AccountId: 011433970860
ContactId: 616c29cf-80f6-438a-a09e-9e7af1906d1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1248900 ms
Total Talk Time (AGENT): 561144 ms
Total Talk Time (CUSTOMER): 421578 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/616c29cf-80f6-438a-a09e-9e7af1906d1e_20250130T18:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. Um, my name is [PII], and I was wanting to speak to you about a, um, my premium. I believe it was, uh, they tried to draw it through my account and my, uh, my retirement check hadn't hit yet, so I wanna make sure I don't lapse and see how I can take care of it or if they're gonna run through it again.
[AGENT][POSITIVE] OK, um, well, I'll be more than happy to assist you with your premium payment. And [PII], may I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] I don't have my policy number with me right now, but I can give you any other information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, well, let's do the phone number first and then I can look the policy up with your social if you don't mind.
[CUSTOMER][NEUTRAL] OK, no, not at all, um, phone number is [PII].
[AGENT][POSITIVE] Thank you, and then your social whenever you're ready.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to populate here.
[AGENT][NEUTRAL] And it's kind of taking this time. I apologize. This is for, let's see.
[AGENT][NEUTRAL] This is a cancer policy?
[CUSTOMER][NEUTRAL] Yes, uh huh.
[AGENT][NEUTRAL] OK, here it is. Hold on one moment, it's coming up now. And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Uh [PII] uh email [PII] and um [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, let me check with, let me see if this is a check.
[AGENT][NEUTRAL] Let me reach out to customer service and see how that would work because in our system, it hasn't been returned, so it's still showing like the payment was made. So let me see if if it can be made over the phone or if we have to wait, you know, for the return to pay. I'm going to get those options and then I'll let you know, OK?
[CUSTOMER][NEUTRAL] OK, because you know I just assumed that um it didn't get paid now I guess I could check my account while you're looking again um I just I just don't want it to lapse, you know, it's so important that I have this policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but you can do what you need to do and um I'll be checking on my end of it. I'll wait for you.
[AGENT][NEUTRAL] OK, look for um [PII]. It says we received it for 3:37 20, and I'll call them on the other line. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Purring
[CUSTOMER][NEUTRAL] Thank you for calling the APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII]. How are you doing?
[CUSTOMER][NEUTRAL] I'm fine, [PII], how are you there?
[AGENT][NEUTRAL] I'm doing good. I just have a quick question. I have an insured on the other line check payment. She says that she, her retirement check wasn't there, so she doesn't think it's clear, but on our end, it does show that it was paid. Do we have to wait until it's returned or how can she?
[CUSTOMER][NEUTRAL] Certainly.
[CUSTOMER][NEUTRAL] Her retirement check.
[AGENT][NEUTRAL] Yes, I guess she pays her bills with her retirement check and at the time we drafted, the retirement check wasn't in there, but in line, it says that she's paid till March. You want to look at it?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, it's 228-8209.
[CUSTOMER][NEUTRAL] Can you give me just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And wait a minute, uh, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, she's paid to 41, let's say [PII] [PII] [PII]
[CUSTOMER][NEUTRAL] We received, we received a payment 11:28.
[CUSTOMER][NEUTRAL] Three payments of $112112.40 that covered January, February and March.
[AGENT][NEUTRAL] So if it is
[CUSTOMER][NEUTRAL] I hope she doesn't get an NCS if her check wasn't in there.
[AGENT][NEGATIVE] I hope not either. She said she was going, I don't, she said she was gonna check her account, her bank account to see if she saw the amount, the 33,720 on [PII], um, and I told her I was gonna check with customer service to see what we would do in this case because do we have to wait until it's returned?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, because as far as on our end as far as we know it's been paid, we won't know until the bank notifies us that it wasn't.
[AGENT][NEUTRAL] If it is,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK there.
[AGENT][POSITIVE] Yes, well, that helped me. Well, thank you, [PII].
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right. Bye-bye.
[CUSTOMER][POSITIVE] Have a good day, dear. Bye. Thank you, bye.
[AGENT][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So yes, um, on our end, it does look like the payment was made. So if it is returned from the bank, you know, at a later date, then you can, um, well, the bank will notify you first, so you can give us a call, um, and if you want to make the payment over the phone or um let customer service know that they can then draft it, but we can't do anything with it now because it's not showing anything was returned, it just shows the payment has been made.
[CUSTOMER][NEUTRAL] OK, well then, thank you. So what was your first name? I'm sorry.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And uh thank you for checking on and uh I will keep an eye on it uh very good to know I I see that my deposit and that check came in at the same time but then I saw that they gave me um a return, uh, insufficient fund charge but and I don't see the 337 being deducted so I'm not sure if they're still trying to figure out all their checks and balances, but I will keep an eye on it and uh like you said if it was um.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will find out for sure through my bank and you said I could call in and pay it over the phone?
[AGENT][NEUTRAL] Um, yes, we can see if that's an option at that time or if they're just gonna run it, um.
[AGENT][NEUTRAL] You know, once you call it, yeah, they can either run the check or see if uh payment by phone is an option, but they will let you know uh once it's returned.
[CUSTOMER][NEUTRAL] Oh, if they have to
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] If it's returned, I hope it's not.
[CUSTOMER][NEUTRAL] Me too, me too. OK. All right. Um, what?
[AGENT][NEUTRAL] All right, OK, go ahead.
[CUSTOMER][NEUTRAL] I, I appreciate you checking on that and I, I had submitted a claim and I don't know if you have access to seeing if the if the claim has been um is being processed.
[AGENT][NEUTRAL] Oh, sure. Um, hold on one second.
[AGENT][NEUTRAL] Um, so I am showing that we received the claim on [PII] and it is currently in processing.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see if I can ask this question correctly. Do you, uh, are you aware of they just, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, cover medications that were provided to me through like chemo or infusions or if they cover like, um,
[CUSTOMER][NEUTRAL] Uh, uh, scans or, uh, surgeries or anything of that sort.
[AGENT][NEUTRAL] Oh, sure, let me look at your benefits. Hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And again just for the call, all the information provided is a verification of benefits, not a guarantee of payment, and I'm looking now for you.
[AGENT][NEUTRAL] Radiation therapy, chemotherapy, and immunotherapy benefit, um, the policy would pay up to $500 per calendar month.
[CUSTOMER][NEUTRAL] Her calendar month.
[AGENT][NEUTRAL] Mhm. So each month, it would be $500 that you can use towards radiation, chemo, or immunotherapy.
[CUSTOMER][NEUTRAL] So each month at $500 doesn't matter how many treatments I get it's just $500 per month.
[AGENT][NEUTRAL] Right, mhm.
[CUSTOMER][NEUTRAL] OK, so is that all that it, it, um, it provides?
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] What about like surgeries and
[AGENT][NEUTRAL] Let me go to the first page.
[AGENT][NEUTRAL] So it so hospital confinement, um, there is a drugs and medicine benefit. So let me see what confinement is for this policy. Sometimes it's 18 hours, sometimes it's 24. Hold on one second.
[AGENT][NEUTRAL] OK, so for this policy, um, confinement is 18 consecutive hours. So, um, any drugs or medication um due to the hospital confinement or outpatient, there's um coverage for that. There is a surgery benefit. Now, the surgery benefit is kind of hard to quote because it's per unit.
[AGENT][NEUTRAL] So like basically each surgery has a number, you know, like let's just say um
[AGENT][NEUTRAL] A surgery you got is 5 units. So they would multiply the 5 units times $15 but the max that it would pay out on a surgery is $1600.
[AGENT][NEUTRAL] But there's no like limit on the surgeries.
[CUSTOMER][NEUTRAL] And um so that would be I don't understand what units means what's units?
[AGENT][NEUTRAL] Unit is just is billing. So like if you don't let me give you an example, um, I don't know if any type of surgery that you have, it can have one unit or it can have 500, depending on the surgery, the, the number of units is different. I wouldn't be able to tell you, I don't know how it's deciphered, but it's all in the medical billing that we get when we're processing the claim.
[AGENT][NEUTRAL] So let's say you need some type of procedure and it's 2 units, it would be that 2 units times $15.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, very good, um, so from what I gained, it's the benefits do cover radiation, amino and, and chemo, and then there are some surgery benefits and then hospital confinement, 18 consecutive hours with drugs or um or outpatient. OK, um, what is that confinement, um, pay out?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Uh, let's see. Hospital confinement is $100 per day for the 1st 90 days.
[AGENT][NEUTRAL] And then $100 per day thereafter, um, after the 1st 90 days it's gonna look into what other benefits can be used. Um, if this is the only benefit, then it'll be still $100 per day.
[AGENT][NEUTRAL] Um, if it's outpatient.
[CUSTOMER][NEUTRAL] OK, you
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] If it's outpatient surgery or in an ambulatory surgery center, um, it would be up to $200 per day that a surgery is performed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, on the, uh,
[CUSTOMER][NEUTRAL] On the outpatient, um, I don't know if like uh an endoscopic test would be considered.
[CUSTOMER][NEUTRAL] Part of that on an outpatient basis.
[AGENT][NEUTRAL] Are you being admitted or would you be going home the same day?
[CUSTOMER][NEUTRAL] Uh, uh, outpatient, uh, going home on the same day.
[CUSTOMER][NEUTRAL] You said something about $200 a day, but um so I don't know.
[CUSTOMER][NEUTRAL] That it is a hospital confinement, but it's, you know, in and out.
[AGENT][NEUTRAL] Well, so confinement and outpatient don't go together. Confinement is in in hospitals once you're admitted.
[CUSTOMER][NEUTRAL] Well yeah and I thought that that's what I understood, but right now you said something about outpatient surgery um that pays out 200 a day. Did I misunderstand that?
[AGENT][NEUTRAL] No, no, you, you're right, you just mentioned confinement. I didn't want you to get the two confused, but yes, outpatient is 200 per surgery or per day, the surgery is performed.
[CUSTOMER][NEUTRAL] Oh, OK, got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I guess I'll have to.
[AGENT][NEUTRAL] So really it depends on the the coding. Is it a procedure, they're counting it as diagnostic testing, we would be able to decipher all that once we get the billing.
[CUSTOMER][NEUTRAL] OK, OK, and um how, how far back does this go? because I know I've had several outside testings done in that fashion and I never really placed a claim on it um can this be retroactive?
[AGENT][NEUTRAL] Mhm. So there's no timely filing limit. So you can file a claim at any time as long as the policy was active on your data service. So this policy has been active since [PII], so [PII]. So you really could go back until [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, as long as I have my procedure codes and my documentation from the place of service.
[AGENT][NEUTRAL] Say that one more time.
[CUSTOMER][NEUTRAL] I would need um documentation or billing statement from the place of service and that in itself would require like the date of service and the procedure codes and the amount charged.
[AGENT][NEUTRAL] So you'll need, um, because this
[AGENT][NEUTRAL] You have your major insurance, right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it would be the explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] The itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, if it's at a hospital, any anything that you're filing for, if it's done in a hospital, they may
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, call it a UBO4 like umbrella, Bravo, and then 04.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is something in office, um, they may call it an itemized bill, but it's the same document, the UB just is hospital charges.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and just make sure it has the diagnosis codes, the procedure codes, and then all the charges on there.
[CUSTOMER][NEUTRAL] OK. Charges, procedure code, and uh diagnosis diagnosis.
[AGENT][NEUTRAL] Uh, diagnosis codes, procedure codes, charges, and then the um cancer claim form.
[CUSTOMER][POSITIVE] OK, you've been very helpful. Um, I, I know I'm taking your time and asking all these questions, but is there some.
[AGENT][NEUTRAL] Well, that's what I'm here for.
[CUSTOMER][POSITIVE] Oh, I appreciate you. Is it?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I is there like a website where I can go and get all this info?
[AGENT][NEUTRAL] Where you can get like the breakdown of your benefits?
[CUSTOMER][POSITIVE] Yeah, right, can yes, definitely.
[AGENT][NEUTRAL] Well, no, not on our website, but I can email this to you.
[CUSTOMER][POSITIVE] Oh please, that'd be awesome. Yeah, email it please. Uh that would be [PII].
[AGENT][NEUTRAL] Or mail it, OK.
[AGENT][NEUTRAL] [PII]. OK, so I'll send, I'm, I'm getting it together now, and I will send you your um policy certificate and then it'll have it all your policy documents. So it lists all, everything will cover the amount and then there's like a pages, a few pages for definitions if you need to look up what anything in the schedule is saying, um.
[CUSTOMER][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And hold on one second, let me copy your email address.
[AGENT][NEUTRAL] All right, so I just sent that over to you. And did you have any other questions or anything else I can assist you with?
[CUSTOMER][NEUTRAL] Um, [PII], what department are you in?
[AGENT][NEUTRAL] I'm on the care team, um, kind of like customer experience, customer service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK great I'm checking my email right now to make sure I received it because this is a very good.
[AGENT][NEUTRAL] So on the
[CUSTOMER][POSITIVE] Formative conversation for me.
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEGATIVE] I haven't received it as yet.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, let me know if you received. It may go to your spam and it's going to come, it'll say care team.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] I know you're working on it. I can hear those fingers moving.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You are one fast typer.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] My daughter, when she's pretending to be taking calls, she gets over here and just click click like, I'm like, what are you doing? Well, that's what mommy does.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Exactly, exactly, um, I have a [PII] granddaughter and, and she watches her mommy do the same, right? And I'll like, I'll walk in and I'm like, what? You're gonna burn that thing up. You're just making those fingers go so fast, it's just like mommy and I love it. I just love it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Certificate, yeah.
[CUSTOMER][NEUTRAL] Just wanna make sure you get that [PII] sometimes I forget to put that A in there.
[AGENT][NEUTRAL] Let me double check.
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Sometimes, um, like when I, when we send stuff, sometimes the caller says it goes to their spam, so I don't know.
[CUSTOMER][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] not there. You say pretty good about getting so.
[AGENT][NEUTRAL] Hold on, let me resend it.
[AGENT][NEUTRAL] Oh, it says it just sent at [PII], so it it may not have been there when you were checking.
[CUSTOMER][NEUTRAL] True, um, I just got into my inbox and I could see it that it's something's loading, so that's probably it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, got it.
[AGENT][POSITIVE] You got it. Alrighty. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, thank you so much [PII] you're terrific.
[AGENT][POSITIVE] Thank you and thanks for calling APL. If you need anything, just let us know, and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.