AccountId: 011433970860
ContactId: e384d7af-44cf-4d4b-ae15-a6a6c79f251c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 850479 ms
Total Talk Time (AGENT): 275918 ms
Total Talk Time (CUSTOMER): 440031 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/e384d7af-44cf-4d4b-ae15-a6a6c79f251c_20250221T23:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. My name is uh [PII]. I have a policy with you guys and I just need to check on some things.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with your policy. Can you please give me your policy number?
[CUSTOMER][NEUTRAL] My policy number, hold on, let me look at my phone.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Policy number is 239-0292.
[AGENT][NEUTRAL] OK, let me look that policy up real quick.
[AGENT][NEUTRAL] You said that was 235-0292?
[CUSTOMER][NEUTRAL] No, 239-0.
[AGENT][NEUTRAL] 90.
[CUSTOMER][POSITIVE] 292. Yes ma'am, I'm sorry.
[AGENT][POSITIVE] OK. No, that was me. I'm sorry.
[AGENT][NEUTRAL] OK, Ms. [PII], can you verify your date of birth for me please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] OK, my phone number is [PII]. My address is [PII] and my email address is [PII].
[AGENT][POSITIVE] OK, thank you. I appreciate you verifying your policy for me, Ms. [PII].
[AGENT][NEUTRAL] OK. And you said you had some um questions about the policy. How can I help you with your questions?
[CUSTOMER][NEUTRAL] Yes ma'am. OK, so I submitted um a claim.
[AGENT][NEUTRAL] Mm, yes.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] Um, I can't remember when I submitted because I had the doctor to do it, but I gave it to them. They sent it to you guys and I see that y'all confirmed that y'all got it on the [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so what is mm I see out to the side where it says um.
[CUSTOMER][NEUTRAL] Upload files. Do I need to upload anything?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] If the doctor's office sent the claim in for you already and I see that they, they did it by claim form through the physician's office, um, it, once we get it, it, um, takes 7 to 10 business days to process it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But if there's anything else that's needed, um, a letter will be sent to let you know what else is needed. But no, if the doctor submitted it for you,
[AGENT][NEUTRAL] Then they should have had everything that they needed along with um the form from the physician's office.
[CUSTOMER][NEUTRAL] OK. Cause yes, I, uh, actually attached my diagnosis uh paper when I, that came from the pathologist, the pathology report.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, when I gave it to the doctor to fill out the information so that they wouldn't have to, you know, print it out or whatever. I just printed it out myself, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, I, I do see it was submitted. There were 2 submissions on that day.
[CUSTOMER][NEUTRAL] Yes, so the first one is because she submitted it after she filled it out before I found out that I need to do a pay ID number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] The second time she typed, put the pay ID number at the top.
[AGENT][NEUTRAL] OK. And then she said um in the HA 1500 standard form from the physician's office with it?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know what
[CUSTOMER][NEUTRAL] Yeah, anything that you ask for, I, I, hold on, I have my originals on the car because I picked them up from the doctor yesterday, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] Let me see what she.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] You said a HIPAA?
[AGENT][NEUTRAL] It's a H H I F A.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's a 1500.
[CUSTOMER][NEUTRAL] OK, what is that HR?
[AGENT][NEUTRAL] It's just a standard claim form that comes from the physician's office.
[CUSTOMER][NEUTRAL] I'm sure she did that.
[AGENT][NEUTRAL] Or it might say CMS.
[CUSTOMER][NEUTRAL] Let me pull out and see, cause I don't, she had a file and I had my original papers that I gave to her that I filled out so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Don't, don't start me down.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] No, what did this little lady do?
[CUSTOMER][NEUTRAL] Hey, this is me.
[CUSTOMER][NEUTRAL] This is me.
[CUSTOMER][NEUTRAL] You filled out the paperwork.
[AGENT][NEUTRAL] Did she include the medical records?
[CUSTOMER][POSITIVE] She included what I gave for her.
[AGENT][NEUTRAL] That was completed by the physician? Oh, OK.
[CUSTOMER][NEUTRAL] Well, see the pathology report, if you pull it up, it should be, I don't know if you can see what I sent in, but it would be the one that says pathological.
[CUSTOMER][NEUTRAL] Pathology, tissue exam.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] I can't see the paperwork. uh the only thing that I can see is that it's been received.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I'm not for sure. I know she filled out the critical illness part, the claim form.
[CUSTOMER][NEUTRAL] But I don't know anything about a 150.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Is that what you were referring to?
[AGENT][NEUTRAL] Well, if you go to our website.
[AGENT][NEUTRAL] The [PII].
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] And you pull up the critical illness claim form under claims and forms.
[AGENT][NEUTRAL] There's a little cheat sheet at the top of it that tells you everything that you need to send in.
[CUSTOMER][NEUTRAL] Yeah, I have that.
[AGENT][NEUTRAL] That way you, OK, good. That way you could just double check.
[AGENT][NEUTRAL] To make sure that she sent everything that was supposed to be sent in.
[CUSTOMER][NEUTRAL] OK, it says.
[CUSTOMER][NEUTRAL] But the only thing I'm falling for is critical uh uh critical illness benefits.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So the ambulance and the hospitalization due infection, family caregiver, accidental death, registration benefits, accidental disbursement, I mean, dismemberment, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, real preparation benefits provided a copy of the I I'm not dead, no local transportation and family member lodging, none of that. The only one that applies to me is the first one.
[CUSTOMER][NEUTRAL] The critical illness benefits provide medical records, which I did, and a completed physician statement.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Which is a statement, the critical illness benefit may include the first time diagnosis, additional diagnosis, and any other recurring diagnosis depending on your specific plan coverage, um.
[CUSTOMER][NEUTRAL] It just says the medical records, provide the medical records and the completed attendance physician statement, which is what I feel like is what you guys.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, attendant, yeah, so I provided.
[AGENT][POSITIVE] She, OK, good.
[CUSTOMER][NEUTRAL] The illness benefits provide medical record and the completed, so the medical record I provided was the pathological, the path.
[CUSTOMER][NEUTRAL] Logical tissue examines showing that I was diagnosed with cancer and that
[CUSTOMER][NEUTRAL] It's evasive and that's what they were asking on the form.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, good, good. Sounds like, it sounds like you've got just from what you're telling me, sounds like you've got everything that you need, um, and like I said, we did receive it on the [PII]. You gotta give it 7 to 10 business days for them to process it completely. If you want to call back in about uh 10 days.
[AGENT][NEUTRAL] And just ask for a claim status and we can give you a status on the claim as to where it's at if anything else is needed.
[AGENT][NEUTRAL] Or if it's, or if it's been paid.
[CUSTOMER][NEUTRAL] OK, and then this dizzy. I'm sorry, this dizzy ass nurse. So, I don't know, she, I'm sorry. I, I'm looking at this and crazy. I have no medical degree, but I can read and I can find words that mean the same, or
[AGENT][NEUTRAL] That's OK, go on.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] The same word, word match.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And on here, it says um he selected um surgical removal.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The doctor talked to me and she's wanting to do, because the mass is so big, they're gonna do chemotherapy first and then they're gonna do surgical removal. So actually, chemotherapy should have been checked on here too.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] So you'll probably have to take it.
[CUSTOMER][NEUTRAL] And they got it and so.
[AGENT][NEUTRAL] You probably have to take it and have them check the chemotherapy and initial it and then resubmit just that portion of the claim.
[CUSTOMER][NEUTRAL] OK, I, I'm gonna wait, but it does say.
[AGENT][NEUTRAL] If she didn't, if she didn't check it.
[CUSTOMER][NEUTRAL] But it does say on here that the diagnosis is [PII] and that is stage 2 and the diagnosis code. So all that is there and it is evasive.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But they are gonna do a surgical removal.
[CUSTOMER][NEUTRAL] But then again that that was what she told me, so she might have got something else that said that she's gonna go a different route. I don't know. I just know to show up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If she decides to do surgical removal, um, you can resubmit at that time for.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, they're gonna do that.
[AGENT][NEUTRAL] Just the, just for that um part of it after it's done so you can have all your documentation.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] I will, I'll go see them Tuesday, so what I'll do, I will.
[CUSTOMER][NEUTRAL] Check back in maybe Tuesday before I go see them and then just have to check in and scan it back in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] With that
[CUSTOMER][NEUTRAL] Would that push it back?
[AGENT][NEUTRAL] No, it'll just give it the information if there's anything that's needed, um, it's always 7 to 10 business days from the first time you file.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's always 7 to 10 business days cause there's a lot that they have to look through and go through and contact your physician and all those things have to be done.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I got, I got it, trust me, look, sad part about this is this is my 2nd rodeo, so.
[AGENT][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] Dealing with, well, parents and all so.
[AGENT][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] I, I'm familiar with paperwork, so.
[AGENT][POSITIVE] Well, you sound like you're good at it because you caught things that they didn't even catch.
[CUSTOMER][NEUTRAL] Uh yeah, I, I mean like once you know what to look for, you look at, you look at it.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] And I, and I should have looked at it before I left, but I just, I'm one of those people that trust that people are gonna do their job and do it just as effectively as I'm gonna do it because I
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I kept looking over the paperwork and like,
[CUSTOMER][NEUTRAL] My mom, like she was like, you fill out that just have your name on it cause you're not, you don't have a medical degree. I'm like, OK, my mama, but I can read, but OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I'm gonna see what you say cause I don't wanna hear your mouth no more. So, but.
[CUSTOMER][NEUTRAL] Yeah, so I got that done and
[CUSTOMER][NEUTRAL] Submitted it, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I OK.
[AGENT][NEUTRAL] Are you finding anything else you need help with?
[CUSTOMER][NEUTRAL] So the 1
[CUSTOMER][NEGATIVE] Uh, no, I think that's, that's it. Look, it's just discouraging it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] People don't double check and check or whatever, but um
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I should have had her to email it to me then I could have reviewed it and then at the same time I told her to put that pay number at the top of it, but.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's OK. So 17 to 10.
[AGENT][NEUTRAL] It's gonna work out.
[CUSTOMER][NEUTRAL] 7 to 10 business days.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] From the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright that'll be fine.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. I hope you have a good rest of your weekend.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. You too. Bye.
[AGENT][POSITIVE] Thank you bye bye you take care thanks for calling APO.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright