AccountId: 011433970860
ContactId: 8344b6c4-d660-4134-88bc-c6ae689fca7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408920 ms
Total Talk Time (AGENT): 233423 ms
Total Talk Time (CUSTOMER): 167620 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/8344b6c4-d660-4134-88bc-c6ae689fca7d_20250314T21:49_UTC.wav
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[CUSTOMER][NEUTRAL] Do do do do you do.
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hey how you doing? It's Friday.
[AGENT][POSITIVE] Good, how are you? Oh yes.
[CUSTOMER][NEUTRAL] Woohoo! I get happy on Friday, sad on Monday, happy on Friday.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] But um do you know anything about cancer policies?
[AGENT][NEUTRAL] Yeah, what's up?
[CUSTOMER][NEUTRAL] Oh, cool. Um, I have this insured on the phone. She's trying to file a claim for her husband, uh, who was diagnosed with leukemia and, um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Melanoma and uh she's trying to, OK, it's an old C 200 policy. I have never heard this policy before, but it's old, it's dirt because he was issued in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh yeah, I saw one issued in [PII] today.
[CUSTOMER][NEUTRAL] Oh wow. Yeah, I feel old now because I was like, I was only [PII] when he did have this policy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh goodness, OK, do you, what's that policy number?
[CUSTOMER][NEUTRAL] 131446.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the thing is she's trying to get his home healthcare, um, billing, but she is saying they won't give it to her, that we will have to request it. But I was telling her I didn't see anything in the benefits as far as home health being covered, so, but I didn't.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But she said it also, he was receiving wound care treatment. I wonder if that will fall under the outpatient benefit or should they, should she, should we try to contact them? Maybe she's uh submit a HIPA authorization form, but.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, let's see, so.
[AGENT][NEUTRAL] Let me pull up.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Oh man.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's dedication to keep some policies for this long, to be quite honest.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] If I had policy through APL, I wouldn't even, I don't even think about it.
[AGENT][NEUTRAL] And a lot of them, yeah, I know, right? A lot of times these older ones, which is crazy, don't even pay nearly as well as the newer ones are for as much. So the fact that they've just kept these for so long that, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, there's some of these policies that are pretty old to where they paid a lot, like they were unlimited. I was like,
[AGENT][POSITIVE] Mhm. Yes, and it's like pretty much as long as you're receiving treatment, you're gonna get paid.
[CUSTOMER][NEUTRAL] That's why y'all don't.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. So outpatient is gonna be for like surgery and therapy, like chemo and stuff. Um, and then there's lodging, let's see.
[CUSTOMER][NEUTRAL] And I know I see the miscellaneous, but there's nothing as far as home health and I didn't know.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] that will fall on our outpatient, but it has a list of what is covered treatment.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Right. So there's outpatient, like I said, chemo, radiation surgery, and then there's like ambulance, and then there's transportation if they travel more than 50 miles one way, there's lodging, and then there's um like specified disease. And then there's a daily benefit like if they're confined to a hospital as well as the possibility of ICU if they have that.
[AGENT][NEGATIVE] Um, but there isn't anything for home health. Now there is something in their policy called an unspecified loss where if what they've submitted is not covered, but we've paid something else, we basically pay 10%.
[AGENT][NEUTRAL] Um, so it the it says we will pay in addition to all other benefits 10% of the total amount payable. So let's say they submitted something for um chemo or radiation or whatever and we paid whatever that amount is $1000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's the total claim amount we would pay 10% of that $1000 so that would be what $100 so we would pay a total of $1100 because that essentially is to try and cover anything else that's not listed in the policy, so yeah, but they don't have home help so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And I didn't think, I mean, why submit, try to have a headache trying to get something that's not gonna be covered.
[AGENT][NEGATIVE] Right, yeah, and, and it's not, um, they don't like I said it this one doesn't cover nearly as much. It looks like we've received a few things that are not covered in the past, um, but we haven't gotten anything from them since [PII], so it's been a minute but um, yeah, we don't, they don't have home help.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What's the.
[AGENT][NEUTRAL] And now if he was confined to a hospital and it wasn't home health, he was there because he needed to be there for whatever reason that would be different, but home health is not listed as a covered benefit.
[CUSTOMER][NEUTRAL] Yeah, and I did explain that to her. She's like, well, I spoke with someone, and they told me to sending everything in relation to the cancer. I was like, I understand that you wanna try to get a max benefit, but if it's not covered, why go through the headache of trying to get information, but um,
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] Yeah, especially if they're not willing to just give it to you, you know, like.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I think so.
[AGENT][NEUTRAL] Yeah, it does. It really does. Um, like I said, these, these older ones just don't cover nearly as much. I mean, even.
[AGENT][NEUTRAL] It's mostly confinement and treatment and travel for this particular policy. It's really not a lot and lodging lodgings included in that. There's really not a lot of anything else.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's very limited.
[AGENT][NEUTRAL] It is very much so.
[CUSTOMER][NEGATIVE] I'm being nosy and see how much they pay. Goodness, 203 $201 every quarter. Oh, for something that doesn't pay a lot, that's not good.
[AGENT][NEUTRAL] I know that seems, I know, right, like they could probably have a newer one that's like a GC 14 or something that's gonna cover a whole plethora of things and not be paying that much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But who knows?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah. All right, well, I appreciate it. I'm gonna try to explain it to her, um.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, well, I'm here until [PII] so if for whatever reason they're just still not understanding just call right back and I'll be here. I think I'm the last one over here in the claims support queue anyway so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh, well, all right, well, I appreciate you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] And you have a good one.
[AGENT][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Alright, bye.