AccountId: 011433970860
ContactId: 634c17a8-632a-4898-8ece-713a874a046c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 819559 ms
Total Talk Time (AGENT): 444646 ms
Total Talk Time (CUSTOMER): 273207 ms
Interruptions: 3
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/634c17a8-632a-4898-8ece-713a874a046c_20250116T20:20_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][POSITIVE] Hi, [PII]. Good afternoon. How are you doing?
[AGENT][POSITIVE] Hey, I'm doing wonderful thank you so much for asking how about yourself today?
[CUSTOMER][NEUTRAL] I'm good. My name is [PII], and I have a plan with you and uh I sent some information back, uh, may have been August, September of everything that I had. I just sent everything and then I just got back. They only paid for transportation benefits, however, or something about that um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The claim, I guess was it for that year or whatever. However, what do I do? because post that I still had radiation, I've had surgery, uh, breast removed, um.
[CUSTOMER][NEUTRAL] Physical therapy, um, back and forth out there, like, what do I send in now? I take chemo medicine now, I take an estrogen blocker now. So what, what do I do for, for now? I, I don't know what else to do. And somebody asked me, have you sent in your information? And I'm like, I thought that was it. So I don't know, that's why I'm calling to ask you.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, yeah, I could definitely take a look at that with you, Ms. [PII]. Do you happen to know your policy number?
[CUSTOMER][NEUTRAL] Uh-huh, it's 007.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] 643
[AGENT][POSITIVE] Perfect. And while I'm pulling up that policy, Miss [PII], do you mind if I also grab a quick call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh-huh, yes, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. And would you be able to verify just uh some information with me real quick?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, would you be able to verify for me, Ms. [PII], your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. And if you could verify with me your mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. And then it looks like uh just the email as well.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Thank you so much, and I see the phone number on file is the same one you just gave me.
[AGENT][NEUTRAL] And yes, I am seeing all of that information.
[AGENT][NEUTRAL] Um, we got from you in
[AGENT][NEUTRAL] Let's see, it looks like in September and let me take a look at that further.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] You said right now you are.
[AGENT][NEUTRAL] receiving radiation and you're wondering about what information we need.
[CUSTOMER][NEUTRAL] I've, I've received radiation. I finished, yeah, I received radiation December, I finished radiation [PII], so I had 30 rounds of that. Like I said, even back in August, uh, I had the breast breast surgeon, so I stayed in the hospital, uh, I was in the hospital for 24 hours, um.
[AGENT][NEUTRAL] For those benefits.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What else? Uh, I've done physical therapy. I've been back and forth from multiple other appointments back and forth, so, and this is
[CUSTOMER][NEUTRAL] Even after August, so I don't know, do I send that stuff in to let you look at it or what all do I do? Um, I started chemo medicine and um
[CUSTOMER][NEUTRAL] When I start my medicine, it's been 34 months now since I started that.
[CUSTOMER][NEUTRAL] So like I said, I don't know what else to do.
[AGENT][NEUTRAL] So it looks like as far as your
[AGENT][NEUTRAL] OK, so as far as your chemo benefit, um, it looks like
[AGENT][NEUTRAL] It looks like it's for a 12 month period, so for [PII], it looks like the maximum benefit had been reached, but you do have some um benefits for
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like they're monthly, and indemnity amounts, um, monthly for anti-nausea or pain medication prescribed while receiving radiation therapy. So you could still be eligible for those, it looks like, um, and I might have to dig through some more of your claims because they're broken into, um, there's only so many line items that can fit them on, so it's broken into some different sections. But since September, since we received your last stuff, you might be eligible for October, November, December benefits there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I do see where your surgery was on here, um, but they do need, they do need an itemized surgery bill. You could have additional surgical benefits, um, that we just haven't been able to give you because we still need a copy of that surgery bill um back from August. And so you might try to see if you can get a hold of that, um, to make use of those additional benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. You said itemized surges?
[AGENT][NEUTRAL] Itemized surgical bill, you betcha.
[CUSTOMER][NEUTRAL] OK, I to my bill. OK, I'm writing this down.
[AGENT][NEUTRAL] And let me go on, I'm just on 2 out of 3,
[AGENT][NEUTRAL] So, this one.
[AGENT][NEUTRAL] It looks like.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then so that's been paid.
[AGENT][NEUTRAL] OK, that's the same one, the 828. OK, sorry, hang tight with me, my friend.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh no, I'm fine. I'm, I'm just asking what do I need to just try to turn in.
[AGENT][NEUTRAL] Yeah, no, I think as far as anything that's gone on since your last set of paperwork that you've turned in, I would highly encourage you to just send um everything you have and we can always request more if we need more, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so what months do I need to turn in for? Uh, would you tell me, uh, October, November, December?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, October, November, and actually September. I don't see anything on here. The last thing I see is from [PII]. So I see you turned this in early September. So if you've received anything in September for treatments, turn that into.
[CUSTOMER][NEUTRAL] OK, and then go back to the surge.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And, and then the itemized uh surgical bill for that.
[AGENT][NEUTRAL] Yes, from the [PII], um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it
[CUSTOMER][NEUTRAL] And so my chemo for the once a year chemo, since I take the, the medi medication chemo medicine, I take or does it have to be intravenously chemo?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That I actually get to get.
[CUSTOMER][NEUTRAL] Um, the benefits for.
[AGENT][NEUTRAL] So I think from my understanding, and I will double check this, but it looks like from what I'm seeing is that chemo benefit, it's a $12,000 benefit. It looks like you maxed out on the benefit went up to $20,000.
[AGENT][NEUTRAL] And in [PII], we, we hit that.
[CUSTOMER][NEUTRAL] OK, so it doesn't start over in [PII]?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And this one, I want to double check your policy. I'm not sure if the chemo benefit starts um 12 months from the date you first started taking it or if it starts the calendar year. So I would just like to double check before I mislead you there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but as far as, yeah, as far as what I was seeing missing that itemized surgical bill, um, to help provide benefits there, and then the other things that I see that um show denials are gonna be things that say like lab work's not covered or um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just sent everything. I didn't know what was what.
[AGENT][NEUTRAL] Office visit, yeah, exactly, as you should. I'd rather give you a denial code than have you miss out on a benefit because you didn't think it would fall, you know what I mean, like, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And what about transportation?
[AGENT][POSITIVE] I definitely recommend something at all.
[AGENT][NEUTRAL] OK, and then the
[CUSTOMER][NEUTRAL] As of as of September or is that a max on that as well?
[AGENT][NEUTRAL] So the transportation benefit and I'm actually, I'm gonna pull up that policy document um real quick so we can look at it. I want to make sure, again, I'm not giving you any wrong information, um, but they did separate that one. Let me pull it back up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like
[AGENT][NEUTRAL] We did have a lot of those transportation benefits pay. Um, there was only one was denied as a duplicate, which means we paid it on a different area, and then the other one,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then the transportation benefit actually it's limited to 12 round trips per calendar year, um, and it looks like for [PII], um, because it states calendar year that that's been met, but now that it's [PII], um, I believe that's going to reset for you for 12 trips. And so it looks like on that one, you just met the amount, um, at 12 trips.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I have that document pulled up and let me scan through it to double check that chemo benefit for you, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And then I just just for the sake of saying it, um, I just want to let you know any benefits I give you over the phone is always just a verification of coverage and never a guarantee of payment. I'm sure you've heard that from us before, but I just like to say it every time.
[CUSTOMER][NEUTRAL] OK, that's true.
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] Yeah, I didn't even think about and another lady that has um the the public um the American public life, and she was like, Have you turned in your stuff and I'm like turning my stuff. I say I've turned stuff in and that was it. And she said, no, you need to turn stuff in because some things are not maxed out, some things are, some things are covered and some she was like you need to call and just send the stuff in and and just if they don't can't use it, they won't pay you for it. They'll let you know this is, you know, so.
[CUSTOMER][NEUTRAL] I didn't even think about it anymore till she just mentioned it to me and I was like, oh, OK, I'll call today then.
[AGENT][POSITIVE] Yeah, no, that's smart, and she's so so true there, like, it's so much easier for us to have information we don't need and be able to take care of you completely than to
[AGENT][NEUTRAL] To not have stuff that you could have been paid out for, you know, because you're paying for this policy with, you know, that it's here for you to take benefit from when you need it. Um, and so I am looking at your policy documents. It does look like the chemotherapy 12 month period begins the first day you receive radiation therapy, chemotherapy, or immunotherapy. Um, and so it looks like it will reset on your one year mark of those therapies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what is my one year mark? I'm trying to think when I start, came on March. I think it was March I started chemo.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK, so then you'd be um.
[CUSTOMER][NEUTRAL] It'll start over in March again.
[AGENT][NEUTRAL] Perhaps, yes, and I um can look back as far as
[AGENT][NEUTRAL] I mean, I can look back really far, but I, I'll, I'd have to go through them individually, but if you know it was in March, then um that would be it, it would be, uh, you'd wanna go.
[AGENT][NEUTRAL] I believe to the day, so if it was [PII], it would be [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that'll be fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, is there any other information I can help you with, Ms. [PII]?
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] That's it, Ms. [PII]. I'm gonna um get all my stuff together and I'll start putting it together and send it in.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] And y'all can just go from there.
[AGENT][NEUTRAL] And then do you have a copy of your policy document that like goes over your benefits? Do you have anything like that on hand?
[CUSTOMER][POSITIVE] I, I really appreciate it.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Yes ma'am, they sent it to me and I download it as well, mhm.
[AGENT][POSITIVE] OK, perfect.
[AGENT][POSITIVE] Good I just wanted to make sure if you didn't have a copy that you had one, in case you had any questions or you want, I mean, I, I know it's um a lot to go through, but I always feel like people should be empowered to have information so.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] All righty, well, hey, thank you so much.
[CUSTOMER][POSITIVE] I do have and I really appreciate it. All right, thank you so much.
[AGENT][POSITIVE] Absolutely, Ms. [PII]. You take care and we'll talk to you soon. Bye-bye.
[CUSTOMER][NEUTRAL] Uh, uh-huh, bye-bye.
[CUSTOMER][NEUTRAL] All right, bye-bye.