AccountId: 011433970860
ContactId: 50d3f494-4782-4132-994b-3c8bd2645a9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 428239 ms
Total Talk Time (AGENT): 217860 ms
Total Talk Time (CUSTOMER): 104694 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/50d3f494-4782-4132-994b-3c8bd2645a9b_20250106T16:38_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Uh, yes, this is [PII], and I'm calling to check on my cancer claim. Yeah, I've got a claim number.
[AGENT][NEUTRAL] All right, [PII], I can assist you, I can assist you today with your claim status. Can I get a callback number for you please?
[CUSTOMER][NEUTRAL] Do you need that?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] May I have your policy number, please?
[CUSTOMER][NEUTRAL] The policy number is 00505224.
[AGENT][NEUTRAL] Thank you. Could you please verify your date of birth, address, and email address, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII], um.
[CUSTOMER][NEUTRAL] [PII] and what other number?
[AGENT][NEUTRAL] Your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], thank you so much for verifying the information. Are you calling on claim 3542724?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 3106556
[AGENT][NEUTRAL] That claim was processed several years ago, are you sure?
[CUSTOMER][NEUTRAL] Oh, OK, no that's not right then. I'm looking at the wrong thing. It's the one that I sent in recently.
[AGENT][NEUTRAL] The recent one is [PII], you sent it in. It was processed on [PII]. That is claim number 3542724.
[CUSTOMER][NEUTRAL] 3543724
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is that have y'all done it yet?
[AGENT][NEUTRAL] Yeah, that claim was processed on [PII], um, but there was additional information required. We sent documentation to the address on file with the information that is required. Um, so did you receive it and send that information back to us?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, let me see.
[CUSTOMER][NEUTRAL] OK this is stated.
[CUSTOMER][NEUTRAL] 1114 24. OK, can you tell me what you were needing?
[AGENT][NEUTRAL] Yes, ma'am. I can let you know. So it looks like um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] 2.
[AGENT][NEUTRAL] It looks like um you had some drug charges for um [PII]. We would need an itemized billing for that. You were hospitalized. Um, we needed the facility bill for that. You were hospitalized in June and in July.
[CUSTOMER][NEUTRAL] Is what?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] In June and July of this year?
[AGENT][NEUTRAL] In [PII], yes, ma'am.
[CUSTOMER][NEUTRAL] I, I want
[AGENT][NEUTRAL] Well, it, I mean, we can only go by what you submit. If it looks like you could have been hospitalized, maybe you wasn't, but um.
[AGENT][NEUTRAL] Let me look at what
[AGENT][NEUTRAL] Let me look at what you sent in.
[AGENT][NEUTRAL] Um, your chemo, um, was maxed.
[AGENT][NEUTRAL] So you wouldn't get paid for any chemo um because it was maxed. Everything else, um, is we're needing itemized billing, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What we have here.
[CUSTOMER][NEUTRAL] So it doesn't look like I'm owed anything, right?
[AGENT][NEUTRAL] Um, no, not for chemo, but um,
[AGENT][NEUTRAL] It's, we don't, you, you send it in um explanation of benefits, but we're not getting the bills like the itemized bills letting us know. um, there was one bill, there was a medical claim bill. We wasn't sure what it was for if you were in the hospital. It just says, our lady at Lake um Regional.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] For 6 from 64 to 618, it was a $94,000 charge and we wasn't sure what that was for. That is why we.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] was assuming maybe it was a hospitalization.
[CUSTOMER][NEUTRAL] Oh, I think that.
[CUSTOMER][NEUTRAL] What about my radiation?
[AGENT][NEUTRAL] So chemo, radiation and, and immunotherapy are all in the same category. And so, um
[CUSTOMER][NEUTRAL] I received
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Let me look at your policy. While I pull up your policy, this is a verification of your coverage, not a guarantee for payment. So let's look and see if your policy is um a benefit year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you have $7500 per 12 month period and let's see when your 12-month period begins.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah you got to.
[AGENT][NEUTRAL] Really?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. So yours is like a yearly?
[AGENT][NEUTRAL] Um, benefit and so for [PII], you maxed out, you can get benefits for 2025 when it comes to chemo, radiation, or immunotherapy.
[CUSTOMER][POSITIVE] OK. OK. Thank you.
[AGENT][NEUTRAL] Is there anything else, [PII], I can help you with today?
[CUSTOMER][NEUTRAL] I don't think so thank you, ma'am.
[AGENT][POSITIVE] Mm, thank you for calling APL. Have a great day.