AccountId: 011433970860
ContactId: 04163c4a-195d-42dc-b01b-d6166d46a807
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 870469 ms
Total Talk Time (AGENT): 413368 ms
Total Talk Time (CUSTOMER): 473810 ms
Interruptions: 11
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/04163c4a-195d-42dc-b01b-d6166d46a807_20250124T19:11_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, my name is [PII], and I was just calling to find out. I'm having a surgery.
[CUSTOMER][NEUTRAL] Um, next month.
[CUSTOMER][NEUTRAL] And I wanted to see how much you guys would cover off it.
[AGENT][NEUTRAL] OK. Can you spell your first name for me?
[CUSTOMER][NEUTRAL] Sure, it's [PII]
[AGENT][NEUTRAL] [PII], what's uh, your policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, I don't have a policy number. I have a certificate number or a group number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy er number, the policy er number?
[CUSTOMER][NEUTRAL] Which one do you want?
[CUSTOMER][NEUTRAL] Um, the inpatient or the outpatient? Outpatient, OK. 02.
[AGENT][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] The OK, hold on a second, the number before the elm should be the same.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, ML 8.
[AGENT][NEUTRAL] So give me the number before the M.
[CUSTOMER][NEUTRAL] Oh sorry, I'm sorry. 02.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] 549-577 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] And your phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, you said this is for outpatient surgery?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it'll be done in a hospital?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] OK, can you verify your date of birth, your mailing address, and your email address, please?
[CUSTOMER][NEUTRAL] Sure, my date of birth is [PII]. My mailing address is [PII]. And what else do you need my email?
[AGENT][NEUTRAL] Email
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII], for verifying. So your policy effective date is [PII]. Um, it is active at this time and I'm showing the maximum outpatient benefit is up to $3000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Per calendar day. So it's a per calendar day benefit versus calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and of course the information provided is verification, not a guarantee of payment. And did you have any other questions about the benefits?
[CUSTOMER][NEUTRAL] What's the difference between calendar day and calendar year? I don't.
[AGENT][NEUTRAL] Mhm. Calendar day means that that's, you have a $3000 benefit per calendar day. So if you had a surgery today, your benefit is up to $3000 and if you had one next week, you get a new benefit of up to $3000. So it's per calendar day, daily.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I didn't know that.
[AGENT][NEUTRAL] Whereas 3000.
[AGENT][NEUTRAL] You know, calendar year means that once you exhaust the 3000, it's, it's done for you have to wait to the next year.
[CUSTOMER][NEUTRAL] Just one thing.
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] That's per calendar year, so your benefit is a really, a really good benefit.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause this, this one, this one here, I just called um [PII] and they said my out of pocket would be 3000.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So how much is that 3000 would be covered?
[AGENT][NEUTRAL] And so we can't verify until we get a copy of the explanation of benefits from your primary, um, but, um, if you've not met your major medical deductible for 2025, more than likely it'll apply towards your deductible and the policy that you have with American Public Life will assist with amounts applied towards your deductible or your co-insurance and or co-pay amounts. So we could reimburse the deductible amount up to 3000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Which is good.
[CUSTOMER][NEUTRAL] OK, cause I, I've met my deductible already.
[AGENT][NEUTRAL] Oh, you have?
[CUSTOMER][NEUTRAL] Mhm. We, I, I, I have a chance to say that we have a zero deductible.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so then it would be co-insurance. So whatever amount is applied towards your co-insurance, this policy can reimburse coverage charges up to $3000 per per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So then I would have to find out from Amet how much my co-insurance is? I'm, I'm
[AGENT][NEUTRAL] And you won't know until after the surgery has been done.
[AGENT][NEUTRAL] Because they won't file a claim. The hospital will not file a claim until after the services have been rendered.
[CUSTOMER][NEUTRAL] But they'll ask me for some money up front cause that's what they did when I had my first surgery.
[AGENT][NEUTRAL] Usually
[AGENT][NEUTRAL] Are you presenting both cards and you really need your ID card? Do you not have a copy of your card?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] No, I have because I have my card right in front of me. Yeah, I gave them both and they, yeah, and yeah, they, they, they, they charged me. I had to pay $1200.
[AGENT][NEUTRAL] Oh, you sure do. That's where you got the number. OK.
[AGENT][NEUTRAL] Did you
[CUSTOMER][NEUTRAL] This was back March, hm?
[AGENT][NEUTRAL] Did you submit a claim?
[AGENT][NEUTRAL] It was in March of what year?
[CUSTOMER][NEUTRAL] It was in [PII]. What are we in now? [PII].
[AGENT][NEUTRAL] 25, we're in [PII].
[CUSTOMER][NEUTRAL] [PII], yeah, it was [PII], it was [PII].
[AGENT][NEUTRAL] OK, so your policy did not become effective. Actually, you had one before this one. Let me look at the previous policy that you had.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is it [PII]?
[CUSTOMER][NEUTRAL] Yeah, my surgery date was [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'm gonna look at the outpatient benefit under your policy. I do show that we received the claim, but the claim was denied, citing that the maximum outpatient benefit is exhausted. So let me see what that benefit was under this, the other policy that you had.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think that may have been a calendar year and I was going through, I may have had a chemo that before then that probably they put towards the APL cause I, I'm, I'm a survivor. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, good deal. So, under the previous policy that you had, um, the maximum outpatient benefit was up to $3250 and it was per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so by the time we received the claims for your [PII] date of service you had already exhausted that 3250.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And so that's the difference between calendar year and calendar day, right.
[CUSTOMER][NEUTRAL] Yeah, I think, I think
[CUSTOMER][NEUTRAL] Yeah, 11 chemo.
[CUSTOMER][NEGATIVE] One chemo probably wipe that out.
[AGENT][NEUTRAL] Right. Right. So that's the difference.
[CUSTOMER][NEUTRAL] Yeah, cause it was like 100 and some 1000 for for one chemo session. Yeah, and I had to have 6. I'm almost 2 years in remission.
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] How are you doing?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Very good.
[CUSTOMER][NEUTRAL] Yeah, so right now, um, this is also under the cancer. This is a part of the cancer, the treatment because the radiation shrunk.
[AGENT][POSITIVE] That's good.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Um, my right breast where I had the cancer significantly. So now I look like, I look like the hunchback of Notre Dame backwards.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Backwards, OK.
[CUSTOMER][NEUTRAL] So I'm, I'm one, I got, I got a size, what, uh, probably uh uh.
[CUSTOMER][NEUTRAL] Because they're still kind of big cause I had, I was a 40 40DD.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And now I'm probably at 38.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 38 C.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh no, 38
[CUSTOMER][NEUTRAL] That one is, uh, what's the smallestc B.
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] One is A, well this one's a, I think it's a, I think she said I'm 38B and a 38D on the other side.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEGATIVE] Yeah, cause, and you can, you can see it and it just like it puts me in, like when I don't have the padding in my bra, and when I see myself, it brings me back to feeling that I still have cancer, so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh, done.
[CUSTOMER][NEGATIVE] Yeah, and it's, yeah, I don't mean to get emotional, but it just like, it, it throws me back because um when I started doing the chemo, I noticed it more that that breast was getting smaller, smaller, smaller, smaller.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] So, yeah, and then after I had the surgery and then um radiation shrunk it back again. After I had radiation, that's when it shrunk again. So it's like I look in the mirror and I'm like, oh my, I'm, I'm like, do I have cancer again? Do I have cancer again? So, yeah, it's cause it's, it's, it's, it's a big difference. You can see the difference.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] If I don't pad, if I don't pad the right side, you can, and I use to, you know, the, the.
[CUSTOMER][NEUTRAL] You know the, the breast pads you put into your um your bras?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I have 2 of those.
[CUSTOMER][NEUTRAL] To try and make it look even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I got it.
[AGENT][NEUTRAL] I got it
[CUSTOMER][POSITIVE] And yeah, so, mhm. But and then, and I think emotionally, I will be better after the surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. When is, when is your upcoming, when is it?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, the [PII] of next month.
[AGENT][NEUTRAL] [PII] of next month, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And it's, it's still a part of the cancer treatments.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] So, hopefully, most of it will be get covered.
[AGENT][NEUTRAL] But you
[AGENT][POSITIVE] Right. Well, you have a $3000 per calendar day benefit. That's, that's wonderful.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I know, it's, it's so much better than the other. I have to tell my coworkers.
[AGENT][POSITIVE] Right, exactly.
[CUSTOMER][POSITIVE] Uh, this, this one is so much better.
[AGENT][POSITIVE] Exactly.
[AGENT][POSITIVE] Yeah. Well, I'm glad that you're doing um really well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And blessings to you. Yeah.
[CUSTOMER][NEUTRAL] Yes, I am. Thank you, thank. Also, uh, so when I do I give this before cause I'm gonna contact the doctor now and send them this, but they're supposed to have all of my information in their system anyway, but I'm gonna send it to them anyway so that, you know, cause apparently they have run my, my, my first insurance, the AMed because I got the authorization for it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, um, I'm just gonna send them this, the letter I got and then a copy of my card just in case.
[AGENT][NEUTRAL] Right, and you may suggest to them, uh, to just contact us to verify the benefit, and you have a little leverage now because you know what your benefit is. You can also let them know that with APL your benefit is up to $3000 per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm, OK, alright, and then they, they should, I mean, hopefully you guys will cover it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, I mean, it's not, we have no control over whether they um require that you pay something before the surgery. Um, if, if that happened.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then, um, you can submit the claim to us yourself and the reimbursement can go to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but it would be a lot easier on you if, if they're willing to, uh, you know, submit the, submit it to both insurance companies for you.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Just do it themselves, yeah. Mhm.
[CUSTOMER][NEUTRAL] And what do I need if they don't? Do I just need the, the history and the, the notes?
[AGENT][NEUTRAL] So you'll need 3 documents. Um, the first document is an APL claim form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I can email that to you if you would like, just in case.
[CUSTOMER][NEUTRAL] Please, just in case, yes.
[AGENT][NEUTRAL] And, and then, uh, you know, once they do the surgery, you know, they'll uh generate an itemized bill. We would need a copy of the hospital's itemized bill.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then, um, since we're secondary to your major medical plan, we'll need a copy of AMed's explanation of benefits that corresponds with the date of service to the [PII] date.
[CUSTOMER][POSITIVE] You'll be OK.
[AGENT][POSITIVE] Yeah, and so you know that's why I say it's a lot easier it's a more smoother transition if you know you're, yes.
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][POSITIVE] If they do it. Mhm, mhm. Oh, you're so good. You're so you're my little angel today. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you so much. All right. You have a wonderful weekend and stay warm wherever you are.
[AGENT][POSITIVE] You're welcome. I'm gonna
[AGENT][NEUTRAL] Yeah, cause it's a little chilly. It's a lot better today, but it's been really cold. Um, did you want me to go?
[CUSTOMER][NEUTRAL] Are you in [PII]?
[AGENT][NEUTRAL] No, I'm actually in [PII].
[CUSTOMER][NEUTRAL] Oh, OK, OK. Oh yeah, yeah, it's kind of cold there. Mhm.
[AGENT][NEUTRAL] Yeah, it has been a little cold. Yeah.
[CUSTOMER][NEUTRAL] It's cold here. It's cold here.
[AGENT][NEUTRAL] Oh, it is. Is it generally cold in [PII]?
[CUSTOMER][POSITIVE] I feel like, yes, I feel.
[CUSTOMER][NEUTRAL] Not like this for so many days, cause I don't know if you heard on the news, we had snow in, in the north end of um [PII], in the panhandle, it was snowing.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, I heard, I heard. You all don't usually get snow, do you?
[CUSTOMER][NEGATIVE] Mm mm, not like that. Mm mm.
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] No, and they were saying, my mom was saying, because my mom doesn't live too far from me that she saw flurries today. Yeah, but it's, it's, it's like maybe in the [PII] right now.
[AGENT][POSITIVE] Oh wow. Mhm.
[CUSTOMER][POSITIVE] And tomorrow it's supposed to start in the [PII] and get up to the [PII], and then Saturday Sunday it gets a little bit better and then by next week we're back up into the 80s.
[AGENT][NEUTRAL] [PII], uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] Yeah, but this is, it's, it's chilly, but it's welcome because we have so many hot days, so this is welcome.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Right. You're gonna enjoy them and then you'll be ready for the hot days again.
[CUSTOMER][NEUTRAL] Yes, yes, yes, mhm, mhm.
[AGENT][NEUTRAL] So now, Don, do you want me to go ahead and email you the claim form?
[CUSTOMER][POSITIVE] Yes, please, that would be good.
[AGENT][NEUTRAL] OK, and so let me verify the email address again. I have a [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right, so you'll receive it probably within the next 10 minutes.
[CUSTOMER][POSITIVE] OK, thank you so much. Thank you.
[AGENT][POSITIVE] All right. You're absolutely welcome, [PII]. Anything else I can help out with today?
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] OK, thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.