AccountId: 011433970860
ContactId: b4e3b6c0-9d7a-4f11-b842-c9249aeb3f0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502239 ms
Total Talk Time (AGENT): 357082 ms
Total Talk Time (CUSTOMER): 168588 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/b4e3b6c0-9d7a-4f11-b842-c9249aeb3f0d_20250218T18:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking and how may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII].
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hi, I've got policy number 256-6030. Mr. [PII].
[CUSTOMER][NEUTRAL] I'm wondering if you can, he said that he received.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Letter one with his name and policy number and the other one with not and he wants to know which one he needs to send back.
[CUSTOMER][NEUTRAL] Do you have any clue what we might have sent him? And he said he's got his medical records.
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] I mean, I remember talking to him.
[AGENT][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me look at the notes because I spoke to him. I could have swore I did on [PII], checking the status of the mail in line for processing advised he is subject to preexisting because of his face is uh effect date. No takeover information is listed on P now. I explained to him because I stayed on the phone with him for a long time. Uh, let's see, I explained to him, you know, the preexisting. I got my notes out here, but um.
[CUSTOMER][NEUTRAL] Well, I was looking.
[CUSTOMER][NEUTRAL] the, yeah.
[CUSTOMER][NEUTRAL] Yeah, that's all.
[AGENT][NEUTRAL] Uh, so what is he, uh, I'm, I'm not really sure. Today he's calling because
[CUSTOMER][NEUTRAL] He's calling because he received.
[CUSTOMER][NEUTRAL] Um, 2 things from us, yeah, and I don't see where anything has been sent.
[AGENT][NEUTRAL] Bladder?
[CUSTOMER][NEUTRAL] And I'm just trying to figure out how to best help you.
[AGENT][NEUTRAL] No, we, we ain't sitting in all.
[AGENT][NEUTRAL] Let's see, uh, also verify, also verify that [PII] did not receive the info he sent in on a blah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yeah, I don't know what he's talking about. I, I mean, you, you can send him over to me because I spoke to him and yeah, uh, like I said, on the [PII]. Well, it's, yeah, I think it's a day or two ago.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I don't know. There's no notation that somebody sent him anything, so I don't know why he's saying that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's why I was just like, I wonder if, cause he said he went to the hospital and got medical records, so I didn't know. I don't see where anybody is really requesting medical records.
[AGENT][NEUTRAL] Nope.
[AGENT][NEGATIVE] And the only thing he's getting that from, he's getting that from because you know I believe in telling everybody everything up front. He's subject to preexistence. So I don't believe in that having them file a claim and then they're under the impression that that's it. No, because he was thinking that, and I stayed on the phone with him for a long.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] time [PII] so long that I told him he's like, well, I might as well not have this policy. I said, Well, sir, I can't tell you that. I said, but I can't, we don't process claims over the phone. I said, but you should reach out to the pharmaceutical company, the issue of the drug. Sometimes they have programs that will assist you.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, you want to get with the social worker at the treatment facility because they're there to assist you with programs that may be in place. Me and him got so in debt. We got so in debt that I told you and told him, well, you're right, it is expensive, but it's gonna make you hit a 10.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're 100% out of pocket. I said, and once you hit 100% out of pocket with your main insurance, they're gonna be paying everything at 100%. He goes, yeah, they told me that. So go ahead and send him over to me and um I'm gonna try to decipher what he's saying because, you know, I think he's trying to make something happen and it's just.
[CUSTOMER][NEUTRAL] I wonder
[CUSTOMER][NEUTRAL] Yeah, it's just a process and.
[AGENT][NEUTRAL] You know, he, he said he was gonna get the medical records and I told him, you, you have, you, you can do that. But understand that your, your claim is gonna be investigated. It's gotta be investigated. So.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, um, and unless it's that email, uh, [PII] said that she would email him the treating physician form.
[AGENT][NEUTRAL] But go ahead and send him over, uh huh.
[AGENT][NEUTRAL] The list of training, yeah, that's, that's probably all we sent him.
[CUSTOMER][NEUTRAL] That's the only thing that I could even, but he said he got home and opened it up.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I bet you that's what it is.
[AGENT][NEUTRAL] It may be, it's the list of treating physician and then she probably sent him the HIPAA form because, you know, we need that to request the medical records. So that's normally two things that we send, but I'll tell them it's not a problem. Yeah.
[CUSTOMER][POSITIVE] All right. I don't, I really do appreciate that, [PII].
[AGENT][NEUTRAL] Uh, you, you verified everything, right?
[CUSTOMER][POSITIVE] I did and I'll get him on the line for you so if you'll hold on just a second, thank you [PII]. I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you, [PII].
[AGENT][POSITIVE] All right. Uh-huh. You're welcome.
[CUSTOMER][POSITIVE] Mhm. Hi Mr. [PII], I have [PII] on the line she's going to assist you further with the documents, OK? OK, yeah thank you thank you you have a wonderful day and thank you [PII].
[AGENT][POSITIVE] Thank you. Hey, Mr. [PII], I spoke to you, uh, a day or two though on the [PII].
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] I spoke to you yesterday.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, I know, and then, uh,
[AGENT][NEUTRAL] OK, so I understand that you're calling because you had some forms were they emailed to you?
[CUSTOMER][NEGATIVE] Yeah, I got them already. I got two of them. One has my name and my policy number, and they look the same. One is just blank without my name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh. Right. That's the list of treating physician form. Yeah, it's just a list of treating physician form. And so it's 2 pages is what it probably is. So you just need to fill out because remember we talked about pre-existing. We only need to know the physicians that you saw 12 months prior to your effective date for the condition that you're filing for. So that would be for the cancer, nothing else, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, but uh like I said, I didn't see this person for my cancer treatment until this year.
[AGENT][NEUTRAL] It doesn't matter we still have to have that form filled out. We have to have their name and we'll be reaching out to them as well, mhm.
[CUSTOMER][NEUTRAL] OK. OK, so I didn't get that one from them.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah, you need to put down that person's name, address, and phone number as it states on there.
[CUSTOMER][NEUTRAL] They're far from the house.
[AGENT][NEGATIVE] If you don't need to use the 2nd page, don't use the 2nd page because that's just if some people have a ton of doctors, but if you don't need to use the 2nd page, you don't use it. Just use the first page and list what you need to list as instructed on that form.
[CUSTOMER][NEUTRAL] OK, just
[CUSTOMER][NEUTRAL] OK, now I sent you all that paperwork [PII].
[AGENT][NEUTRAL] OK. And remember,
[CUSTOMER][NEUTRAL] No, for the doctor. I'm sorry [PII], and you should have that paperwork when I uh went to see him in January. So y'all should already have that.
[AGENT][NEUTRAL] It doesn't, it doesn't, it doesn't matter. You still have to fill that form out that form still has to be filled out about by you because that is a part of our investigation. If you do not fill that form out, they're not gonna process your claim, OK?
[CUSTOMER][NEGATIVE] OK, I'm just gonna fall out.
[CUSTOMER][NEUTRAL] OK. Well I fill the form out. What about the, what about the medical record since y'all already have it.
[AGENT][NEUTRAL] Um, once you fill that out and send that in, whoever's assigned your claim, they will investigate all that. They will have your claim. They will go through what they have. They will make a determination at that time whether they need to reach out to your doctor for additional records or not, but they are going to reach out to that doctor because they're gonna, they're gonna ask certain questions and that's just a part of the investigation, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so he asked when I came out there, then I should start getting myself started.
[AGENT][NEUTRAL] I'm sorry, what did you say now?
[CUSTOMER][NEUTRAL] So then we all make a decision. I should know about 2 or 3 weeks from now.
[AGENT][NEUTRAL] Um, uh, well, well.
[AGENT][NEUTRAL] No, not with medical records are involved. Again, you're gonna have to wait for your claim to be processed and they're gonna go from 15 days from the date that you sent in that first piece of mail, [PII]. It looks like it's already been assigned to somebody. So, and, and as I told you when I spoke to you yesterday that it was going to be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Process this week because they're gonna go according to that first date but if you don't have that information what we're talking about in that claim is gonna be denied asking you to send that in and they're gonna send you that form again so we'll be in your best interest to get that form over to us ASAP, which is what you said you were going to do yesterday. You need to get that form in so that that doesn't delay your process even longer but once we get that information in, they're gonna have to investigate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then.
[AGENT][NEUTRAL] And then that's gonna take some time as well, OK?
[CUSTOMER][NEUTRAL] OK then.
[CUSTOMER][NEUTRAL] OK. Because I found out, uh.
[AGENT][NEUTRAL] All right. Anything, uh-huh.
[CUSTOMER][NEUTRAL] Then my radiation treatment is $4000 for 6 or 9 weeks. That's all it's gonna be.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, OK, let me go and get this filled out so I can get it faxed to you on the day then.
[AGENT][NEUTRAL] OK, alright, anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that was it, thank you.
[AGENT][POSITIVE] OK, thank you for calling ATO Mr. [PII]. Take care and have a great day.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm.