ca2c159-6dc1-4af3-a97e-8584f04954a2_20250131T21:12_UTC.wav
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[AGENT][POSITIVE] Afternoon. Thanks for calling Eli [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. I'm calling from, uh, hear me? Can you hear me?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] I can hear you now. I can hear you now.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. Hi, my name is [PII] and I'm calling from um uh [PII], and I need information on how to file a cancer claim for my husband who's covered on here as well.
[CUSTOMER][NEUTRAL] Um, in reading the paperwork, it just is really tired and I'm like, oh my gosh, this is a lot to do. Um, could you help me with that?
[AGENT][POSITIVE] Yes, I can help you with that. Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's um [PII].
[AGENT][NEUTRAL] Can I get the policy number?
[CUSTOMER][NEUTRAL] Um, shoot, hold on, IPL. I don't know the policy number off the top of my head. I'm so sorry.
[AGENT][NEUTRAL] I can bring it up by name, that's fine. And you said you're on the policy as well?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what was the last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] You said [PII] was the first name?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And what state are you in?
[CUSTOMER][NEUTRAL] I'm in [PII]. We're in [PII].
[AGENT][NEUTRAL] OK, give me one.
[AGENT][NEUTRAL] Your date of birth?
[CUSTOMER][NEUTRAL] It's [PII], I have the policy number right here. I can't believe I have it right here.
[AGENT][NEUTRAL] Can you
[AGENT][NEUTRAL] I found it.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] 2541023. I'm looking at all these papers. I'm like, oh there it is.
[AGENT][NEUTRAL] Yes, ma'am. And can you
[AGENT][NEUTRAL] Can you verify your address?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And lastly, your email address looks like we have a work email.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, Miss [PII], thank you for that.
[CUSTOMER][POSITIVE] I can give you another one if you need it.
[AGENT][NEUTRAL] No, we just, I just have to verify what we have on file, but that's the one we have on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said you're needing help um with um what to submit to file a claim for your husband?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, so have you been?
[CUSTOMER][POSITIVE] The way that I read the form, uh, I'm sorry, go ahead. I'm so sorry.
[AGENT][NEUTRAL] You can go ahead, um, and then I can let you know.
[CUSTOMER][NEUTRAL] No, go ahead, just go ahead.
[AGENT][NEUTRAL] Um, so he's been recently diagnosed with cancer.
[CUSTOMER][NEGATIVE] He was diagnosed last year. He went through um all the procedures, and when I had called back in November, they had told me, just wait until you get all the explanation of benefits. And oh my [PII], there's so many, there's so many. And so now that we've gone through, we're done with the cancer treatments, I have time to breathe now.
[CUSTOMER][NEGATIVE] I need to file this claim, but there's just so many, and I'm sitting there going, how do I do this? There's so
[AGENT][NEUTRAL] OK, so when was he diagnosed with cancer?
[CUSTOMER][NEUTRAL] He was diagnosed um.
[CUSTOMER][NEUTRAL] In September?
[CUSTOMER][NEUTRAL] I want to say September, I have to look it up. Exactly the date, like [PII], I think it was.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me pull up the policy, um.
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] I'm just looking to see if it has a waiting period, um, and what the pre-existing conditions are. So give me one second.
[AGENT][NEUTRAL] OK, so there's no waiting period. Um, the pre-existing condition is 12 months. So, um, the way you can start off is by, um, so for sure since this is the first time, we are going to need um a path report.
[CUSTOMER][NEGATIVE] Oh, and, and hopefully the last time, Lord, because I don't want to go through this again.
[CUSTOMER][NEGATIVE] he, he had Merkel cell carcinoma, very deadly cancer, and oh my gosh, it's crazy.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead. Uh, we have to do what?
[AGENT][NEUTRAL] So, so, uh, I'm gonna take the items that we're gonna need. Um, so we're gonna need the path report?
[AGENT][NEUTRAL] Uh, path, the path report diagnosing him of, of cancer.
[CUSTOMER][NEUTRAL] The what? The path, oh, the pathology report. OK.
[CUSTOMER][NEUTRAL] Pathology report. Yes, I have that.
[AGENT][NEUTRAL] And then we are going to need um and so like I said, since this is the first time that he's been diagnosed, um, we're gonna have to um request medical records to make sure that it's not a pre-existing condition.
[AGENT][NEUTRAL] Um, but like I said in the meantime, you can send in the path report and then send in the itemized bills that you have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] See, that's the thing. There's so many of them, uh, because when I talked to the lady in November, she sat there and said, I need all the explanation of benefits.
[CUSTOMER][NEUTRAL] Oh my gosh. He went 30 days with radiation, so there's, I've got over.
[AGENT][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Over 100 of them.
[AGENT][NEUTRAL] So let me see, um, uh.
[CUSTOMER][NEUTRAL] And then because he was covered under um both my insurance and uh Medicare, she said she wanted both of them.
[CUSTOMER][NEUTRAL] Oh my gosh, that's like 300,300 documents, you know, plus.
[AGENT][NEUTRAL] Let me, let me see, um, as far as this policy if we require EOBs or if it's just itemized because some depending on what area, um, what policy you have and what areas, some of them we go by EOBs and some of them we can go by the itemized bill as long as it has the.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The, the chemo name or the procedure code, um.
[CUSTOMER][NEUTRAL] Radiation, yeah, he had radiation, so.
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] OK, that's all up.
[AGENT][NEUTRAL] Uh, see where you are.
[AGENT][NEUTRAL] So yes, so on this particular policy it requires that we pay by actual charges and so we are gonna need the um the EOB because of this policy, um, so I mean if you.
[CUSTOMER][NEUTRAL] And then there's, so like, so like I have all the EOBs for Medicare.
[CUSTOMER][NEUTRAL] But Blue Cross Blue Shield is still pending a whole bunch of them from back in October. So that's why, you know, I've been kind of sitting here waiting to see what they're gonna do.
[CUSTOMER][NEGATIVE] I don't want to wait forever. This is driving me nuts. They're taking forever. Um.
[CUSTOMER][NEUTRAL] So what do I do? Do I just, as they come in, do I keep sending them? Do I start now and just keep sending them or what do I?
[AGENT][NEUTRAL] Um, you can start now and send what you have because like I said, what's gonna happen is that once we get the documents, we're gonna have to, um,
[AGENT][NEUTRAL] Request the medical records from, from the doctor. And then once we, yeah, we have to cut some records from the doctor. And so what do we have in in-house we're gonna be pending that until we get the medical records and reviewing those medical records to make sure it's, it's not pre-existing. So once we get that approval back or once we get those medical records and review them and determine that it's not pre-existing, then
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We will be processing whatever we have, so you have time to send in everything else. Um, so I would like I would just start off sending in the path report with whatever itemized bills that you have.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And how do, how do I do that? Am I doing that through the mail? Am I doing that because I, I know that I have started on the website, uh, uploading them, but there's no way that I'm gonna be able to put all.
[CUSTOMER][NEUTRAL] That many on there. There's so many.
[AGENT][NEUTRAL] OK, and so that was my next I was gonna let you know the way, so of course the website is.
[AGENT][NEUTRAL] One of the ways, um, you can mail in or you can fax in.
[CUSTOMER][NEUTRAL] OK, that's a lot of paperwork. We're talking like over 400 copies of stuff, so.
[AGENT][NEUTRAL] Yeah. I mean, I can tell you that um as far as the chemo and radiation, it only pays, let me see, it only pays up to 15,000 per 12 month period.
[AGENT][NEUTRAL] Um, and like I said, that's actual charges based on the EOB.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I mean if you wanna send some of them in, um, and then if there's some still some benefit left over once we start processing the claim, um, then we'll send something out.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, because we're already at like 323,000 and and what was charged, so um.
[AGENT][NEUTRAL] And we don't go by like charge the amount we go by basically um the amount that's due from.
[CUSTOMER][NEUTRAL] So like, yeah, I just don't know.
[CUSTOMER][NEGATIVE] No, no, no.
[AGENT][NEUTRAL] What's on the ABA like the amount that's due or um we calculate based on that portion.
[CUSTOMER][NEUTRAL] OK. So I'm still, um, I'm still overwhelmed, but, so you first said that I need to send the pathology report, which is fine. And then you said I need to have, have you, how do you do the medical records?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Request.
[AGENT][NEUTRAL] So let me, let me see if that form is on our website. There is a physician form. Let me see if it's on our website because you can fill that out and send that into us and we can request.
[AGENT][NEUTRAL] Um, the medical records from this doctor, give me one second, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what do you mean by pre-existing condition? It's a, it's a rare cancer that showed up, so I don't know.
[AGENT][NEUTRAL] So the policy.
[AGENT][NEUTRAL] So the policy started [PII]?
[AGENT][NEUTRAL] And so since it's a new policy, um, we have to request medical records from 12 months prior to the policy being active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just to confirm that there was no other treatment for um the cancer and that's for any policy that started whenever they start if it's.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, I see. OK. Mhm.
[AGENT][NEUTRAL] And that's something that shows in the, they read it reads that in the policy um that explains about preexisting.
[AGENT][NEUTRAL] OK, so that form is not on the website. What you can do, um, if you can write.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Down his um doctors that he's seen.
[AGENT][NEUTRAL] Not all the doctors, but um the doctors that would have his medical records. Um, so you can send that in with the past report and we can work on requesting the medical records, um, and then
[AGENT][NEUTRAL] Once you're able to send in the itemized bills with some of the EOBs, um, you can do that after that.
[AGENT][NEUTRAL] Because at least you'll have time to get those together while we're requesting the medical records and getting those back, cause sometimes the doctors, they
[AGENT][NEUTRAL] I mean, it could take
[AGENT][NEUTRAL] Some time to send back and some I'm gonna send them back within a few weeks, so.
[AGENT][NEUTRAL] If you want to start with that.
[CUSTOMER][NEUTRAL] But, um, so usually when you request, um,
[CUSTOMER][NEUTRAL] Access to medical records, usually the, the patient has to sign the form. So how are you gonna do that without the patient signing the form?
[AGENT][NEUTRAL] Yes, so
[AGENT][NEUTRAL] And so that's why I was gonna, um, there is.
[AGENT][NEUTRAL] Another form that oh let me see hold on a second let me see which one.
[AGENT][NEUTRAL] So this particular form is on our website. If you go just to the [PII] and click on where it says claims and forms. There is a form called an authorization to disclose protected health information.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So that form will need to be filled out. And so we send this, a copy of this form with our request for medical records and they are able to release those records to us with this form filled out.
[CUSTOMER][NEUTRAL] OK, I see it.
[CUSTOMER][NEUTRAL] OK, I got that one here it is.
[CUSTOMER][NEUTRAL] OK. And then I'll just put that in there too. OK, what else am I missing?
[AGENT][NEUTRAL] That is it for right now. Like I said, if you can fill out that form and then like I said, um, since the physicians form is not on the website, if you can just write down.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] His physicians so that way we can request the records. And like I said, while we're doing that, request the records and wait for those to come back, then you can gather the itemized bills and uh you'll be um and just send those in once you have those together.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So at least that information that I gave you.
[CUSTOMER][NEUTRAL] Now, if I try to, if
[CUSTOMER][NEUTRAL] Yeah, if I, how much space is in, if I try to upload them?
[CUSTOMER][NEUTRAL] Onto the system
[CUSTOMER][NEUTRAL] Is there enough room for all of them so I don't have to mail them in or do we know?
[AGENT][NEUTRAL] Yeah, there should be nothing because I mean when you upload, you don't have to do several claims you can just do 11 claim. So I mean if you're gonna save them all.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I'm talking about the EOBs.
[AGENT][NEUTRAL] Oh, I mean, you can upload because we get claims that are like.
[AGENT][NEUTRAL] Even like thousands of pages, so I mean, um, so it should allow you to upload.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, yeah, because there's a lot of them. And it's crazy the way they, they do them. It's, it's.
[CUSTOMER][POSITIVE] It takes forever to get them in, but OK, thank you, [PII]. I think I'll probably be calling you back again because I'm, I'm gonna, I just wanna make sure I have everything, everything done because I wanna get this done and get it over with and.
[AGENT][NEUTRAL] Uh, that's no problem, Miss [PII].
[CUSTOMER][POSITIVE] And get moving, so, all right, honey, thank you so much.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] No problem at all. Was there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, I think I've got it all. Thank you.
[AGENT][POSITIVE] No problem. Well, thanks for calling April. You have a wonderful day. uh-huh, bye.
[CUSTOMER][NEUTRAL] OK. Uh-huh.
[CUSTOMER][POSITIVE] Have a day. bye-bye.