AccountId: 011433970860
ContactId: a48326bc-d107-47e2-9451-aa26d5989d11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1272599 ms
Total Talk Time (AGENT): 596400 ms
Total Talk Time (CUSTOMER): 488333 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/a48326bc-d107-47e2-9451-aa26d5989d11_20250513T18:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling EPL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], um.
[CUSTOMER][NEGATIVE] I was uh diagnosed with cancer, uh, in early March.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] Uh, I just need to, I, I have, I guess I have questions and need to know to how to fill out the.
[CUSTOMER][NEUTRAL] The form and what all I need to do.
[AGENT][POSITIVE] OK, yeah, I'm happy to help. Um, let's take a look. Do you have your policy number by chance?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 254
[CUSTOMER][NEUTRAL] 0564
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And then if I could just verify your name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And then lastly, I just need to verify the physical address we should have on file for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Um, so have you gotten the actual, have you gotten the claim form, uh, that needs to be submitted already?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. I believe so. It's uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, I've got uh like it's section A section B.
[AGENT][NEUTRAL] OK, yeah. Let me pull it up.
[CUSTOMER][NEUTRAL] Um, statement, OK.
[AGENT][NEUTRAL] What up here.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Like um where it says non-local transportation lodging.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All of that I've I've got receipts for all of that stuff that's happened so far.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And, and, uh, but what, what exactly, I, I see my uh on my medical oncologist on, on Thursday and uh
[CUSTOMER][NEUTRAL] I just need to know what to get from y'all for y'all.
[CUSTOMER][NEUTRAL] So I can file this or what I mean I guess I need to know the process because I I don't know.
[AGENT][NEUTRAL] OK, yeah, so let me.
[CUSTOMER][NEUTRAL] I guess it's easier to say I don't know what I don't know and.
[CUSTOMER][NEUTRAL] I don't know anything.
[AGENT][NEUTRAL] I gotcha. No, it's totally fine. Let's see. OK.
[AGENT][NEUTRAL] OK. So,
[AGENT][NEUTRAL] Um, your cancer plan does have
[AGENT][NEUTRAL] Um, a first occurrence benefit, it's a lump sum.
[AGENT][POSITIVE] That you're eligible for with the diagnosis of cancer. So let's start there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the first occurrence benefit is a one-time payment of $5000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To receive that benefit payment.
[AGENT][NEUTRAL] You're going to need.
[AGENT][NEUTRAL] The pathology report.
[AGENT][NEUTRAL] Showing the initial cancer diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, have you had any sort of surgeries or anything or biopsies that you're needing to file for?
[CUSTOMER][NEUTRAL] Yeah, I've, I've had uh one biopsy, uh, and one surgery so far.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, for surgeries?
[AGENT][NEUTRAL] What you will need.
[AGENT][NEUTRAL] Is the pathology report.
[AGENT][NEUTRAL] For that.
[AGENT][NEUTRAL] With the diagnosis.
[AGENT][NEUTRAL] Including any biopsies that were done.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Have you done any um sort of, have you had like hospitalizations or have you had any chemo, radiation, anything like that yet?
[CUSTOMER][NEUTRAL] Yeah, I've, I've, I was with my surgery, I was in the hospital for like 5 days and then I've gone through 2 rounds of radiation and I'm doing immunotherapy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On Thursday.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh well, I've got a treatment and then I'm doing chemo also.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, for hospitalizations, um, this will also be included for surgeries and any of your chemo and radiation.
[AGENT][NEUTRAL] You're gonna need an itemized medical bill from each provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we need the explanation of benefits.
[AGENT][NEUTRAL] From your other medical carrier showing the amounts allowed and paid for the service.
[CUSTOMER][NEUTRAL] Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] So that'll so any time that you're filing a claim, you'll need to do the claim form. Now you can do this in steps you can do it all at once it's really whatever works best for you and it's easiest for you because sometimes.
[AGENT][NEUTRAL] These can be a little overwhelming. It's a lot of information, um.
[AGENT][NEUTRAL] But you do
[CUSTOMER][POSITIVE] I, I will agree with you there right now.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] So that's why I was saying there are some individuals who will choose um to start with.
[AGENT][POSITIVE] The first occurrence lump sum benefit um and start there that kinda gets the ball rolling.
[AGENT][NEUTRAL] Um, and then generally, my recommendation to some insured is if you're able to, um, if you're not, I, I totally understand, but, you know, maybe start with one set at a time, meaning I'm gonna go ahead and file all of my claims that I have right now for surgery in hospital, you know, and just focus on that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then move to the next, um.
[AGENT][NEGATIVE] Because, yeah, it can be a lot of paperwork, unfortunately.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you by chance get, um, Mr. [PII], did you get uh like a page one with your claim form that has like instructions on it or anything?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes ma'am, I've got some, yeah, I've got kind of, I'm kind of following that bullet point outline looking paper.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] And so that really is, is gonna be um very helpful because it does break it down depending on what you're filing it for kind of what we need for that.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Do you have any other questions about like benefit amounts or filing or?
[CUSTOMER][NEUTRAL] So for receipt.
[CUSTOMER][NEUTRAL] No, I, I guess the thing for me is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I contacted, uh.
[CUSTOMER][NEUTRAL] My, uh, uh, my, my, uh, doctor, and they have somebody in the office that does all this paperwork and the doctor reviews it and everything, but, uh, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I guess what I'm, I'm, I'm trying to say is that.
[CUSTOMER][NEUTRAL] To get this initial paperwork to you, I've got a list of stuff here that y'all need.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, and then how do I get it to you?
[AGENT][NEUTRAL] OK, so you can get it to us a couple different ways. You can put it in the good old post office box and mail it to us. You can have, uh, you can fax it and if you have a medical, if your doctor's office is helping you, they might actually help and fax the paperwork on your behalf, um, or it can be submitted online. It's really just personal preference what works best for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I guess what I'm I'm, I'm thinking about right now is basically just to get the initial paperwork to you for that first initial benefit.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then like you said, start with.
[CUSTOMER][NEUTRAL] Um, and just do sections of the of the of the paperwork that you have that on the bullet points and the stuff that you.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And you know, like for transportation and stuff like that, do you want actual receipts or?
[CUSTOMER][NEUTRAL] I, I, I
[AGENT][NEUTRAL] Yeah, are you just gonna be filing for like mileage or is it gonna be lodging also?
[CUSTOMER][NEUTRAL] Both
[AGENT][NEUTRAL] Both, OK. Yeah, so they would want um an actual, if you have an actual receipt for those, that would, yeah, that would be what they would be asking for.
[CUSTOMER][NEUTRAL] OK, and, and, and then like I said, I, I'm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Just, just trying to get all this figured out and uh.
[CUSTOMER][NEUTRAL] Um, yeah, and, and, and so I guess what I, I really wanna do first is just get the fact.
[CUSTOMER][NEUTRAL] Uh, get this established.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know that and, and with y'all and, and yes, he's got cancer and so we're gonna do this initial thing and then just kind of start at the beginning and start working our way through.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] And, and, uh, every time we get a section like do like doing my my surgery because I have a copy of the Blue Cross Blue Shield what they paid for and what they didn't pay for and all that kind of stuff.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have a copy of uh you know, they sent me a copy or maybe there's something I need to.
[CUSTOMER][NEUTRAL] Ask them for.
[CUSTOMER][NEUTRAL] To to get a a more.
[CUSTOMER][NEUTRAL] Logical piece of paper because it's like 24 sheets of stuff.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] And I think that's kind of a commercial.
[CUSTOMER][NEUTRAL] Um, receipt that they send to.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] No, uh, like, like my, uh.
[CUSTOMER][NEUTRAL] Uh, what
[CUSTOMER][NEUTRAL] Um, Blue Cross Blue Shield pay for and what.
[CUSTOMER][NEGATIVE] They didn't pay for
[AGENT][NEUTRAL] Right, that, yeah, that's, yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So, um.
[CUSTOMER][NEUTRAL] And I'll, I'll uh.
[CUSTOMER][NEUTRAL] Um, contact them and.
[CUSTOMER][NEUTRAL] So um what I need to get from them is.
[CUSTOMER][NEUTRAL] Just a list of what they've covered so far and what they haven't covered.
[AGENT][NEUTRAL] From your primary insurance? Is that what you're referring to?
[CUSTOMER][NEUTRAL] Is there a
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yeah, yeah, so.
[CUSTOMER][NEUTRAL] I mean, is there a name for that or something that might help me?
[AGENT][NEUTRAL] It is the explanation of benefits from, from them. That's what you want because the explanation of benefits will show um the date of the service provided from your um provider and then it'll show um exactly what the copay, deductible, you know, everything was and so that's what we need to showing those amounts allowed and paid for the services. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK. And every time that we send in like a new set of expenses do we have to fill these particular sheets out that we have uh every time or do we just send it with.
[CUSTOMER][NEUTRAL] A number like a policy number.
[AGENT][NEUTRAL] A claim form needs to be filled out for each claim that you're doing.
[AGENT][NEUTRAL] So you can do multiple claims under with one claim form meaning that you could submit this cancer claim form.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Gather all your paperwork for the initial diagnosis.
[AGENT][NEUTRAL] Submit that along with your itemized bills for your hospital, chemo, radiation, and the explanation of benefits. You could do all that at once.
[AGENT][NEUTRAL] But if you choose to do the
[CUSTOMER][NEUTRAL] And then after
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Let let me ask a question real quick and after the first initial set of papers are sent in, everything going forward.
[CUSTOMER][NEUTRAL] How does that get sent in?
[AGENT][NEUTRAL] They would always be submitted the same way either in the mail, fax, or online. Those are the three different ways that you can.
[CUSTOMER][NEUTRAL] But not
[CUSTOMER][NEUTRAL] But not with a new claim form because we've already done that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, they'll need a new claim form.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, for each because it's gonna be a new, uh, it's gonna be a new claim, OK, so uh the, um, the only thing I won't have to submit is the initial.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Diagnosis and all of that stuff, right?
[AGENT][POSITIVE] Correct, yeah.
[CUSTOMER][NEUTRAL] Or do I need to make a copy of it?
[CUSTOMER][NEUTRAL] Each time
[AGENT][NEUTRAL] No, no, no, no, that only has to be submitted once, just the first time.
[CUSTOMER][NEUTRAL] This is the first time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And then your radiation and chemotherapy is just gonna have a limit on it. So the 12 month max is 15, excuse me, 15,000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So, of course, if for some reason, your radiation, chemo, immunotherapy benefit amount of 15,000 was exhausted prior to that 12-month period, um, you know, obviously, you wouldn't need to submit any claims for that because there would be nothing payable uh within that time frame since it was exhausted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And and so like on the.
[CUSTOMER][NEUTRAL] The chemotherapy, is that uh my cost or?
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] What, what exactly or is it just.
[CUSTOMER][NEUTRAL] Or the radiation, let's go radiation because I've gone to 2 rounds of that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what, what am I.
[CUSTOMER][NEUTRAL] I guess benefits for radiation.
[AGENT][NEUTRAL] Well, it's a, it's kind of a, it's a lump sum. They, they do radiation, chemo, and the immunotherapy all together under one balloon. And so it's the, it's the 15,000 amount for all three of those.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is that a reimbursement for expenses or?
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][POSITIVE] Correct. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you want, I don't know if you have um
[AGENT][POSITIVE] I can email or I can send it to you in the US postal mail if that's better to you, but if you don't have a copy, uh, Mr. [PII] of the policy and the scheduled benefits, I am happy to send that to you because on your scheduled benefits page it does break down um all of the benefits with the dollar amount and the time frames on them if that would be helpful.
[CUSTOMER][POSITIVE] That would be wonderful if you could send that to me uh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] In the just the regular mail that way uh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I'll have it in writing and I can put all this together.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, absolutely, absolutely, it'll come in a, in an envelope. It's uh it's 48 pages.
[AGENT][POSITIVE] Um, but you, you only really, there's the couple pages you need that are really helpful are kinda in the middle, but um, it is helpful to have just for reference, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Did you have any other questions or concerns?
[CUSTOMER][NEUTRAL] Do you call her and ask her name um.
[CUSTOMER][NEUTRAL] What about medical equipment getting reimbursed for that that is that a claim medical equipment that's a separate I saw that on there medical equipment on there, so OK.
[AGENT][NEUTRAL] Um, yeah, so it looks like there is a benefit for medical equipment on the scheduled benefits. You get one benefit per covered person per calendar year, and the reimbursement on that is $150.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Can you tell us your name again in case we have any more questions?
[AGENT][POSITIVE] Yeah, absolutely, my.
[CUSTOMER][NEUTRAL] Can we ask for you?
[AGENT][POSITIVE] Yeah, you can. I can't promise you'll get me, but I'm happy to give you my name. My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. [PII]. All right.
[AGENT][NEUTRAL] Yeah and if you guys have any other questions please please feel free to call us we can we can help and if you have any claims that do get submitted and for some reason are denied or need more information, don't hesitate to call because if somebody in customer care can't help you we can always have like a claims examiner um look at it.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] And they're really good at giving you exactly maybe what needs to be said to a provider or doctor that way you get what you need.
[CUSTOMER][NEUTRAL] OK, I understand, yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That sounds wonderful. Sir, I wanna thank you so much.
[AGENT][POSITIVE] Oh, Mr. [PII], you're so, yeah, you're so you're so welcome and I'm sorry to hear that you're going through all this, but you know, I'll keep you guys in my thoughts.
[CUSTOMER][NEUTRAL] Helping a confused man out and.
[CUSTOMER][POSITIVE] I appreciate that so much and um.
[CUSTOMER][NEUTRAL] Any other questions? OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I, I will let you, um.
[CUSTOMER][POSITIVE] Go on and, and, and work your magic for someone else and, and just thank you from the bottom of my heart.
[AGENT][POSITIVE] Oh, it's been my pleasure and I'm getting that mailed out to you guys. So it's coming from [PII], so it shouldn't take too long to get to you, OK?
[CUSTOMER][POSITIVE] OK alright thank you so much so much.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You're welcome. Take care.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.