AccountId: 011433970860
ContactId: 9dc21de1-3cb6-4861-ba7f-5a3ab4447b89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1282969 ms
Total Talk Time (AGENT): 492072 ms
Total Talk Time (CUSTOMER): 531630 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/9dc21de1-3cb6-4861-ba7f-5a3ab4447b89_20250314T21:41_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling AP speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, yes, who am I speaking with?
[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] OK. My name's [PII] and my husband, um, has, is a, has insurance through your company.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm trying to, I'm trying to get the charges and everything so I can file with you and um he had a home health care through Paradigm Paradigm and they won't send me anything they said you need to send a request to them for the paperwork.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I know, I, I don't understand it.
[AGENT][NEUTRAL] Yeah, most providers just send it to us, but, uh, Ms. [PII], what's that policy number, please? I can see the type of policy you have.
[CUSTOMER][NEUTRAL] Um, I don't, I've never, I've never had his policy number. I don't know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can give you the name if you could look it up I I'll write that down.
[AGENT][NEUTRAL] Uh yes, ma'am. You said the last name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII] First name [PII].
[AGENT][POSITIVE] Oh, thank you for spelling this.
[AGENT][NEUTRAL] [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, how to show you.
[AGENT][POSITIVE] And give me one quick moment, I'm sorry.
[CUSTOMER][POSITIVE] Alright, and if you don't mind, give me that policy number so I'll have it, please.
[AGENT][NEUTRAL] Uh, yes, ma'am. 131446.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What does this mean?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For a cancer policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And he has been diagnosed with cancer?
[CUSTOMER][NEUTRAL] He is deceased, yes.
[AGENT][POSITIVE] Oh, I'm so sorry.
[CUSTOMER][NEUTRAL] Yes, he had melanoma and leukemia.
[AGENT][POSITIVE] Bless his heart. I'm so sorry.
[CUSTOMER][NEUTRAL] Thank you. He was an APL agent.
[AGENT][NEUTRAL] Was he? I thought that name sounds familiar, but I don't know all the agents we've had.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh wow, he's had this policy since [PII], blessed. I was only [PII] old.
[CUSTOMER][NEUTRAL] Yeah, I know, I know. Yeah.
[AGENT][NEUTRAL] Technically 3.
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][POSITIVE] Yeah, I knew he had it on time.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Give me one moment pulling up the policy information.
[CUSTOMER][NEGATIVE] Yeah, they're really giving me a hard time. I'm trying to get everything together to file with you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You can't imagine what a nightmare it's been. I mean, seriously.
[AGENT][NEUTRAL] And they said that we had to contact them in order to get the information. That sounds.
[CUSTOMER][NEGATIVE] I know because they they want, they won't send it to me, they want to send it to you and I have a zero balance there as far as I know.
[AGENT][NEUTRAL] It's definitely different.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And it's just
[CUSTOMER][NEUTRAL] Yeah, I told her I said I've got 11 different facilities that I'm getting records from.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] They're the only one that's done this to me. Even MD Anderson Cancer Treatment Center sent me everything without a nightmare involved.
[AGENT][NEUTRAL] Yeah, that's, that's a shocker for sure for uh in the [PII]. No, no bad talking of him, but most providers, you know, it's like pulling teeth to get information sometimes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, it's been, it's been tough, I tell you, because he passed away in April.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I've been doing this on a daily basis since.
[CUSTOMER][NEUTRAL] And because of HIPAA, you're gonna have to go through so much.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, well, and I'm looking on the policy, but I don't see anything as far as home health being covered.
[CUSTOMER][NEUTRAL] OK, well, they told me to just file everything that had to do with this cancer.
[AGENT][POSITIVE] Yes, I understand that because we want to make sure you get the max benefit that's payable.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, let's see. Well, and I'm gonna say if you have the pathology report for first diagnosis, if he's received any treatment or confined in the hospital,
[CUSTOMER][NEUTRAL] Yeah, I've got all that.
[AGENT][NEUTRAL] Um, I would say, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] He was in.
[CUSTOMER][NEUTRAL] Yeah, he's had um a lot of um Baylor.
[CUSTOMER][NEUTRAL] Hospitals, he's been in and out of [PII]. I've got all that. I've got all his PET scans. I've got all his rehab centers. I've got all his surgical stuff.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All that
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I, and, and all of his visits to the oncologist.
[CUSTOMER][NEGATIVE] It's what I'm sending. I don't know what is that exactly is covered.
[AGENT][NEUTRAL] Uh, I see under the benefits, uh, there's daily hospital confinement, um.
[AGENT][NEUTRAL] There's outpatient benefits. It's the amount of $100 for each date you receive one or more of the following cancer treatments as outpatient surgery, cobalt therapy, X-ray therapy, or chemotherapy. These treatments must be administered.
[AGENT][NEUTRAL] And the facility test is not covered, and there's an ambulance benefit and then there's a miscellaneous benefit where they will pay additional.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 10 cents of total amount payable with respect to other benefits shown, so there's a miscellaneous benefit.
[CUSTOMER][NEUTRAL] I don't even know how to get, you just, you remind, I've never even looked into his um ambulance care. We were on a daily basis with them.
[AGENT][NEUTRAL] For ambulance services.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, I don't know how to get that billing I guess through the city, huh?
[AGENT][NEUTRAL] Uh, probably, yes, ma'am. I will say what you have right now, you can go ahead and send it to us, but I don't see anything as far as home health is being covered.
[CUSTOMER][NEUTRAL] Well, it was wound care.
[AGENT][NEUTRAL] Wound care.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The wound care and home health care cause he couldn't walk. So.
[AGENT][NEUTRAL] Let me, um, I probably
[AGENT][NEUTRAL] Well I have to transfer you to an examiner, uh, but let me double check with them on how to get that information. Do you mind holding for a moment?
[CUSTOMER][POSITIVE] No, that'd be fine thank you.
[AGENT][POSITIVE] OK, thank you so much. Hold on one moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] Deferring.
[AGENT][NEUTRAL] Do do do do do do do do do.
[CUSTOMER][NEUTRAL] This is [PII]. How can I help you?
[AGENT][NEUTRAL] Oh, hey, how are you doing? It's Friday.
[CUSTOMER][POSITIVE] Good. How are you? So yes.
[AGENT][NEUTRAL] Woohoo! I get happy on Friday, sad on Monday, happy on Friday.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] But um, do you know anything about cancer policies?
[CUSTOMER][NEUTRAL] Yeah, what's up?
[AGENT][NEUTRAL] Oh, cool. Um, I have this insured on the phone. She's trying to file a claim for her husband, uh, who was diagnosed with leukemia and, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Melanoma and uh she's trying to, OK, it's an old C 200 policy. I have never heard this policy before, but it's old, it's dirt because he was issued in '84.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, I saw one issued in '69 today.
[AGENT][NEUTRAL] Oh wow, yeah, I feel old now because I was like, I was only [PII] when he did have his policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh goodness, OK, do you, what's that policy number?
[AGENT][NEUTRAL] 131446.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the thing is she's trying to get his home healthcare, um, billing, but she is saying they won't give it to her, that we will have to request it. But I was telling her I didn't see anything in the benefits as far as home health being covered, so, but I didn't.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But she said it also, he was receiving wound care treatment. I wonder if that will fall under the outpatient benefit or should they, should she, should we try to contact them, maybe she uh submit a HIPAA authorization form, but
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, let's see, so.
[CUSTOMER][NEUTRAL] Let me pull up.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh man.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] That's the dedication to keep some policies for this long, to be quite honest.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] If I had policies through APL, I wouldn't even, I don't even think about it.
[CUSTOMER][NEUTRAL] And a lot of them, yeah.
[CUSTOMER][NEUTRAL] I know, right? A lot of times these older ones, which is crazy, don't even pay nearly as well as the newer ones are for as much, so the fact that they've just kept these for so long that yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I mean, there are some of these policies that are pretty old to where they paid a lot, like they were unlimited. I was like.
[CUSTOMER][POSITIVE] Mhm. Yes, and it's like pretty much as long as you're receiving treatment, you're gonna get paid.
[AGENT][NEUTRAL] I see why you.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so outpatient is gonna be for like surgery and therapy like chemo and stuff, um, and then there's lodging, let's see.
[AGENT][NEUTRAL] And I know I see the miscellaneous, but there's nothing as far as home health and I didn't know.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] That will fall on our outpatient, but it has a list of what is covered treatment.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Right, so there's outpatient, like I said, chemo radiation surgery, and then there's like ambulance and then there's transportation if they travel more than 50 miles one way, there's lodging, and then there's um like specified disease and then there's a daily benefit like if they're confined to a hospital as well as the possibility of ICU if they have that.
[CUSTOMER][NEUTRAL] Um, but there isn't anything for home health now there is something in their policy called an unspecified loss where if what they've submitted is not covered but we've paid something else we basically pay 10%.
[CUSTOMER][NEUTRAL] Um, so it the it says we will pay in addition to all other benefits 10% of the total amount payable. So let's say they submitted something for um chemo or radiation or whatever and we paid whatever that amount is $1000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's the total claim amount we would pay 10% of that $1000 so that would be what $100 so we would pay a total of $1100 because that essentially is to try and cover anything else that's not listed in the policy, so yeah, but they don't have home help so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] And I didn't think, I mean, why submit, try to have a headache trying to get something that's not gonna be covered.
[CUSTOMER][NEGATIVE] Right, yeah, and, and it's not, um, they don't like I said it this one doesn't cover nearly as much. It looks like we've received a few things that are not covered in the past, um, but we haven't gotten anything from them since [PII], so it's been a minute but um, yeah, we don't, they don't have home help.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] And now if he was confined to a hospital and it wasn't home health, he was there because he needed to be there for whatever reason that would be different but home health is not listed as a covered benefit.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Yeah, and I did explain that to her. She's like, well, I spoke with someone and they told me to sending everything in relation to the cancer. I was like, I understand that you wanna try to get a max benefit, but if it's not covered, why go through the headache of trying to get information, but um.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, especially if they're not willing to just give it to you, you know, like.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] I think so.
[CUSTOMER][NEGATIVE] Yeah, it does, it really does, um, like I said, these, these older ones just don't cover nearly as much. I mean, even.
[CUSTOMER][NEUTRAL] It's mostly confinement and treatment and travel for this particular policy. It's really not a lot and lodging lodgings included in that. There's really not a lot of anything else.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it's very limited.
[CUSTOMER][NEUTRAL] It is very much so.
[AGENT][NEGATIVE] I'm being nosy and see how much they paid.
[AGENT][NEGATIVE] Goodness, 2003 $201 every quarter. Oh, for something that doesn't pay a lot, that's not good.
[CUSTOMER][NEUTRAL] I know that seems, I know, right, like they could probably have a newer one that's like a GC 14 or something that's gonna cover a whole plethora of things and not be paying that much.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But who knows?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah. Alright, well, I appreciate it. I'm gonna try to explain it to her, um.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, well, I'm here until [PII] so if for whatever reason they're just still not understanding just call right back and I'll be here. I think I'm the last one over here in the claims support queue anyway so.
[AGENT][POSITIVE] Oh, right. Well, I appreciate you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] And you have a good one.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] All right, bye.
[CUSTOMER][NEUTRAL] Alright bye.
[AGENT][POSITIVE] Uh, Ms. [PII], thank you so much for holding. Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I spoke with an examiner, just asking her to go through the benefits and everything, and she said it would not be covered, um, as far as home health.
[CUSTOMER][NEUTRAL] The hometown area
[AGENT][NEUTRAL] Yes, ma'am. I was thinking maybe an outpatient, but it looks like it's specific as far as what treatment would be covered, but home health is not one of them. But she said there is a miscellaneous benefit um that pays an extra 10% of the total amount payable with other, uh, with any other coverage charges on the claim to kind of help with certain things that may not have been covered, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But you don't have to submit anything.
[CUSTOMER][NEUTRAL] Well, what am I gonna get?
[CUSTOMER][NEUTRAL] Yeah, um, see, my, my son's an agent for y'all too, and he said go ahead and, and to file that so but I still don't know how to get it from them if they won't send it to me, they have to talk to you for some reason.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I don't understand that. Uh, the only thing I can suggest, I can think to suggest if you are fill out that claim form and that last page, which is a HIPAA form, um, just write a letter stating, can you please contact this office, they won't release to me um to request home health.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I was wondering if, if, if I gave you their number, are you able to do a conference call with me on?
[AGENT][POSITIVE] Uh, sure. We can do a conference call, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII]. And the girl's name is [PII].
[CUSTOMER][NEGATIVE] And she would not budge an inch for me. Maybe if she knows you're from the cancer, uh, insurance, you might.
[AGENT][POSITIVE] OK, we can definitely give it a try. And what is your callback number? I forgot to ask and um I apologize.
[CUSTOMER][NEUTRAL] OK. It's, that's OK. [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], verify your mailing address to make sure we have it correct in the system.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][POSITIVE] OK, thank you so much. Give me one moment, I'm gonna try to do a conference call, OK? And you said the lady's name is [PII]?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling Paradigm Home Care. If this is an emergency, hang up and dial [PII]. If you know your party's extension, you may dial it now.
[CUSTOMER][NEUTRAL] If you are a hospital or a physician's office, press [PII].
[CUSTOMER][NEUTRAL] If you are a current or former patient, press [PII].
[CUSTOMER][NEUTRAL] For all other options, press [PII].
[CUSTOMER][NEUTRAL] To speak with our referral team. Press [PII].
[CUSTOMER][NEUTRAL] To speak with our insurance department, press [PII].
[CUSTOMER][NEUTRAL] So speak with our
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, Ms. [PII], I tried to call and it sounds like it was trying to send me to somebody but it didn't hung up, so I'm gonna try one more time, OK?
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thanks for calling Paradig Home Care. The office is closed for the day. One moment.
[CUSTOMER][POSITIVE] Thank you for calling Paradigm Home Care.
[AGENT][NEUTRAL] Hi, um, this is, my name is [PII]. I'm calling from American Public Life and I had an insurance, uh, spouse asked us to call your office saying you need to speak with us in order to release any kind of, um,
[AGENT][NEUTRAL] Claims or any billing to be submitted to us?
[CUSTOMER][NEUTRAL] Uh, so for that you don't always have to give them a call back when they're open. This office closes at [PII].
[AGENT][NEUTRAL] OK. What's the office time so I can let her know?
[CUSTOMER][NEUTRAL] Uh, they're [PII]
[AGENT][POSITIVE] [PII]. OK, thank you so much.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Uh, ma'am,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, a guy answered the phone and he states that their office is closed at [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, yeah, it would be [PII] there, yeah.
[CUSTOMER][NEUTRAL] OK, well thank you for trying out. I don't know what else to do except do that conference call so they can.
[AGENT][NEUTRAL] Is it central.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Alright, you're welcome. And I will say if you have the other information, if you can go ahead and submit that to us so they can start working on that.
[CUSTOMER][NEUTRAL] OK, I will. I just thought it'd be kind of confusing to do it that way. I was gonna try to get it all together.
[AGENT][POSITIVE] Oh no, it, it will be fine, but I understand and I appreciate that for sure. Yes, ma'am.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Alright, well I'll call back again tomorrow well you're not open tomorrow, never mind. Thank you.
[AGENT][POSITIVE] Yes, ma'am. Thank you for calling APL. Have a great day, Miss. [PII].
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.