AccountId: 011433970860
ContactId: 6a504169-b911-4026-80fc-8768781ba035
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 907619 ms
Total Talk Time (AGENT): 267793 ms
Total Talk Time (CUSTOMER): 214170 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/6a504169-b911-4026-80fc-8768781ba035_20250225T17:20_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] Yes. Uh, my name is [PII].
[CUSTOMER][NEUTRAL] And my policy, you need my policy number before explaining what.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, 00486564.
[AGENT][POSITIVE] Thank you. May I have a good contact number just in case we disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And I have your policy here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII]. Uh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][NEUTRAL] OK, I had filed, uh, I have the.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] The annual 10,000 chemo benefit. Then I have the additional 10,000 chemo.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Rider.
[CUSTOMER][NEUTRAL] OK, I have.
[CUSTOMER][NEUTRAL] Gotten uh the one for last year and I've submitted one in January.
[CUSTOMER][NEUTRAL] And I did the
[CUSTOMER][NEUTRAL] 7,90437 on the additional, the writer, and then the 10,000. And then on the back of it, it said I had met my
[CUSTOMER][NEUTRAL] Benefits for this period, but I'm showing it's still what? 2000 and something when I send this other one in.
[AGENT][NEUTRAL] Whoa, whoa, wait, wait a second, hold on one second. I see the 10,000.
[AGENT][NEUTRAL] There this is between two different claims or this is the same claim because I see two we.
[CUSTOMER][NEUTRAL] It's on the same. No, it's, it's on the, the total claim was 17,000.
[AGENT][NEUTRAL] It's the same.
[CUSTOMER][NEUTRAL] 904.
[AGENT][POSITIVE] OK, this is it in 37 cents. OK, yes, I'm in the right place.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so to in this period, I would still need 2000 whatever when I I'm ready to send in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The other 17,000, but I know all out of it will be the 2000 something. But on the back of this, it said I had met the maximum for this period.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I will have when I get the 2000 and whatever.
[AGENT][NEUTRAL] PE.
[AGENT][NEUTRAL] The maximum benefit payable for chemotherapy.
[AGENT][NEUTRAL] I submit for this benefit period. OK, hold on one second.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hi Ms. [PII], do you mind if I place you on just a brief hold? I'm just looking at the policy and the claim, um, for the benefits. OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] I know that's not the certificate.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the wait. I I think I may have confused myself. So I just have a question. Did you say that the um the total for the chemotherapy was 20,000 to 10,000 for the policy, and then 10 additional?
[CUSTOMER][NEUTRAL] That's my policy.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] I have the 10,000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the annual chemo, OK. And then I have the writer.
[AGENT][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] 14,000.
[AGENT][NEUTRAL] OK, that's what it is. So that code that you see at the back that's saying that the max is met, that's on the $10,000 for the chemo just for the policy. You do still have more for the rider, but that's just saying your chemo benefit for your actual policy has been paid in full because that one was $10,000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 00, OK.
[CUSTOMER][NEUTRAL] OK, so when I submit this order, I know it'll just be 2000 whatever.
[AGENT][NEUTRAL] The 2.
[CUSTOMER][NEUTRAL] Mm, OK. Uh.
[CUSTOMER][NEUTRAL] Let me ask you this. I have not looked, I haven't felt like looking through my policy, but anyway, they started me on Zometa yesterday, which is a bone builder because mine is in the bone. It
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Does this pay in an additional part of the policy? I don't know that I, I haven't looked.
[AGENT][NEUTRAL] Oh, no, you're fine. You just want to know if the medication is gonna be covered?
[CUSTOMER][NEUTRAL] Would that be
[CUSTOMER][NEUTRAL] Yeah, if this medication will be covered under, I mean.
[CUSTOMER][NEUTRAL] In addition to this,
[AGENT][NEUTRAL] To the king, OK. So what I'm showing from what I see, the policy outside of the riders, the policy.
[CUSTOMER][NEUTRAL] That I have.
[AGENT][NEUTRAL] will only pay the chemotherapy and then there's a daily hospital like benefit if you're in the hospital, but in terms of like the actual medication, it wouldn't cover, um, it wouldn't cover it.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, and then is there, there's a mileage thing, uh.
[CUSTOMER][NEUTRAL] Would that cover the times I go to the doctor and
[AGENT][NEUTRAL] So for mileage, it has to be um 50 miles, a minimum of 50 miles round trip.
[CUSTOMER][NEUTRAL] OK, 50 miles round trip.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me make sure I'm saying that right. Hold on one moment. Let me pull up all the benefits.
[AGENT][NEUTRAL] Oops, hold on one moment.
[AGENT][POSITIVE] Sorry, we have to go through um page by page, so I do apologize.
[CUSTOMER][NEUTRAL] Oh, that's fine, that's fine.
[AGENT][NEUTRAL] Yeah, that's the daily hospital benefit.
[AGENT][NEUTRAL] There goes here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See if there's a way I can search it.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Expectation.
[AGENT][NEUTRAL] OK, I think I'm getting closer. Hold on one second. No, these are the different types.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There goes the rider.
[AGENT][NEUTRAL] I don't see anything for transportation. I just see the cancer and the radiation and chemo and additional chemo. Hold on, I'm gonna keep going though. I'm I'm only on page 21. It's 29 altogether.
[CUSTOMER][POSITIVE] Oh gosh, I'm putting you to a lot of work.
[AGENT][NEUTRAL] That's what I'm here for.
[AGENT][NEGATIVE] OK, 22, this is just not free to sign.
[AGENT][NEUTRAL] Are you sure your policy has transportation?
[CUSTOMER][NEUTRAL] I thought in the past, I thought.
[CUSTOMER][NEUTRAL] Something.
[AGENT][NEUTRAL] I can check again. I just didn't see anything.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I remember the 50 miles.
[AGENT][NEUTRAL] OK, cause that's definitely transportation. Let me see.
[AGENT][NEUTRAL] Coverage. I'm trying to see. I, I found the table of contents. I'm trying to see if I can match the the pages on there to the pages that we have so I can try to get to the right place.
[AGENT][NEUTRAL] Because I don't see.
[AGENT][NEUTRAL] Surgical anesthesia.
[AGENT][NEUTRAL] I see everything except transportation and lounge.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Oh ambulance. OK, here we go. Ambulance transportation. OK, so.
[AGENT][NEUTRAL] I got to read it so I make sure I can explain it right. That I have received it.
[AGENT][NEUTRAL] OK, yeah, it's 50 miles, it's at least 50 miles both both ways from there and from there back home, it has to be 50 miles.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not, OK. Uh, now, would that be like if I went, uh,
[CUSTOMER][NEUTRAL] For doctor visits.
[AGENT][NEUTRAL] If you have treatment at the doctor's, so it's, um, let me see if it specifies.
[CUSTOMER][POSITIVE] And labs
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] to receive treatment and so this is for only, OK, so only to receive treatment in a hospital that is at least 50 miles away using the most direct route. So this will only be for hospital treatments in the hospital.
[CUSTOMER][POSITIVE] Oh, OK, OK. That's what I needed to know, and you have helped me, so I appreciate it.
[AGENT][POSITIVE] Well, you're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's all. I appreciate it.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling [PII]. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye