AccountId: 011433970860
ContactId: f3e2acb9-d1dd-466b-b301-65c27ac3adaf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 635750 ms
Total Talk Time (AGENT): 302103 ms
Total Talk Time (CUSTOMER): 290738 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/f3e2acb9-d1dd-466b-b301-65c27ac3adaf_20250515T15:28_UTC.wav
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[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um.
[CUSTOMER][NEUTRAL] Do I give you my policy number or what do I give you?
[AGENT][NEUTRAL] Um, your name and are you the insured or you're calling from a provider's office? OK.
[CUSTOMER][NEUTRAL] I uh
[CUSTOMER][NEUTRAL] 5.
[AGENT][NEUTRAL] So it's just your name and your uh a good contact number and your policy number.
[CUSTOMER][NEUTRAL] Policy number is 2531373. Um, my contact number is [PII] [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] I don't think I wrote that down right.
[AGENT][NEUTRAL] And Ms. [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII] and then what?
[AGENT][NEUTRAL] You're mailing and email.
[CUSTOMER][NEUTRAL] My email address?
[AGENT][NEUTRAL] Yes, and your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] email [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][NEUTRAL] OK, that's what I'm calling about. I submit that information and I verified twice that you guys have it, but I don't see anything going on with it.
[AGENT][NEUTRAL] Um, we received the claim on [PII] and we received the claim on [PII]. The turnaround time for claims is 7 to 10 business days from the date that we received it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the claim, both of them are currently in processing. So once the claim is finished processing on the online service center, you'll see the claim number populate and you'll be able to click your um explanation of benefits. You'll also get a text saying that your claim has finished processing and then you can go on.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You'll get
[CUSTOMER][NEUTRAL] You OK, slow down.
[CUSTOMER][NEUTRAL] OK, so 10 days from that would be 123456789, 10, so the [PII].
[AGENT][NEUTRAL] Right. Around the [PII] is when the claim should be finished processing. You'll receive a text message letting you know that the claims are done processing and then you can then go online and review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It's not done.
[AGENT][NEUTRAL] When we finish your claim, we will send you a text message and you can then go online to check the the decision.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so another thing that I need to talk to y'all about, I, I've been reading the policy, um, of course I'm new to this, so of course I have all these questions. OK, so, um, I have another copy of a bill. It was for the MRI and then this falls up underneath the category of diagnostics testing, is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, MRI, yes, diagnostic testing.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] OK, so the one that I sent over on the [PII], yeah, the [PII] is the biopsy. Would that fall up underneath the dioptic, diagnostic uh testing as well?
[AGENT][NEUTRAL] Mm, um, diagnostic, well, it depends on the coding, honestly. Sometimes it could be considered preventative, sometimes it could be um diagnostic. Either way, your policy has coverage.
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][NEUTRAL] Wait, OK, back up, you say either way it's what?
[AGENT][NEUTRAL] Either way, your policy has coverage whether it comes in as diagnostic testing.
[AGENT][NEUTRAL] Or as like a, it depends on the coding. I don't, because biopsies can be considered a surgery, so either way we have, go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it's, um, right.
[CUSTOMER][NEUTRAL] OK, I'm sorry. It, um, OK, so then I have one more, so it would be OK, so.
[CUSTOMER][NEUTRAL] The first mammogram that I had would have been my preventative, my annual. OK, so this is how all this started. OK, so I wouldn't send that one because it would be my preventative, OK, right?
[CUSTOMER][NEUTRAL] So they sent me for further evaluation. So that would be the 2nd mammogram that would be considered as a diagnostic because they're looking for something.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Right, I understand how it's happening. Go ahead, go ahead.
[CUSTOMER][NEUTRAL] That would be the
[CUSTOMER][NEUTRAL] Oh, OK. Uh, I'm well high happened to me.
[CUSTOMER][NEGATIVE] So I don't want to send you guys something that doesn't fall into the correct category for the insurance. If you guys don't consider it, I don't want to waste my time or your time. So that's the reason why I'm trying, mhm.
[AGENT][NEUTRAL] Right, I'm
[AGENT][NEUTRAL] Right. So,
[AGENT][NEUTRAL] I'm trying to answer your question. So, to answer your question, you have multiple benefits that it could be considered under. I was just letting you know, no matter what the coding is, you have the coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, so just send it.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK, I'll send it. I'll just, you know, don't wanna send it and then it's not the, uh, whatever. So yesterday I had the MRI so I'll go ahead and send that.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] And then file it away, mhm.
[AGENT][NEUTRAL] Um, another thing that you can do, I don't know if you know of this option, but if, if the providers, unless you're filing for like that first occurrence benefit where you get the big lump sum, if there is a positive diagnosis, OK, I would just
[CUSTOMER][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] That's what that one was.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] That's with the 1st claim on the 7th.
[CUSTOMER][NEUTRAL] was when I sent proof that I had the cancer. That's what the lady told me to send.
[AGENT][NEUTRAL] Right, so all I'm trying to explain is if the provider, I don't know if the providers have the policy numbers so that you don't have to do all the work. I was just trying to let you know you have another option because they're supposed to be filing this for you, so you don't have to do it outside of that lump sum that comes to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, the reason probably why I'm doing it is because I do have a primary uh insurance and they're filing a claim with them. This is gonna help me, y'all is gonna help me with my co-payments and whatnot.
[AGENT][NEUTRAL] Have they told you that they won't bill to your secondary?
[CUSTOMER][NEUTRAL] No, they haven't yet.
[AGENT][NEUTRAL] OK, the reason I'm asking, I'm just giving you options to take off of your plate.
[AGENT][NEUTRAL] Technically, whether you, you can have however many insurances you want to, unless they tell you that they're not going to bill, give it to them and let them handle everything so you don't have to worry about it unless you want to. Um, I was just like you know there's another, there's another option out here because sometimes they can get frustrating with the paperwork and
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, you asked for this and then this, I sent this in and so to just eliminate that, they can file for you. They'll file with your primary first. If you have a sec, you know, however many, they'll just go down the line until either the balance is satisfied or, you know, there's a denial or something. Outside of that, that lump sum that will come straight to you, they can, they can process everything else unless you want to file the claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that makes sense too and then I was also told that this here will be paid directly to me, is that not correct?
[AGENT][NEUTRAL] Um, no, it's not. It depends. So like that first occurrence benefit, yes, that goes straight to you. Um, it could be something to where like you, you get, like you have the MRI or diagnostic testing and your primary pays something and there's still something left over, we could pay that to them or, you know, so it depends. So it's not just to you, we can pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] wherever it needs to be allocated as long as you have the benefit.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So it could be both.
[CUSTOMER][NEUTRAL] OK, so, huh?
[AGENT][NEUTRAL] I was just saying, I was just saying, so it could be both, it could be something paid to you or we could be paying off a bill to the provider.
[CUSTOMER][NEUTRAL] I, I didn't hear you.
[CUSTOMER][NEUTRAL] Right, OK, either or.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, well I'm gonna go ahead and send this one over and I'll share that information as well.
[CUSTOMER][NEUTRAL] OK, well I'll follow up again on the [PII], um, so I'll probably need to know how to go in, but you said I click on it and then I'll be able to see the claim, uh, information and status or whatever because right now it's not showing nothing.
[AGENT][NEUTRAL] Yes, so once the claim is finished, when you go under my claims, it'll have, um, you'll then see the claim number and you'll see a like a PDF there that you can click on, that's your explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I got you. OK. OK. Thank you. I'm, I'm learning and unfortunately, I gotta learn having cancer, but
[AGENT][POSITIVE] Well, you're very welcome.
[CUSTOMER][NEUTRAL] Uh, you got to learn some kind, I guess.
[CUSTOMER][POSITIVE] OK, thank you for your time. Sorry for the confusion.
[AGENT][NEUTRAL] Oh no, you're fine. Was there anything else I can help you with today?
[CUSTOMER][NEGATIVE] No, no, no, that was it. That was it. I just wanted to make sure I was doing it right, you know what I mean? It's kind of frustrating. I'm not good with computers, so, um.
[AGENT][NEUTRAL] Well, if you have any questions,
[CUSTOMER][NEUTRAL] That's what the follow up is and so I wanna make sure I'm doing it right. Yeah, OK. Well, I am. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] But see if they'll see if they'll um let you, see if they'll take your, I won't even, I won't even see, say if, I would tell them I have an additional cancer policy and this is my policy number, you bill them.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Alrighty. Well, thank you for calling APL. You're welcome. I hope you have a good day.
[CUSTOMER][POSITIVE] All right, well, thank you.
[CUSTOMER][POSITIVE] I will thank you you too bye bye.
[AGENT][POSITIVE] You're welcome. Thank you. Bye bye.