AccountId: 011433970860
ContactId: d805c782-acf2-4abc-a3ca-dbdee143757c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495160 ms
Total Talk Time (AGENT): 195399 ms
Total Talk Time (CUSTOMER): 293226 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/d805c782-acf2-4abc-a3ca-dbdee143757c_20241230T19:32_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], good morning. Uh, my name is [PII], and I wanted to file a cancer claim form. Um, a couple of weeks ago, I spoke to someone and they said that I had to, um, along with the form, um, attach all the explanation of benefits from both our insurances, except for the fact that one of my insurance is just taking a very long time and I don't have all the EOBs.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it best to just wait until I get all of them and then file the claim?
[CUSTOMER][NEUTRAL] Cause I know like this is the end of the year so I'm not sure how that works.
[AGENT][NEUTRAL] So, there, well, first, um, let me pull up your policy. [PII]. May I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Sure, 503.
[CUSTOMER][NEUTRAL] 4108617
[AGENT][POSITIVE] Thank you and then your policy number when you're ready.
[CUSTOMER][NEUTRAL] 2541023
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth and your mailing and email address.
[CUSTOMER][NEUTRAL] My date of birth is [PII] and the mailing address is [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So there's no um timely filing, so you can file the claim at any time as long as the um policy is active, but yes, you, so, so you don't have to worry about, you know, time frame or anything, but it would be.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The reason I'm hesitant is because I have seen uh like claims be denied requesting an explanation of benefits, so I don't want to say, send it in and then that's one that's missing and it's denied, but I don't want to hold it up and then something else can be processed. So I, I think this one will be up to your preference.
[CUSTOMER][POSITIVE] Beneficial.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, cause there's, he, it's, it's for my husband and he's on the claim, uh, on the policy as well. And uh he, he had uh radiation treatment um from September to October.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and so I have all the explanation of benefits for September, but I don't have Octobers. They're taking a very long time to get October's done. So I'm like, OK, here we are already in December, and I still don't have October.
[AGENT][NEUTRAL] So then, yeah, I would just do, so you have September, you don't have October or November, right? I, I would just do September then.
[CUSTOMER][NEUTRAL] Well, he didn't
[CUSTOMER][NEUTRAL] Yeah, he didn't, he didn't have radiation in November. He had 6 weeks of radiation starting in the middle of September to the middle of October, um, and so I have all the explanation. I have them for one insurance company. I have them for his, uh, Medicare company, but Blue Cross Blue Shield, which is my health insurance that he's covered under, is just taking forever.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh so yeah, so there's still probably 3 weeks of EOBs that I don't have, yeah, and I'm not sure if they need all of that because it's like a one-time claim thing, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That you're missing.
[CUSTOMER][NEUTRAL] Or not. But, you know, I guess I can wait until I get them and then file it next year. We're not in a hurry. Um, but I just want, I just
[AGENT][NEUTRAL] You could, um, if you, if you wanted to do it all, because as soon as we receive it, they start processing, so it it's not um like they'll hold it and wait for the others. So I would, if you, but depending on what the paperwork says though, it might show September to October on one.
[AGENT][NEUTRAL] I would say to go ahead and submit it.
[CUSTOMER][NEUTRAL] Yeah, I have, I, I have like, I'm not kidding you, I have like 35 EOBs.
[AGENT][POSITIVE] Wow. Yeah.
[CUSTOMER][NEUTRAL] Lots of them. There are a lot of them.
[AGENT][NEUTRAL] I was
[AGENT][NEUTRAL] I was gonna say you say 30.
[CUSTOMER][NEUTRAL] And that's just
[CUSTOMER][NEUTRAL] And that's just from Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] I have more from Aetna Medicare. There's a lot of them because he went through radiation. So you have the EOB from the doctor, you have the EOB from the radiation, you have the EOB from the CT, you know what I'm saying? They didn't, they didn't just do one, they did each one in every day. He did 30 days of radiation.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A lot. He did 30 days of radiation, so there's a lot of EOB.
[AGENT][NEUTRAL] Yeah, that is
[CUSTOMER][NEUTRAL] And I'm like, and I know my, and I know my policy is kind of like a one time, you just get this amount and that's it.
[CUSTOMER][NEUTRAL] I don't think they pay a portion of each EOB. Am I correct? I'm not sure.
[AGENT][NEUTRAL] Well, let me take a look at your benefits because I do see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Cancer treatment benefit. Hold on, let me pull up the breakdown. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah, yeah. Mhm. Mhm.
[AGENT][NEUTRAL] Um, let's see. So, no, your this policy does have, it has several benefits, um.
[AGENT][NEUTRAL] So, for example, the radiation therapy, um, the policy does pay up to $15,000 towards radiation therapy, chemotherapy, or immunotherapy, um, per 12-month period.
[AGENT][NEUTRAL] Um, you have the first occurrence benefit. If there is a positive diagnosis, the policy will pay out the $5000.
[AGENT][NEUTRAL] Um, then you have like the diagnostic testing, the surgical benefits, anesthesia, um,
[CUSTOMER][NEUTRAL] OK, well then I'll wait till the end. I'll wait till I get everything. It is gonna be a huge package and I was gonna try to do it online and and attach every because I have all the EOBs on my computer that I have currently, um, and attach it online, but I don't know if there's enough room for all of them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I really don't.
[AGENT][NEUTRAL] It probably, it probably will give you a, um, I think there is like a um a millibyte or I forgot the unit, but however many, um, but yeah, if you, if you mail it to us.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] So I probably, it'd be better to do it on paper, yeah.
[AGENT][NEUTRAL] Yeah, especially if there's so many like that.
[CUSTOMER][NEUTRAL] It's gonna be
[CUSTOMER][NEGATIVE] Yeah, he had uh Merkel, I'm gonna say had because I'm claiming that he doesn't have cancer anymore, so we haven't, we haven't, that's right, we're claiming it. Um, but he had Merkel cell carcinoma, which is a very aggressive skin cancer. Wear sunscreen, honey, wear sunscreen.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, we're claiming it to then.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I have to, I'm like.
[CUSTOMER][NEGATIVE] This man never wore sunscreen.
[AGENT][NEGATIVE] I'm, well, we say allergic to the sun, but like if I, um, if I'm in the sun too long, I'll break out in hives and it like zaps me.
[CUSTOMER][NEUTRAL] Wear sunscreen?
[CUSTOMER][NEUTRAL] Yes, ma'am, yeah. I tell everybody now, wear sunscreen. But anyway, um, so yeah, so he had to do 30 days in a, well, not in a row, they didn't, they gave him the weekends off, but he had 30 days every day of radiation, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was a lot, a lot. And that, that's when she had surgery before that too, so. But like we're saying, we're gonna claim it, that it's all gone.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] We will, and we're gonna claim it with you. You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Yes, ma'am. All right, thank you for your time. Yes, ma'am. Um
[CUSTOMER][POSITIVE] No, no, you kind of made it easier. I'll just wait until I get all of them and then I'll send you guys this big gigantic package.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APO. It was a pleasure speaking with you and I hope you have a happy New Year.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] You too. You too, sweetheart. Take care.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.