AccountId: 011433970860
ContactId: d6531274-ac14-440a-af91-f5ba8f6d1e21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1279560 ms
Total Talk Time (AGENT): 365189 ms
Total Talk Time (CUSTOMER): 583519 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/d6531274-ac14-440a-af91-f5ba8f6d1e21_20250317T16:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hey, um, I just need to find out we just faxed a form over for um with something like authorization to disclose protected health information so that I would be able to handle things for my brother and I wanted to see if y'all have gotten that and have updated it in the system because I can't pull it anywhere, of course, to see if it's been received or whatnot.
[AGENT][NEUTRAL] OK, I can.
[CUSTOMER][NEUTRAL] Um, is there a way you can see?
[AGENT][NEUTRAL] Verify that for you. And your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have that policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah, I sure do. It is 65, OK, 650-596.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And what's your brother's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] It's um [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah give me a moment.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] And I can tell you the date it was sent if you need that um but it was back.
[AGENT][NEUTRAL] Uh, when was that sent? Just to verify.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] It would have been last Tuesday. They said usually these, once they get them, these don't take long at all that they go on and usually.
[CUSTOMER][NEUTRAL] Update system so that you know, things can get handled.
[AGENT][NEUTRAL] Yes ma'am, give me a moment.
[AGENT][POSITIVE] Oh yes
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, one came in on the [PII].
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh that would have made it Thursday, OK.
[AGENT][NEUTRAL] What day was it? Oh, that was Thursday.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yes, it looks like it has been received. Give me one moment to add it into the system, OK?
[CUSTOMER][POSITIVE] Oh, that would be so nice. Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Well, it's in the system but I don't know if it let me.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Change anything. Give me one, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Is that what I
[CUSTOMER][NEGATIVE] Yeah, I was wondering if that's what I saw on the claims, but it shouldn't have failed on the claims. There was something received on the [PII] in claims, but.
[CUSTOMER][NEUTRAL] Um, I didn't think that would be it. I thought maybe that was actually a claim because we have submitted a claim, um.
[CUSTOMER][NEUTRAL] You know, so.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me double check to see what it is. Hold on one quick moment for me, please. I apologize, Ms. [PII].
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] All right, Ms. [PII]. I'm so sorry for the delay, but you, um, you say you're calling for, I do show it's been received, but it hasn't been entered in the system. And I'm wondering if our claims department have to enter that, but I do show it. Um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] Y'all still won't be able to talk to me then, so to speak.
[AGENT][NEUTRAL] Well, I'm trying to verify to make sure because um I wanna make sure we get it.
[CUSTOMER][NEUTRAL] Yeah, because I, I also want to verify to see if y'all had gotten this other fax that we had sent in on the same day. There were 2 others that came in for some claims to at least make sure they are received.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I kind of need to know that too. I know, I know it takes about 9 to about 12 days kind of to ever to, to get the decision.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, on things, but based on history in the past.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] But, you know, if they can't find them, it's like, 00.
[AGENT][NEUTRAL] OK, and I did confirm my consent. I do see that we received that I can speak with you, um.
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] But I see claims being received on the [PII] and they are in line for processing. I don't see anything besides the authorization coming in on the [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Um, OK, because, um, I don't, because I know there was one we did online, the wellness one, the one that I think you get, I can't remember how much it is, maybe 75 a year or 50, I can't remember if you just have a little test done.
[CUSTOMER][NEUTRAL] And um but then there was also some facts as that came in that was radiation treatments.
[CUSTOMER][NEUTRAL] From back in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, the system is slow this morning. Give me one moment.
[CUSTOMER][NEUTRAL] It's Monday. Everything is slow on Monday.
[AGENT][POSITIVE] That is so true. Yes, ma'am.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Why that is, I do not know.
[CUSTOMER][NEUTRAL] Yeah, it seems like Mondays and Fridays when I used to have to deal with the computer.
[AGENT][NEUTRAL] Mondays and Fridays.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see what this one was.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I see a um claim information coming in through the online service center, but that was on the [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And this looks like for wellness, so that's in line for processing.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You said also for, [PII], I'm sorry.
[CUSTOMER][NEUTRAL] But then I see the symptoms.
[CUSTOMER][NEUTRAL] Oh, I'm, I'm sorry. There was, uh, at the on the same day when we were faxing and stuff, we faxed in, um,
[CUSTOMER][NEUTRAL] Where there were two separate ones that came in, each one was 8 pages each. And um it was for June and [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Where he had um radiation treatments.
[CUSTOMER][POSITIVE] And we had sent those so hopefully somewhere they are there and gonna fall in line from, you know, be.
[AGENT][NEUTRAL] And I do show uh one for July, let me double check one for June. Looks like they came in on the [PII] as well.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, they were faxed back to back, yeah.
[AGENT][POSITIVE] And this one is for June. So yes, ma'am, I do show we received them and they are in line for processing.
[CUSTOMER][POSITIVE] So thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, yeah, that, that's, that, that's a relief. I just wanna make sure because I know once they're in line for processing, hey, that's fine.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Now I, now tell me again, is it truly in there to where you can talk with me about everything or is it still kind of waiting to get put in there for real put in there?
[AGENT][NEUTRAL] No, um,
[CUSTOMER][NEUTRAL] You know, that dysplasia.
[AGENT][NEUTRAL] Like I was looking at the claims that come through and I see the authorization form and I did, um, kind of let my supervisor know, so she did say I can proceed since we do show it's been received.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm good.
[CUSTOMER][NEUTRAL] Oh, sweet. OK, OK. Um, well, let me see if there was anything, while I have you to ask you, um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, let me ask you this, um, there was nowhere I've I've looked on the policy. Is there, do you have any idea, um, like when they have radiation or chemo, like for each treatment, what they, I know it's a $10,000 a year calendar year cap. Um, is there any way of knowing like per treatment what they actually pay if they approve it?
[AGENT][NEUTRAL] No, ma'am. Um, we won't know until after it's been processed, but, um,
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I didn't know if according to the policy it's like a set amount this is what they pay too.
[AGENT][NEUTRAL] Oh, no, ma'am, because I believe the policy language probably states uh actual charges, so more likely needed the primary EOB.
[CUSTOMER][NEUTRAL] Oh, OK. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, you got it. We made sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Well, we got the primary and secondary, yeah, we got the we got the itemized bill and the primary and the secondary.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh, good. Yes, ma'am. So, uh, exactly amount that is payable, that's something we won't know until after it's been processed, unfortunately.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][POSITIVE] We got all of that for you.
[CUSTOMER][NEUTRAL] And decided. OK. And one other question, and I think I was told yes on this, um, besides stuff like this, like if he had say a lung biopsy or a prostate biopsy, can we submit that? Do y'all, is that something like that that y'all consider for some sort of payment?
[AGENT][NEUTRAL] Uh, let me look at the policy cause I know some policies have sur uh surgical benefits. And these are, what, were they metastatic or Lord words? I can never say that word. Was it, um, did it spread possibly to other areas as far as this cancer?
[CUSTOMER][NEUTRAL] Um, well, I know he, at one point, that first diagnosis that y'all, you know, paid that money on was in his left lung. And then this is now the one he had the lung biopsy was the right lung.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And, um, you know, which was very positive, very. Um, and he did have a prostate biopsy. And really, it does show when I'm looking at it, does have adenocarcinoma, but it is not like those Gleason scores are not way up there. Thank goodness.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][MIXED] They're on the lower end, which is better. But he does have some form of, you know,
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] They still consider it quote cancer just not crazy aggressive.
[AGENT][POSITIVE] Well, that's good.
[CUSTOMER][NEUTRAL] It's on the very low one.
[CUSTOMER][NEUTRAL] But um,
[AGENT][MIXED] That is good cause some of these cancers are too aggressive and it's just horrible.
[CUSTOMER][NEUTRAL] I was thinking
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, but I was wondering because I was thinking that they had said yeah.
[CUSTOMER][NEUTRAL] That this does cover some surgeries that are related to cancer.
[CUSTOMER][NEUTRAL] Because that would definitely be like.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And I do show um a surgical benefit. So anytime uh when you submit the itemized billing for the surgical procedures, also submit the path report.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEGATIVE] Absolutely, I've got them. I've got them ready to go, but I wouldn't want to send them if you, you know, it's no worth, no purpose and wasting the time to send them if um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, because we've got the itemized, the path, the itemized report, and I can't remember if they asked for the EOB on that. For some reason, it doesn't seem like that was required on that when I was looking at the criteria.
[AGENT][NEGATIVE] I don't believe so. Yes, ma'am. I don't believe so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Cause I
[CUSTOMER][NEGATIVE] On your page that wasn't listed as part of the criteria.
[CUSTOMER][NEUTRAL] You know, but if it had been.
[AGENT][MIXED] Definitely the, definitely the path report, but as far as uh EOB I don't believe so. Just looking to see if it states actual charges and it's computer slow again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it doesn't ask for um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so we don't need the primary EOB just the billing and the path report.
[CUSTOMER][NEUTRAL] For that.
[CUSTOMER][NEUTRAL] Right, yeah, we had, we got it just in case. I said, you know what, I, I told the billing office, I said we want everything just in case.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah, it's right, it's best to have too much than not enough, yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm. And there was one other procedure that's related. I don't know if it'll pick it up or not or, or any a thing on it, but he had what they call, I think I'm saying this right, a life port inserted.
[CUSTOMER][NEUTRAL] To get though I keep.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Like they draw they draw blood. He never has to be stuck again, let me put it that way. They can draw blood out of it, you know, they give chemo and then give whatever they want in it or take out of it.
[AGENT][NEUTRAL] So the port, yes.
[AGENT][POSITIVE] Yes, ma'am. I would say to definitely submit the billing for that port.
[CUSTOMER][NEUTRAL] Isn't
[CUSTOMER][NEUTRAL] OK, all right, well, we, we, we will do that then. Um, I'm still waiting on, I think the
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Well, on that port you probably, well you don't have a pass report on that it's just the billing and probably the EOBs on that.
[AGENT][NEUTRAL] Uh, from what I understand, just the billing, um, I don't think they need the EOB for the port.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I might just send it just because that'll be OK, right?
[AGENT][NEUTRAL] I mean, if you want to send it, yeah, yes, ma'am. Like I said, it's best to have too much information than not enough, so you can definitely submit that to us if you feel so.
[CUSTOMER][NEUTRAL] Just in case.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'll just keep watching the system and once things are processed I'll see it on that claims page and.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] And I do believe if I'm looking correctly his bank information is in there when they are it will it automatically just.
[CUSTOMER][NEUTRAL] Uh, transmit to that is from through the Bank of Troll. If you pull it up, you'll see it's got the Bank of Troll on it.
[AGENT][NEUTRAL] Uh, yes, I do show we received his direct deposit information so that it is in the system.
[CUSTOMER][NEUTRAL] So that's what'll happen they won't mail something they'll just direct deposit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, awesome. OK, cause I don't trust the mail anymore at all.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I don't think most people do because, you know, some people can get into your mailbox. There are still those among us, unfortunately.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, 00 yes, yes, they are, you know, unless it's coming UPS or FedEx or something like that, that's the only way I trust it anymore.
[AGENT][NEUTRAL] Right. Were they ask for signature, yes, ma'am.
[CUSTOMER][POSITIVE] Oh, OK, but I think you have basically answered for right now, everything I needed to know.
[CUSTOMER][POSITIVE] Um, and I totally appreciate y'all are so easy to talk to. Uh, we're, we've got one other that we're dealing with and to say it's like pulling teeth and jump through a million hoops.
[AGENT][POSITIVE] Alright, good deal.
[CUSTOMER][NEGATIVE] That don't even begin these people.
[AGENT][POSITIVE] Oh, I'm so sorry.
[CUSTOMER][NEUTRAL] That that's it it is and it's not Aflac. I wish we had Aflac in y'all. It's another one.
[CUSTOMER][NEGATIVE] And they are awful.
[CUSTOMER][NEGATIVE] Awful.
[CUSTOMER][NEUTRAL] But, you know, so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We, we can hope that everything works out because it's just, I don't know, it's just too much, um, when it's uh.
[CUSTOMER][NEUTRAL] Well,
[AGENT][POSITIVE] We always want, when you make a call with something as serious as cancer that you get the right people and people who care to talk and tell you exactly what is needed, so you won't have to be jumping over hoops.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Well, and you're already under enough stress.
[AGENT][POSITIVE] Exactly, yes, ma'am.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] And um, as they say that commercial when you're, if a family member has Parkinson's, you have Parkinson's. And it's kind of the same way with cancer. You feel like you've got it too because you're living it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You're living it with them, yes, especially, yeah, oh no, I completely understand because it's a.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Anytime someone's sick, uh, it, it affects everyone, especially the loved ones, especially, yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, but I appreciate your time so much and um.
[CUSTOMER][NEUTRAL] You know, we need something we'll, we'll call back, but I, I, for right now, I think we're pretty settled until we see what happens with these things and because like I say, there is more to come in, but I want to see what happens with these first.
[AGENT][NEUTRAL] Oh, yes, ma'am.
[CUSTOMER][NEUTRAL] Um, but they don't come in because they were done this year. So actually, the hospital doesn't even have the ELBs back and all yet, so they submitted them, but, so, but uh.
[CUSTOMER][POSITIVE] Yeah. OK. Well, but like I say, thank you so, so, so much.
[AGENT][POSITIVE] You are welcome, Ms. [PII], and is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] I think that'll be it for right now.
[AGENT][POSITIVE] All right. Well, I thank you so much for calling APL. You have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you, ma'am. Bye.
[CUSTOMER][NEUTRAL] Mm bye.