AccountId: 011433970860
ContactId: 5e40f931-9e02-45c3-8fa1-ad2b0b351244
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 280679 ms
Total Talk Time (AGENT): 155001 ms
Total Talk Time (CUSTOMER): 133866 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/5e40f931-9e02-45c3-8fa1-ad2b0b351244_20241230T22:44_UTC.wav
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[AGENT][NEUTRAL] Yeah, you're speaking with [PII]. How may I help you today?
[CUSTOMER][POSITIVE] Well, hello, Miss [PII], full of energy over there. Give me some girl. This is [PII].
[AGENT][POSITIVE] Hey, [PII]. Look, you know, I'm, I got 15 minutes before I get off and I'm off tomorrow. So, yeah, I'm full of energy.
[CUSTOMER][POSITIVE] [PII] bless you. You go, girl. That's right. Well, hopefully this will be a quick, quick call. Um, all right, so it, the policy is 107673.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this is for Mr. [PII], oh, OK, number 2, and it's on [PII].
[CUSTOMER][NEUTRAL] And I, I'm speaking with participant #2.
[CUSTOMER][NEUTRAL] Uh, yes, I, I.
[AGENT][NEUTRAL] OK, the main insured. OK. Mhm.
[CUSTOMER][POSITIVE] OK, and so team, uh, care team transferred it to me. I've helped her with her my part now she just has some questions on benefits so care team verified everything and I can give you her number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you can give it to him.
[CUSTOMER][NEUTRAL] OK, 425-226.
[CUSTOMER][NEUTRAL] 4493.
[AGENT][NEUTRAL] All right, I can see can I help Ms. [PII]?
[CUSTOMER][POSITIVE] OK, well, Miss [PII], you enjoy tomorrow off and have a wonderful [PII], honey.
[AGENT][POSITIVE] You too. You'll be blessed. Bye.
[CUSTOMER][POSITIVE] Yes, you as well. Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, uh huh.
[AGENT][NEUTRAL] My name is [PII] and I'm in the claims department. How can I help you today?
[CUSTOMER][NEUTRAL] Well, I just had a question.
[CUSTOMER][NEUTRAL] Uh, because on my premium, but she answered it for me and then I, I was just gonna ask.
[CUSTOMER][NEGATIVE] You know, my husband is in um catastrophic.
[CUSTOMER][NEUTRAL] As far as benefits go?
[CUSTOMER][NEUTRAL] On the cancer medication that Medicare, Medicare is paying for his pills, um, they paid everything the last two months, the entire, which is like a $12,000 pill.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] If you can imagine, so there are no coverage for that, no benefit for that, right? When, once he's in catastrophic and once Medicare pays the entire amount.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, now Ms. [PII], we don't process uh claims across, you know, over the phone, but you can send in any claims to be reviewed and you do have to have your Medicare explanation of benefit, uh, with your claim because it does is based on what Medicare applies. So yes, ma'am.
[CUSTOMER][NEUTRAL] Right, yeah, that's what I thought and then does it, um, then does it start back over in January?
[AGENT][POSITIVE] Well, when once, once you max out your benefits for the year, and let me see what you're talking about like chemo and radiation, correct? And this is unlimited. This is unlimited. So we'll continue to pay as long as you send in your claims and your Medicare EOB whatever can be paid towards chemo radiation or chemotherapy. This is an unlimited policy. We will continue to process your claims. There's no, there's, it's just unlimited.
[CUSTOMER][NEUTRAL] Does it go back?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, it is.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yes, ma'am. This is the unlimited benefits.
[CUSTOMER][NEUTRAL] Oh, I didn't realize that, I guess, so they do still cover it.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, once you send in any information that you want us to review, we can continue the process of any claim we review it if anything can be paid on that medical claim, we will process and pay it.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright then I'll gather up the information and I have some of them that were the last 2 or 3 or 3 months I guess it was 2 months, OK.
[AGENT][NEUTRAL] OK. Yes, ma'am. So you just send it in for review and if uh anything can be paid on that towards any chemo, radiation, medical treatment, you know, it's all based on what Medicare applied and what they paid and what you owe, so we'll go from there once we receive the paperwork.
[CUSTOMER][NEUTRAL] Oh, OK, even though they covered the entire pill then, huh?
[AGENT][NEUTRAL] Yeah, well, that, that's what I'm saying there's no guarantee to pay over the phone. We have to wait till we get the paperwork and review it. And if benefits can be paid, we would pay. And if, if there's nothing to be paid, then you'll get a denial telling you why what benefits would not pay up.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, OK, all right, well thank you, [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I think that should do it.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yeah, you have a good new year.
[AGENT][POSITIVE] You too, Mr. [PII], and thank you for calling American Public Life, and you have a wonderful day. Bye-bye.
[CUSTOMER][POSITIVE] OK you too thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.