AccountId: 011433970860
ContactId: dcd882da-5730-4905-99e7-ecc9a2a0bc5d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 858210 ms
Total Talk Time (AGENT): 321931 ms
Total Talk Time (CUSTOMER): 429084 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/dcd882da-5730-4905-99e7-ecc9a2a0bc5d_20250512T16:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, you need my policy number?
[AGENT][NEUTRAL] Uh yes, please.
[CUSTOMER][NEUTRAL] OK, it's 253.
[CUSTOMER][NEUTRAL] 1373.
[CUSTOMER][NEUTRAL] Ebola outbreak.
[AGENT][NEUTRAL] And can I get your date of birth, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Can you verify your address for me?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then your email address?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Uh, looks like we have a personal email address.
[CUSTOMER][NEUTRAL] Oh shoot, I'm sorry, I forgot you guys changed it. Uh OK, [PII], which [PII] [PII].
[AGENT][POSITIVE] OK, perfect, thank you. um, and then I did notice on the
[CUSTOMER][NEUTRAL] I need to remember that, OK, huh, go ahead.
[AGENT][NEUTRAL] Uh, I, I noticed on your city it has [PII] instead of
[CUSTOMER][NEUTRAL] [PII], yeah, yeah.
[AGENT][NEUTRAL] OK, is that still right?
[CUSTOMER][NEUTRAL] It's either or. I mean, one, no, it's right. Both of them are right. Um, I say right in the middle, some bills come with Providence, some bills come with [PII]. Uh, my letter, original letter, which all came, it had [PII] on there. Um, I think as I have been talking to you guys, you guys have changed it to [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, and then last.
[CUSTOMER][POSITIVE] Either one is still good, so huh.
[AGENT][NEUTRAL] OK, perfect. Um, do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] It should be the same [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And we do have a contact number on file of a 909 area code, is that still right?
[CUSTOMER][NEUTRAL] That's my, yeah, [PII]. That is not yours. Give it here.
[CUSTOMER][NEUTRAL] Uh, that's my cell number.
[AGENT][POSITIVE] OK, perfect. How can I help you today?
[CUSTOMER][NEUTRAL] That's not yours.
[CUSTOMER][NEUTRAL] OK, so, um, they have taught me to upload the, uh, reports on there, so I was calling to confirm that you guys do have them it says received but I don't see any activity done on them yet.
[AGENT][NEUTRAL] Uh, yes, I show we have received them and they're currently being reviewed and in processing.
[CUSTOMER][NEUTRAL] OK, so because um I sent over the um.
[CUSTOMER][NEUTRAL] The verification letter that I do have um breast cancer.
[AGENT][NEUTRAL] OK. Um, let me make sure.
[CUSTOMER][NEUTRAL] So I was just seeing making sure you guys don't need no more information on that.
[CUSTOMER][POSITIVE] I really wanna see.
[AGENT][NEUTRAL] OK, yes, I do see a pathology report. We have received that.
[CUSTOMER][POSITIVE] OK good.
[CUSTOMER][NEUTRAL] OK, so that's the only thing you need for that particular claim, right?
[AGENT][NEUTRAL] Uh, yes, if you have a first occurrence benefit, then that's what we need for that is the pathology report.
[CUSTOMER][NEUTRAL] And, and you already have it.
[AGENT][NEUTRAL] Let me make sure and pull you have.
[AGENT][NEUTRAL] Yes, we do. Uh-huh.
[CUSTOMER][NEUTRAL] OK, good. OK, and then on the second one it was my um.
[CUSTOMER][NEUTRAL] Uh uh.
[CUSTOMER][NEUTRAL] Let me think of, um, my biopsy.
[AGENT][NEUTRAL] OK, let me see what your.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], that's not hers. OK, just go on and let her have it and um, um, take it from her later, I guess.
[CUSTOMER][NEGATIVE] She ain't gonna give it to you that easy.
[AGENT][NEUTRAL] OK, so it looks like on here, um, let's see, so not a guarantee of payment, basic outline of your policy. We've got a benefit for radiation, chemo, and immunotherapy, um. Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Wait, wait, wait, wait, you're going a little bit too fast for me. OK, so what happened with that?
[AGENT][NEUTRAL] Um, so that one, are you trying to get reimbursed for the biopsy? Is that why you had submitted it?
[CUSTOMER][NEGATIVE] They told me to submit you guys to reimburse me for it.
[AGENT][NEUTRAL] Um, I'm trying to see if that's a benefit cause there's, so there's a benefit if for treatment, like if you got radiation or chemo, um, there's a.
[CUSTOMER][NEUTRAL] Yeah, I'm, I'm being that's being lined up so um I don't know. OK, so what about the MRI? Do you guys assist with covering that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it looks like, let's see.
[AGENT][NEGATIVE] You do have a cancer.
[CUSTOMER][NEUTRAL] This is all new to me so I don't know.
[AGENT][NEUTRAL] Yeah, I understand. Yeah.
[CUSTOMER][NEUTRAL] It's a, it's a lot. It's a, it's, it's really it's a lot. So the MRI I'm scheduled to go.
[CUSTOMER][NEUTRAL] Uh, Wednesday.
[CUSTOMER][NEUTRAL] So I had a question about that. I don't wanna submit nothing that you guys don't assist with, so I'm trying to get familiar what to submit and what not to submit. Um, do you guys assist with any of the co-payments or anything like that?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, it's, it's basically you've got your, any, so we, we do the treatment, we will do, there's um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A benefit for the surgery, um, if you have surgery.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I'm having that.
[AGENT][POSITIVE] There's a benefit for
[CUSTOMER][NEUTRAL] So the treatments, the surgery, the what about the hospital?
[CUSTOMER][NEUTRAL] The treatment, the sur[PII] mhm.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] That would be, it's, so the radiation and chemo, that would be for like whether that's billed by your physician or the hospital. That's a $15,000 benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, um, yeah, I have to have uh 3 types of treatments.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] It's gonna be chemo, it's gonna be her reception, and then it's gonna be the hormone uh balancer.
[AGENT][NEUTRAL] OK. Um, there is a surgical, um, benefit as well. So if you, if you have surgery, um, and that
[CUSTOMER][NEUTRAL] Yeah, I'm having both breasts removed.
[AGENT][NEUTRAL] OK. And then there's an anesthesia benefit.
[CUSTOMER][NEUTRAL] Yeah, they put me to sleep, OK.
[AGENT][NEUTRAL] And then um there's also a prosthesis benefit if you have a sur surgical implant.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yeah, yeah, I'm having that done.
[AGENT][NEUTRAL] Do you have, did you say you uploaded these online? Is that right?
[CUSTOMER][NEUTRAL] What's that?
[AGENT][NEUTRAL] Um, your the claim, the information you sent us, did you do that on our portal, the online, OK, um.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] So your policy certificate should be on your dashboard and you can read through that, um, and it, it gives an outline of what's covered under the schedule of benefits on page 23.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so that's gonna tell you at length on what, like everything that's covered under this policy.
[CUSTOMER][NEUTRAL] OK, hold up let me page 2.
[CUSTOMER][NEUTRAL] I know it's just I, I have it. I've seen it, it, it's just a lot.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I understand, yeah.
[CUSTOMER][NEGATIVE] It's a, it's a lot. So I'm more of a verbal person. I'm gonna call and still reverify it because I'm, I'm don't wanna waste your time. I don't wanna waste my time cause it's like I said, I have too much stuff to go through.
[AGENT][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] So, um, yeah. So, OK, so the treatment, surgery, anesthesia, OK, so the biopsy, the reason why, um, I also sent that over is because they had to numb me.
[CUSTOMER][NEUTRAL] To do that.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] I don't think the biopsy.
[CUSTOMER][NEUTRAL] And that code is on there? OK, go ahead.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][POSITIVE] powerful.
[CUSTOMER][NEUTRAL] Um, the hospital, um, stay, uh, do you guys cover that?
[AGENT][NEUTRAL] And the hospital stay, it would just be for the actual surgery, so it's not gonna be for the hospital. The only thing that it would pay for if for some reason you did go to ICU.
[AGENT][NEUTRAL] The step down unit.
[CUSTOMER][NEGATIVE] Oh, don't wish that, uh-huh.
[AGENT][POSITIVE] Yeah, I know, I'm just giving you the benefits.
[CUSTOMER][NEUTRAL] I think I've seen that, yeah, right, right.
[AGENT][NEUTRAL] Yeah, um, but that if, if we're talking about hospital, that's what we do cover on there.
[AGENT][NEUTRAL] Um, let me see, make.
[CUSTOMER][NEUTRAL] So the initial date you do.
[AGENT][NEUTRAL] If it's ICU or a step down.
[CUSTOMER][NEUTRAL] No, I mean the actual sur surgery date you do cover.
[AGENT][NEUTRAL] Right. We'll cover the surgery. So what's billed by the um physician. Let me see.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Make sure I'm not missing anything.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, I needed, um, to ask, um, the medical wig, do you guys assist with that?
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEGATIVE] Uh, looks like no, there's no benefit coverage for that.
[CUSTOMER][NEUTRAL] OK, for the week.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah. So the surgery benefit is for the physician. So that's gonna be for the physician charges and not the hospital.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for the doctor.
[AGENT][NEUTRAL] Well, OK, sorry, let me, let me read this part. So,
[AGENT][NEUTRAL] When you have your mastectomy, if, if you're gonna be inpatient in the hospital, there is a per confinement uh benefit of $50 and that's for each day that you're inpatient, you know, 24 hours in the hospital. So it pays $50 per day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK so.
[CUSTOMER][NEUTRAL] $50 daily OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK dokey, OK, and then how long does it take for you guys to process the claims? I think they told me 3 to 10 days or no?
[AGENT][NEUTRAL] Yes, um, it's about 7 to 10 working days, and that's given that we've received all the information that we need. Um, I will tell you when you're submitting the claims, um, be sure that you've got your bill charges, you know, where the services were rendered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The diagnosis.
[CUSTOMER][NEUTRAL] Let me do what? I'm sorry, huh?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, so you'll need when you submit the information for the claims for us to process, you'll need the charges that they billed, um, like the total charges, um, where it was, where it took place at like what hospital or uh physician, um, the.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, oh, that should have the header on there though, right? I mean when they send it, I'm just right, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, there, there should be an itemized statement.
[CUSTOMER][NEUTRAL] So because it should have the header with the address, your telephone number should have their claim number on it and the breakdown of everything because.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, OK, that makes sense.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what's the status of the ones that I just sent over?
[AGENT][NEUTRAL] Um, those that look like we received 57 and 58, and those are currently in processing.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, well I think that's it. OK, so you don't need no additional information on those.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] I don't show that we do at this time, so, um, and like, OK yeah.
[CUSTOMER][POSITIVE] OK, that's good. OK, mhm.
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][POSITIVE] Um, just feel free to give us a call back if you have any questions at all. I understand not wanting to, it can be overwhelming trying to read this online, so definitely call us anything you think of. We're happy to help and assist, so.
[CUSTOMER][POSITIVE] OK, thank you so much you have a great day.
[AGENT][POSITIVE] OK, thank you. Thank you for calling APL you as well. Bye bye.
[CUSTOMER][NEUTRAL] OK bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.