AccountId: 011433970860
ContactId: 35c05ffb-9a72-42ad-a00d-bbd0f3ec56ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497950 ms
Total Talk Time (AGENT): 226368 ms
Total Talk Time (CUSTOMER): 118923 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/35c05ffb-9a72-42ad-a00d-bbd0f3ec56ee_20250513T13:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I was calling in regards to my claim.
[CUSTOMER][NEUTRAL] That I recently filed and I had a few questions.
[AGENT][NEUTRAL] OK, you're
[AGENT][NEUTRAL] OK, so you're wanting to check you have some questions on a claim that you've recently submitted to us for yourself, is that correct?
[CUSTOMER][NEUTRAL] Mhm, yes ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And Miss [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] The policy number is 02525111.
[AGENT][POSITIVE] Thank you one moment while I get your information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so first off, Miss [PII], any information that is provided today will be a verification of benefits and not a guarantee of payment, and I will have to verify several things with you first for security. So first off, if you could please uh verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one that you gave me, so that is your best contact number that we should have, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK thank you and lastly your email address please and this does appear to be your work email.
[CUSTOMER][NEUTRAL] It [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying all of your information. OK, so which claim do you have a question on Ms. [PII]?
[CUSTOMER][NEUTRAL] The most recent that I filed um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm trying to see what date was that.
[AGENT][NEUTRAL] Because I do show that we received one on [PII] and this one actually just went through our nightly processing on last night.
[AGENT][NEUTRAL] Is that the one?
[CUSTOMER][NEUTRAL] Yes, that's one of
[AGENT][NEUTRAL] OK, alright, so one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so how can I help you with that one?
[CUSTOMER][NEUTRAL] OK, I see in the remarks to say the maximum amount has been paid for chemo radiation, which is included with immunotherapy too.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] So what is my maximum amount?
[CUSTOMER][NEUTRAL] For the year.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] Give me just a moment to pull up some additional information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I'm just taking a moment, Miss [PII]. Thank you for your patience.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So your maximum OK, your radiation therapy, chemotherapy, and immunotherapy benefits is a maximum of $15,000 per covered person per 12-month period. It's not a calendar year, it's a 12-month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so it started at [PII].
[AGENT][NEUTRAL] Yes, ma'am. It would have been when your treatment first started.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, my next question is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the transportation benefit.
[CUSTOMER][NEUTRAL] For 37 for the IVIG.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] The last time they paid me for that uh but this time they did not apparently.
[CUSTOMER][NEUTRAL] One, it was 37 IVIG and 312, it was immunotherapy.
[AGENT][NEUTRAL] Let me look at the remarks.
[AGENT][NEUTRAL] OK. According to the remarks, and did you go to the exact to the same location? Your treatment was at the same place?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was at the same place.
[AGENT][NEUTRAL] OK, so this, the remarks states the transportation and lodging benefit is payable when a covered person who has been diagnosed as having cancer to receive covered radiation therapy, chemotherapy, immunotherapy.
[AGENT][NEUTRAL] Or excuse me, immunotherapy treatment, bone marrow stem cell transplant or surgery in a hospital that is at least 50 miles away from the covered person's home.
[AGENT][NEUTRAL] On your recent claim it.
[CUSTOMER][NEUTRAL] It was PT mouse.
[AGENT][NEGATIVE] It appears there was no covered treatment received. Therefore, transportation and lodging is not covered for this state of service.
[AGENT][NEUTRAL] Please refer to your policy contract.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's what the remark reads.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] OK. Well, do you have any other questions for me?
[CUSTOMER][NEUTRAL] So for the benefit that it paid for transportation, what did it pay?
[AGENT][NEGATIVE] On this claim, it does not show that it paid anything.
[CUSTOMER][NEUTRAL] For 312.
[AGENT][NEUTRAL] Let me pull that data service up.
[AGENT][NEUTRAL] It looks, uh, according to what I'm seeing, it's 28,650.
[CUSTOMER][NEUTRAL] No, did it pay for mine, my daughter's or which one or didn't say.
[AGENT][NEUTRAL] It, I can't differentiate that. I can only see that it was a transportation benefit.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so even though the funds, amount of funds for the immunotherapy, I still have um.
[AGENT][NEUTRAL] For 28,650.
[CUSTOMER][NEUTRAL] Immunotherapy a couple of more times during the summer. Can I still file the mileage for that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's see. Your mileage, let me.
[AGENT][NEUTRAL] Let me look at what your mileage how your mileage benefit reads.
[AGENT][NEUTRAL] It states that the max of the hm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Maximum of 12 trips per covered person per calendar year for all mode of transportation combined.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So that answers that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, so did you have any other questions on this for me?
[CUSTOMER][NEUTRAL] No ma'am.
[AGENT][POSITIVE] OK. Well then, thank you, Ms. [PII] for calling APL and I do hope that you have a very nice day today.
[CUSTOMER][POSITIVE] Thank you and you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you so much.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.