AccountId: 011433970860
ContactId: a1ef0b71-66e3-482c-bc6a-9f077d40f3a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1365390 ms
Total Talk Time (AGENT): 709032 ms
Total Talk Time (CUSTOMER): 584901 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/a1ef0b71-66e3-482c-bc6a-9f077d40f3a2_20250213T19:43_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. My name is [PII], and I wanted to ask some questions. I've gotten some information I needed clarification, please.
[AGENT][NEUTRAL] OK, uh, you need any clarification on your policy or, uh, was it in regards to a claim?
[CUSTOMER][NEUTRAL] Plain, yes ma'am.
[AGENT][NEUTRAL] Sure, OK, we can take a look at that claim. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] It's 02525083.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alright, and uh [PII], just gonna verify some information really quick. Can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Perfect. Last thing I need is the email address we've got on file for you uh looks like it might be through your employer.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that information. OK, bear with me just a moment let me take a look at this claim.
[AGENT][NEUTRAL] OK. So it looks like we're missing uh some information for this claim. Uh, the first would be the pathology report, um, for the first diagnosis of cancer. Have you sent that to us?
[CUSTOMER][NEUTRAL] Um, I received the, uh, I, I'm sorry, I information to, uh, my surgeon, and they filled the information and this is my first time ever having to use any of this sort, and, uh, they had the policy I mean they had the claims form and they were gonna fill it out and they were gonna send it in to y'all. Did you receive anything?
[AGENT][NEUTRAL] You're OK?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No ma'am, what we've received it looks like it all came from you, um, and that's the biggest thing that I'm seeing is of course in order to process just about anything on this policy we do first have to have that, uh, pathology report, um, so if you can um you could see if they'll send it to us if not um they can give it to you, you can upload and send it to us and then we'll be able to get these continued, uh, processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, because it's probably been.
[CUSTOMER][NEUTRAL] I had my surgery on [PII] and say it was probably within a month of that. I had had the paperwork and everything and uh took it to them. So yeah. Uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEGATIVE] But anyway, so you've not received anything from Doctor [PII].
[AGENT][NEUTRAL] No, nothing, uh, especially again not that pathology report, which is the biggest thing that we do need, um, I will say, uh, [PII] that the quickest and easiest way you could get claim information to us is going to be through our online portal. Have you created an account with us before?
[CUSTOMER][NEUTRAL] Uh no, ma'am, uh,
[CUSTOMER][NEUTRAL] Um, all of this is I need to do.
[AGENT][MIXED] You're perfectly fine, yeah, I mean, it's, it's confusing anyway.
[AGENT][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] See where it says go to I I do see that.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I do see the website.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So that's actually the public website so our portal website is it's that same web address except it's secured. [PII] so the word secured before that a.m. public, um, that would be our online portal and then to create an account you would just uh use the same information that we just verified to the same email.
[AGENT][NEUTRAL] Um, and then from there you'll see a spot where you can upload claim information. It gets to us very fast, so of course it's processes that much quicker, but you know if they're able to send you your pathology report or anything else that way like itemized statements um you can simply upload them to us like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can they send it directly to you from this from that website or not?
[AGENT][NEUTRAL] They wouldn't be able to through the portal that is a bit different um however I do have a fax number they could send it to, uh, pretty quick. I can give that to you if you'd like to give that to them.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, hold on, I wanna write that down. Alright, so on the [PII]
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] It's secured with an ED.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Secured. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Right, I'm not even sure that you need the WW hang on, no, uh, so no [PII]. I know it sounds funny, it's just secured. [PII].
[CUSTOMER][NEUTRAL] OK, alright, uh, OK, hang on one second.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]. OK, um, and then the fax number is what?
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, fax number [PII].
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] Who do I make it attention to?
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] OK, so this policy is my cancer number or cancer policy number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, alright, so that's the first thing I saw was that y'all needed to pathology report. The it says provide the itemized billing from their office, the procedure codes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, um, so with that it's really depends on each provider they're all very different, of course, um, sometimes it could all be in one, but it is different than the actual bill that you might receive, um, so if you were to tell them they they'll have that information, just ask them for that itemized statement that shows diagnosis and procedure codes and then again as soon as we've got that we can continue processing.
[CUSTOMER][NEUTRAL] Diagnosis and procedure code.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, the 3rd thing it says on here is a fully itemized hospital facility billing with all charges identified.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Different from the itemized billing of the other?
[AGENT][NEUTRAL] It could be um that's why we do specify it a bit differently I know it's extremely confusing um personally I would.
[AGENT][POSITIVE] Tell the provider or the hospital wherever you went for treatment explicitly what it says that we need if they have any questions or anything they are more than welcome to give us a call as well um so you don't have to start being you know middle man and all of this they can absolutely give us a call if they need clarification on information that we need we do talk to providers all the time.
[CUSTOMER][NEUTRAL] OK, the other one said policy provides benefits from transportation to the place of treatment where the distance is 50 miles from legal residence. According to this is.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Your legal residence is less than 50 miles from the current treatment. That's not true. Um, we live about a
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so
[CUSTOMER][NEUTRAL] We live about an hour and
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Uh, we live about an hour and a half from where I had my surgery and where I go to see Doctor, um.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, so on the initial claim form, um, did you specify uh the transportation?
[CUSTOMER][NEUTRAL] I don't think I don't remember. hang on a second, I kept a copy of that form. Let me see just a sec.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, well, there was one part on this where it was talking about like an accident. Well, none of that had anything to do with an accident and it would only be my own car as far as somebody taking me back and forth and, um, it, it had the attending physician statement.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Well, I will say [PII] that this might have simply this might be just like a default um denial message for this part of the claim simply because we could be missing that information from that said provider and so we were unable to actually see you know where it was that might be that was missing that out of my statement information because typically with that benefit for the transportation.
[AGENT][NEUTRAL] On the claim form, of course if you specify that you know you did travel all we would really do is of course look at your home address and then the address that's on um wherever you went for treatment and then just kind of do the math ourselves that way.
[CUSTOMER][NEUTRAL] Oh, OK, um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so, and like I said, I'm looking at that on that claims part and it really doesn't say anything about the travel end of it, but I don't read these every day, so I may not be reading it right.
[AGENT][NEUTRAL] You're perfectly fine and again even if you did I do and they're still confusing so don't feel bad.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So basically, um, you need the pathology report. Now I will say this, I had another coup a couple of other policies. I have like the hospital indemnity and I have like a
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh good gosh, I'm the blank of the gourd, but critical care and this I had those three policies as well. But this one is strictly just the cancer as far as what you about correct?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] That is correct, um, and now I will say I can get the policy pulled up to see for sure, um, but some of them do offer additional benefits for, um,
[CUSTOMER][NEUTRAL] It was a it was a totally separate group of people I dealt with, so I just was double checking to make sure I'm on the same page with you, so, um.
[AGENT][NEUTRAL] That's perfectly fine. So this one is, yeah, a strict cancer policy, um, but I'm gonna get the policy pulled up because some of them do offer benefits for, um, like preventative tests. So like, um, mammograms, Pap smears, colonoscopies, things like that.
[CUSTOMER][NEUTRAL] OK, because that's
[AGENT][NEUTRAL] So let me check that right quick and see.
[CUSTOMER][NEUTRAL] One thing that happened was I had, I had a uterine cancer basically and no carcinoma or something and uh
[CUSTOMER][NEUTRAL] Anyway, they went in and they took that out with a total hysterectomy, you know, and everything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I got really great news and it's came back in probably less than 1% reoccurrence, so that's called a win.
[AGENT][POSITIVE] Oh, that is amazing.
[CUSTOMER][NEUTRAL] Yes, ma'am. And so it wasn't in my lymph nodes or anything like that. But I had a complication from it because uh they did the laparoscopic surgery, but when they did the surgery, they couldn't take the uterus out, so they had to end up opening me up above my belly button, say 4 inches, 5 inches, give or take. I'm probably bad on distance. So they had to open me up there to get it all out.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Well, time passed, which again, December 31st was the surgery and time's flying, but I'd say maybe roughly 3 weeks ago, give or take. Um, I had a blood clot burst in my stomach.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Where that was.
[CUSTOMER][NEGATIVE] So that was kind of, uh, you know, fortunately, but it was very weird. It was one of those to where, you know, we were, I thought I was almost home free, to be perfectly honest. And then the next thing that happened, that happened. And uh I was home and all of a sudden, literally, I, I was gonna take a shower and clean and do all that. And literally, blood just started coming out of my stomach, just a ton of it.
[AGENT][NEUTRAL] Sure.
[AGENT][NEGATIVE] Oh my gosh, that is horrific.
[CUSTOMER][NEUTRAL] So then I've been on home health since then for, you know, like I said, this is maybe week 3 at this point, give or take. I'm not sure on my date. I don't have that sitting in front of me. And uh it's still gonna be a little bit because they had to go in so deep and
[AGENT][NEUTRAL] Yeah, oh man.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Uh, anyway, does that come back part of with the cancer information or does that not? Because the blood clot came from the same area where the.
[CUSTOMER][NEUTRAL] I mean, do I need to report that differently or is that gonna still be on everything that she has or how does that work with y'all?
[AGENT][NEUTRAL] You could still submit that to us if that was excuse me, and that's a very good question um, personally I would ask your physician what they think um.
[AGENT][POSITIVE] I would think yes.
[AGENT][NEUTRAL] If it had to do with it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's where it was. It was.
[AGENT][NEUTRAL] But I would, I would ask them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] What they're, you know, because they have all that medical, all of that like if it's actually in regards to that or if it was simply just, you know, one of those things which absolutely does not seem like it, um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let's see and so for this as well I don't know if you're aware of this or not um but you do have so once we get that pathology report from you um you do get a lump sum benefit as well that's a one time, um, lump sum of $5000 just simply for getting the pathology report.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sorry, how much did you say?
[AGENT][NEUTRAL] 5000.
[CUSTOMER][NEUTRAL] 5000
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] And if you would like, I don't know if you have this information or not, [PII], but I can definitely send you a copy of this policy that shows all of your covered benefits, uh, the dollar amounts, frequencies, things like that. It's very easy to read. I promise it's not just a bunch of jargon.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, I'd appreciate it so.
[AGENT][NEUTRAL] Sure, did you want me to email this to you?
[CUSTOMER][POSITIVE] Uh yes ma'am, that'll be fine.
[AGENT][NEUTRAL] OK, um, did you want me to send it to the email we've got the, um, it looks like it's the one through your employer or did you want me to send it to a different email?
[CUSTOMER][NEUTRAL] No, that's OK you can send it to that one.
[AGENT][NEUTRAL] OK alrighty I'll go ahead and send that now um and just for good measure I'll go ahead and include a link um for our online portal as well.
[CUSTOMER][NEUTRAL] OK, OK. Um, so,
[CUSTOMER][NEUTRAL] Nothing's been denied on this claim and stuff I think you're just waiting for information.
[AGENT][NEUTRAL] Right now if you look at it um on our website it might say denied but it's not truly denied it's we are just missing information.
[CUSTOMER][NEUTRAL] OK, alright, um, so I will say one thing I ran into with this other part of the uh other insurance policies that I had when I contacted the billing they didn't want it to come from me they wanted it to come from the insurance and they wanted them to say that they were requesting it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I will ask and I will see, but that might literally come back to be we want y'all to request it. I'll just we'll have to.
[AGENT][POSITIVE] Interesting, um, yeah, that's, and again, that's perfectly fine if you run into that they're more than welcome to call us, um, but if they're if they're waiting for us to reach out, you know, we'll, we'll work with you don't worry, just let us know.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] So what they wanted was like y'all to fax well not I mean like I said it might be different when I send this, you know, but they wanted them to send a fax number saying we need this information to complete this form and so it was that was the kind.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Huh.
[AGENT][POSITIVE] I don't really hear that a lot, but yeah, no that's perfectly fine again we'll do what we can to get you help don't worry about that.
[CUSTOMER][NEUTRAL] No, no, no, and I said that wasn't y'all's end, it was the disability indemnity sort of thing, OK, so.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, so really all you need from me is that pathology report, the itemized billing, and on the travel.
[CUSTOMER][NEUTRAL] I mean, I don't know. It might be close, but I would think it would be over 50 miles, you know, seriously, but at the same time, uh, from my street there it might be, but.
[AGENT][NEUTRAL] That's sure.
[AGENT][NEUTRAL] We can definitely take another look at that. So yeah, send us that pathology report, the itemized statements that show those diagnosis and procedure codes. Once we've got that and then we get all of this other stuff, uh, processed if for some reason that.
[AGENT][NEUTRAL] Transportation benefits doesn't kick in or it doesn't change um we can take a deeper look at it at what additional information we might need but I I really do think that once we have those itemized statements then that would be accurate.
[CUSTOMER][NEUTRAL] OK, alright, and so the itemized procedure and code itemized hospital facility building with charges identified and take care of it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. That's it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright and uh.
[CUSTOMER][NEUTRAL] I will see what I can do and what was your name again please ma'am?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK, uh, I know I may never talk to you again, but I certainly.
[AGENT][NEUTRAL] No, you're fine, of course, yeah definitely um so I will say too there was something else um if you they send you this information and you're the one who uploads this information through our portal um just so you are aware it does have to be on a desktop or a laptop computer it our website doesn't really have much support for mobile devices.
[AGENT][NEUTRAL] Just so you're aware.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so you have received information it just wasn't complete.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, we did receive that information we were just missing some.
[CUSTOMER][NEUTRAL] OK alright and is there a deadline on time frame for getting this?
[AGENT][NEGATIVE] No, ma'am, there is no timely filing limit.
[CUSTOMER][NEUTRAL] OK, alright, now let me ask you this once in this information, hopefully this is the last of it, um, because this, I mean if something else.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Occurs of that blood clot stuff and information if they include that with it, then the uh
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Anything else if it ever occurred, it would be a new claim and a new new thing, right?
[AGENT][NEUTRAL] Yes, um, as, so if there was something different that came up like, um, you know, of course, God forbid, a different kind of cancer or something like that or a different location, or even if it, you know, something like that, we would of course need that pathology report and then um go forward from there.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, so, like, um, well, I might as well because you mentioned it, but I do have a colonoscopy scheduled on the [PII]. And so, so is that still part of just normal?
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Yes, so you do have that benefit. um, I'm sorry, I just.
[CUSTOMER][NEUTRAL] Or is it
[CUSTOMER][NEUTRAL] I mean, is that like
[AGENT][NEUTRAL] Closed out of it, but I can get it back up. Give me just a second. I can let you know how much that is. Um, typically with these you're limited to, it covers one, per calendar year. Let me go find it. Oh my goodness, hang on.
[CUSTOMER][NEUTRAL] Uh huh, OK.
[AGENT][NEUTRAL] I just had it. So it could be, you know, a um well, let me actually go to it. Let's see. There it is, diagnostic testing, I think.
[AGENT][NEUTRAL] OK, yes, so.
[AGENT][NEUTRAL] Subject to maximum test, limited to. OK, so yeah, it lists um 15 different kinds of diagnostic tests. Um, so again, mammogram, breast ultrasound, uh, colonoscopy, ovarian cancer blood test, pap smear, chest X-ray.
[AGENT][NEUTRAL] Um, anything like that, and it's limited to one test per calendar year. It pays $50 per test. And then if there's a follow up, um, for any of them, that's covered as well, uh, for one per calendar year, that would be a $100 benefit.
[CUSTOMER][NEUTRAL] OK, so should that the information be turned into you as well?
[AGENT][NEUTRAL] Uh yeah, definitely if you've got that, so this policy, this policy has been effective since [PII], but I think if I'm, let me get back to you, hang on.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I think I looked earlier.
[AGENT][NEUTRAL] You've had a couple other older policy numbers, but technically you've had a a cancer policy with us since [PII]. Um, so if you.
[CUSTOMER][NEUTRAL] Yeah, I, I'm [PII] and I've always had one, you know, and so.
[AGENT][NEUTRAL] Yes, so with this, um, again, since there's no timely filing limit if you've had any of those kinds of tests over the past several years since [PII], well [PII], you can still file those claims.
[CUSTOMER][NEUTRAL] No, all of this has happened. We came up since [PII] as far as, you know, this, this is when everything kind of came to a head, I guess.
[AGENT][NEUTRAL] Well, I mean, even if you had like um a Pap smear or mammogram or anything like that.
[CUSTOMER][NEUTRAL] Oh yeah, OK, OK, all right.
[AGENT][POSITIVE] Definitely.
[CUSTOMER][POSITIVE] OK, well I appreciate it and I will see what I can do about this if they come.
[AGENT][POSITIVE] You are very welcome.
[CUSTOMER][POSITIVE] Send it. I just call back and say, hey, this is what they're wanting.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Absolutely, um, preferably I would really encourage, uh, see what you could do about getting them to call us, you know, because that's just less on you to have to worry about, um, and just stress that we do talk to providers all the time but you know that's why you're not caught in the middle, you know, and it's already confusing enough and you don't need that extra we can help it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, I really appreciate it, [PII], thank you for your help.
[AGENT][POSITIVE] Oh, you're very welcome. I know that's information overload. Did you have any other questions for me at the moment?
[CUSTOMER][POSITIVE] No ma'am, I think you've helped me quite a bit, so.
[AGENT][POSITIVE] Alright, well I'm sure glad I was able to. I hope you have a great rest of your day, [PII].
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you, bye bye.