AccountId: 011433970860
ContactId: d74ddf63-11b4-4bc6-a2ea-ee01508b9517
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530750 ms
Total Talk Time (AGENT): 185608 ms
Total Talk Time (CUSTOMER): 265260 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/d74ddf63-11b4-4bc6-a2ea-ee01508b9517_20250124T20:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] here here. How can I help you?
[CUSTOMER][NEUTRAL] Uh, can you hear me OK? Because it sounds choppy on my end.
[AGENT][NEUTRAL] Yes I can hear you.
[CUSTOMER][NEUTRAL] OK, um, let me see if I move my phone if it gets better. Um, I'm trying to get together my paperwork to file claims, um.
[CUSTOMER][NEUTRAL] When it says that you need a pathology report.
[CUSTOMER][NEUTRAL] Um, when, when you're, if you're doing the initial, the new or the surgery, OK?
[CUSTOMER][NEUTRAL] Is there OK, so I had.
[CUSTOMER][NEUTRAL] Um, I did call and ask for a pathology where they diagnosed my cancer, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do I need a separate pass?
[CUSTOMER][NEUTRAL] I don't know if the pathology is gonna because they.
[CUSTOMER][NEUTRAL] What they did initially is they did the biopsy and they said it was like a 90% chance and they technically didn't confirm that yes, it is cancer until after they removed it and did the, the checked in.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Would they, would, would I actually would that report be the one that they would need is the one after they had this when they removed it and then.
[CUSTOMER][NEUTRAL] Checked at that time?
[AGENT][NEUTRAL] Yeah. Anytime a biopsy is performed, you would send in that pathology report.
[CUSTOMER][NEUTRAL] OK, so every biopsy and the, and basically, I guess the surgical then pathology. So I need more than one pathology is what I'm trying to figure out.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Not just the first one when they because they told me the initial or the very first time they diagnosed it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, if you're filing for surgery prior to the date that it was confirmed, then we would need that pathology report as well.
[CUSTOMER][NEUTRAL] What I'm sorry, explain what you mean. Say that again.
[AGENT][NEUTRAL] I would suggest submitting both pathology reports cause it's possible that there were services related to cancer, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And without all of the information, you can miss out on some benefits. So I would just suggest to send in anything related to cancer for us to review.
[CUSTOMER][NEUTRAL] OK, so just when I talk to them, anything related to cancer, please send me those reports.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. The other thing is, um, it says the.
[CUSTOMER][NEUTRAL] The radiation therapy hm. OK, so I had like radiation, for instance. The itemized medical bill, is that what came from my, like my, I have um Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] Is that the itemized thing that you're wanting me to turn in?
[AGENT][NEUTRAL] That would be the explanation of benefits.
[CUSTOMER][NEUTRAL] Or is it from the doctor?
[AGENT][NEUTRAL] Yes, the bill from the
[CUSTOMER][NEUTRAL] OK, so I need an explanation of benefits too, OK.
[CUSTOMER][NEUTRAL] And then, so then I asked the doctor for the itemized medical bill then.
[CUSTOMER][NEUTRAL] If I don't already have it.
[CUSTOMER][POSITIVE] Correct
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] invoice. OK, what is the itemized invoice then?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] That's a bill.
[CUSTOMER][NEUTRAL] Oh, that's prosthetic stuff. OK, never mind, I'm sorry, that's not related to me, OK.
[CUSTOMER][NEGATIVE] OK, so here's my other thing. I have to take Synthroid every single month and my insurance doesn't even cover it. So does it also cover that? The prescriptions I have to take now that I no longer have a thyroid?
[AGENT][NEUTRAL] I can take a look at your policy.
[CUSTOMER][NEUTRAL] Or is it just for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and [PII], what's a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what's your policy number?
[CUSTOMER][NEUTRAL] Oh hold on I wrote it down.
[CUSTOMER][NEUTRAL] 252-854-7
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And also verify your address and date of birth.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And verify your email address.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] Um, [PII] or it might be under my school one, I think it's actually under my school and I apologize, it's [PII].
[AGENT][POSITIVE] OK, yep, that's what we have on file and thank you for verifying that information, all right.
[AGENT][NEUTRAL] And you wanna know about the coverage for a prescription?
[CUSTOMER][NEUTRAL] Yes, does it cover prescriptions that I have to take now that I no longer have?
[AGENT][NEUTRAL] OK, and this is a verification of coverage. It doesn't guarantee the payment of a claim.
[AGENT][NEUTRAL] Um, the drug itself would be covered if it is either immunotherapy, chemotherapy, or hormone therapy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Yeah. So if it's not one of those, then it would not be covered.
[CUSTOMER][NEUTRAL] OK, so I'm trying to think, so.
[CUSTOMER][NEUTRAL] I don't know if they consider it hormonal because I don't, I no longer have a thyroid, so I have to take that. Do they consider that hormonal or no?
[AGENT][NEUTRAL] Um, I wouldn't know without, um, the specifics you can send in a copy of the prescription or, um, invoice from the pharmacy um along with your claim information and it can be reviewed.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And then what else? like I know that I had the radiation.
[CUSTOMER][NEUTRAL] Done, um, do they cover also like when you've had radiation like you did the low iodine diet and then they, you take the radiation pills and then they do the full body scan looking for the cancer um do they cover that, that scan?
[AGENT][NEUTRAL] Not the scan associated with the radiation therapy. Um, the radiation is only covered for the delivery.
[CUSTOMER][NEUTRAL] What do you mean the delivery? I'm sorry. I'm, I'm just trying to process what you're saying.
[AGENT][NEUTRAL] Sure. The treatment, the radiation treatment, this policy will pay for that, any of the services related to it as far as um the devices or management or scans, X-rays, things of that nature is not covered under the radiation benefit.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Not when they're checking to see if it's still there or not.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so radiation, surgery, um.
[CUSTOMER][NEUTRAL] We're checking on the inch of the medicine and
[CUSTOMER][NEUTRAL] I think that's it and maybe I'm trying to think. I think that's it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, well, is there anything else?
[CUSTOMER][NEUTRAL] I think that's it. Alright, so I was, I'm gonna try to fill these out. No, I think that's it. I was just trying to see if I make could I go in and start filling out as far as like, you know, the process or the paperwork or the applications or whatever and then upload the documents once they get to me or do I have to wait and upload it all at one time?
[AGENT][NEUTRAL] Um, depending, depending on what you have, once we receive that information, if it's processed before you submit the additional information, then it's possible that the claim will be denied requesting the information that you had sent, um, so it's, it's really at your discretion. It takes 7 to 10 business days for us to process a claim.
[AGENT][NEUTRAL] So if you are sure that you can get it to us before that 7, uh 10 day time frame, then yeah, you can start submitting your information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, OK, so I probably should wait because my, the doctor's office is not great about doing things. OK, well, I think that's it. I will try to get all that from them and then I'll fill out the applicant that thing then. OK, I appreciate it. Thank you for your help.
[AGENT][POSITIVE] No problem, [PII] any time. Thanks for calling APL. You as well thanks bye bye.
[CUSTOMER][POSITIVE] Have a great day.
[CUSTOMER][POSITIVE] All right thank you bye bye.