AccountId: 011433970860
ContactId: 9051b4cc-2327-452a-b699-b8dceb568c25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1683150 ms
Total Talk Time (AGENT): 643646 ms
Total Talk Time (CUSTOMER): 432498 ms
Interruptions: 5
Overall Sentiment: AGENT=-0.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/9051b4cc-2327-452a-b699-b8dceb568c25_20250106T13:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII]. I was calling to see when I'm able to file a claim.
[AGENT][NEUTRAL] OK. Are you wanting to know, I mean, are, are you trying to find out if your policy is active?
[CUSTOMER][NEUTRAL] Well, I know it's active. I just, it's, um, I need to know what day I can start back filing claims. I don't remember what they did.
[AGENT][NEUTRAL] OK, so yes ma'am, in order to answer your question, I can try and help you with this. I can. I will just need to pull up your policy information first and verify some things with you for security. So first off, who am I speaking with?
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And Miss [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] 252
[CUSTOMER][NEUTRAL] 7441.
[AGENT][NEUTRAL] 7441. Was that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, and Ms. [PII], I will need to verify, as I said, several things first for security and any information that is provided would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your home mailing address?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Excuse me, [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me. So this is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Thank you. And lastly, your email address and it does appear to be your work email?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you very much. OK, so are you filing claims for yourself, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, for my husband.
[AGENT][NEUTRAL] OK, now when I see that we did receive a claim and process that for you in the beginning of December.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're wanting to know when you can start filing claims again?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I believe that you're, give me a moment. I believe your policy is on a, what type of claim are you inquiring on filing?
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] The claim that I filed in [PII] is totally different than the claim than the claim that I'm asking about. It's a, it's his cancer treatment claim is what I'm asking about.
[AGENT][NEUTRAL] OK, so you have not yet filed any of those. Is that correct?
[CUSTOMER][NEGATIVE] Not under this new policy. No, I have not. And I know in the past, I've had to wait since the last time I found the first one on the previous policy. At least that's what I was told.
[AGENT][NEUTRAL] OK, so give me just a moment.
[AGENT][NEUTRAL] To pull up some additional information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Oh, here.
[AGENT][NEUTRAL] It's still loading some information cause I'm gonna have to look at both of your policies. So bear with me please, Miss [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so on your policy benefits, Ms. [PII], it shows that the maximum for his, uh, are you referring to radiation, chemo, or immunotherapy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So that benefit is for a 12-month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I can see that this last payment um.
[AGENT][NEUTRAL] When did he begin his treatment? I see that we paid out the maximum amount.
[AGENT][NEUTRAL] On the policy.
[AGENT][NEUTRAL] Back in March. When did he start his chemotherapy?
[CUSTOMER][NEUTRAL] He started chemotherapy in December.
[AGENT][NEUTRAL] Last year.
[CUSTOMER][NEUTRAL] Last year.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He was on it for the whole year.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so did he start his che I'm trying to see when he figure out when exactly he started his chemo.
[CUSTOMER][NEUTRAL] OK, now, I'm trying to, this, this is a little bit difficult because any other time I've ever called, all I've gotten was a date. All I need is a date.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like you said, it's 12 months. So the first time, I don't remember when I first played on the pilot last year.
[AGENT][NEUTRAL] And that's
[CUSTOMER][NEUTRAL] I just need to know, can I start finding a claim?
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] It would be 12 months from the time you filed the first claim.
[CUSTOMER][NEUTRAL] So what is the first claim for the policy that expired?
[AGENT][NEUTRAL] And, yes, ma'am. And I'm having, yes, ma'am, and that's what I'm trying to determine, but I'm having to look at both of your policies.
[CUSTOMER][NEUTRAL] Why?
[CUSTOMER][NEGATIVE] One of them is expired and that's the one you should be looking at because it tells you when I filed the first claim.
[AGENT][NEUTRAL] According to this, it looks like the first claim that we received for his chemotherapy was [PII].
[CUSTOMER][NEUTRAL] OK, so is it separate?
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] So do I have to wait till [PII] 5, OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] That's all I need to know because when I called in December they told me [PII].
[AGENT][NEUTRAL] I don't see a claim on the policy from last year for anything paid prior to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, that's all I need to know.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And I'm just trying to double check that because I know that that's important. I'm
[AGENT][NEUTRAL] And again,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yes, and that is the first claim date that I can see that we, we paid a, a benefit for his treatment.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So [PII] is when I can file the next plan.
[AGENT][NEUTRAL] Yeah, yes, ma'am.
[CUSTOMER][NEUTRAL] Are there any other benefits?
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] That's on the policy that is available to claim for that.
[AGENT][NEUTRAL] I'm sorry, your voice cut out. Could you repeat your question?
[CUSTOMER][NEUTRAL] My question is, is there any other benefits that's on the policy that is available to claim?
[CUSTOMER][NEUTRAL] Is it something that hasn't been claimed on this policy that's left available?
[AGENT][NEUTRAL] For this past calendar year.
[AGENT][NEUTRAL] Is that what you're inquiring? Some of the benefits on your policy are per calendar year and some of them are for a twelve-month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What's the difference? Is that both the calendar year?
[AGENT][NEUTRAL] Calendar year is [PII].
[AGENT][NEUTRAL] 12-month period is from the time of treatment, from the first date of service.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] To the following 12 months.
[CUSTOMER][NEUTRAL] OK, well, whichever one you wanna sell me first is fine.
[AGENT][NEUTRAL] OK, I'm gonna place you on a brief hold for just a moment if that's OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] This is ridiculous.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I, I can't, I mean, really?
[CUSTOMER][NEUTRAL] This call will be recorded
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] Miss [PII], thank you so much for holding for me. So what I'm gonna try to do is connect you with one of the examiners to verify what benefits are still left since there were two policies involved. I don't want to give you any incorrect information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] To verify what you have left that you could file for for [PII]. I'm sorry, [PII]. We're in [PII] already. Wow, OK. So yes, ma'am, if that's OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK. Well, can I help you with anything else before I do that and you will not have to re-verify any of your information.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, well, thank you again for calling APL and I hope that you have a very nice day.
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. So one moment, please.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEGATIVE] No work.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How, how can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. Good morning.
[CUSTOMER][POSITIVE] Good morning.
[AGENT][NEUTRAL] I have a lady on the phone. He's got these multiple cancer policies.
[AGENT][NEUTRAL] And she's wanting to know what is still out there available for her to fall from last year.
[AGENT][NEUTRAL] Is this something as of today we're supposed to create a hub ticket for a call back within 24 hours?
[CUSTOMER][NEUTRAL] I haven't heard anything about that.
[AGENT][NEUTRAL] I don't know either.
[AGENT][NEUTRAL] But I don't, I mean, I've, I've done the best that I can on answering her questions but uh looking at both policies. She wanted to know when she could start filing for her husband's treatment again and it looks like the first claim that we paid on him.
[AGENT][NEUTRAL] I guess I need to give you 2 policy numbers.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] One is 242-6704.
[AGENT][NEUTRAL] [PII] is the last name and it's for part two.
[AGENT][NEUTRAL] And by looking at that, it looks like the first claim that we paid on his chemo and radiation was back for February.
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] So it would be after February before she could file again for that, correct?
[CUSTOMER][NEUTRAL] Let me pull up the EOP.
[CUSTOMER][NEUTRAL] If the EP will pull up.
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][NEUTRAL] Yeah, there it is. Let's see.
[CUSTOMER][NEUTRAL] CLP.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] And I told her that some of the benefits are, you know, a calendar year and some of them are.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, her, her, her, her benefit period was um 16-2024 [PII], so she can start uh filing. It's on, it's on EOB. You have to pull the EOB up.
[AGENT][NEUTRAL] A 12 month period. So she says.
[AGENT][NEUTRAL] Say, where's that claim?
[AGENT][NEGATIVE] I don't say, God, uh this is too much.
[AGENT][NEUTRAL] I mean, which, how do you know what EOB to pull up?
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] Oh, you'll pull up the last one cause it's the PE4 P1E0047, which is the maximum payable for the uh chemotherapy.
[AGENT][NEUTRAL] And that shows 31.
[CUSTOMER][NEUTRAL] Um, if you'll look at the actual EOB, um, at the bottom, it states the benefit period, um, 1620 24 to 162025 is exhausted.
[AGENT][NEUTRAL] Well then that
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, adults, OK.
[AGENT][NEUTRAL] I, I can look at that, but I mean, how would
[AGENT][NEUTRAL] How would we know to look at that? I mean, to look at the full EOB we just read the remarks and it doesn't say that.
[CUSTOMER][NEUTRAL] Yeah, I always look at the EOB on all of my claims because there might be special notes on the EOBs.
[AGENT][NEUTRAL] And it would always be the first one?
[CUSTOMER][NEUTRAL] Um, it would always be a lot if you have a
[AGENT][NEUTRAL] I mean, the last one, the first.
[CUSTOMER][NEUTRAL] Right. The, the last one, if you have a PEOO 47.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that means that's the one that you would look at the chemo and that should give you the note that, um, the, the benefit period.
[AGENT][NEUTRAL] OK. And then.
[AGENT][NEUTRAL] And then what about every other, she's wanting to know about anything else that they could still file for for last year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] CHPP.
[AGENT][NEUTRAL] No no
[AGENT][NEUTRAL] Well,
[AGENT][NEGATIVE] I gave her, I told her February because that's when I, I looked at the first claim we paid and that was for, that's when it said. So she's, she's already kind of frustrated.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me get her policy.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] And she's got 2 of them.
[CUSTOMER][NEUTRAL] Pull it up
[CUSTOMER][NEUTRAL] Uh, yeah, cause they changed to the GC 7002, right?
[AGENT][NEUTRAL] You know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] But that didn't go into effect till September, so.
[CUSTOMER][NEUTRAL] Let's see what she has.
[CUSTOMER][NEUTRAL] She has chemo radiation.
[CUSTOMER][NEUTRAL] And it's on her husband, right?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so, yeah.
[CUSTOMER][NEUTRAL] I can talk to her, but yeah, um, if he has any, he had any wellness, he had any, um,
[CUSTOMER][NEUTRAL] Or any imaging test done.
[AGENT][NEUTRAL] And she says,
[CUSTOMER][NEUTRAL] She could still file on that 242.
[CUSTOMER][NEUTRAL] Um, 6704.
[AGENT][NEUTRAL] And she has
[AGENT][NEUTRAL] So, and she's gonna say, well, I don't, I can tell you, she's gonna say, well, I don't know what I filed.
[CUSTOMER][NEUTRAL] I can tell you that all she's filed for [PII] is chemo and radiation.
[AGENT][NEUTRAL] Cause I saw a PET scan under the new policy number.
[CUSTOMER][NEUTRAL] OK, so let me get the.
[AGENT][NEUTRAL] That's what I'm saying. I, I, I don't know how.
[CUSTOMER][NEUTRAL] 242-6704.
[AGENT][NEUTRAL] To tell her what she's, I see labs, I see.
[CUSTOMER][NEUTRAL] Let's see the new one.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] I'm gonna put you on hold just one second, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] I get out of
[AGENT][NEUTRAL] Ms. [PII], this is Ms. [PII], this is still [PII], and I'm still looking at some of your information on the, on the chemo and it radiation benefits, the date is going to be after [PII]. It will be after [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we're still looking at the
[AGENT][NEUTRAL] Imaging, it appears that there are some imaging benefits that you could still fall for for that for the last, this last calendar year.
[AGENT][NEUTRAL] But I'm double checking on that as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on the explanation of benefits for the last claim that we reviewed under your policy, which you are set up in the online service center I can see it does give you that date.
[AGENT][NEUTRAL] For the benefit period of [PII].
[AGENT][NEUTRAL] On his chemo, showing that that was the benefit period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so bear with me just one moment please.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, and under her new policy starting tomorrow she can file for the chemo and radiation and then um she can file for um a wellness test.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] But I'll talk to her and tell her.
[AGENT][NEUTRAL] OK, so new policy, chemo and radiation.
[CUSTOMER][NEUTRAL] Beginning tomorrow, [PII].
[AGENT][NEUTRAL] I just told her about the date as far as the [PII], I gave her that information just now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, I think we're gonna have to ask if we're gonna have to do all this to know what exactly they're still eligible for or still have left on the table.
[AGENT][NEUTRAL] Uh, we're gonna have to have some additional training. I just think I, I, I, I, yeah, I don't know. Yeah.
[CUSTOMER][NEUTRAL] I, is, is this something new that the that the insured are calling for?
[AGENT][NEUTRAL] Um, this is just a new process of how we're to handle certain, I mean handling calls and sending requests. It's brand new and starting today, like today.
[CUSTOMER][POSITIVE] OK. OK. So you're the lucky one who got the first phone call.
[AGENT][NEUTRAL] Um, but anyway.
[AGENT][NEUTRAL] Oh, the first, I mean, the first one that's really, you know, complicated and I don't know, I mean, I'm not doing this right, but
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I don't want to tell this lady his husband has cancer, the wrong thing.
[CUSTOMER][NEUTRAL] Right, yeah, just
[AGENT][NEGATIVE] And using the chat, I don't think is the most effective way for us to try to help these people, and I don't review cancer claims and knowing what policy, what benefits they still have available out on the table that they haven't claimed.
[AGENT][NEGATIVE] You know, I'm not comfortable answering that.
[CUSTOMER][NEUTRAL] Yeah, the, um the, yeah, the only thing that's on a 12 month period is, is the king chemo radiation. Everything's on a, um, is on a calendar year. So yeah, that's, it's just that finding for, if they've maxed out their chemo and how much chemo they, yeah, that's, that's gonna be the hard part is the chemo and radiation.
[AGENT][NEUTRAL] Is the chemo and radiation.
[AGENT][NEUTRAL] Calendar year.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then looking out, maxing out everything else. I mean, looking through every claim to see if they've met, if they filed or anything else that's on a 12 months.
[CUSTOMER][NEUTRAL] Do you, do you, do you know the CLHBQ screen or C CLHBP screen?
[AGENT][NEUTRAL] Yeah, I can, yeah.
[CUSTOMER][NEUTRAL] OK, you can go on there and put in the year that you're looking for and then to tell you everything that we paid.
[AGENT][NEUTRAL] OK. All right, well, I thank you for taking this call. I'm probably gonna get in trouble for transferring it to you, but I, I.
[AGENT][NEUTRAL] I'll just have to take that hit.
[CUSTOMER][NEUTRAL] That's fine. OK, yeah, just tell me, you know, it's a new process. You gotta give me some leeway, yeah.
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] So anyway, but I did give her the 16 to 16 uh for the, his chemo. So anyway, let me tell her cause I didn't tell her I was transferring her. Let me tell her that I'm gonna join, just join these calls, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, this is still [PII], and I have one of the examiners, um, [PII] on the line who is gonna further look at this with you to tell you, you know, about any remaining benefits available for this past calendar year.
[AGENT][NEUTRAL] [PII], can you hear Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. And so, Ms. [PII] [PII] knows that you've already been fully verified. So is there anything else that I can help you with before I release you with [PII]?
[CUSTOMER][NEUTRAL] No ma'am, that'd be
[AGENT][POSITIVE] OK. Well, thank you again for calling APL and I hope that you have a very nice day.
[CUSTOMER][POSITIVE] I thank you
[AGENT][NEUTRAL] Yes, ma'am.