AccountId: 011433970860
ContactId: 6e1e984e-d887-42a1-a328-bd5224df8a09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 676700 ms
Total Talk Time (AGENT): 246167 ms
Total Talk Time (CUSTOMER): 300984 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/6e1e984e-d887-42a1-a328-bd5224df8a09_20250219T21:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling Ali [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, I have an an old cancer policy and.
[CUSTOMER][NEUTRAL] And I have a first my first question is.
[CUSTOMER][NEUTRAL] That it it has for example $10,000 a year chemo and radiation per calendar year payment. My question is, if a person's own or has any other insurance, Medicare or whatever that that pays first.
[CUSTOMER][NEUTRAL] Does this pay in addition or does this pay after other insurance is paid?
[AGENT][NEUTRAL] OK, let me go and pull up your policy and I will have to look at the very risks to be able to determine that. Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Your policy number?
[CUSTOMER][NEUTRAL] 01643852. I, I called earlier at one time the number was different and I called 2 or 3 months ago.
[CUSTOMER][NEUTRAL] To ask a couple of questions and they're gonna send me because I didn't have I don't have a copy of the policy they're gonna send me a copy.
[CUSTOMER][NEUTRAL] And they're gonna send me 2 or 3 forms because I was in the hospital several times and I was in intensive care. They're gonna send me a couple of forms for that.
[CUSTOMER][NEGATIVE] And nothing ever came, uh, I mean, nothing ever came so.
[AGENT][NEUTRAL] OK, can I
[AGENT][NEUTRAL] Can I get your name, date of birth?
[CUSTOMER][NEUTRAL] My name is Doctor, yeah, it's uh [PII] and it's [PII] [PII] or [PII].
[AGENT][NEUTRAL] OK, because the policy number you gave me, it doesn't bring that up. Can you repeat the policy number again?
[CUSTOMER][NEUTRAL] Is 01643852.
[AGENT][NEUTRAL] Yeah, that's coming up with somebody else. Hold on one second.
[AGENT][NEUTRAL] Um, so, um, can you spell your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And can you spell the first name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] First name is [PII]
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The original, the original number was A.
[CUSTOMER][NEUTRAL] 0105825
[AGENT][NEUTRAL] Yeah, well, let me, um, I can't pull it up with that. Um, hold on one second.
[CUSTOMER][NEUTRAL] This policy
[CUSTOMER][NEUTRAL] Yeah, this policy was issued. I do have that information [PII].
[AGENT][NEUTRAL] And what state do you live in?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What's your social? Excuse me.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The first time I called the person said, yeah, that's a really old policy.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so, can you verify your address?
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][NEUTRAL] Yes it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have an email address you want to put on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] At Yahoo
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Mr. No, thank you for that. So the policy number is 643852.
[CUSTOMER][NEUTRAL] Yeah, well, the one I'm, yeah, the, the one page I have has a 0 in front of it, but.
[CUSTOMER][NEUTRAL] It actually is 01643852 but.
[AGENT][NEUTRAL] Yeah, it's, it's without the one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So you want to know um if this policy pays for chemo after um your primary insurance?
[CUSTOMER][NEUTRAL] Well, yeah, well, for example, uh, now that the person's on Medicare.
[CUSTOMER][NEUTRAL] You know, Medicare just pays the hospital just hospitals just bill that immediately if that's your primary.
[CUSTOMER][NEUTRAL] And then they bill your secondary so my, my question is I, I just, uh, I only carry this because there was a good chance in my family of cancer. My, my question is does it with Medicare paying and with United Health or whatever paying.
[CUSTOMER][NEGATIVE] Does this only pick up what you have left? It's not gonna pay you $10,000 in addition for chemo and radiation, even though it was somebody else haven't paid before is, is my question that.
[CUSTOMER][NEUTRAL] It's logical that
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see, um, cause some of our policies pay pay bill charges and some of our policies go by actual charges. So if it's an actual charge um policy, then we pay um based off the EOB. If it's uh pay by bills, then we will pay bill charges. Um, so let me see which one yours is and then I can kind of.
[AGENT][NEUTRAL] Um, answer the question. So give me one second.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] So it would be um an actual charge um policy.
[AGENT][NEUTRAL] Excuse me. So we would go based off of, of the EOB, the extra charges from the EOB.
[AGENT][NEUTRAL] For, uh, when it comes to chemo and radiation.
[CUSTOMER][NEUTRAL] Actual one.
[CUSTOMER][NEUTRAL] I don't really understand what that means. I'm sorry.
[AGENT][NEUTRAL] So, um,
[AGENT][NEUTRAL] Meaning that we would go based off of the EOB when it, only when it comes to chemo or radiation.
[CUSTOMER][NEUTRAL] Well, what is ELB?
[AGENT][NEUTRAL] The explanation of benefits from your insurance, whether it be Medicare or UnitedHealthcare, or where, um, whichever, um, prime in whichever insurance that you have.
[CUSTOMER][NEUTRAL] OK, but my, my, my question is.
[CUSTOMER][NEUTRAL] for example, this has a first occurrence and diag you know, diagnosis benefit of 5000.
[CUSTOMER][NEUTRAL] OK, the, it's understandable policy is gonna pay that 5000 to you the first time it happens.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, OK, my, my question is, and I'm sorry to repeat it, is, is this gonna pay what's left of a bill after Medicare and whatever pays?
[CUSTOMER][NEUTRAL] Or is it like the first.
[AGENT][NEUTRAL] So when it comes to
[AGENT][NEUTRAL] So, when it comes to chemo and radiation.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The only way that we will pay is if.
[AGENT][NEUTRAL] Just say if you go get chemo radiation done and the claim is sent to your, your regular insurance, um, when that regular insurance process their claim and generate an explanation of benefits that shows what the charges were, um, just say if you have any out of pocket or anything like that, then that would be what we go. So if there's an amount in the section where you have like an out of pocket or something like that, that would be what we'll pay.
[AGENT][NEUTRAL] Um, but as far as like any other services like surgery or um like you have.
[AGENT][NEUTRAL] Um, trying to think, if you have like surgery done.
[AGENT][NEUTRAL] We don't go based off of that EOB from your prime insurance. It's only for chemo and radiation.
[CUSTOMER][NEUTRAL] OK, I'm gonna, sorry, as long as I've got you, I waited so long for information on this. I, I, I'm gonna say it again. Let's just assume they bill you they that you're in the hospital and you get a bill for you don't get a bill. They, they, the hospital bills and they bill Medicare, let's say $10,000.
[CUSTOMER][NEUTRAL] And Medicare.
[CUSTOMER][NEUTRAL] Pays
[CUSTOMER][NEUTRAL] And then our United Health, which is my secondary, they pay and they, they pay the, let's just say they pay the whole bill.
[CUSTOMER][NEGATIVE] That y'all aren't gonna pay anything then, is that correct?
[AGENT][NEUTRAL] That's correct, so that's what I'm saying. If they pay the whole bill and don't apply anything to your responsibility, then we won't, but I mean, it would be really hard to say.
[AGENT][NEUTRAL] Unless we see the EOBs from the insurance, um, for the, for that service.
[CUSTOMER][NEUTRAL] OK, I guess that's where I'm, I'm following through my understanding, tell me again what EOB stands for.
[AGENT][NEUTRAL] It's called an explanation of benefits. That's what the, the insurance is when they process their claims, they generate that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Explanation of benefits and they normally send a copy to the member, um, and they normally send it to like the provider um but that's what that stands for.
[CUSTOMER][NEUTRAL] OK, so I guess like if a person gets Medicare and it shows OK, we paid this and this, but you may be charged this.
[CUSTOMER][NEUTRAL] Uh, then that was chemo or or radiation and it says, OK, you may be charged, so let's just say $1000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Then y'all might pay that $1000 correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][POSITIVE] OK this uh this has uh uh intensive care writer and I happen to be.
[CUSTOMER][NEUTRAL] In intensive care a couple of times but I never got the forms to file. Could you send me those?
[CUSTOMER][NEGATIVE] That they promised they would send them but they didn't.
[AGENT][NEUTRAL] Yes, I can send them or if you wanna send them the uh let me see uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes because we, there's a note in here where they um they sent them out, but I can go ahead and put a request in for um the intensive care forms to be sent out or if I mean if you um haven't received them within a couple of days, um you can just send in your um itemized bills, um.
[CUSTOMER][NEUTRAL] Yeah, well this was several months.
[CUSTOMER][NEGATIVE] Yeah, this, I don't know what you have for notes, but it had to be a couple of months or more they're gonna send me a copy of the policy which I don't have and they're gonna send a couple of those forms and I didn't get either one.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, this is from um October because I'm seeing the note in here with the rep um requested information, but like I'll go ahead and put in another request, um, like I said if you don't receive them in a couple of days, you can just send your itemized bills um and that's what we will need to um go ahead and um process the claim, get the claim started.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] OK I understand thank you I appreciate it.
[AGENT][POSITIVE] No problem, Mr. [PII]. Was there anything else that I can help you with today?
[CUSTOMER][POSITIVE] That's all thank you.
[AGENT][POSITIVE] No problem, thanks for calling April. You have a wonderful day.
[CUSTOMER][NEUTRAL] OK