AccountId: 011433970860
ContactId: 4889fad3-144e-4825-9039-78cf6340a92e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 888489 ms
Total Talk Time (AGENT): 231183 ms
Total Talk Time (CUSTOMER): 404288 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/4889fad3-144e-4825-9039-78cf6340a92e_20250115T20:06_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling Eels [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. My name is [PII]
[CUSTOMER][NEUTRAL] I'm calling on behalf of my wife and her cancer policy.
[CUSTOMER][NEUTRAL] The number is 532,280.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] We were
[AGENT][NEUTRAL] Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][NEUTRAL] And Mr. [PII], can I get your last name, I'm sorry, your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, Mr. [PII], thank you for that. How can I help you?
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] She just finished up her, her 2nd round of, of chemo, and, uh, we had a very hard time getting some of our EOBs and, uh.
[CUSTOMER][NEUTRAL] Stuff from the doctors this past year.
[CUSTOMER][NEUTRAL] And I need to go back to a
[CUSTOMER][NEUTRAL] I uh
[CUSTOMER][NEUTRAL] I think this was sent on [PII].
[CUSTOMER][NEUTRAL] That's how far back I'm going, uh.
[CUSTOMER][NEUTRAL] It was asking for, uh, submit the explanation of benefits for an anesthesia charge on [PII].
[AGENT][NEUTRAL] OK, let me pull up
[CUSTOMER][NEUTRAL] I'm wondering if
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] The the stuff that I have already sent in to you, do you still have that on file?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Yes, sir, we have the claims, I mean, on file, um, from which you've already submitted to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][POSITIVE] I'm I'm sorry for my
[CUSTOMER][NEUTRAL] My uh
[CUSTOMER][NEUTRAL] Procrastination and getting all this sent in, but, uh, we were not, uh, anticipating going through this again in, uh, [PII]. And, uh, we didn't start getting a lot of the, uh.
[CUSTOMER][NEGATIVE] The, uh, benefits explanations and everything for [PII] until [PII]. And it's, it's just been a mess and, and, uh, I've been putting this off for a while.
[CUSTOMER][NEUTRAL] And I need to, we need to get this done and get this over with, but this, uh.
[CUSTOMER][NEUTRAL] Thing that I received back from you on [PII].
[CUSTOMER][NEUTRAL] Uh, it's asking for.
[CUSTOMER][NEUTRAL] The anesthesia charges on [PII].
[AGENT][NEUTRAL] OK, let me look at the EOB and see. Um, give me one second.
[CUSTOMER][NEUTRAL] Have I
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Yes, so it's saying, um, placing the surgery charges to include the itemized billing.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] From your surgeon's office for the anesthesia.
[CUSTOMER][NEUTRAL] OK, all right, and then it's asking for.
[CUSTOMER][NEUTRAL] An itemized bill from my surgeon and the facility for the anesthesia procedure.
[CUSTOMER][NEUTRAL] Performed on [PII], the day she had her surgery. You've not received any of that yet?
[AGENT][NEUTRAL] Now let's see.
[AGENT][NEUTRAL] So [PII] surgery. No, sir, we haven't received that itemized bill either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Let me see, uh,
[CUSTOMER][NEUTRAL] Uh, asking for the surgical benefit also.
[CUSTOMER][NEUTRAL] OK, so, uh.
[CUSTOMER][NEUTRAL] I'm going to get all this.
[CUSTOMER][NEUTRAL] Try to get all this together and send you uh.
[CUSTOMER][NEUTRAL] Send you the copies of what we have, uh.
[CUSTOMER][POSITIVE] To, uh, satisfy.
[CUSTOMER][NEUTRAL] Your uh response back to me on my, uh, explanation of benefits from you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And one of these, one of these concerns, the transportation.
[CUSTOMER][NEUTRAL] Uh, to and from our treatments.
[CUSTOMER][NEUTRAL] You needed an address.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] I, I think I had given that to you, but I will send that in again. Uh, I drove it.
[CUSTOMER][NEUTRAL] Over probably 70, 80 times in the last couple of years, 2 years.
[CUSTOMER][NEUTRAL] And, uh, it's well over 62 miles around, uh, one way.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] From my house to where we get the chemo administered in his office.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, I will, I think you've already got.
[CUSTOMER][NEUTRAL] You've already got uh some uh.
[CUSTOMER][NEUTRAL] Receipts for the drugs that he gave her the day of, each day that she had chemo, the drugs that he give her.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It's pre-chemo drugs that he give her. Do you show any records of that for all of 23?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] If I'm showing that we did pay out some chemo for 23, um, let's see.
[AGENT][NEUTRAL] Yes, so we paid some kima for 23.
[CUSTOMER][NEUTRAL] How much was that? Do you remember? Can you see it?
[AGENT][NEUTRAL] Uh, let me, let me go back, um, to that. Oops.
[CUSTOMER][NEUTRAL] Uh, this is not the chemo itself. It's pre-chemo drugs to, uh, it was a steroid, it was an and a nodule. It's a, uh,
[CUSTOMER][NEUTRAL] It was a Benadryl for any, uh, reaction that they might have. That's what these drugs were.
[AGENT][NEUTRAL] OK, let me see, um, because there's, there's some drugs that are not covered and some are. So let me look at the policy to see which ones are covered and then I can give you.
[AGENT][NEUTRAL] What amount we pay cause the one I was gonna give you is basically what we paid under the chemo benefit, um, but it might fall up under there as well, so give me one second.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So as far as any drugs like for in hospitals that she's had, um,
[AGENT][NEUTRAL] So was, was these while she was in the hospital or when she was out of the hospital?
[CUSTOMER][NEUTRAL] This is, uh, this is drugs where she, where she takes her chemo at his office. He's, he's not in a hospital.
[CUSTOMER][NEUTRAL] He's his own oncologist, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's, it's, it's a pre-chemo drug that he gives, gives them before they take the chemo. I think I sent all of those receipts in already for [PII].
[AGENT][NEUTRAL] OK, so, so there's a different, so there's the drugs and medicine benefit, and it's for if she's confined, but there's also a chemo benefit where some of the drugs will probably fall up under that. So I can give you um what we have paid off for chemo because that will still be up under the chemo benefit if they fall up under that benefit.
[AGENT][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] OK, can, can you go back to the very beginning, my first claim, can you tell me what, what you paid out then and, uh, first claim?
[AGENT][NEUTRAL] For 23 for chemo?
[CUSTOMER][NEUTRAL] Uh, yes, for anything during 23.
[AGENT][NEUTRAL] OK, let me go to another screen. I can give you the amount that we have paid out.
[AGENT][NEUTRAL] So as far as any kind of claims we paid out in 23, they were 97, 28, 90.
[CUSTOMER][NEUTRAL] OK, can you see how many chemos were involved in that?
[AGENT][NEUTRAL] So out of that amount, we paid out 9,018 90 cents as far as chemo.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Because the way the chemo benefit works, it pays up the actual charges up to 10,000 per calendar year. So if she has any other chemo drugs that we haven't paid in 23, um, there's still about maybe uh let me calculate that.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Well, I have a, uh, I have a rider on my policy that pays up to $20,000 a year.
[AGENT][NEUTRAL] Uh, let me see. Not for chemo, um, cause the chemo is only 10,000, um.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] No, ma'am, my, my policy states.
[CUSTOMER][NEUTRAL] It's, it's a 20,000 extra 10,000.
[CUSTOMER][NEUTRAL] Dollar rider for chemo.
[CUSTOMER][NEUTRAL] On my policy.
[CUSTOMER][NEUTRAL] I have that rider.
[AGENT][NEUTRAL] I'm look
[AGENT][NEUTRAL] Yeah, I'm looking at it just now to see if there's one that says 20,000 because I'm looking at it like I said, it's only showing 10, but give me one second, let me see if there's another writer on here.
[AGENT][NEUTRAL] Yes, so I, I see that. It's uh I see that portion under here, so, so yeah, so she's only used 9,018904 23 as far as chemo.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, uh.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] There is uh another $11,000.
[CUSTOMER][NEUTRAL] Uh, available to chemo in [PII].
[AGENT][NEUTRAL] There is there's an exact amount of $10,981.10 that she can use for chemo for 23.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] The 20,000 for 24 also.
[AGENT][NEUTRAL] Yes, sir. So there's, there's nothing been used for 24.
[AGENT][NEUTRAL] No, we haven't received any claim for 24 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK, I'm gonna try to sort all this out and and uh.
[CUSTOMER][NEUTRAL] Get this sent off to you as quickly.
[CUSTOMER][POSITIVE] Hopefully by the end of next week and uh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The uh the first benefit that was paid.
[CUSTOMER][NEUTRAL] was a
[CUSTOMER][NEUTRAL] It was a one time.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Yearly preventative.
[CUSTOMER][NEUTRAL] For some
[CUSTOMER][NEUTRAL] Do what?
[AGENT][NEUTRAL] The one-time yearly preventative benefit?
[CUSTOMER][NEUTRAL] Yes, ma'am. I think that's what it's called.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] How much was it
[AGENT][NEUTRAL] So the yearly, um, it's $60 a year for
[AGENT][NEUTRAL] Um, screenings.
[AGENT][NEUTRAL] So in [PII], we paid for an X-ray and that was 60 and then in [PII], we paid for a CAT scan and that was 60.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] OK, I'm, I'm asking what, what was the very first check that you sent to me?
[CUSTOMER][NEUTRAL] Whenever we turn something in.
[AGENT][NEUTRAL] OK, let me go. That was the, the benefit, so it was actually multiple I mean multiple items on that check.
[AGENT][NEUTRAL] Um, so the total for that check, the first check was 8,93979.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] I will, uh, let me see, for, for [PII].
[CUSTOMER][NEUTRAL] You're gonna need the anesthesia charge for that, and then I need to get the anesthesia and surgeon charges and everything for the surgery on [PII].
[CUSTOMER][NEUTRAL] Of [PII]
[CUSTOMER][POSITIVE] I will try to get all that together and send that to you.
[AGENT][NEUTRAL] Uh, Mr. [PII], that's fine. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, nothing that I can think of right now. Your name is [PII]?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK, I have talked.
[CUSTOMER][NEUTRAL] Uh, I've talked to a [PII], a [PII], and a [PII], I think, during all this. So you're, you're the 4th 1 in line, [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] All right, ma'am. I thank you for your help. uh you have a good rest of the day.
[AGENT][POSITIVE] You as well, Mr. [PII], and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Goodbye.
[AGENT][NEUTRAL] Uh-huh, bye.