AccountId: 011433970860
ContactId: ac760504-3610-4235-ac5a-37914c4c4835
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 950000 ms
Total Talk Time (AGENT): 484019 ms
Total Talk Time (CUSTOMER): 367690 ms
Interruptions: 7
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/ac760504-3610-4235-ac5a-37914c4c4835_20250604T18:08_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII]. I'm calling because I'm trying to get some information. I turned in a whole bunch of information.
[CUSTOMER][NEGATIVE] And I'm not sure what all information we're supposed to be turning in for claims to be paid. I know they sent us different paperworks that were supposed to be turning in, but I mean, we're only getting certain things from the doctor. They were turning in and I'm not sure what all is supposed to be turned in.
[AGENT][NEUTRAL] OK, so you're trying to find out what, how to know what you would need to file a claim with APL is that correct? Yes, ma'am, I can try and help you with that and who am I speaking with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, yes, yes.
[CUSTOMER][NEUTRAL] My name is [PII]. Last name is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And Ms. [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] It is area code [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, and your policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] It is, hold on real quick. It is 2.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] It is 258.
[CUSTOMER][NEUTRAL] 2109.
[AGENT][NEUTRAL] OK, thank you. So give me a couple of moments, Ms. [PII], so I can get the policy information pulled up. Once I do, I will have to verify several things with you for security and also any information that is provided will be a verification of benefits and not a guarantee of payment. Alright, so one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII]. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And your uh the claims for you or your spouse?
[CUSTOMER][NEUTRAL] It's for my husband.
[AGENT][NEUTRAL] OK, and what is his name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And your home mailing address, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. The phone number that we have on file for you, Ms. [PII], is the same as the one you gave me, so that is your best number that we should have, is that correct?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] OK, thank you. And then the last piece of information is your email and this does appear to be your work email.
[CUSTOMER][NEUTRAL] Yes, it is. It is gonna be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying your information and I can see too, Ms. [PII] that you called in and spoke to someone yesterday, so you did get your new profile set up on the portal. OK, that's good. All right, so I do see that there was one claim that was processed last Friday, and I can see that that was not approved, so let me look at the remarks to see what.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What was, uh, and you can also see these remarks in your portal.
[AGENT][NEUTRAL] If you click on the claim number, it there is a copy of your explanation of benefits, Ms. [PII].
[AGENT][NEUTRAL] That will have the same remarks on there, OK? To make it easier for you than to try to write all these down because there were multiple dates of service on this claim that we looked at.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So for the first
[AGENT][NEUTRAL] OK, so for [PII], there were two dates, two line items for that date.
[AGENT][NEUTRAL] And it states based on your effective date of coverage, it is necessary that we obtain your past medical history to determine if the claim is due to a preexisting condition. Please complete the enclosed form and return to our office.
[AGENT][NEUTRAL] That was one of the remarks, and I can see, let's see, the other one states please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So those are the two remarks for the data service of [PII].
[CUSTOMER][NEUTRAL] Yeah, cause this paperwork that I sent along with that would have the hospital information, the date that which has the biopsy, the date that should have the [PII] with the biopsy, the day that we found out when they did the biopsy attached to that.
[AGENT][NEUTRAL] And there's
[AGENT][NEUTRAL] OK, but
[CUSTOMER][NEUTRAL] That's the day that we found out.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, go ahead with what you were saying.
[CUSTOMER][NEUTRAL] Yeah, cause that's the day we found out, which was [PII].
[CUSTOMER][NEUTRAL] That's the day he was hospitalized cause they had to curry him from one hospital to another hospital because he was rushed through one hospital and they told us that he needed to see, we had to have the oncologist step in immediately, so we had to be careful at it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. So when, so again, for the 35 data service, now I can see that it's also that same remark as the first one that I read to you. Based on your effective date of coverage, it is necessary that we obtain your past medical history to determine if your claim is due to a pre-existing condition.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Please complete the enclosed form and return it to our office.
[CUSTOMER][NEUTRAL] Yeah, see that's the
[CUSTOMER][NEUTRAL] OK. Yeah, cause that's the day that we got the prognosis. That's, that was our first day.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm. So that form though will have to be, yeah, the form though to
[CUSTOMER][NEUTRAL] That's the day that they, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that we can obtain the past medical history. That is something that we will have to, you know, you will need to complete and you can upload that in your portal as well, Ms. [PII]. That's something that doesn't necessarily have to be mailed back to us. You can upload it.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we have to have.
[AGENT][NEUTRAL] OK. So let's see, that was for.
[CUSTOMER][NEUTRAL] Yeah, cause I think the medical records. Yeah, cause that's the medical records that came from the ER from being transported from the biopsy, all those are the reports, because we checked in on the [PII], because we were at our primary's office and they sent us straight through the emergency room on the [PII]. And on the [PII] is when the oncologist.
[CUSTOMER][NEUTRAL] met us at the other hospital after being curve flighty.
[CUSTOMER][NEUTRAL] This is all done on the [PII]. We have to be careflighted in the wee hours of the morning.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because this, that's when they found it.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Over the, over the middle of the night cause it had to uh, I mean, we were told from our primary.
[CUSTOMER][NEUTRAL] We need to get to the ER now.
[CUSTOMER][NEUTRAL] We had to go then. Everything was done with a biopsy.
[CUSTOMER][NEUTRAL] That, that morning.
[CUSTOMER][NEUTRAL] At [PII], and there, that's how I went. And they gave and from [PII], Methodist of [PII].
[CUSTOMER][NEUTRAL] That's the medical records. That's all everything.
[CUSTOMER][NEUTRAL] From there.
[AGENT][NEUTRAL] OK, so have you received your copy of the explanation of benefits or been able to see that in the portal?
[CUSTOMER][NEUTRAL] Uh, no, I hadn't cause I was trying to see, like I said, yesterday was like, yeah, yeah, cause yesterday was our first day. We were not able, we've been trying to get back and forth into that system.
[AGENT][NEUTRAL] Because there's so many line items.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Back and forth, and yesterday was our first day cause we've been calling back and forth, back and forth, back and forth trying to get into the system, and we were not able to get into there.
[AGENT][NEUTRAL] Right, because there had been a, there was an update to it over the weekend, so anyone that was had already prior registered on the portal prior to this weekend did have to set their profiles up again like they like they had never set them up before and that was part of the security on the new portal but I do see, like I said that you had called and spoken to someone yesterday.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] And they were able to help you according to the note I see.
[AGENT][NEUTRAL] So you should be able to log in.
[CUSTOMER][NEUTRAL] Yeah, she was having us.
[AGENT][NEUTRAL] Yeah, so you should be able.
[CUSTOMER][NEUTRAL] OK, log back in and then.
[AGENT][NEUTRAL] And you can go to that claim.
[AGENT][NEUTRAL] For Mr. [PII] and the remarks for each of the line items and dates of service, that's gonna be listed on the 2nd page.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll call.
[AGENT][NEUTRAL] And I think because there's, you know, quite a few line items, it's gonna be easier for you, Ms. [PII], to be able to just look at that.
[AGENT][NEUTRAL] Cause there's, I'm reading verbatim from what it states.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, let's see.
[AGENT][NEUTRAL] I'm waiting on one of my screens.
[AGENT][NEUTRAL] Because this claim had for dates of service 343-5317 [PII] and [PII].
[CUSTOMER][NEUTRAL] Yeah, that's when he's been seeing, he's taking chemo.
[CUSTOMER][NEUTRAL] And he just started radiation uh Monday before last. So he's taking chemo and radiation at the same time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now you have not filed for that though yet.
[CUSTOMER][NEUTRAL] No. Well, the doctor.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] The doctor has the paperwork, and I think he just had them to complete it yesterday.
[CUSTOMER][NEUTRAL] And now we have something else that's about to take place because
[CUSTOMER][NEUTRAL] As of next Monday, they will be put in a feeding tube in, so we're about to go through something else.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, it's just more stuff now, so.
[CUSTOMER][NEUTRAL] So I just need to go in there and pull all that off and.
[CUSTOMER][NEUTRAL] Uh, get the doctor to fill out all of that.
[CUSTOMER][NEUTRAL] Yeah, I just have there.
[AGENT][NEUTRAL] Yes, ma'am. And then on our and just for future reference, and I've talked to you before, Ms. [PII], I believe, um.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] The easiest, let's see, yes, because I emailed you the cancer claim form and the initial user guide for this online service center because I remember speaking to you now that was back in the middle of May.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that cancer claim form.
[AGENT][POSITIVE] It has very detailed instructions on the first page.
[AGENT][NEUTRAL] As to what you need to submit. Mhm.
[CUSTOMER][NEUTRAL] OK, and I think that's the form that.
[AGENT][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Yeah, and I think those are the forms the doctor has now. I think those are the forms he has that he just filled out yesterday, so they should be giving us those today.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think those are the forms that he actually has.
[CUSTOMER][NEUTRAL] OK, so I'll just go in there and look and see. cause like I said, since the portal.
[AGENT][NEUTRAL] Yes ma'am, so if you want to look back, right, if you want to look back to on that email, I mean in your inbox from [PII], you should have an email from care team at AMpublic.com that had, like I said, the user guide for the other portal and also a cancer claim form. Now that cancer claim form is also on our public website, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] At just at [PII] under claims and forms. But it may be easier for you to just go back to that email that I sent you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For it. But again, it has all the instructions on page one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And, but I can go into that link now for where the paperwork was turned in, yeah, into the portal where I turned in the papers and then pull those off of there.
[AGENT][NEUTRAL] Mhm. And your name portal.
[AGENT][NEUTRAL] Or you can pull the explanation of benefits. Your documents that you submitted to us, no, ma'am, but your, the review of the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Under in the claim there's only gonna be one claim number at this time for Mr. [PII] in your portal.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] And so you would, you know, just click on that and then you can download that explanation of benefits.
[AGENT][NEUTRAL] And it will give you the dates of service and then the remark codes.
[CUSTOMER][NEUTRAL] OK, OK, that's the point.
[AGENT][NEUTRAL] And what they mean will be on page 2.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the same as with the other portal, you know, you have access to your policy information, all of that's in there. This is just a little more robust uh portal, so therefore that's why new profiles had to be created.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Well, is there anything else, Ms. [PII] that I could try and help you with at the moment?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's all I was needing.
[AGENT][POSITIVE] OK, well, if you have any other questions, please give us a call back and we will be very happy to help you.
[CUSTOMER][POSITIVE] OK, and thank you so much.
[AGENT][POSITIVE] Oh, well, you're very welcome and I will certainly be keeping both you and Mr. [PII] and my thoughts and prayers.
[CUSTOMER][POSITIVE] OK, and thank you so much.
[AGENT][POSITIVE] You're very welcome, Ms. [PII], and thank you again for calling APL. I do hope you have a nice afternoon.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.