AccountId: 011433970860
ContactId: 862765be-600a-4aca-b3b6-c792747843bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 577880 ms
Total Talk Time (AGENT): 232339 ms
Total Talk Time (CUSTOMER): 246285 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/862765be-600a-4aca-b3b6-c792747843bc_20250212T14:30_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, um, I have, we have um a cancer policy through y'all and I haven't submitted any claims in a while, and I wondered if someone could look back on our account and tell me like if what I can submit for now. I don't know what's maxed out or not.
[AGENT][NEUTRAL] You mean is this for your the wellness screening?
[CUSTOMER][NEUTRAL] That's something y'all can help me with?
[CUSTOMER][NEUTRAL] Uh, no, no, no, it's not. I have, my husband has cancer and so we've been filing things on it for a couple of years and I just, at one point, I thought last year they told me not to do anything else. I don't know if it was time to start again or no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's your name?
[CUSTOMER][NEUTRAL] Um, it's under [PII]. My name is [PII]. I have our number if that matters. Uh-huh.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, yeah, let me have that policy number.
[CUSTOMER][NEUTRAL] OK, let's see it is.
[CUSTOMER][NEUTRAL] 711407
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] I know there's a cap on certain things and we've done lots of testing and started about chemo and I just didn't know.
[CUSTOMER][NEUTRAL] I thought it wasn't January to January, it was some other month, but I don't know why I thought that.
[AGENT][NEUTRAL] Yeah, it's a calendar year so if it starts in January.
[CUSTOMER][NEUTRAL] Uh, even chemo?
[AGENT][NEUTRAL] Yeah, it starts, yeah, from, so it's from month to month, a 12 month.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] over here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. So when did he start his chemo?
[CUSTOMER][NEUTRAL] So like it's
[CUSTOMER][NEUTRAL] Um, he just started a new treatment today. So we, we, I mean, I'm not ready to do it yet. I just was thinking for some reason I thought it's chemo. They told me he went from like March to March or something based on when he started it. I don't know. I guess I didn't know what I was talking.
[AGENT][NEUTRAL] On today, OK.
[AGENT][NEUTRAL] That's yeah that's correct. It's not calendar year, it's, it's uh 12 month period, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I see what you're saying yes, treatment, OK, got you, and I just don't know when I, I can't keep up, so I didn't know if you could tell me when that we could do that again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can take a look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know if the, the benefit was maxed?
[CUSTOMER][NEUTRAL] Uh, yes, it was.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me 1 2nd to take a look, OK.
[CUSTOMER][NEUTRAL] I think we did a bunch more after Max and I I think I didn't ever send anything else in last year.
[AGENT][NEUTRAL] After that, OK.
[CUSTOMER][NEUTRAL] Do, do diagnostic things also show from.
[CUSTOMER][NEUTRAL] Date of service for a calendar year or is that?
[CUSTOMER][NEUTRAL] Is that how everything works there.
[AGENT][NEUTRAL] No, it just depends on the benefit and so that chemo radiation benefit is, is different.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] I'm sure there's a way I could look that up, but it was overwhelming me, so I just found an 800 number. So thank you for looking for me. I appreciate it.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] I know
[AGENT][NEUTRAL] You're welcome. Absolutely. So the radiation chemo immunotherapy benefit is up to 20,000 per 12 month period. So like you said, he started in March is from March to March or whatever month he starts.
[CUSTOMER][NEUTRAL] It was March. OK. I, I just didn't know when it when it was we started.
[AGENT][NEUTRAL] Well, I'm not saying that's when he started. I was just using your words, but I'll go in here and look.
[CUSTOMER][NEUTRAL] Oh, I got you. I see what you're, yeah, for example, yes, I got you. Yes, OK. OK. All right.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So there's uh [PII] chemo. OK, so we paid 20,000 on um it's he had it on [PII] and we received the claim and we pay the 20,000 on that claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that was in May, so for [PII] [PII].
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So we don't do that again until May.
[AGENT][NEUTRAL] Right, it was specifically [PII].
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] OK, I didn't know which, I mean, we've done so many chemos. I didn't know which one that it's paid for, so but thank you for that. And then, um, as far as like the CTs and bone scans and all that stuff, there's no sense in me like back dating. I haven't sent anything in since June or July, so do I go back for those dates of service and procedures or do I just start in January?
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] No, no, you can just go ahead and submit them just it whether you know if you don't believe they will be or won't be, I would submit them anyway just so we can take a look at them, um, so like for instance, let me see.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 222.
[AGENT][NEUTRAL] Like some benefits are per calendar year on the policy as well, you know, so it's kinda.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yeah, let's see.
[AGENT][NEUTRAL] OK, diagnostic and prevention benefit. Let me go there.
[AGENT][NEUTRAL] But I know that this benefit is one time per calendar year so like if um he's had certain tests let me get the list of the covered test.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I think he submitted in before looking at his history like a PSA.
[AGENT][NEUTRAL] That falls under that diagnostic testing benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, yeah, he, he has those done. I mean he has a test done like that every 3 or 4 weeks, we just, I just didn't know what to submit or not, so.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No we do.
[AGENT][NEUTRAL] And really under the let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Medical imaging. So for medical, there is a medical imaging benefit. It covers 300 per image up to a maximum of 2 per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, so I don't need, I mean, I just don't need to do backdate that. I could start in January, I think, because I know that we did more than 2 last year, I'm sure.
[AGENT][NEUTRAL] OK, let me check history for that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I do show that that benefit was max for 2024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll just start afresh with all other things and then I'll wait until middle of May, you said to do another chemo radiation immun. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, his chemo was [PII].
[CUSTOMER][NEUTRAL] OK, got you, OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Uh, I appreciate you. And so when I do send those in, I mean, I haven't done in a while, so I do dates of service with the procedure code or the what what all does do y'all need on there?
[AGENT][NEUTRAL] What I am going to do is send you a claim form because you'll need to have a cancer claim form completed.
[AGENT][NEUTRAL] And included with the itemized bills that you send us.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And on page one of the claim form.
[AGENT][NEUTRAL] Um, our specific instructions as to what documents are required dependent upon what type service is done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I love this page because it's real clear. If I were to receive it, I think it's clear to understand.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] OK, good, perhaps I will. I don't know.
[AGENT][NEUTRAL] You will, cause you know pretty much already. You don't think you do, but you do.
[CUSTOMER][NEUTRAL] Nothing is very clear to me anymore, but I think maybe so. Well, thank you so much.
[CUSTOMER][NEUTRAL] Yeah, maybe. I don't know. So you have my email, is that how you'll send it, or is that uh OK. OK. Good, thank you.
[AGENT][POSITIVE] Yeah, give me a second. I'm trying to pull that up. Let me see. There we go. You're welcome.
[CUSTOMER][POSITIVE] Nice to talk to nice people.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Do you know what the address is on file, the email address?
[CUSTOMER][NEUTRAL] Um, our email is probably [PII].
[AGENT][POSITIVE] Yes, I'm, I'm gonna send it to that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just sent that over.
[CUSTOMER][POSITIVE] Thank you so much for all your help.
[AGENT][POSITIVE] Oh, you're welcome. You're welcome. Any other questions for [PII] I can help out with today?
[CUSTOMER][POSITIVE] Mm, no, ma'am, thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Take care you too bye bye.
[CUSTOMER][NEUTRAL] Mm