AccountId: 011433970860
ContactId: 93e8d149-3e20-4056-b3dd-b57588541303
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1142140 ms
Total Talk Time (AGENT): 415936 ms
Total Talk Time (CUSTOMER): 407916 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/93e8d149-3e20-4056-b3dd-b57588541303_20250106T13:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How, how can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], it's [PII]. Good morning.
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] I have a lady on the phone he's got these multiple cancer policies.
[CUSTOMER][NEUTRAL] And she's wanting to know what is still out there available for her to fall from last year.
[CUSTOMER][NEUTRAL] Is this something as of today we're supposed to create a hub ticket for a call back within 24 hours?
[AGENT][NEUTRAL] I haven't heard anything about that.
[CUSTOMER][NEUTRAL] I don't know either.
[CUSTOMER][NEUTRAL] But I don't, I mean, I, 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.
[CUSTOMER][NEUTRAL] I guess I need to give you 2 policy numbers.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] One is 242-6704.
[CUSTOMER][NEUTRAL] [PII] is the last name that's for part two.
[CUSTOMER][NEUTRAL] And by looking at that, it looks like the first claim that we paid on his chemo and radiation was back for February.
[CUSTOMER][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] So it would be after February before she could file again for that, correct?
[AGENT][NEUTRAL] Let me pull up the EOP.
[AGENT][NEUTRAL] If the EP will pull up.
[AGENT][NEUTRAL] Come on.
[AGENT][NEUTRAL] Oh, there it is. Let's see.
[AGENT][NEUTRAL] Yeah LP.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And I told her that some of the benefits are, you know, a calendar year and some of them are.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, her, her, her, her benefit period was um 16-2024 to 16-2025, so she can start uh filing. It's on, it's on EOB. You have to pull the EOB up.
[CUSTOMER][NEUTRAL] A 12 month period, so she says.
[CUSTOMER][NEUTRAL] So where is that claim?
[CUSTOMER][NEGATIVE] I don't say God, I this is too much.
[CUSTOMER][NEUTRAL] I mean, which, how do you know what GMB to pull up?
[AGENT][NEUTRAL] And it's
[AGENT][NEUTRAL] Oh, you'll pull up the last one because it's the PE40P1E0047, which is the maximum payable for the uh chemotherapy.
[CUSTOMER][NEUTRAL] And that shows 31.
[AGENT][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.
[CUSTOMER][NEUTRAL] Well then that
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I don't, OK.
[CUSTOMER][NEUTRAL] I, I can look at that, but I mean, how would.
[CUSTOMER][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.
[AGENT][NEUTRAL] Yeah, I always look at the EOB on all of my claims because there might be special notes on the EOBs.
[CUSTOMER][NEUTRAL] And it would always be the first one?
[AGENT][NEUTRAL] Um, it would always be a lot if you have a.
[CUSTOMER][NEUTRAL] I mean, the last one, the first.
[AGENT][NEUTRAL] Right, the, the last one, if you have a PEOO 47.
[CUSTOMER][NEUTRAL] OK.
[AGENT][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.
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] And then what about every other she's wanting to know about anything else that they could still file for for last year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] CHPP.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Well, 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.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me get her policy.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And she's got 2 of them.
[AGENT][NEUTRAL] pull it up
[AGENT][NEUTRAL] Uh, yeah, because they changed to the GC 7002, right?
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] But that didn't go into effect till September, so.
[AGENT][NEUTRAL] Let's see what she has.
[AGENT][NEUTRAL] She has chemo radiation.
[AGENT][NEUTRAL] And it's on her husband, right?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so, yeah.
[AGENT][NEUTRAL] I can talk to her, but yeah, um, if he has any, he had any wellness, he had any um
[AGENT][NEUTRAL] Or any imaging test done.
[CUSTOMER][NEUTRAL] And she says
[AGENT][NEUTRAL] She could still file under that 242.
[AGENT][NEUTRAL] Um, 6704.
[CUSTOMER][NEUTRAL] And she has
[CUSTOMER][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.
[AGENT][NEUTRAL] I can tell you that all she's filed for [PII] is chemo and radiation.
[CUSTOMER][NEUTRAL] Cause I saw a PET scan under the new policy number.
[AGENT][NEUTRAL] OK, so let me get the.
[CUSTOMER][NEUTRAL] That's what I'm saying. I, I, I don't know how.
[AGENT][NEUTRAL] 242-6704.
[CUSTOMER][NEUTRAL] To tell her what she's done. I see labs, I see.
[AGENT][NEUTRAL] Let's see, the new one.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I'm gonna put you on hold just one second, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][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.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] But I'll talk to her and tell her.
[CUSTOMER][NEUTRAL] OK, so new policy, chemo and radiation.
[AGENT][NEUTRAL] Beginning tomorrow, [PII].
[CUSTOMER][NEUTRAL] I just told her about the date as far as the [PII], I gave her that information.
[CUSTOMER][NEUTRAL] Just now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I think we're gonna have to ask if we're gonna have to do all this is to know what exactly they're still eligible for or still have left on the table.
[CUSTOMER][NEUTRAL] Uh, we're gonna have to have some additional training. I just think I, I, I, I, yeah, I don't know, yeah.
[AGENT][NEUTRAL] I, is, is this something new that the that the insured are calling for?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 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.
[AGENT][POSITIVE] OK. OK. So you're the lucky one who got the first phone call.
[CUSTOMER][NEUTRAL] Um, but anyway.
[CUSTOMER][NEUTRAL] Oh, the first part, 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
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I don't want to tell this lady his husband has cancer, the wrong thing.
[AGENT][NEUTRAL] Right, yeah, just
[CUSTOMER][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.
[CUSTOMER][NEGATIVE] You know, I'm not comfortable answering that.
[AGENT][NEUTRAL] Yeah, the, um, the, yeah, the only thing that's on a twelve-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.
[CUSTOMER][NEUTRAL] It's the chemo and radiation.
[CUSTOMER][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] And then looking at 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.
[AGENT][NEUTRAL] Do you, do you, do you know the CLHBQ screen or C CLHBP screen?
[CUSTOMER][NEUTRAL] Yeah, I can, yeah.
[AGENT][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.
[CUSTOMER][NEUTRAL] OK, alright, well I thank you for taking this call. I'm probably gonna get in trouble for transferring it to you, but I, I.
[CUSTOMER][NEUTRAL] I'll just have to take that it.
[AGENT][NEUTRAL] That's fine. OK, yeah, just tell me, you know, it's a new process. You gotta give me some leeway, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So anyway, but I did give her the 16 to 16 uh for his chemo. So anyway, let me tell her because I didn't tell her I was transferring her. Let me tell her that I'm gonna join just join these calls, OK?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ms. [PII].
[CUSTOMER][NEUTRAL] Yes. Hi, this is still [PII], and I have one of the examiners, um, Dehay 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.
[CUSTOMER][NEUTRAL] Doha, can you hear Ms. [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and so Ms. [PII], does she 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][POSITIVE] No ma'am. OK, well thank you again for calling APL and I hope that you have a very nice day.
[CUSTOMER][POSITIVE] I thank you. Yes, ma'am.
[AGENT][NEUTRAL] Good morning, Ms. [PII].
[CUSTOMER][POSITIVE] Good morning.
[AGENT][NEUTRAL] Um, you just need to know um what.
[AGENT][NEUTRAL] Eligible benefits you still have for [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, the only thing that, uh, and it's on your husband, [PII], is that right?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, yes, ma'am. The only thing that he's eligible for right now for [PII] is if he had a wellness test, um, like a um PSA or um any kind of cancer screening test. Um, that's the only thing that he would be eligible for for [PII].
[CUSTOMER][NEUTRAL] OK, so, um, when I spoke with somebody in December, she also mentioned 2023.
[AGENT][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Well she mentioned a benefit that wasn't claimed from [PII], so I was wondering if you could take that one as well.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, 2023. OK, so let me, let me get that policy or let's see, 2023.
[AGENT][NEUTRAL] Sell HBP 2020.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, hold on.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] 2023.
[AGENT][NEUTRAL] 17
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, he's maxed out of everything for [PII].
[CUSTOMER][NEUTRAL] OK. So I did see something to the effect of
[CUSTOMER][NEUTRAL] Like, um, type, if you do like blood work or something.
[CUSTOMER][NEUTRAL] Do you like get a claim for that?
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] It was something I was reading. I'm not sure.
[AGENT][NEUTRAL] Uh for what?
[CUSTOMER][NEUTRAL] Like if there's any blood work done.
[AGENT][NEUTRAL] No, ma'am. None of our policies cover laboratory tests.
[AGENT][NEUTRAL] Um, the only, the only blood work that would be covered would be like a cancer screening test would be like the PSA or um any of your cancer screening tests, but just your general lab work that is not covered.
[CUSTOMER][NEUTRAL] What do you mean a cancer screening test? What test does that look like? Like, I know you said PSA. I'm not familiar with that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me, let me get, let me get to those. Um, that would be, in his case, it would be like a mammogram, a breast ultrasound, a breast thermography, um, a breast cancer cancer blood test, a colon cancer blood test, a PSA, um, a flexoid sigmoidoscopy, a colonoscopy.
[AGENT][NEUTRAL] A virtual colonoscopy, um, ovarian cancer blood test, Pap smear, chest X-ray, hemacult stool specimen, serum protein electrophoresis.
[CUSTOMER][NEUTRAL] Marshal.
[AGENT][NEUTRAL] Um, in a pap test.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] A genetic test wouldn't count, would it?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, and so, OK, so.
[CUSTOMER][NEUTRAL] That's fine for him. Now, as far as the
[CUSTOMER][NEUTRAL] My question is for.
[CUSTOMER][NEUTRAL] A mammogram. You, you need the results, right? In order to claim it.
[AGENT][NEUTRAL] No, ma'am, um, we have claim forms on our website and that you would go to the wellness claim form and on that claim form it just um ask you to pick that you had a mammogram, the date and then the doctor's name and phone number at the bottom, and that's all we need.
[CUSTOMER][NEUTRAL] OK, cause um I think I should have a
[CUSTOMER][NEUTRAL] Open claim for [PII] for myself because I did get a mammogram that I didn't put in for.
[AGENT][NEUTRAL] OK, yes ma'am, you just need to fill out one of those claim forms and submit that and we can go ahead and get your mammogram process for for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, I will get that done, um.
[CUSTOMER][NEUTRAL] OK. And then you said you just need the doctor name and phone number.
[AGENT][NEUTRAL] Right, yes, ma'am.
[CUSTOMER][NEUTRAL] Well, I just pull up the claim and see what I need to submit.
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] I said I'll pull the claim form like you told me and see what I need to submit.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes ma'am and if you have any questions don't don't hesitate to give us a call back and we'll be more than happy to help you with that claim form.
[CUSTOMER][POSITIVE] OK, thank you so much. I appreciate your time this morning.
[AGENT][POSITIVE] You're so very welcome, Ms. [PII]. Is there anything else I can help you with this morning?
[CUSTOMER][NEUTRAL] No, that would be all.
[AGENT][POSITIVE] Well, thank you for calling Peel. You have a wonderful day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you.