AccountId: 011433970860
ContactId: c3fc178d-9bb2-4e2a-952d-343c181fb17c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1056329 ms
Total Talk Time (AGENT): 357065 ms
Total Talk Time (CUSTOMER): 292671 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/c3fc178d-9bb2-4e2a-952d-343c181fb17c_20250107T20:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and my policy number is 95265.
[AGENT][NEUTRAL] 95265.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's your first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And last name, yes, that's [PII].
[AGENT][NEUTRAL] And what's a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me that one more time.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Today, it just sounds like everybody is like far away.
[CUSTOMER][NEUTRAL] Really I'm having problems with my phone as well. Is this better?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Yeah, that's fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] [PII] and verify your date of birth and your mailing address, please.
[CUSTOMER][NEUTRAL] [PII] mailing address [PII].
[AGENT][NEUTRAL] OK, and your email address on file?
[CUSTOMER][NEUTRAL] Uh, well, that probably has changed, but my new email address is To [PII].
[AGENT][NEUTRAL] Mhm, that's what we have. [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] That's correct. Well, that's that, that's good, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's what we have and how can I help you, [PII]?
[CUSTOMER][NEUTRAL] Yes, I was calling to see that I've had cancer twice if whether or not I had been reimbursed for the second time because I had documents for [PII]. Does your system show whether or not I was compensated for the second time that I was diagnosed with cancer?
[AGENT][NEUTRAL] You said that was in [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I show benefits paid out for radiation in [PII]. I don't show anything for [PII].
[CUSTOMER][NEUTRAL] OK, should I send um.
[CUSTOMER][NEUTRAL] Then the invoices that I have for that period.
[AGENT][NEUTRAL] Is it a, is it the same diagnosis or different?
[CUSTOMER][NEUTRAL] Uh, I would think it's the same one, bladder cancer.
[AGENT][NEUTRAL] It's a different diagnosis?
[CUSTOMER][NEUTRAL] No, it's the same diagnosis.
[AGENT][NEUTRAL] OK, so did it.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I mean, has it been
[CUSTOMER][NEUTRAL] So what, what diagnosis.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] I was trying to think of the word remission. Was it in remission and it came back in [PII]?
[CUSTOMER][NEUTRAL] No, it's just that I have bills that I had that I was wondering that I, I submitted it for reimbursement.
[AGENT][NEUTRAL] Filed him. OK, got it.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Not seeing the diagnosis without pulling up your documentation. So, I mean, if you, it's either the same or it's a different one.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] not.
[AGENT][NEUTRAL] So have you been diagnosed with any other cancer other than the one in [PII]?
[CUSTOMER][NEGATIVE] No thing. No, no, no, same thing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so, is it radiation treatment that you had in [PII]?
[CUSTOMER][NEUTRAL] I just had a lot of different deals and I was just wondering have I been reimbursed.
[AGENT][NEUTRAL] Yeah, I don't see any any claims for [PII] for you.
[CUSTOMER][NEUTRAL] OK, so the bills that I have, should I send them to you because the policy I have paid for all the expenses, doesn't it?
[AGENT][POSITIVE] Yes, you get a, a preventive benefit once per per year.
[CUSTOMER][NEUTRAL] And how much is that?
[AGENT][NEUTRAL] Yeah, I did see a lot of those. One moment.
[CUSTOMER][NEUTRAL] But was I reimbursed for those?
[AGENT][NEUTRAL] I'm checking.
[CUSTOMER][POSITIVE] OK, I appreciate it.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] OK cool
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] I love
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm just going through your policy real quick.
[CUSTOMER][POSITIVE] I really appreciate it, ma'am. I really do. I really do.
[AGENT][POSITIVE] Oh, you're welcome.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I do, I do not show where we paid any.
[AGENT][NEUTRAL] For you
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] You nothing was paid in [PII].
[AGENT][NEUTRAL] As far as, as far as, uh, a wellness, a wellness benefit.
[AGENT][NEUTRAL] For, for your
[CUSTOMER][NEUTRAL] OK, so all the, so all the expenses that I had for other procedures that I can't be reimbursed?
[AGENT][NEUTRAL] So if, if, if the procedures are uh the for the cancer claims, you can send those in.
[CUSTOMER][NEUTRAL] Ma'am?
[AGENT][NEUTRAL] But I was looking to see if you had that wellness. Uh, some cancer polic uh of our cancer policies has that, um, it's a preventive, uh, benefit where you can submit like a mammogram or a Pap smear or there's other tests that can be submitted for a benefit. It's one time a year. That's what I was looking for in your policy, and this policy does not have that, nor do I see any that have been paid for you.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] So I don't need to like a Pap since it was bladder cancer, I don't need to submit a bladder, a Pap smear uh result.
[AGENT][NEUTRAL] No, ma'am, because I, I don't see that benefit under this particular policy.
[CUSTOMER][NEUTRAL] OK, but the going to the urologist's office for the expenses I had there, I can send those so send those bills.
[AGENT][NEUTRAL] So would that be for like an office visit?
[CUSTOMER][NEUTRAL] What was the process that I was going through when I was.
[AGENT][NEUTRAL] Or did you have treatment?
[CUSTOMER][NEUTRAL] Yeah, I had treatment.
[AGENT][NEUTRAL] What type of treatment?
[CUSTOMER][NEUTRAL] Ah, let's see.
[CUSTOMER][NEUTRAL] I'm, that's what I'm looking for.
[CUSTOMER][NEUTRAL] I'm trying to think because some of this is [PII], it shows um final diagnosis.
[CUSTOMER][NEUTRAL] I didn't have uh chemo or radiation when I was diagnosed with uh
[CUSTOMER][NEUTRAL] It's just that I had the, the cancer removed.
[AGENT][NEUTRAL] OK, that's what, that's what happened in [PII].
[CUSTOMER][NEUTRAL] I'm looking at uh so I don't see that well let's see.
[CUSTOMER][NEUTRAL] I'm trying to see.
[CUSTOMER][NEUTRAL] Trying to see reported date [PII].
[CUSTOMER][NEUTRAL] Oh no, this is so much collective date. That is [PII]. Does your system show [PII]?
[AGENT][NEUTRAL] Yeah, I do see charges for [PII], some surgery charges and the hospital charge for [PII].
[CUSTOMER][NEUTRAL] OK, well that.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, was I compensated for that?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so I will pay for that for [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, well, after that, will I pay for anything else that I had?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Pardon me?
[AGENT][NEUTRAL] For the year [PII], I see radiation and an outpatient surgery benefit that was paid and the hospital bill. That's for year [PII].
[CUSTOMER][NEUTRAL] OK I will.
[AGENT][NEUTRAL] And uh
[AGENT][NEUTRAL] Then
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] I see chemo was paid.
[CUSTOMER][NEUTRAL] How much was paid for chemo just interested in knowing.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] So, in [PII], uh we paid out 9500. That's just for the chemo, but there were other things like your surgery, you received that first occurrence benefit, the biopsy was paid, anesthesiology was paid.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So almost over about 13,000 for everything for 98.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Make a notation of that.
[AGENT][NEUTRAL] 99. I'm showing that chemo was done and a surgery.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Um, we paid 6
[CUSTOMER][NEUTRAL] OK, 908 was about 130,000 you said?
[CUSTOMER][NEUTRAL] OK, what other year?
[AGENT][NEUTRAL] In [PII], we paid roughly a little over 3, 13,000 98.
[CUSTOMER][NEUTRAL] OK, well, and any other year?
[AGENT][NEUTRAL] For 99, we pay your chemo benefit of 6,908.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we paid for a surgery at $368 368 dollars and then you must have submitted some type of a drug benefit. We paid $25 on that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $25?
[AGENT][NEUTRAL] Uh-huh. It's a drug benefit for 225.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, for radiation, we paid $11,094.60.
[AGENT][NEUTRAL] And then for outpatient hospital, we paid $800 and then the outpatient surgery, we paid $1560.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Nothing in [PII].
[AGENT][NEUTRAL] Nothing in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see 25.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Looks like you had some hospital bills.
[AGENT][NEUTRAL] Um, 1,215 1921 $2200.
[AGENT][NEUTRAL] No chemo or anything. It's just lab and outpatient. You had a surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Nothing in [PII].
[AGENT][NEGATIVE] You did, you did submit information for like screenings and things of that nature, mammograms and those were denied. It's not covered by the policy, and I didn't see it in the policy either, and that is about it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you very much. So everything in [PII] you said so nothing for [PII]?
[AGENT][NEUTRAL] If it's related to your cancer, I would go ahead and submit them for review. I'm not guaranteeing anything because we have to look at the documents first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you're more than welcome to submit the documentation, the itemized bills.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll do it.
[AGENT][NEUTRAL] And then an an APL claim form.
[CUSTOMER][NEUTRAL] OK, can you, uh, can you mail me an ATL claim form, please?
[AGENT][NEUTRAL] Um, I can. Would you like for me to email it to you?
[CUSTOMER][NEUTRAL] Yeah, you can email it to that address is [PII]. OK.
[AGENT][NEUTRAL] OK, give me 1 2nd. I'll do that while I have you here on the phone.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'll email it to the address, the email address you verified.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] If you take or how.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] I just emailed it over to you, give it a few minutes.
[CUSTOMER][POSITIVE] OK, great. OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so I'm gonna send uh the invoices I have from [PII] and [PII].
[CUSTOMER][NEUTRAL] So you, you just not showing.
[AGENT][NEUTRAL] You think
[AGENT][NEUTRAL] Yeah, anything related to your cancer. Now, if you're sending in balance due statements, those are not sufficient. We would need the itemizations, the itemized bills because it would need to show us your diagnosis, what you had done, the, you know, the procedure codes.
[CUSTOMER][NEUTRAL] Your system
[CUSTOMER][NEUTRAL] Yeah, right.
[CUSTOMER][NEUTRAL] OK, this is OK, it has what I have is a clinical lab results. Is that what you need?
[AGENT][NEUTRAL] What is it again?
[CUSTOMER][NEUTRAL] Clinical lab results.
[AGENT][NEUTRAL] I don't believe that'll be sufficient, uh, [PII], is there any way that you can get copies of the itemized bills?
[CUSTOMER][NEUTRAL] I could ask for them, but it does show the urology group shows the diagnosis of bladder cancer for [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I'll, I'll leave that up to you. You can submit what you want.
[AGENT][NEUTRAL] Um, but just know that if it's not all that they need, they'll, they'll reach out to you via mail to let you know what, what additional information may be required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because I do have an appointment with this doctor on [PII], so I'll send what I have, and then you can contact me and I could bring you to the doctor for what I'm gonna need.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll do that. I'll, I'll send it to you, uh, in the very near future.
[AGENT][POSITIVE] OK. All righty.
[CUSTOMER][NEUTRAL] And and you don't have anything in your system showing for those dates, the [PII] on up to the [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] OK, well I'll send that to you. That's a problem.
[AGENT][POSITIVE] All righty.
[CUSTOMER][POSITIVE] Thank, thank you so very much. You've been very kind.
[AGENT][POSITIVE] Oh, you're welcome, Ms. [PII], and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You too. Happy [PII].
[AGENT][NEUTRAL] Um, you too.