AccountId: 011433970860
ContactId: b80c3b7b-8bbe-4845-822a-3a6190666f72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 795760 ms
Total Talk Time (AGENT): 539647 ms
Total Talk Time (CUSTOMER): 221742 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/b80c3b7b-8bbe-4845-822a-3a6190666f72_20250218T15:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Yes ma'am. My name is uh [PII].
[CUSTOMER][NEUTRAL] I have a cancel insurance policy with y'all.
[AGENT][NEUTRAL] What was your first name?
[AGENT][NEUTRAL] What was your first name?
[CUSTOMER][NEUTRAL] [PII] ma'am.
[AGENT][NEUTRAL] OK, [PII]. OK. OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, and I just got off the phone with my radiation doctor and that uh my whole thing for 9 weeks, the radiation treatment is gonna be $4000.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, are you?
[AGENT][NEUTRAL] Let me, let me pull up your policy, um.
[CUSTOMER][NEUTRAL] Yes, ma'am. Go ahead.
[AGENT][NEUTRAL] So I can tell you how to file a claim because it wouldn't be through a phone call. So just one moment.
[CUSTOMER][NEUTRAL] OK, now.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I did file a claim before I got the paperwork on the [PII] of uh.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] OK, OK. Let me get a call back for you, [PII], please.
[CUSTOMER][NEUTRAL] [PII] ma'am.
[AGENT][NEUTRAL] All right. And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, let me see, 256-6030.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, thank you. One moment please and I'm gonna pull up your policy.
[AGENT][NEUTRAL] OK, [PII]. Can you please verify your date of birth, your address, and your email address if you have one, please.
[CUSTOMER][NEUTRAL] Oh OK, date of birth is [PII].
[CUSTOMER][NEUTRAL] Email address is [PII].
[AGENT][POSITIVE] Alright, thank you so much for verifying the information. So today you're calling in about your radiation, um, and you, I do see.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You just can't tell me you have
[AGENT][NEUTRAL] Where you file, um, submitted some claims, one on [PII] and the other one on 214.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So, basically you were calling to let us know that you are gonna do radiation and that's the approximate amount of your radiation. Is that?
[CUSTOMER][NEUTRAL] Yeah, yes, yes, ma'am, $4000 for 9 weeks.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, what you would need to do is um
[AGENT][NEUTRAL] You know, once you, you know, do the radiation they submit you your billing.
[AGENT][NEUTRAL] You will need to submit to us the itemized billing for that as well as the explanation of benefits from your primary carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK then.
[AGENT][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Some like y'all, y'all are my primary carrier or what, which one would it be?
[AGENT][NEUTRAL] No, we're not your primary. um, your primary would be, for instance, if you have Blue Cross and Blue Shield.
[CUSTOMER][NEUTRAL] Yeah, I get that. OK, submit it to them too.
[AGENT][NEUTRAL] Yeah, no, no, no. OK, so how um how it works with the cancer policy is, while I pull up your policy, this is a verification of your coverage and I guarantee payment, which we pay actual charges. So your radiation, chemo and immunotherapy is $20,000 per benefit, 12 month benefit period. So that means say, say for instance, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They say you, your stuff is uh $15,000 right? And they bill $15,000 to Blue Cross and Blue Cross say, well, we're gonna pay 10.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] And we're gonna leave 5 for [PII]'s responsibility. What we do, we add what Blue Cross paid, what is your responsibility together, and that's what we give you, which that means actual res yeah. So that's how that works. So that means that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Once you get the billing from the hospital, and once you get the explanation of benefits of how Blue Cross pays your claim, you send that to us. We will look at it, we will add those two amounts together and that's what we will send you up to $20,000.
[CUSTOMER][NEUTRAL] Oh, OK, now another thing they told me I can bring $350 except a payment arrangement with them from the rest of it like that if I want to do it that way.
[AGENT][NEUTRAL] So they're not gonna bill your insurance?
[CUSTOMER][NEUTRAL] They gonna bill my insurance, but they said I can do it either way. I want to do that they told me.
[AGENT][NEUTRAL] Oh, OK. Oh, OK.
[CUSTOMER][POSITIVE] Yeah, just, just in case I didn't have any insurance or anything like that, uh, I can set a payment arrangement with them.
[AGENT][NEUTRAL] Oh, OK. So, yeah, when.
[CUSTOMER][NEUTRAL] I told him I had insurance and everything.
[AGENT][NEUTRAL] Yeah, so once you, once they start sending you your bills for the radiation, then and once um Blue Cross, if that's your carrier, once they pay for it and they send you what's called an explanation of benefits, you send both of those documents to us and that's how we will process your claim for the radiation.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I ask you another question if you don't mind, ma'am?
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] I looked in the book it says if you're diagnosed with cancer, you get up to $5000.
[AGENT][NEUTRAL] What type of cancer did they diagnose you with?
[CUSTOMER][NEUTRAL] I think that is
[CUSTOMER][NEUTRAL] Prostate cancer.
[AGENT][NEUTRAL] OK. All right. So, um,
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] All right. So, um, you do have, um, which is called internal cancer first occurrence benefit, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which means that
[AGENT][NEUTRAL] If you've been diagnosed with cancer, uh, internal cancer, they will give you a $5000 lump sum benefit, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and that's just a lifetime, you, you know, if you get cancer again somewhere else or whatever and you file claims, we will pay other benefits, but we wouldn't give you that $5000 lump sum again because it's only a lifetime benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just a one time thing yeah I understand that, yes ma'am.
[AGENT][NEUTRAL] Yeah. Mhm. So that's how that works.
[CUSTOMER][NEUTRAL] OK, so when would I hear from y'all again and all, all my like this stuff I sent to y'all on the [PII]?
[AGENT][NEUTRAL] OK, so I just wanna let you be aware. I looked over, um, I didn't look at what you sent, but um.
[AGENT][NEUTRAL] I do see where we're gonna have to do a pre-existing investigation, which means that we're gonna send you a form to fill out with all your doctors that you saw from 0101 of 24 to 1231.
[AGENT][NEUTRAL] A 24 and you fill those out as long as what Prix means is they just want to make sure that you did not see a doctor.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] um before you came on with us, cause if you did that mean for this, for prostate cancer. So if you saw, if you saw a doctor for prostate cancer before you came on with us, then
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It would be considered preexisting. If you didn't see that doctor.
[CUSTOMER][NEUTRAL] I thought that. I won't get anything then, right?
[AGENT][NEUTRAL] Yeah, if you saw the doctor after [PII], then your benefits will be payable.
[CUSTOMER][NEGATIVE] So basically I saw the doctor, let's say in January. They won't pay for nothing then right.
[AGENT][NEUTRAL] If you saw them after [PII] of this year, so if you saw them on [PII].
[AGENT][NEUTRAL] Then it would be payable. As long as you.
[CUSTOMER][NEUTRAL] It would be payable.
[AGENT][NEUTRAL] Yes, as long as you didn't see the doctor before.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Well, I didn't see the doctor until
[CUSTOMER][NEUTRAL] Uh, he did, he did, I did a, they call it a prostate, I did a prostate exam.
[AGENT][NEUTRAL] The PSA test? OK.
[CUSTOMER][NEUTRAL] Yeah, I did a PSA test. I did that back in like in.
[CUSTOMER][NEUTRAL] Oh shoot, [PII].
[CUSTOMER][NEUTRAL] Mm, let's see.
[CUSTOMER][NEUTRAL] [PII], I can't remember when I did the PS test. But what I did, he just took my prostate and then I did a biopsy in January.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah. So that's what they do is just check to make sure that you wasn't seeing a doctor for prostate cancer before you came on with us.
[AGENT][NEUTRAL] And that's what that means, yeah.
[CUSTOMER][NEUTRAL] OK, I'll send all that in there. Did y'all get all the paperwork for that?
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] Diagnosed with the date is the month and everything should be on there.
[AGENT][NEUTRAL] Yeah, yeah. But um we have to do the pre, so what they're gonna do is gonna send you a treating physician form and the only doctors that you put on there is the ones that you saw last year. You wouldn't put any of your doctors that you are seeing for this cancer because that was this year. So you only put people that you saw last year on there and like maybe your.
[AGENT][NEUTRAL] If you have a primary care doctor that you might have saw last year or something.
[CUSTOMER][NEUTRAL] Yeah, Doctor [PII], I saw him.
[AGENT][NEUTRAL] Yeah, so that's the only doctors that you put, you wouldn't put any doctors for this year because that doesn't matter. Only the doctors that you saw um 01 of 24 to 1231 of 24. Um, and so once.
[CUSTOMER][NEUTRAL] I saw a doctor.
[CUSTOMER][NEUTRAL] 0124
[AGENT][NEUTRAL] Yeah, [PII] through [PII] of [PII]. So that's considered a one year look back cause that's how we have to do is a one year look back. So once we do the one year look back and they say, oh yeah, um [PII] didn't go to the doctor last year for prostate cancer, he's good to go. That's how we do the pre-X investigation. So you're gonna get a form in the mail.
[CUSTOMER][NEUTRAL] Well I didn't go there.
[CUSTOMER][NEUTRAL] I've seen the doctor for my, like you said, the blood work, the pH level. He just, he just monitored for me.
[AGENT][NEUTRAL] Yeah, this is just wellness, yeah, that's just a wellness visit. But it, but they're just looking to make sure you wasn't diagnosed with cancer last year and that the doctor didn't tell you you had cancer last year. That's what they're looking for.
[CUSTOMER][NEUTRAL] No, I didn't get I didn't get diagnosed cancer last year, not at all.
[AGENT][NEUTRAL] Yeah, yeah, so that's just um.
[CUSTOMER][NEUTRAL] So y'all, so I just send it when I get that letter y'all can y'all email it to me I fax it and I just fill it out and send it back to y'all.
[AGENT][NEUTRAL] Um, I can email it to you right now.
[AGENT][NEUTRAL] And then once you, if I'll email it to you, fill it out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And since so and if you can fill it out as soon as possible and
[AGENT][NEUTRAL] Send it back to us.
[CUSTOMER][NEGATIVE] I had to fill out the night when I get out of work.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I can fill out the night. You send it to me now when I get on print it out.
[AGENT][NEUTRAL] I have um [PII], um, [PII].
[AGENT][NEUTRAL] The the school, OK, I can email it to that email address that we have on file.
[CUSTOMER][NEUTRAL] still got public school.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um just fill that out and send that back to us as soon as possible. Um, that way, it'll hurry up the process and make sure you um
[AGENT][NEUTRAL] You know, just put the doctors from [PII] to January, I mean, [PII]. You don't have to put any doctors that you saw this year.
[CUSTOMER][NEUTRAL] OK, well, the only one I saw last year was my doctor, my primary doctor, and that was the one I saw. He was the one I saw last year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that's the only one that you.
[CUSTOMER][NEUTRAL] And that's the one I talk about the PH, yeah, you know the one I said take the PH level with my primary doctor, so that's the only one I saw last year with him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's the only doctor that you, you put on there. That's the doctor that we will request medical records from and then we will go from there. So, I'm going to email you the treating physician um form and you just fill that out, um, put his information, the doctor's information on there and send that back to us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so
[CUSTOMER][NEUTRAL] So for doctor yeah with his name on it and everything and then text it back to y'all.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So y'all have something like with the the hospital phone number and everything on the fax number y'all would need?
[AGENT][NEUTRAL] Um, I think it, it's gonna, um, ask you for, it's gonna tell you to put the doctor's name, address, and phone number. If you have a fax number, if not, then we can reach out to them and get that fax number.
[CUSTOMER][NEUTRAL] From the hospital.
[CUSTOMER][NEUTRAL] Well, I can get it for you and just put on a piece of paper.
[AGENT][NEUTRAL] Yeah, OK, yeah.
[CUSTOMER][NEUTRAL] I call him and get the to the uh uh thing out here where I get like uh when you go see the doctor for my medication and stuff cause every year I go get my blood work done and that's one of the years I got my blood work done. He kept saying it going up and he said I'm about to refer you to see uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You might have, you know, just cause he said he just want to see some of my PH levels going up. He found blood in my urine and everything like that, so.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] And that was last year when he did all this stuff for me. Ain't no other doctor I've seen.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So just put that, that doctor on that form and send that back as soon as possible. I'm gonna go ahead and email it to you. So, [PII], is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] You know, anything but that right there.
[CUSTOMER][NEUTRAL] So once y'all get there everything starts rolling in after that.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, I'm gonna send it to me so I can get it back to you as quick as I can.
[AGENT][POSITIVE] OK. All right, will do. Thank you so much.
[CUSTOMER][NEUTRAL] And I get the fax number for y'all and I put on, I put the fax number on there too.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you for calling APL. You have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too, ma'am.