AccountId: 011433970860
ContactId: 4cfff9b0-d8b8-42d4-aa15-6f1918810848
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557630 ms
Total Talk Time (AGENT): 229570 ms
Total Talk Time (CUSTOMER): 228297 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/4cfff9b0-d8b8-42d4-aa15-6f1918810848_20250529T21:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], I think we were disconnected. Were you talking to you about my cancer benefits?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] When did you make the call?
[CUSTOMER][NEUTRAL] Uh, I
[CUSTOMER][NEUTRAL] About 2 minutes ago, not even 2 minutes ago, so it wasn't you, OK, it wasn't you then.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] No, it wasn't me um but I can help you.
[CUSTOMER][NEUTRAL] Yeah, because I had a it was a drop call or something anyway I couldn't hear her anymore right in the middle of the sentence it stopped.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] All right, I've been.
[CUSTOMER][NEUTRAL] Last year I got had breast cancer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I received um treatment, chemotherapy, and this year, I received 6 injections.
[CUSTOMER][NEUTRAL] Um, from the hospital, uh, for my cancer.
[CUSTOMER][NEUTRAL] My question is.
[CUSTOMER][NEUTRAL] Does the, does it continue my benefits? Will it continue into this year for cancer that I had last year?
[AGENT][NEUTRAL] Um, let me look into your policy. Can I get your name and a call back in case we get disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. My name is [PII]
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Policy number is 00728463.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And if we get disconnected, like it sounds like it happened already, um, is the [PII] number um the one to call back?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, it stopped.
[CUSTOMER][NEGATIVE] No, she didn't call back. It was just right in the middle of the her sentence it it was disappeared.
[AGENT][NEUTRAL] Oh, I, I know I mean if this call gets disconnected I'll be able to call you back. Is this the correct number you would like me to call back?
[CUSTOMER][POSITIVE] There you go. Thank.
[CUSTOMER][NEUTRAL] Yes, this is the number.
[AGENT][NEUTRAL] OK, OK, I just wanted to make sure just in case.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Yeah, that's the one.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK [PII], can you verify your date of birth please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the mailing address and phone number that we have on file?
[CUSTOMER][NEUTRAL] That would be um [PII].
[CUSTOMER][NEUTRAL] And what else?
[AGENT][NEUTRAL] Uh, the phone number that we have on file, is it the one you're calling from?
[CUSTOMER][NEUTRAL] I believe so [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And let me take a look at your policy and see what it says.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] 3, what does that say? 3.
[AGENT][NEUTRAL] Alright, I'm able to pull up your policy, so let me check and see.
[AGENT][NEUTRAL] What your benefits are and see if it goes per calendar year it should go per calendar year, but let me double check and see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this is just a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] I'm showing you have a drug and medicine benefit.
[AGENT][NEUTRAL] Uh, it looks like.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You have that uh a hospital confinement of up to $100 per confinement, $50 per prescription. Oh, here we go, surgical.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You have a surgical benefit with a unit dollar amount of $20 per unit, a maximum of $2000 per operation. Um, but you were saying injections.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I had chemo last year.
[CUSTOMER][NEUTRAL] And one of my drugs included in the chemo was Herceptin.
[CUSTOMER][NEUTRAL] And it has continued this year, just the Herceptin. I've gotten 5 injections.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, 6 injections this year.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they're like
[CUSTOMER][NEUTRAL] It's part of a chemo cocktail.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But it's
[AGENT][NEUTRAL] Um, so it looks like for that, for the chemotherapy and immunotherapy, you have actual charges of up to $10,000 per 12 month period. So it'll go for 12 months, so not calendar year. So say you started now, um, you would get up to $10,000 of the actual charges um for the next 12 months. So it's not by calendar year.
[AGENT][NEUTRAL] So you'll just wanna keep track of when you have of the month that you had the month that you started them.
[CUSTOMER][NEUTRAL] Oh, OK, so.
[CUSTOMER][NEUTRAL] Oh, so the month that I actually started chemo was in April of last year.
[AGENT][NEUTRAL] OK, so you've reached your, your 12 months.
[CUSTOMER][NEUTRAL] So it continue.
[CUSTOMER][NEUTRAL] And then, but see it that I, I was gonna wait till I filed up, you know, had them all before I did it because I did January, February, March, April, April, May, so a total of 6 injections this year.
[CUSTOMER][NEUTRAL] So, should I just
[CUSTOMER][NEUTRAL] Put them and send them all in and.
[CUSTOMER][NEGATIVE] Because I know I didn't get $10,000 from you all last year. Last year my medical, my hospital bill was like a million dollars or something like that.
[CUSTOMER][NEUTRAL] That included the chemotherapy and stuff, so.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Yeah, I would, I would go ahead and submit them.
[AGENT][NEUTRAL] Um, and we will go off of the 12 months, so, um, you've already had 6 this year, so you have.
[CUSTOMER][NEUTRAL] Yeah, I've had
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That ends it. I have no more after that. [PII] was my last one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, I would go ahead and um file those claims or have your doctor file those claims, however you would like to do it.
[CUSTOMER][NEUTRAL] Ma
[AGENT][NEUTRAL] Um, because I am showing that it's in its actual charges of up to 10,000 per 12 month period, um, so.
[AGENT][NEUTRAL] I would definitely file a claim for those.
[AGENT][NEUTRAL] And it looks like you have some claims on here so you know to give an itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, with procedure codes on them and everything as well.
[CUSTOMER][NEUTRAL] OK, now do I need to send you my uh.
[CUSTOMER][NEUTRAL] Aetna insurance as well or just the hospital bill?
[AGENT][NEUTRAL] This isn't secondary, so you shouldn't need to send the Aetna. Now if they paid um a partial payment towards these, you will need to send in the explanation of benefits showing that some of it was paid, um.
[CUSTOMER][NEGATIVE] I don't think any of it was paid because they can't even find, they, I, I've been on the phone an hour and a half with them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] To try to find out why I still have to pay $800 and something dollars per injection, so.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I don't think they know anything.
[AGENT][NEUTRAL] Yeah, um, if they're not paying anything and they're just denying it, go ahead and bring it over or go ahead and file the claim through us. This isn't secondary insurance, it's not gap coverage. Um, so if they're not paying anything, you can, you can send in a document showing that Aetna isn't paying anything, um, but I will say if they do ever pay any sort of amount towards it, you will want to send in an explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was
[AGENT][NEGATIVE] But if they're denying it, um, I, I would be safe and send in the denial, uh, letter.
[CUSTOMER][NEUTRAL] OK, so I'll just, I'll just.
[AGENT][NEUTRAL] Would you file a claim with us?
[CUSTOMER][POSITIVE] OK, so I'll send, I'll, I'll send in their explanation of benefits that way I'm covered.
[AGENT][POSITIVE] Yeah, yeah, that, that's what I would do just to be safe.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, see, I think.
[CUSTOMER][POSITIVE] I appreciate your time thank you very much.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Appreciate it.
[AGENT][POSITIVE] Alright, take, take a breather and we'll, we'll get through this, OK? Thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] You're sweet. Bye bye.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Alright bye.