AccountId: 011433970860
ContactId: 10c52e64-2840-4fff-b150-d5f015ba9cc6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 358850 ms
Total Talk Time (AGENT): 113049 ms
Total Talk Time (CUSTOMER): 176470 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/10c52e64-2840-4fff-b150-d5f015ba9cc6_20241231T17:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you today?
[CUSTOMER][POSITIVE] Hi, [PII]. It's [PII]. Happy [PII].
[AGENT][NEUTRAL] Same to you.
[CUSTOMER][POSITIVE] Good. I've got a policy 1775159.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][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.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Can you assist her further?
[AGENT][POSITIVE] Sure can, thank you so much.
[CUSTOMER][POSITIVE] Thank you, [PII]. Let me get her on the line one moment.
[CUSTOMER][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][POSITIVE] Uh-huh. God bless you. You too. God bless you too thank you bye bye.
[AGENT][NEUTRAL] [PII], this is [PII] in the claims department. I understand you needed to know when your benefit year starts for 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 my um
[AGENT][NEUTRAL] And you 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.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, one moment while I take a look.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Right export claims it does every claim. We don't need that. We don't, but if that's what it takes. I don't know.
[CUSTOMER][NEUTRAL] I have to get it.
[CUSTOMER][NEUTRAL] this is it.
[CUSTOMER][NEUTRAL] I just did.
[CUSTOMER][NEUTRAL] It takes it to next step. Can you find that one literally?
[AGENT][NEUTRAL] So your benefit year starts 11-7, 117. So 117 of 23 to 117 of 24, 117 to 24 to 117 to 25.
[CUSTOMER][NEUTRAL] Oh, OK, so this one benefit that I'm about to process or send over to y'all to see about processing that should cover for my $20,000 for the year since it was a $51,000 claim.
[AGENT][NEUTRAL] Um, I can't say that because I'm not looking at your explanation of benefits, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If yours pay um.
[AGENT][NEUTRAL] Actual charges, then we would have to look at the actual charges, which actual charges does mean what your provider, not provider, what your other carrier paid and what your patient responsibilities are, we add those two together and that is what is considered actual charges.
[CUSTOMER][NEUTRAL] OK, and it was, and what, what was that added together you said that was what you uh tell me again.
[AGENT][NEUTRAL] Actual charges mean what your insurance carrier pay, which is not us, but your primary care insurance, and what your patient responsibility is, and we will add those two together and that will be considered your actual charges.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Got you OK alright we're trying to get this downloaded and sent over to you.
[CUSTOMER][NEUTRAL] Um, hold on, did you have any more questions and anything else I can help you with?
[CUSTOMER][NEGATIVE] What she's trying to do is download it from my laptop into a PDF file, so that we can send it, but we're apparently not knowing how to do this. We are trying and it's making us pull up every claim instead of one from my insurance company, and with me having had cancer, that's a lot of claims to try to pull up and fish through. Do you know how you can get it to pull up one at a time?
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Um, no, you might need to reach out to them, um, to see if maybe they can send over um just a particular data service or a drug or, um, I'm not even sure if they have a filter, um, if you can filter through, um, for a data service, um, but you you should be able to filter um a data service or something like that or maybe um just a drug itself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, alright, well thank you for your help. I'll try to get it sent over to you all to that.
[AGENT][NEUTRAL] OK, and [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, I'm also gonna, I think it's in my benefit package. I haven't had time to send it over yet, but I'm, I have some hotel fees and some, uh, other drugs, I think that y'all cover. And so I'm going to try to send those over as well.
[AGENT][POSITIVE] OK, not a problem at all.
[CUSTOMER][POSITIVE] All right well thank you have a good day.
[AGENT][POSITIVE] You do the same. Thank you for calling APO. Have a great day. Bye bye.