AccountId: 011433970860
ContactId: 8740316f-3a73-4bbb-8b74-6128a1bf658b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 516597 ms
Total Talk Time (AGENT): 309625 ms
Total Talk Time (CUSTOMER): 174633 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/8740316f-3a73-4bbb-8b74-6128a1bf658b_20250408T16:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEUTRAL] Doing all right thank you so I've got a member on the line um and we're just kind of needing some clarification regarding uh coverage on a cancer policy. Would you be able to help me with that?
[AGENT][POSITIVE] Yeah, I should be able to help.
[CUSTOMER][NEUTRAL] OK, um, so I can give you that policy number whenever you're ready.
[AGENT][NEUTRAL] OK, yeah, go ahead.
[CUSTOMER][NEUTRAL] So it is 711643.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So I feel like I should know this, and I'm kind of surprised I've not been asked this before, um, but she said that she's, uh, just finished up, um, radiation and now she's currently on, um, some medication that's chemo, like for chemo. Um, she gave me a name and anastrozole, I don't know. Um, but essentially I looked it up and it is
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Anastrozole?
[CUSTOMER][NEUTRAL] Yeah, that's it thank you. um, so yeah, and hormone based chemo and so she was asking if that would fall under the bucket for her chemo benefits and I looked in the policy and of course I see a lot of words that I don't quite understand, um, and I see the drugs, but I don't know if that would fall under prescription benefits.
[AGENT][POSITIVE] You're welcome
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Or if that would be considered chemo.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Creation, no.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Let me pull up her policy.
[AGENT][NEUTRAL] To see what she has exactly.
[AGENT][NEUTRAL] OK, so her benefits.
[AGENT][NEUTRAL] hospital.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see, OK, so you see on if you're looking at the policy it is page 24, it's number in the hormone therapy benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'm not there. I was looking under the chemotherapy. OK, hang on.
[AGENT][NEUTRAL] Mhm. So there is radiation, chemo, and immunotherapy, which is actual charges up to $20,000 per 12 month period. And then there's a hormone therapy benefit, which is $50 per treatment up to $12 per calendar year, which is typically a monthly basis because it's, it is usually a prescription.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so you know they get it filled either every 30 days or they'll get a 90 day supply, um, we still pay it.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] As 3 months when it's a 90 day supply, um, typically because we have the prescription that shows it's a 90 day supply, um, but let me pull up something really quick to make sure that the anastrozole falls under. I'm pretty sure it is hormone, but I wanted to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She, she has a second medication as well, um, but I, I, I just saw that one versinial, I think, Visinial.
[AGENT][NEUTRAL] Presidio, yeah.
[AGENT][NEUTRAL] OK, so I believe I remember seeing this.
[AGENT][NEUTRAL] Recently.
[AGENT][NEUTRAL] It's, it's like the same types of drugs.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] If this will pull up.
[AGENT][NEUTRAL] I'm pretty certain that the anastrozole is hormone which would just be the $50 but I wanna check, double check the other one as well. Come on, I'm just being so slow.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so.
[AGENT][NEUTRAL] Yeah, so anestrozole is hormone and then.
[AGENT][NEUTRAL] What was the other one?
[AGENT][NEUTRAL] D E
[CUSTOMER][NEUTRAL] That's, oh.
[AGENT][NEUTRAL] DR maybe.
[CUSTOMER][NEUTRAL] Virsennial
[AGENT][NEUTRAL] Berzinio like B E R Z E N O.
[CUSTOMER][NEUTRAL] I sounded it out. I'm just being completely honest. I don't know.
[AGENT][NEUTRAL] OK, if that is, that is chemo, so that one would fall up under her chemo benefit and then the anastrozole would fall up under her hormone benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And those are those can be paid at the same time.
[CUSTOMER][POSITIVE] Interesting. OK.
[CUSTOMER][NEUTRAL] Interesting. So the Vissenial would go under the 20,000 for 12 months. OK. And regardless of whether or not they're both prescription drugs.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. If it is that Virginio, yes.
[AGENT][NEUTRAL] Correct. Yeah. Because it is, it, it's based off of what type of medication it is, not necessarily.
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] You know, cause a lot of chemo is received through IV or through a report, um, but when they are maybe not needing super strong doses or something like that, they can take medication for it. There's also radiation pills that some people can take, which is really unusual and you don't see it a lot.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] But there are pills for all of that that they can take. So for all of it can be done through IV all of it can be done in some form or fashion through uh prescription medication as well. So it depends on what the doctor has planned.
[CUSTOMER][POSITIVE] Interesting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I really appreciate you pointing that out, um, and going forward, um, is this all kind of depending on the policy whether or not the prescription drugs, or is it again like what you said where it depends on like what it does, so like a hormone therapy or chemo immunotherapy, what it is that just kind of like by default prescription would be covered?
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yes, so it depends it's highly dependent on what type of drug it is, on whether it's covered or not because the examiners have a spreadsheet out there of approved chemo, immuno, and hormone therapies, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um and so they reference that when it comes to, OK, I have this type of drug being billed whether it's a pill, whether it's IV whatever on how they are able to.
[AGENT][NEUTRAL] Determine what benefit it should go up under as far as the drugs and medicine benefit.
[CUSTOMER][POSITIVE] OK. So for good measure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's typically gonna be like anti-nausea and stuff when they're receiving the chemo.
[CUSTOMER][NEUTRAL] Right, OK, that is very good to know. So just for good measure if they wanted to know in particular if they're just covered, I would still probably have to ask.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I mean the spreadsheets out there in SharePoint if you wanted to pull it up yeah so when you go under the information by product.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] Awesome, OK, cool.
[AGENT][NEUTRAL] Um, you would just click on cancer and then when you scroll down a little bit, let's see, it's, it's the chemo radiation immuno hormone and then like the 4th 1 down, it's an Excel spreadsheet it says approved drugs.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when you pull that up, that should give you um any like if they can spell it out for you or whatever they it should give you the type of drugs that have already been approved by the medical director as chemo immuno hormone top therapies that we can for sure pay if we receive anything new then we, we ask them before we move forward with payment, yeah.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You are the best [PII] thank you so much I really appreciate all the information like if there's one of those things I really appreciate the help, but you know if I don't have to call y'all, I'd rather not, so I do appreciate that teaching me so I will let her know all of this and I hope you have a great rest of your day. Thank you.
[AGENT][POSITIVE] No problem at all.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] No problem at all. No problem.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You too, no problem.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][NEUTRAL] Uh, hi.