AccountId: 011433970860
ContactId: 88d756d3-2913-457e-8c95-31ee81b1dd51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 797289 ms
Total Talk Time (AGENT): 408735 ms
Total Talk Time (CUSTOMER): 278570 ms
Interruptions: 13
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/88d756d3-2913-457e-8c95-31ee81b1dd51_20250311T17:09_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, my name is uh [PII], and my number is [PII].
[AGENT][NEUTRAL] May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] May I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Uh, [PII] email address [PII]. Address [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] How may I assist you, sir, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK, I just got the, they call me a while ago, my uh uncleansas urologist on the [PII] when I come in, they, they want me to do start taking like uh home what is it, I can't think of that stuff they want you to take for 2 years like.
[CUSTOMER][NEUTRAL] Hormone treatment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Something you say and it's just like $104 every time I come up there to take a shot.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How much is that y'all pay for?
[AGENT][NEUTRAL] You said it's hormone treatment?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] To keep my testosterone, so I won't.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Yeah. Let me check on that. Let me see what is the benefit for that. OK, one moment, let me pull your benefits.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] All right, and let me see.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. It looks like for hormone therapy, we cover $50 per treatment up to 12 treatments per year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so the other part I pay for.
[AGENT][NEUTRAL] The $50 is what we covered. Yes, the other part, you will be responsible. Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The $50 cover it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so how do I go about doing this?
[CUSTOMER][NEUTRAL] What do you need from me? I need for them.
[AGENT][NEUTRAL] Um, you will just.
[AGENT][NEUTRAL] We just need itemized meals.
[CUSTOMER][NEUTRAL] OK, so I pay out of pocket and y'all just pay me back the $50.
[AGENT][NEUTRAL] To you, correct, yes, you just send the itemized bill um for us to go ahead and send you that payment. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, how's the other one going to you, the one on the paperwork I sent to y'all, how's that going?
[CUSTOMER][NEUTRAL] So it's too long?
[AGENT][NEUTRAL] It looks like still under review right now.
[CUSTOMER][NEUTRAL] OK, because he said I gotta do this for the next 2 years. The pills are that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They said I got to take those for the next 2 years.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Oh OK. Yeah, this one covers up to 12 treatments each year. So it's $50 per treatment for 12 treatments each year. So basically uh um monthly treatment for the year and then it's per year, so next year you can continue the same benefits.
[CUSTOMER][NEUTRAL] have come.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So you just need to send it.
[CUSTOMER][NEUTRAL] Now when I pay for my radiation treatment, I got paid $2000.
[CUSTOMER][NEUTRAL] And my other insurance to pay the rest of it. So when I get the $2000 back that I pay them.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Y'all need the billing statement from that on too.
[AGENT][NEUTRAL] You said the radiation treatment?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, for the radiation is different. And do you have a benefit amount for radiation, chemotherapy, or a mantherapy and that one is 20,000 per year.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's a yearly benefit.
[CUSTOMER][NEUTRAL] So get well that
[CUSTOMER][NEUTRAL] So once I pay them the 2, it says y'all.
[CUSTOMER][NEUTRAL] The uh the statement on.
[AGENT][NEUTRAL] Yeah, whenever you receive a treatment, yes, you'll go ahead and send it to us and we'll go ahead and process until um you receive all 20,000 for that year period. And then it will start all over again in the next 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK then.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You know how long it takes for all that to go through once you receive it for me.
[AGENT][NEUTRAL] It really depends. Uh, usually the first time that you're sending in a claim, it can take a little bit longer because we probably need to get medical records and all that. So, uh, the normal processing time for us to review the claim is 7 to 10 business days. After we review the claim and uh make a decision if we need more documents, it really depends on how fast we get those documents and.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, well, I get them as soon as I start that stuff and uh it's up when I get the 104 I get you out to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, you just need to send the itemized bill for that one for the $104 OK, for the $50 benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, that was, that was it. So I I got hear from y'all next week, right, on the other one I'm doing right now.
[AGENT][POSITIVE] Yeah, right. Well, thank you for.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see, um, let me check and see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, the last document was received on the [PII] and.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Was one moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, have you, uh, well, we have sent in a form that you need to complete. It looks like it, um, and it was recently sent over, so once you get that information and send it back to us, we'll continue the processing of the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What form is that?
[AGENT][NEUTRAL] It's going to be let's see um.
[CUSTOMER][NEUTRAL] What one was that?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Medical history.
[CUSTOMER][NEUTRAL] I'll, I'll send it to you.
[AGENT][NEUTRAL] You already send it?
[CUSTOMER][NEUTRAL] on the [PII], that's what that stuff was.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And then I did something for y'all don't know.
[CUSTOMER][NEUTRAL] [PII] too, a lot of medical stuff sent to y'all too.
[CUSTOMER][NEUTRAL] So you take for the [PII] too as well.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Then out my building was [PII].
[AGENT][NEUTRAL] OK, so based on what I got here, and this is what I have right now in front of me.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] The [PII], we process the [PII], [PII] we process on [PII], and then the [PII] we process on [PII]. On [PII], we still need that information. Um, did you receive the form from us and fill it out and send it?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You did. Uh, let me, let me look at these documents because it looks like they're still asking for.
[CUSTOMER][NEUTRAL] Yeah, I've been send that out.
[CUSTOMER][NEUTRAL] That was it, that was on that was on [PII]. I printed it out and that was everything for them. They want an itemized billing for me.
[CUSTOMER][NEUTRAL] I remember that.
[AGENT][NEUTRAL] OK, yeah, we needed the itemized bill and we needed the and we needed the form that we send out uh let me check and see if I see any of these documents because yeah, they.
[CUSTOMER][NEUTRAL] And when I was going to.
[CUSTOMER][NEUTRAL] Y'all got that?
[CUSTOMER][NEUTRAL] Yeah, yeah, I my bills on the [PII].
[AGENT][NEUTRAL] OK, so the itemized bill was on the [PII]. When you receive the form from us, a form that you need to fill out with the history. Did you send that over as well?
[CUSTOMER][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that was all in there too.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I'll faxed everything back to you the same day on the [PII].
[CUSTOMER][NEUTRAL] Sure did. I remember that I find that one. They came in and print it out and then I would uh.
[CUSTOMER][NEUTRAL] Get all the rest of it too.
[AGENT][NEUTRAL] Yeah, I don't see. I'm looking at the documents that you are sending. I don't see that one.
[AGENT][NEUTRAL] I see that that you sent some information from [PII], I think it was. Let me see. Baptist Health.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, but I don't see the form with the list of the history.
[CUSTOMER][NEUTRAL] To all my medical history.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] From [PII]. That's the one I said that's been since, yeah, that was in there too, cause I'm in [PII], so I sent it to.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] So do y'all need it again?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, um, yes, you need to send it because I, I don't see it. I'm not sure what happened, why is it not here but I don't see it. And that's why we're waiting for. We're waiting for the form that we send out to you that you needed to fill out with the history to be sent back to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, cause you said email that form again then.
[AGENT][NEUTRAL] Uh, let me see, I don't have that form here. Um, let me get customers, let me get claims on the line to see if they can send it to you. OK, one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] Hi [PII]. How are you? This is [PII].
[CUSTOMER][NEUTRAL] Hi so how are you?
[AGENT][NEUTRAL] I'm good. I'm here. Um, I have Mr. [PII] calling again. I don't know if I spoke to you about this one. I don't remember. Um, but he's been calling like um almost every day.
[AGENT][NEUTRAL] About his claim. He, he keeps saying that he sent the form that we're asking for, but I, I checked the documents just to make sure, but I don't see it. And now he's asking for a copy of it, um, but I, I don't see it here, so I don't know if you can send him another copy or see if you can find it. I, I really didn't see anything. Um, the policy number is 2,566,030.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's the form for the history, the medical history?
[AGENT][NEUTRAL] Not sure if he's just confused about what to send. I think he's just confused about what to send because, uh, yeah, I told him and I several times and then he said, well, I don't know if I have it, so I'm like, OK.
[CUSTOMER][NEUTRAL] Yeah, just.
[CUSTOMER][NEUTRAL] OK, so yeah, it looks like we're looking for the physician history so that we can check for pre-existing, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And he's saying he doesn't think he has the form?
[AGENT][NEUTRAL] He said that he remember he sent it but then he said he's not sure, so he's a little confused about exactly what he's probably looking at or what he sent.
[CUSTOMER][NEUTRAL] OK, is that his callback number listed?
[AGENT][NEUTRAL] Um, um, [PII], I think he just hang up. Yeah, [PII]. I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I'll call him back. [PII].
[CUSTOMER][NEUTRAL] [PII] yeah I'm sorry.
[AGENT][NEUTRAL] Yeah, that's it.
[CUSTOMER][NEUTRAL] That's just call back? OK.
[AGENT][NEUTRAL] Yeah, that's it, Ms. [PII]. OK.
[CUSTOMER][NEUTRAL] OK, and I'll um I'll give him a call back and just see if he has the form and.
[CUSTOMER][NEUTRAL] And if he doesn't maybe I can email it to him possibly.
[AGENT][NEUTRAL] OK. Yeah, I think that's, yeah, I think that's, that's it. That's what he needs. He's been calling like for a while now and we've been asking for the same information over and over, but uh, yeah, I think it's he's a little probably a little confused about it. So if you can call him and let him know if he has it or if you need to send it again so you can send it.
[CUSTOMER][POSITIVE] Yeah, I'll give him a call.
[AGENT][POSITIVE] Thank you. Have a good day, Ms. [PII]. Thank you. You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] You're welcome you too thank you bye bye.