AccountId: 011433970860
ContactId: dcf6cb6c-1db8-471a-90f5-ec6a73e1d153
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2367379 ms
Total Talk Time (AGENT): 974148 ms
Total Talk Time (CUSTOMER): 697389 ms
Interruptions: 8
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/dcf6cb6c-1db8-471a-90f5-ec6a73e1d153_20250610T12:35_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I was wondering if you could take a look at something for my bill for me.
[AGENT][NEUTRAL] When you say your bill is, are you the group administrator or is this for something personal?
[CUSTOMER][NEUTRAL] Oh this is my personal bill with APL.
[AGENT][POSITIVE] Yes, ma'am. I can try and help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And Miss [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and your policy number please.
[CUSTOMER][NEUTRAL] 01775159
[AGENT][NEUTRAL] 01775159. Is that correct?
[CUSTOMER][POSITIVE] Yes, I'm reading this correctly, yes, ma'am.
[AGENT][POSITIVE] OK, thank you. So.
[AGENT][NEUTRAL] Alright, OK, alright, so one moment Miss [PII] while I get your information pulled up. Once I do, I will need to verify several things with you first for security. So just one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, Ms. [PII], so first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] Thank you and the last piece of information to verify is your email.
[CUSTOMER][NEUTRAL] A my last name of [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], thank you for verifying all of your information. So give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, so yes ma'am, um, how can I help you today?
[CUSTOMER][NEUTRAL] OK, I got a letter saying that it's past due by $53.80 and I had something like a 31 day grace period. Uh, could you check the date on that when I have to pay that by?
[AGENT][NEUTRAL] So I do show that the draft had been returned in April for insufficient funds, so there was an additional draft, um, set a, a double draft set up and that the.
[CUSTOMER][NEUTRAL] Yes, and I'm not sure if it just, if I didn't have that set up right, not through you, I mean through me, for my husband's payday, because it, again, it didn't come out on what I thought I had it set up for, but anyway, what am I looking at? What do I need to do today?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so give me just a moment to see.
[AGENT][NEUTRAL] Let me, I'm gonna have to look at a few more things.
[CUSTOMER][NEUTRAL] I'm just calling to pay it, yeah, OK.
[AGENT][NEUTRAL] OK, so just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] Uh, bear with me, Miss [PII] because my system is.
[AGENT][NEUTRAL] Taking his time. OK, so just a second.
[CUSTOMER][NEUTRAL] Sure, I understand.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Bring me my wallet.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] I'm laughing my husband with his coffee this morning.
[AGENT][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Here you go, baby. Oh, it should be on the calendar then. Can you see where it's at? Thank you.
[AGENT][NEUTRAL] Let
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so just a moment here I'm gonna need to send a message to see what we can do so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Yes, I absolutely hate to lose my cancer policy. Oh.
[CUSTOMER][POSITIVE] So much involved in that.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] And I'm going to, yeah, I've got to just check a few things for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright, so give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you for your patience.
[AGENT][POSITIVE] Yes yes.
[AGENT][NEUTRAL] OK. So, Ms. [PII], uh, we are going to be able to um reactivate the policy. So you are within that grace period.
[AGENT][NEUTRAL] So you're gonna, you're going to pay, you want to pay over the phone, correct? for April.
[CUSTOMER][POSITIVE] Oh wonderful, OK.
[CUSTOMER][POSITIVE] Yes, if, if I may do that, yes.
[AGENT][NEUTRAL] Ma, I mean, you want to get caught up. Is that correct?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] OK, alright, well, what I will need to do then is to get you connected with someone um in our billing group billing department who can process your payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment. And um
[CUSTOMER][NEUTRAL] Is it 5380 or?
[AGENT][NEUTRAL] They will verify that with you because I show the policies paid to one, so that would, you would need to pay April, May, and
[AGENT][NEUTRAL] I believe June.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, but they can verify that with you and I will give them your policy number when I connect you. So is there anything, uh, and then also Miss [PII], one last thing, I can see that you have previously set up your profile in our portal online, so there were some upgrades to the online.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yes, I haven't been on to that in a while, yeah, uh-huh.
[AGENT][NEUTRAL] OK, so there were some upgrades made to the portal. So when you go to that website the next time you will need to select the option to create an OSC account you'll need to set up a new profile.
[AGENT][NEUTRAL] In the portal and if you have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is that where
[AGENT][NEUTRAL] Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I was gonna say is that where I'll go if I wanna try to get it back on auto debit or whatever.
[AGENT][POSITIVE] Yes ma'am, go ahead with your question.
[AGENT][NEUTRAL] No, now that your payment information is um you can't do that still in there, but that's still for your claim status such as that.
[CUSTOMER][POSITIVE] I got you. OK. Well, the only other question I might have then, I'm sorry, I didn't mean to cut you off. You go ahead and tell me about the website first. Sorry about that.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am, no, that's OK that's all I was gonna say is you'll just need to set up a new profile because you will not be able to log in with your old, you know, information.
[AGENT][NEUTRAL] Like in the past. Mhm.
[CUSTOMER][NEUTRAL] I see. OK, well.
[CUSTOMER][NEUTRAL] my only other question that I have is that I've got a lot of claims that I have not filed, and I need to do that. I've been so busy with all these doctor's appointments, um, but I have one. I have some surgeries coming up. I didn't know if maybe I should wait until after the surgeries, and then file it all at one time, maybe. Um, but I'm not sure exactly. I guess I could look on the, on the website. Would it tell me what will be payable toward my mastectomy and my hysterectomy?
[AGENT][NEUTRAL] Uh, yes, and there is a copy of your policy certificate in your portal for your viewing that will list out all of your benefits and any information provided on your benefits as a verification of benefits and not a guarantee of payment. But yes, and you would need to wait until after your surgeries because there are specific documents that are required when you submit a claim on this policy. So I can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can email you if you would like.
[AGENT][NEUTRAL] The uh new user guide for the portal as well as do you know where to obtain the cancer claim form that has all of the instructions on there for what's required.
[CUSTOMER][NEUTRAL] Oh, OK. Sure, that would be great. If you want to email me that. And then I think I know, like, once I get logged in, there's that, you know, the cancer form. And on my travel, that's been my biggest thing that I haven't been turning in for, which I know it's only like 12 a year or something to radiation, chemo, and uh immunotherapy and all of that. Um, am I correct? That's, that's like I would put in
[AGENT][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] Uh, estimated gas like for those days, for 12 days a year or something like that, I think it said.
[AGENT][NEUTRAL] I will have to pull up your policy information to look at that, so give me just a couple of minutes and let me send your, let me send you this email first and then I can pull up your policy information.
[CUSTOMER][NEUTRAL] I haven't
[CUSTOMER][NEUTRAL] Oh well, no problem. We don't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] Oh no.
[AGENT][NEUTRAL] OK, Miss [PII], so I am about to send that to you.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] If you don't see the email in your inbox, you know, in just uh in a few minutes, you might wanna check your junk or spam folder. I don't think that they will go there or it will go there rather, um, but the email that you're gonna be receiving is going to come from [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] And I did put in the subject line for you [PII] so that that's easy to recognize.
[CUSTOMER][POSITIVE] Thank you so much. Let me see if I can find it here.
[AGENT][NEUTRAL] You, uh, yes, ma'am, and it may not, it may not be there yet. It may take it a minute.
[AGENT][NEUTRAL] But it has been sent.
[CUSTOMER][NEUTRAL] Got you. 00.
[CUSTOMER][NEUTRAL] I'll check my junk mail when I do as well.
[AGENT][NEUTRAL] Yeah, um, it's, it's, I can tell you, it's been taking a few minutes for it to come through, so I don't know if it's the attachments, but, um,
[AGENT][NEUTRAL] Yeah, give it just a few minutes and then by the time I look at some of your policy information for you, you should be able to see that.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Yeah, you're right. I don't see it yet or anything, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this was for your mileage or your transportation, is that correct? That you had a question regarding?
[CUSTOMER][NEUTRAL] Yes, I do. The first year in [PII], when I found out I had, I want to say they've already paid me for like maybe 6 or 7 of those. I can't remember. I'm supposed to get, I believe, if I'm not mistaken, it's 12 a year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yes, sir.
[CUSTOMER][NEUTRAL] To radiation.
[AGENT][NEUTRAL] For transportation, it's a maximum of 12 trips per cover person per calendar year for all modes of transportation combined. So that's whether you had to drive or fly or, and that's 40 cents a mile.
[CUSTOMER][NEUTRAL] And all of that.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And on, let's see, give me, there's one more piece of information that I wanted to provide for you on that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so the
[AGENT][NEUTRAL] Transportation benefit is if the comprehensive cancer treatment center is located more than 50 miles from your covered place of residence.
[CUSTOMER][NEUTRAL] Oh yeah, I
[CUSTOMER][NEUTRAL] And we got 2 hours each way.
[AGENT][NEUTRAL] OK. So when submitting the expenses for your travel, we do have to have an itemized bill with the diagnosis and the treatment provided. And that bill should include the provider's address, so where you're going for your treatment would need to be on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And then, um, so that is what you would need to submit.
[CUSTOMER][NEUTRAL] OK, and on those, my my question was, I mean, like I have tons of appointments to do with the cancer. Is that specific to radiation, chemo and immunotherapy?
[AGENT][NEUTRAL] This is for treatment. Yes, ma'am. It's for. It states.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Uh, let me read.
[AGENT][NEUTRAL] Yes, that is for treatment.
[AGENT][NEUTRAL] What it says cancer treatment and evaluation or consultation.
[CUSTOMER][NEUTRAL] OK. Well,
[CUSTOMER][NEUTRAL] OK. Uh, or consultation?
[AGENT][NEUTRAL] That's what this says. Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] When it says consultation, is that like when I got diagnosed or is that like when I go to my oncologist or?
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] We will pay the indemnity amount shown in the schedule of benefits for a second. Oh, no, I'm so sorry. I was about to read you the wrong thing. If a covered person obtains a treatment opinion.
[AGENT][NEUTRAL] At a National Cancer Cancer Institute designated comprehensive Cancer Treatment Center, we will pay the indemnity amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that's for the evaluation and.
[AGENT][NEUTRAL] Consultation, uh, let's see.
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Subject to the maximums per lifetime and at the comprehensive cancer treatment center is located more than 50 miles from your covered excuse me, covered person's place of residence, we will also pay the transportation and lodging indemnity amount shown in the schedule of benefits.
[CUSTOMER][NEUTRAL] OK. Well, the reason I was asking, like, for instance, um, you know, I had to get second opinions. I went to MD [PII] at one point. I, I was at [PII], but now I'm at UT Southwestern where I ended up getting all of my treatments and where I do, I mean, most of my treatments, not all, but, uh, so with those, is that included in the 12 or is that beyond the 12?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, let me see how many you get.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So a cancer treatment center evaluation.
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][NEUTRAL] Or consultation.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So according to this, according to your policy certificate, that I'm so sorry, but those things are listed, but it states they're not included.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And your actual policy, when I'm looking at, when I'm looking at your schedule,
[CUSTOMER][NEUTRAL] 00, so I won't.
[AGENT][NEUTRAL] Of benefits, the benefit amount is not included.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm, I wonder why. I mean, I had to drive all the way to [PII]. I had to stay nights out there and all of that. Now my other policy that I have, which is not necessarily cancer policy, it's called a critical illness policy. They, they cover all of that.
[AGENT][NEUTRAL] Right, on this one though, where it had cancer treatment center evaluation or consultation, that was max of one evaluation or consultation per covered person per lifetime, but it does state that that is not included.
[CUSTOMER][NEUTRAL] It's like a
[AGENT][NEUTRAL] Evaluation or consultation, travel and lodging, max one, so I'm not sure if that was removed by your group, but it does, and you would see that, like I said, it's under uh alphabetic letter T.
[CUSTOMER][NEUTRAL] Oh, OK, I'm.
[CUSTOMER][POSITIVE] Yes right.
[AGENT][NEUTRAL] In your policy certificate.
[CUSTOMER][NEUTRAL] OK. All right. So don't worry with that one then. You're saying that's not covered all.
[AGENT][NEUTRAL] According to this information and you are welcome to submit anything, you know, for us to review Ms. [PII].
[AGENT][POSITIVE] And if it's something that obviously, you know, we can provide a benefit for and are able to approve that.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And then if it's something that's not quoted, it would be reviewed and, you know, just stated that this policy doesn't provide that benefit, something, you know, depending on.
[AGENT][NEUTRAL] The denial reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. OK, well, no problem. Alright, so, alright, well I'll start trying to at least do my transportation ones that I've had for all my treatments, um, and I don't know if you can see I can probably get on the portal. I was curious if you could see how many transportations I've had already because I'm just doing for the year for the cancer treatment, which would be 23 and 24.
[AGENT][NEUTRAL] Yes I am.
[CUSTOMER][NEUTRAL] Uh, in 25, the only type of treatment I had was like a chemotherapy, which I do think that is covered as well, but
[AGENT][NEUTRAL] OK, so just a moment.
[AGENT][NEUTRAL] OK, so for [PII] you said for [PII].
[CUSTOMER][NEUTRAL] For [PII], I was diagnosed in on [PII], I'm sorry, [PII]. I was diagnosed first at one facility and then they sent me to another facility. So really [PII].
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So I see for the calendar year of [PII], there were 7.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Trips paid on transportation.
[AGENT][NEUTRAL] For that year.
[CUSTOMER][NEUTRAL] Oh, OK, so I
[CUSTOMER][NEUTRAL] More if I send those in to you OK so.
[AGENT][NEUTRAL] Uh-huh. And then, let's see, the, for [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Transportation, it looks like there were 6 paid.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The 7 and [PII] and [PII] and [PII]. Gotcha. And that was for.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK, so I can still file on my other.
[AGENT][NEUTRAL] Transportation.
[CUSTOMER][NEUTRAL] Sure, I can follow my other 5 from [PII] and then my other 6 from [PII] um and I'll put that in there and then also my question was.
[CUSTOMER][NEUTRAL] And I'm sure this will happen when I look at the policy, but I'm assuming there's just a certain amount of things that are covered also with the certain drug or at least this is what I was told at first, when I have certain surgeries, such as the mastectomy coming up and the hysterectomy.
[AGENT][NEUTRAL] Mhm. OK. So, on your, on your, in your policy certificate, your surgical benefits are, you have a, it's a $30 a unit dollar amount of $30 and the maximum per operation is $3000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There is an anesthesia benefit that pays 25% of the amount paid for covered surgery.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, now what you were talking about the $30 to whatever that's full surgery, is that what you're saying or?
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, the surgical benefit is broken down into unit dollar amounts, so it pays based on, it's kind of a calculation that we have to, to do when we receive everything, but the maximum benefit per operation is $3000 on this policy.
[CUSTOMER][NEUTRAL] OK. And so my port policies, I'm sorry, port policies, my port surgeries, they did 3 of those. And I think I filed on one of them, maybe I might have filed on 2 of them. There a way I can tell. I know they said that was covered.
[AGENT][NEUTRAL] What's the date of the sir? I would need to know the, yes, ma'am. I would need to know the date of when you had that.
[CUSTOMER][NEUTRAL] Partly, um, perhaps.
[CUSTOMER][NEUTRAL] OK, I know the first one. Let me stop and think because I've had to have 3, unfortunately. In [PII] is when I had my first one.
[AGENT][NEUTRAL] OK, [PII], what date?
[CUSTOMER][NEUTRAL] I don't know
[CUSTOMER][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] Yes, ma'am, but what day in [PII] in [PII]?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] To be honest, I'd have to go back and look. I do not remember the actual date. I want it was around the [PII], but I couldn't promise you that.
[AGENT][NEUTRAL] OK, I don't see anything for the [PII].
[CUSTOMER][NEUTRAL] Didn't think we'd not positive that I filed on that. That's why I'm at.
[AGENT][NEUTRAL] Don't say anything for the [PII]. Yeah, I don't know. It's very hard when there's not without the date, M S, for me to check to see.
[CUSTOMER][NEUTRAL] Do you say
[AGENT][NEUTRAL] Because you have a lot of claims.
[CUSTOMER][NEUTRAL] OK, the same thing.
[CUSTOMER][NEUTRAL] Uh, in September of that year, do you see anything?
[AGENT][NEUTRAL] You know,
[AGENT][NEUTRAL] Well, again, I'm looking, I have to look either
[AGENT][NEUTRAL] Because people submit claims in [PII], for example, [PII] they're submitting claims for [PII] or [PII] whenever and so I can't look at like when we receive the claim, so I would have to go through every single claim to be able to determine unless I have the specific date.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Well, I can look through back through my mind.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Sure, I can look back through my My chart and try to figure it out what I need to know. I just didn't want to refile things. I don't need to refile, you know what I'm saying?
[AGENT][NEUTRAL] Yes, ma'am, and when you set up your profile, obviously in the portal, you will be able to see all of your claims over the last, should be 24 months.
[CUSTOMER][NEUTRAL] And then so.
[AGENT][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That we have received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Oh, I think you've answered all my questions.
[AGENT][NEUTRAL] Let me look
[CUSTOMER][POSITIVE] You go ahead, I'm sorry.
[AGENT][NEUTRAL] Are you sure? OK, one second. I wanna look at one more thing.
[CUSTOMER][NEUTRAL] I think I can find all that here on my my chart for the exact date.
[CUSTOMER][NEUTRAL] Let me see if I can pull one up out of curiosity.
[AGENT][NEUTRAL] Now, I mean for [PII], I see that we paid a surgical benefit for data service of 7-10-2023.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, [PII]. Yeah, that was when I had, um, when I first got diagnosed, they had to do a, uh, not to me, what is it? Oh, they had to do the biopsy and all, they did that surgically. I think that's what that's probably for. So, uh, what I'm, I think I found it here, hang on, I'm so sorry. I know you're busy. Uh uh I can get this [PII] pulled up of 23.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it looks like I had it done uh if this is correct on [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, now I do see that there was a claim receipt for that data service. Give me just a sec, but we did not.
[AGENT][NEUTRAL] There were not any benefits paid on that claim for that data service. Let me pull the remarks.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh wait, so that must
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so bear with me again while I'm looking.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so for the 9:27.
[AGENT][NEUTRAL] Data service.
[AGENT][NEUTRAL] It states in order to give yes that was not approved it states in order to give consideration to this procedure please in the pathology report for this data service.
[AGENT][NEUTRAL] That was for 9:27.
[CUSTOMER][NEUTRAL] Oh yeah, I remember.
[AGENT][NEGATIVE] But I can't
[CUSTOMER][NEUTRAL] OK, and it was never sent?
[AGENT][NEUTRAL] No, ma'am, I don't see.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, well, let's move on to a different day.
[AGENT][NEUTRAL] No ma'am, for that.
[CUSTOMER][NEUTRAL] OK, the other one would have been my the the one that I have to turn around and have them back to back. Let me see, I believe.
[CUSTOMER][NEUTRAL] OK, there's one for [PII] and then there's another one in October, I believe that we'll look. Let's go with the [PII] and see what was.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Also [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] There's no claim on file for [PII].
[CUSTOMER][NEUTRAL] OK, then I probably need to go back and try to do that one that with the cancer center. Um, and then I uh let me see where the other one was. Out of curiosity, I don't know which day we'll look at the two here. [PII]. That one might have been my office visit, not my surgery, though I'm gonna look. Um.
[CUSTOMER][NEUTRAL] I have one for [PII] and I have one for [PII].
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] I don't have anything for [PII] and you said [PII]?
[CUSTOMER][NEUTRAL] Yes, all of [PII], uh huh.
[AGENT][NEUTRAL] Yes, I mean, it's [PII]. Yes, ma'am. I don't have anything for that either.
[CUSTOMER][NEUTRAL] Or [PII], um.
[CUSTOMER][NEUTRAL] Uh, uh, let's see, [PII].
[AGENT][NEUTRAL] No, ma'am, not for that date either.
[CUSTOMER][NEUTRAL] OK, that's OK. I can look. um, OK, so tell me one more thing and I'll quit pestering you. Um, so what would, what do I need to provide when I go back on to redo these when I set up my profile and I turn them in, what exactly needs to be on there for these claims since their surgery?
[AGENT][NEUTRAL] OK, so that claim form that I emailed you, can you check to make sure that you received that? or did you already see that you received it? Because the claim form, Miss [PII], the very first page of that claim form has all of the instructions, so I always recommend that you use that as a checklist.
[CUSTOMER][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] Well,
[AGENT][NEUTRAL] When submitting a claim because it explains about your primary insurance explanation of benefits, the surgery, you know, itemized bill diagnosis code, all of that information is on there.
[CUSTOMER][NEUTRAL] I see. OK.
[CUSTOMER][NEUTRAL] OK, I think I found it. Yes, I do have. And then as far as my all the imaging that we can do once a year on, someone told me that I could have had the policy since [PII], I believe. They said I could go back and do a once a year claim for like my mammograms and my just, I think it's just once a year, right, that it pays for.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] For wellness. Yes, ma'am. If I pray for wellness. Is it a well, you're talking about your screening benefit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am. The screening benefit is a one time per year.
[CUSTOMER][NEUTRAL] OK. I'll try to.
[AGENT][NEUTRAL] And in the portal in in your portal when you set up your new profile, there is, you know, the same option as before for filing a wellness claim, so you would just click there or screening same thing wellness screening to submit for that benefit.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. OK, well, thank you. You've been super helpful for now if I can just pay my bill.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Well, you are very welcome. So if that is all I can help you with, Ms. [PII], I'll be happy to get you connected over um to someone to process your payment.
[AGENT][NEUTRAL] And again, on your payment, just so you know, I do see that back in the end of April, the draft was changed for your request from the [PII]. So it will draft around the [PII] of every month. Yes, it may not be exactly on the [PII], but approximately, you know, it could be a few days before or after, but it's, mhm, yes, ma'am.
[CUSTOMER][POSITIVE] Sure. Thank
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] of every month, OK.
[CUSTOMER][NEUTRAL] Somewhere right around there.
[CUSTOMER][POSITIVE] OK alright well thank you ma'am.
[AGENT][POSITIVE] Well, you are certainly welcome and thank you again for calling APL. I hope you have a very nice day and if you will give me just a moment, I am going to get you connected.
[CUSTOMER][POSITIVE] All right, thank you, you too.
[AGENT][POSITIVE] You're welcome. Yes, ma'am. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Good morning. Thank you for calling APR. This is [PII] billing. How may I help you?
[AGENT][POSITIVE] Well, hello, Miss [PII]. It's [PII]. Good morning. Happy Tuesday.
[CUSTOMER][POSITIVE] Good morning. Thank you.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so the lady that I posted in the chat about, we're finally discussing everything that we needed to and she is ready to make her payment. So it's on policy 177.
[CUSTOMER][NEUTRAL] Hold on just a moment.
[CUSTOMER][NEUTRAL] 177.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 5159, [PII].
[CUSTOMER][NEUTRAL] OK, and you got a good callback number?
[AGENT][POSITIVE] She's fully verified. It's the one in the system. She's fully verified. Customer service did reactivate her policy and she does know that she's going to need to pay all of it to catch it up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] I just don't want to work.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] She wants to pay it up to 61.
[AGENT][NEUTRAL] To catch it up. Mhm. So whenever we bill, if we've already billed her for June, that too. She just wants to make sure this policy is taken care of whenever she needs to pay it too.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause I say the draft is set for the [PII] and it's the [PII], so is it fixing the draft again?
[CUSTOMER][NEUTRAL] If it's set for the [PII] at [PII], we missed the [PII], so it won't catch it.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] All right. So, yeah, whatever she needs to pay is what she's wanting to, she's just wanting to get it current and.
[AGENT][POSITIVE] Good to go.
[CUSTOMER][POSITIVE] OK, I can help her with that.
[AGENT][POSITIVE] I know you can, Ms. [PII]. Well, thank you so much. Are you ready? She's real nice. You ready for Miss [PII]?
[CUSTOMER][NEUTRAL] I am.
[AGENT][POSITIVE] Thank you so much and you have a great day if I don't talk to you again.
[CUSTOMER][POSITIVE] You as well. Thank you, [PII].
[AGENT][POSITIVE] Thanks [PII]. All right, bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.