AccountId: 011433970860
ContactId: 4e74385b-752d-46e0-a984-062e043d2aa3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1162500 ms
Total Talk Time (AGENT): 454099 ms
Total Talk Time (CUSTOMER): 438097 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/4e74385b-752d-46e0-a984-062e043d2aa3_20250107T16:14_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I was wondering if you can help me check on a couple of things with my policy.
[AGENT][POSITIVE] Yeah, I'd love to help you with some policy information today. Can I get um that policy number, please?
[CUSTOMER][POSITIVE] Uh yes ma'am, I have to log in. I'm so sorry, forgot about that.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] No, I have it here somewhere.
[CUSTOMER][NEGATIVE] Well, it never comes quickly, does it?
[AGENT][NEUTRAL] No, that's OK. I think computers know when you're waiting for something.
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Well I mean the phone number instead of the log in. I think that's what's going on here.
[CUSTOMER][NEUTRAL] OK, let's.
[CUSTOMER][NEUTRAL] Go to log in.
[CUSTOMER][NEUTRAL] I know I got you log in somewhere on here.
[CUSTOMER][NEUTRAL] OK, my policy number.
[CUSTOMER][NEGATIVE] Sorry, it's a running slow.
[AGENT][POSITIVE] Take your time. I'm here all day.
[CUSTOMER][NEUTRAL] OK, it's 1775159.
[AGENT][POSITIVE] Perfect. And your first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][POSITIVE] Wonderful, Ms. [PII], thank you so much. I am gonna have to verify with you some additional information if you don't mind.
[AGENT][NEUTRAL] Going through that process with me. Would you be able to verify for me, please, your mailing address?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful. And then just your email and your phone number.
[CUSTOMER][NEUTRAL] It is [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful and is that a good number to call you back on in case we got disconnected?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][POSITIVE] Perfect. All [PII]. And how can I help you today? What questions can I help answer?
[CUSTOMER][NEUTRAL] Well, my daughter and I filed a couple of claims. We did it in two different formats because we weren't sure which format the insurance company would want. We sent the EOB as well as like a detailed thing, I think. We're trying to make sure those claims got sent through properly and see if they're lacking any information for those two claims, first of all.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK perfect so I do see that we received something on the [PII] and on the [PII] um it looks like the claims have not been processed but they are in queue to be processed, um.
[CUSTOMER][NEUTRAL] Do you know how long that might take?
[AGENT][NEUTRAL] The typical turnaround time is 7 to 10 days.
[AGENT][NEUTRAL] Um, for a claim to be processed, um, unfort.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's been a long time coming.
[AGENT][NEUTRAL] Um, unfortunately I won't know if they need more information until they are processed, but if you do, like if they find out they need more information, um, they will send like a request for it, so they'll send you an explanation of benefits just requesting more information for you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. And then I have another question on my policy, my doctor said to be sure and ask. Um, I'm having to do PT due to cancer. Uh, and he said some of the policies cover some on your physical therapy as well. And I told him I didn't know on this one. I haven't looked up the policy to see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, we can take a look and see if you have benefits for physical therapy.
[CUSTOMER][NEUTRAL] And then also they wanted me to check and see.
[CUSTOMER][NEUTRAL] Uh, uh, or I want to check and see on my, uh, monthly how much it cost and what time of the month that comes out of my pay period.
[AGENT][POSITIVE] OK, that is an excellent question. Let me look at that for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So it looks like we typically draft from your bank on the [PII], as long as the first doesn't fall on a Saturday or a Sunday, and the premium amount that we pull is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $26.90.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how long is mine mine's monthly it's not paid up for the year, right?
[AGENT][NEUTRAL] Uh, let me take a look at that billing frequency one more second.
[CUSTOMER][NEUTRAL] Some of my things I went and paid up for the year and I couldn't remember if my cancer was one or not, truthfully.
[AGENT][NEUTRAL] So this one it looks like you bill monthly and you are paid for the month of January.
[CUSTOMER][NEUTRAL] OK, so I'm not due again until [PII]?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, great. All right, and then we'll check about the PT.
[AGENT][NEUTRAL] And then I do not see any physical therapy coverage. It looks like I see um internal cancer first occurrence, heart attack, stroke first occurrence, and hospital ICU cancer benefit, as well as a limited benefit for specific disease cancer.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Insurance.
[CUSTOMER][NEUTRAL] OK, and I have one question on there. I do know I have the transportation benefit and I haven't used it all yet. How many do you see that I have used and filed for my transportation? Because I believe I'm allowed up to 12 a year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I'm not sure.
[AGENT][NEUTRAL] OK, yeah, let me see if I can tell um.
[CUSTOMER][NEUTRAL] I want to say I've used something like 6, but I.
[AGENT][NEUTRAL] Yes, for [PII] I do see that we've done 6 transportation benefits.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] OK, for [PII], I'm in my phone. So I can still utilize 6 more and those have to be from when I was having treatment, such as immunotherapy, chemo, or the actual cancer doctor, right?
[AGENT][POSITIVE] Um, let me read that portion of your benefits. That is a great question.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, so it says I'm just gonna read the like the little section to you if that's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It says, we will pay the actual co-fa of transportation by bus, plane or train, or the mile amount shown on the schedule of benefits for transportation by car of a covered person who has been diagnosed as having cancer to receive radiation therapy, chemotherapy, or immunotherapy treatment, bone marrow or stem cell.
[AGENT][NEUTRAL] Transplant or surgery in a hospital that is at least 50 miles away from the covered person's residence using the most direct route, such a such hospital must be prescribed by a physician and be the nearest hospital which offers these specialized treatments. If the covered person travels by bus, plane or train, you will have the option.
[AGENT][NEUTRAL] To receive the coach fare benefit of um the coach fair benefit or the per mile benefit if you are unable to provide proof of coach fare, the per mile benefit will be paid if treatment is received. I'm so sorry my dog is um not I I don't, I don't know. I'm sorry um.
[CUSTOMER][NEUTRAL] That's OK. That's OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] If you're unable to provide proof of coach, the per mile benefit will be paid if treatment is received on an outpatient basis. We'll also pay the amount shown in the schedule of benefits subject to the maximum number of days. Um, does that feel like it answered your question?
[CUSTOMER][NEUTRAL] Yes, ma'am. I do have one question though. So I know like with my immunotherapy benefit, it just rolled back over, because I'm still having immunotherapy. So anything after [PII] was a [PII] for me, and I can refile on immunotherapy for my $20,000 once a year benefit. Now, what I, my question is, when does that roll over for me on transportation again, they said that it did. Would it be that same [PII], because that's when I started chemo, or?
[AGENT][NEUTRAL] So my understanding is that this works off a calendar year benefit so everything starts over on [PII].
[CUSTOMER][NEUTRAL] Oh, OK. So, except for the immunotherapy, correct? Because it was supposed to start in [PII], is what y'all told me when I called.
[CUSTOMER][NEUTRAL] They said that went by date of service of when I actually began the chemo, which was [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Then I would listen to to that.
[CUSTOMER][NEUTRAL] I'm sorry, 2
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Direction, yes, um, and then I do see I'm sorry it was a lot further down in the paper but I do see you have uh physical occupational speech audio therapy and psychotherapy um covered if it is.
[AGENT][NEUTRAL] Um, physician advised.
[CUSTOMER][NEUTRAL] Is it, if it's what?
[AGENT][NEUTRAL] As long as it's um physician advised like.
[CUSTOMER][NEUTRAL] Oh yeah, I've got all that so, so I need to know what to do.
[AGENT][NEUTRAL] Your doctor, yeah.
[AGENT][NEUTRAL] So physical therapy is a covered benefit.
[CUSTOMER][NEUTRAL] OK, how do I file for that then? I don't know how to go about that. I've had a lot of physical therapy and I'm about to have more.
[CUSTOMER][NEUTRAL] How many do I get a year? What is it covered that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] All right, it looks like you don't have so many, well, I guess you do have some here. You can get up to $25 per visit and up to $1000 per year.
[CUSTOMER][NEUTRAL] Uh, let me write that in my phone too, so $25 per visit.
[CUSTOMER][NEUTRAL] Up to 1000 per year, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now I began my physical therapy, for instance.
[CUSTOMER][NEUTRAL] Just a few months ago.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, so, like, let's say I've already, I know I've done like 1314, maybe more. um
[CUSTOMER][NEUTRAL] So either whatever's the lesser, I'll do the 25 each or I'll do the 1000 for the year. How does that work?
[AGENT][NEUTRAL] Um, so you would just submit like your, your bill.
[AGENT][NEUTRAL] It's gonna be my guess, and I, I would imagine.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Let me see, it doesn't
[AGENT][NEUTRAL] Say let me find out.
[CUSTOMER][NEGATIVE] And then another problem that I ran into last year with my transportation is they wanted it.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Um, like a Google Map, but they, I mean, they did it for me through APL, but what I didn't understand is that it was asking for an actual address every time, and they don't stamp an address every time I go to UT Southwestern. I don't know how to get you that info.
[CUSTOMER][NEUTRAL] At Texas Oncology, when I was using them, they, they had a stamper, and they would stamp it every time I come, UT doesn't do that. So I don't know how to provide y'all with an actual address for them to show you, prove to you that that's where I was for my therapies.
[AGENT][NEUTRAL] They might be able to print something out on letterhead that has the name of their company, their address, and their contact phone number, and you might see if you can get like your invoice printed on letterhead.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] But I would have to do that through them there again, y'all don't do that for me, right?
[AGENT][NEGATIVE] I don't believe so.
[CUSTOMER][NEUTRAL] It's a lot
[CUSTOMER][NEUTRAL] I mean, it takes a lot to get them to do something like that.
[CUSTOMER][NEUTRAL] I have, why it took Texas Oncology months to get me stamped. I was having to beg. Can I please have an address stamp or every time I come in, because I have to prove to my cancer policy. So, anyhow, I would have to contact who then exactly?
[AGENT][NEUTRAL] I would try contacting the facility you were at to see if they could get you just something printed out like your invoice or anything that includes their address on it.
[CUSTOMER][NEUTRAL] Uh, invoice that includes the address on those certain days of service where I had the therapy or the different things.
[AGENT][NEUTRAL] Where you had to travel. And then um for the therapy, like your physical therapy, um it looks like you're just going to want.
[AGENT][NEUTRAL] Um, your itemized invoice and a copy of explanation of benefits if you have that and then any further information, um, whoever processes that claim will be able to help you out.
[CUSTOMER][NEUTRAL] OK, so itemized bill and EOB?
[AGENT][NEUTRAL] Mhm yep.
[CUSTOMER][NEUTRAL] And that's pretty much for everything, right?
[AGENT][NEUTRAL] Yeah, kind of the gist of all of the claims that go in.
[CUSTOMER][NEUTRAL] OK, well, I'm gonna work on trying to get some more of this done. It's just so much to keep up with in the middle of being sick. I'm trying to stay ahead of the game here. Um, OK, let's see then. Uh, so on my new transportation benefit, you're saying that began over in [PII] or in [PII], like they told me the other day.
[CUSTOMER][NEUTRAL] Is that calendar year or is that the actual date of when I started my services, which was [PII]?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because I have a, I have a lot more transportation too, and I'm trying to get my transportation included.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] I know for sure the immunotherapy was after [PII]. They already explained that to me, but I don't know for sure on my transportations.
[AGENT][NEUTRAL] Alright, transportation.
[CUSTOMER][POSITIVE] And I was like a, like you and I discussed, and I've already discussed with another one. I think I get 12 per year. That's why I want to meet, it's really important for me to know when that started over, because I want to file for my next 12, as well as my 6 that I haven't filed on yet.
[AGENT][NEUTRAL] OK, let me, I'm just reading through the benefits, um, I do see like on your other one your immunotherapy it says like 12 months from date, um, everything else doesn't specify which means I think it's gonna be running on that calendar year, um, but I am going to.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That would have been [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just going to
[AGENT][NEUTRAL] Really quickly double check that um with.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Someone else
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it does it, um, further down in like the very end of the document um or like towards the bottom it says per calendar year for all modes of transportation combined.
[CUSTOMER][NEUTRAL] OK. So it, I, I've got 6 more left from 24.
[AGENT][NEUTRAL] Yep and then
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] [PII], um, obviously nothing's been processed yet so I have 2525 is empty.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. And on those transportations from [PII], that will be eventually processed, and I'll send them in. Will those be, I'm just making sure I understand. It had to be getting immunotherapy, it had to be getting, it was all cancer-related.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But it wasn't necessarily immunotherapy. It was like scans and this and that. And so, that's why I'm asking.
[AGENT][NEUTRAL] So yes, so that one let me see previous.
[AGENT][NEUTRAL] It says,
[AGENT][NEUTRAL] Radiation therapy, chemo, or immunotherapy, bone marrow or stem cell transplant surgery in a hospital that is at least 50 miles away.
[AGENT][NEUTRAL] So those were the the covered reasons.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Now, when I get ready to do those files, do I, when I go to, I know we don't go to wellness, we go to a cancer claim. Do I have to file a cover page every time, or do I just put it in? I mean,
[AGENT][NEGATIVE] Um, I would honestly recommend doing one cover page and including as much information under that one cover page as possible, and they'll break it all up by dates of service and what benefits are on there just to save you time and hassle.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great. All right. Well, thank you. You've been very, very helpful. I appreciate it.
[AGENT][POSITIVE] Yeah, absolutely my pleasure. I'm sorry it took me a little longer to find all those benefits for you, but I'm so glad I was able to help you, Miss [PII].
[CUSTOMER][POSITIVE] Yes, I appreciate you [PII]ave a good day.
[AGENT][POSITIVE] You too you take care and have a happy have a happy new [PII].
[CUSTOMER][NEUTRAL] Uh-huh. You too. Bye-bye.
[AGENT][NEUTRAL] Bye