AccountId: 011433970860
ContactId: fefa003b-875e-4d5b-8fee-62cc40b1c9f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 745359 ms
Total Talk Time (AGENT): 223002 ms
Total Talk Time (CUSTOMER): 390024 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/fefa003b-875e-4d5b-8fee-62cc40b1c9f4_20241231T17:49_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I need some help on your website. I'm trying to file a claim and it's been a while since I filed one on here, and it's not taking my username or my password. I was gonna see if you could maybe walk me through the process.
[AGENT][POSITIVE] Oh, it would be my pleasure to assist you. Do you have your policy number available?
[CUSTOMER][NEUTRAL] Um, normally I have that available. Let me see. I don't know that I do, uh, no, that's my claim number for my, that's not the policy number, baby, but I do not.
[AGENT][NEUTRAL] Do you have an APO claim number?
[CUSTOMER][NEUTRAL] I have a claim number from my insurance company, not from APL.
[AGENT][NEUTRAL] Got you. I can look it up by your social if that's OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4651.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, thank you. And what is your name please, ma'am?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] Thank you. And Miss [PII], can you verify your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] All right, thank you. And were you, you said you were not able to log in on the portal?
[CUSTOMER][NEGATIVE] Right. And I thought I had it where I had it saved where it would be auto log in next time, but apparently, I didn't. And now, it's not taking in. My username was [PII] time.
[AGENT][NEUTRAL] It is that [PII]
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, so it's my password that I'm having trouble with then. How do I go into that password?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You, does it say um forgot password or reset password? You see that?
[CUSTOMER][POSITIVE] We're gonna go, we're gonna try that. Hang on just a second, let me let her, my daughter's helping me real quick.
[AGENT][POSITIVE] OK. Not a problem.
[CUSTOMER][NEUTRAL] Yeah, send it to my phone. Maybe it'd be easier.
[CUSTOMER][NEUTRAL] Alright, hold on just one second. I should get a text. What do you text? OK um.
[CUSTOMER][NEUTRAL] OK, there you go. Hang on just one second, ma'am. Sorry.
[CUSTOMER][NEUTRAL] While my daughter's working on that, I have a quick question too. The claim that I'm filing?
[CUSTOMER][NEUTRAL] I'm going, I'm claiming my immunotherapy for the year. I had it done and it's processed finally. It took them a good while to process the claim through my insurance company. They finally processed it yesterday, and my daughter and I are going to attempt to go on and do our claim for the year. I am not sure how, if you have, I'm not sure exactly how to do that. I've been having a friend do it for me and they're not here today. So.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So, what we will need is going to be the itemized pill for your immunotherapy.
[AGENT][NEUTRAL] With the diagnosis code or a copy of the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] And I have the
[CUSTOMER][NEUTRAL] OK, let me uh pull up this so I can read this to you because what I'm concerned about is on the bottom it says explanation of benefits coming soon, says claim was paid out, it's completed. Um, OK, she got me in. Now, to file that claim, uh, [PII], I don't have a light on, so it's hard for me to see in here. Um, hold on just one second, I'm gonna turn the light on.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] What do I what claim page do I file it under?
[AGENT][NEUTRAL] You're gonna do that under the file a claim, not the wellness, but the file a claim.
[CUSTOMER][NEUTRAL] OK, I'm having my daughter click on file a claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You pull it and and you go where the forms are, you go to file a claim.
[AGENT][NEUTRAL] Yeah, no, we don't need a claim form if you've already submitted a claim form for your diagnosis.
[CUSTOMER][NEUTRAL] Is that at the top of
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You can just upload the documents.
[CUSTOMER][NEUTRAL] OK, well this
[CUSTOMER][NEUTRAL] Uh, OK, I'm a little confused on my diagnosis from a year ago.
[AGENT][POSITIVE] Mhm. That's correct.
[CUSTOMER][NEUTRAL] OK, so you don't actually need a claim form you just need to send the paper.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, now what I wanna take you through, uh, will you go to the shrink that for a minute and go to the actual claim. I wanna ask her something about the actual claim. I'm not good at all this techy stuff. Yes, alright.
[AGENT][NEUTRAL] Don't worry about that, Ms. [PII]. I have to ask my daughter for help too.
[CUSTOMER][NEUTRAL] Pull it, pull it all the way down.
[CUSTOMER][NEUTRAL] I understand that.
[CUSTOMER][NEUTRAL] Alright, now it says at the bottom. I'm looking for the explanation of benefits because that's normally at the bottom. I'm seeing if my daughter sees whether there's an explanation of it. It says EOB coming soon, but it also already has that the claim has been paid how much the date of service, it's got all of that on it. It's got how much was paid. So can I go ahead and send this, or do I need to wait for any?
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] No, go ahead and send that and let our adjusters review it and see if they can use that information to complete the process of the claim, you know, if they need any additional help, they will let you know in the form of an EOB, but it would be better for us to have information that we.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Can't pay versus not having information that we can pay so any any documents that you have related to that service, go ahead and send that and let them review it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me see if she knows how to do this and then hold on one second. Can you go ahead and send it now?
[AGENT][NEUTRAL] Take
[CUSTOMER][NEUTRAL] Do you know how to send that to APL uh-huh. You've got to send it over to APL.
[AGENT][NEUTRAL] So when you see upload files or file a claim, you can just um upload it there.
[CUSTOMER][NEUTRAL] Oh, I didn't
[CUSTOMER][NEUTRAL] OK, so she needs to save it to my computer and I think she's out. So then I have a question, all right? Do you need, do you need help there? I know how to upload it on their website, but I don't know where you want me to download this. It's just the document. OK. You would save it to your documents, I would think on the laptop. You. I don't know how to do that.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] It's just like I I don't have to. I haven't pulled up as a document. It's just on the website. OK, if you're pulling it up from a website, how would you how would you download it and save it so that I can send it over that, you know.
[AGENT][NEUTRAL] Yeah, so you would just download the document and save it to a PDF file.
[CUSTOMER][POSITIVE] Thank you have a.
[CUSTOMER][NEUTRAL] Um, OK, so you would download the document and save it to a PDF file.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, if you want out of that, you just go here up here where the arrow is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] While she's working on that, I have a question. On my immunoB benefit, that's what we're following on. Um, and I believe that the new calendar year started over [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I was wondering if you could check that for me.
[CUSTOMER][NEUTRAL] He wants them all.
[CUSTOMER][NEUTRAL] No, if you did all of them, you'd have a bunch. Was it the most recent? It's so make sure you're in the right claim. Yeah, it's the most recent one, it should be, but check it. To be sure, sometimes they don't do it that way. I'm sorry. So anyway, I want to make sure, is my immuno benefit still 20,000 for immuno, chemo and radiation.
[AGENT][NEUTRAL] Yeah, I'm checking your policy because that's usually a 12 month benefit, so it would depend on when it started. So let me just check your policy.
[CUSTOMER][NEUTRAL] It started [PII] and my immuno that I had done was [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was 51.
[AGENT][NEUTRAL] Give me just one second. It's $2,020,000. That is for your radiation, chemo, or immunotherapy. So that is a 12 month period that we pay the $20,000. So, from whatever date your first radiation, chemo, or immunotherapy started, that benefit would last for a 12-month period.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right. What I'm getting at is when I talked with one of your representatives a while back, they said that new 20,000 would come into place on [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's why I'm double checking. OK.
[AGENT][NEUTRAL] Let me just
[AGENT][POSITIVE] Got you.
[AGENT][POSITIVE] I understand, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which claim was that?
[CUSTOMER][POSITIVE] Page 4. Thank you.
[CUSTOMER][NEUTRAL] And there's a bunch, and you gotta click on each one. Do you see the one that I had that one pulled up for you, baby.
[CUSTOMER][NEUTRAL] Let's send it from there. I got out of it.
[AGENT][NEUTRAL] OK. If you don't mind, do you mind holding just one moment, Ms. [PII]? Let me get you to a cancer adjuster and they can see when that.
[AGENT][NEUTRAL] And they can verify that starting date.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. All right. Thank you for your hold just one moment.
[CUSTOMER][NEUTRAL] The date on it, [PII].
[CUSTOMER][NEUTRAL] [PII] or the [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][NEUTRAL] For calling APL, this is [PII]. How may I assist you today?
[AGENT][POSITIVE] Hi [PII], it's [PII]. Happy [PII].
[CUSTOMER][NEUTRAL] Same to you.
[AGENT][POSITIVE] Good. I've got a policy 1775159.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And she is calling. We've already um helped her with the OSC and where to file claims on portal and she's reset her password. She is wanting to know um for her immunotherapy, she does understand that it's a benefit for a 12 month period, but when that started.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Can you assist her further?
[CUSTOMER][POSITIVE] Sure can. Thank you so much.
[AGENT][POSITIVE] Thank you, [PII]. Let me get her on the line one moment.
[AGENT][POSITIVE] Miss [PII], I have [PII] on the line. She's going to assist you further with that immunotherapy benefit. And I hope you have a happy New Year.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Uh-huh. God bless you. You too.
[AGENT][POSITIVE] God bless you too. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII], this is [PII] in the claims department. I understand you needed to know when your benefit year starts for.
[CUSTOMER][NEUTRAL] Um, your immunotherapy.
[CUSTOMER][NEUTRAL] Yes, I spoke with one of your representatives a while back, and they told me it started over [PII].
[CUSTOMER][NEUTRAL] Because that was just really just wanted to confirm that is correct.
[CUSTOMER][NEUTRAL] Yes, I'm wanting to confirm that because I'm about ready to place my claim that was processed on [PII]. That claim was for $51,000. It was for my one immunotherapy. Unfortunately, immunotherapy is very expensive. So basically, it pays kind of for one immunotherapy a year.
[CUSTOMER][POSITIVE] Almost the cancer policy because um so I'm just verifying that I have this right and then I'm doing the right thing here.
[CUSTOMER][NEUTRAL] OK, one moment while I take a look.
[CUSTOMER][NEUTRAL] OK