AccountId: 011433970860
ContactId: 9d301d0d-9194-4a16-aeea-b05f328ca518
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 751049 ms
Total Talk Time (AGENT): 357218 ms
Total Talk Time (CUSTOMER): 398623 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/9d301d0d-9194-4a16-aeea-b05f328ca518_20250129T15:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, excuse me, [PII], this is [PII]. I'm, I live at [PII], and I have a cancer policy with you folks, and I have my policy number if you're ready for that.
[AGENT][NEUTRAL] Yeah, I need the policy number.
[CUSTOMER][NEUTRAL] 00644
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a, it's a semiannual policy.
[AGENT][NEUTRAL] [PII], what's your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And could you repeat your mailing address to me again?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's [PII].
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, uh, my phone number, it's uh.
[CUSTOMER][NEUTRAL] Landline [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have an email address on file that you can verify?
[CUSTOMER][NEUTRAL] No, I do not have anything like that.
[AGENT][POSITIVE] OK. OK, thank you for verifying the information. How can I help you today?
[CUSTOMER][NEUTRAL] Yes, I was, uh, in August I was diagnosed with a lymphoma cancer and on my left groin, and I had to have an operation on [PII], uh, let's see, [PII] here at the, the Bass Hospital here in [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then, uh, during the next few weeks, I had to heal and then I had to take 15 days of radiation here at the Bass Hospital in [PII] for 15 days. It started [PII] of last year and ended, uh, [PII] of last year. Anyway, uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] Uh, I, I don't know how much is left in that policy or anything, but my cancer doctor, her office needs forms from you folks to fill out and everything.
[CUSTOMER][NEUTRAL] And I have the fax number if you need that. Her, her, the doctor's name is Doctor [PII] I don't know if you're familiar.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] What type of form does she need?
[CUSTOMER][NEGATIVE] Well, uh, filling out to to verify that I, I'm telling you everything I just told you is the truth and then um again I don't know uh if there's any money coming to me or anything I would appreciate it. I, I just don't know.
[AGENT][NEUTRAL] Yeah, so we do not need the provider to fill out any form, um, but we do need the itemized bills for the radiation and for the surgery that you had, so that you would get that from your provider and send it to us, but there's nothing that the provider needs to complete.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Well, now they thought there the offices thought that there would have to be some forms and everything.
[AGENT][NEGATIVE] Not for the provider to complete.
[CUSTOMER][NEUTRAL] Because they would
[CUSTOMER][NEUTRAL] They would have to fill out everything because I don't know the terminology or anything I just know the dates and and what I had performed so uh so there's nothing you could send to them through the fax machine?
[AGENT][NEUTRAL] OK, they do not have to complete anything [PII]. I can send you a cancer claim form. Now that's for you though, but it does tell you what um what documents we require from your providers in order to review a claim for benefit payment for you. That might help. It's on page one.
[AGENT][NEUTRAL] But you don't have an email address um but there's not anything that that the provider has to complete and send to us other than their itemized bills so that's what they would send APL.
[CUSTOMER][NEUTRAL] No, I don't.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] So that's all they have to uh send you then. I thought that there'd have to be some forms to fill out for them and they assume that too.
[AGENT][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] There it's not.
[AGENT][NEUTRAL] Yeah, no, the assumption is wrong. So under this policy we just need a copy of their itemized bills for the surgeries, the radiation that was done.
[AGENT][NEUTRAL] Um, we will
[CUSTOMER][NEGATIVE] And, and you, you can't send them anything to start this. I, I can't walk very well and I just don't wanna have to walk into the hospital from my house and everything all the time. That's why they were going to fill out everything that was necessary.
[AGENT][NEUTRAL] OK, so what, what, what can be done is that if you can give your provider our phone number, just have them call us and then we can explain it to them and then let them know what documents we require in order to process a benefit under this policy that might be easier.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so I don't, I don't have to, to fill out anything though or anything.
[AGENT][NEUTRAL] OK, will your providers be sending the claims to us on your behalf?
[CUSTOMER][NEUTRAL] Uh, well, um.
[CUSTOMER][NEUTRAL] I don't know what the process is.
[AGENT][NEUTRAL] Yeah, so if your provider sends us the claims, you don't have to do anything.
[CUSTOMER][NEUTRAL] OK, so, uh, Doctor [PII]'s office, you're talking the, the, uh, cancer?
[AGENT][NEUTRAL] Whoever performed the surgeries and whoever you, you're uh wherever the radiation is being done, we can receive itemized bills from those locations.
[AGENT][NEUTRAL] To review a payment for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Now you do understand that Medicare and HealthChoice, my two insurances, they've taken care of all the, the, the bills. You do understand that.
[AGENT][NEUTRAL] We do require their explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK, all right. OK, so this could be more than just my cancer doctor, right? Because she did not perform the surgery uh actual surgeon did.
[AGENT][NEUTRAL] OK, so you have a cancer policy. So what I'm speaking of is related to any service that you had regarding to the cancer. So there would be a hospital charge, uh, there would be a surgeon's charge for the removal of the cancer. That's who we would need to claim from, that doctor.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, OK, so this is gonna take a while, isn't it?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, that's why I suggested maybe have the provider's office call us and then we could tell them what documentation is is needed.
[AGENT][POSITIVE] Um, and they understand, they'll understand and that way you don't have to to do anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK well I appreciate it so so that's what I have to do is then let them get in touch with you.
[AGENT][NEUTRAL] Right, to make it easier versus you trying to um communicate what it is that we need, um, they're thinking that they need to fill out a form they don't so we can we can clarify that as well when they call us.
[CUSTOMER][NEUTRAL] OK, all right, and.
[AGENT][NEUTRAL] And just tell them what our processes are.
[CUSTOMER][NEUTRAL] OK, and is there any particular person I need to visit that they need to visit with or or not?
[AGENT][NEUTRAL] So they'll contact the same number that you did, the [PII] option two. Anyone on our team can assist them and they would need to provide the policy number that you gave me, so make sure they have your policy number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK, um, anything else I should I should know?
[AGENT][NEUTRAL] You know, just give them our policy number, have them contact us and then we'll tell them what documentations we need in order to consider a benefit.
[AGENT][NEUTRAL] And on your end, um, of course, they should probably already have Medicare's, uh, explanation of benefits if they submitted it to them. So we'll need a copy of the EOB for each surgery that you had.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But we can explain that to the provider.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] And all that has already been paid to them from Medicare and HealthChoice.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So you guys don't actually send any money to them correct?
[AGENT][NEUTRAL] OK, so if they're submitting the claim on our behalf.
[AGENT][NEUTRAL] And if you're saying that you want the payment to go to them or if you want it to go to us, then you'll need to let your provider know on their claim form.
[AGENT][NEUTRAL] Um, there is an assignment of benefit, and if they put a check.
[AGENT][NEUTRAL] In that box then we have to send the benefit to them if it's blank then the benefit will come to you so that type of information we can discuss with them.
[CUSTOMER][POSITIVE] OK, because like I said, uh Medicare and Health Choice has already paid everything already to every everyone so I feel that since I'm the one that pays you folks that.
[AGENT][NEUTRAL] That way
[AGENT][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] I would deserve the money correct or not?
[AGENT][NEUTRAL] Yeah, I would agree, but we would have to receive the ELBs first, uh, [PII] before I can make a, uh, uh, you know, a comment as to yes or no. I know you're saying that they paid it all, uh, but we need to see the documentation, um.
[CUSTOMER][NEUTRAL] And I know that probably
[AGENT][NEUTRAL] You know, to process the claim and if what you're saying is true, yes, it's a possibility that the payment is due you, but we'll need to get the documentations first so that might be a a conversation that you have with your providers as well if you're saying that Medicare paid everything.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah, and HealthChoice, my secondary.
[AGENT][NEUTRAL] And health choice, yes. And so that means that if that be the case, your balance with any of the offices, the hospital, the surgeon's office should be 0. and so you may want to
[CUSTOMER][NEUTRAL] And they they would they would show that on whatever they send you.
[AGENT][NEUTRAL] Yeah, it'll that'll be reflected on the EOBs.
[AGENT][NEUTRAL] So we'll need them to the explanation of benefits.
[CUSTOMER][NEUTRAL] What is that?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OB you said.
[AGENT][NEUTRAL] Uh, [PII] Boy explanation of benefits from Medicare and Health Choice.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well, uh, OK, well, I, I know I've asked probably some stupid questions, but, but.
[AGENT][NEUTRAL] So,
[AGENT][POSITIVE] No, no, no, they're really good questions.
[CUSTOMER][NEUTRAL] Well, um, you know, I mean, I've had the.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I've had the cancer policy for years and years and years and years as I'm sure you could tell on the screen.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And, and it has paid twice to me because this is, this is the 4th cancer I've had unfortunately over the last 11 years so uh and I'm sure that reflects on your policy there or your screen so I was just wondering because I was just under the impression that since I do have Medicare and Health Choice and they've paid it all so far that I didn't think that any of the the cancer policy would go to those folks then.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and that may be a true.
[CUSTOMER][NEUTRAL] Since it's already been paid for and I know it has to all be verified. I understand your point of view.
[AGENT][NEUTRAL] Right, and, and
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, well, I'll, I'll get to them, but they really acted like they, they had to have all these forms through this.
[AGENT][NEUTRAL] Yeah, maybe some insurance companies, Rony require that they fill out forms under this cancer policy. We do not require that the provider fills out a form. All we need is the itemized bills.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I'm sure that the screen is showing that I'm I'm paid up until March of this year because I pay it twice a year.
[CUSTOMER][NEUTRAL] The premium.
[AGENT][POSITIVE] You are correct.
[CUSTOMER][NEUTRAL] OK, well, I, I knew that it hadn't, I haven't been done for it yet for them, but I paid it. I think the last payment I gave you folks was in September of last year.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And I pay it twice a year.
[AGENT][NEUTRAL] Correct, so you're paid up to [PII] of this year.
[CUSTOMER][NEUTRAL] OK all right well I'll, I'll tell them I hope they understand everything that I'm gonna tell them because I'm kinda.
[AGENT][NEUTRAL] Yeah, they will just just have them contact our office um and then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we'll be able to explain.
[AGENT][NEUTRAL] Uh, the documents that we need and that they do not need to, they do not need to fill out a form.
[CUSTOMER][POSITIVE] OK, all right, uh, I appreciate your help. I really do. you've been very professional and I do appreciate that and very patient with me.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh, absolutely, [PII].
[AGENT][POSITIVE] My pleasure. All [PII]. If no other questions, thanks for calling APM. It's, it's [PII]
[CUSTOMER][POSITIVE] Well thank you again, thank you again bye bye. And what was your name again, your first name?
[CUSTOMER][POSITIVE] OK all right well thank you [PII] I appreciate it.
[AGENT][POSITIVE] You're welcome thanks for calling AP have a good day.
[CUSTOMER][NEUTRAL] All right, goodbye.