AccountId: 011433970860
ContactId: 9bf24363-ec57-4ef3-8022-7fae4fdc754d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 469640 ms
Total Talk Time (AGENT): 161444 ms
Total Talk Time (CUSTOMER): 275940 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/9bf24363-ec57-4ef3-8022-7fae4fdc754d_20250220T21:26_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, yes, my name is [PII].
[CUSTOMER][NEUTRAL] Do you need my date of birth?
[AGENT][NEUTRAL] Um, I need uh the policy number if you have it, Ms. [PII].
[CUSTOMER][NEUTRAL] No ma'am, I'm sorry I don't. I'm still at work.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] OK, bear with me just a second. Let me do a name search and let's see, let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have your address, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And I need to verify your date of birth and email address for verification.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And email is [PII].
[AGENT][POSITIVE] Perfect. Thank you. And how may I assist you today?
[CUSTOMER][NEUTRAL] OK, I'm fixing to start radiation, and before I start radiation, you know, I, I need to know a little bit more clarification because I did went through all the chemo and once a month, I would send you a claim form, and then the billing for that month that showed the, the chemo. So then I went to surgery and you denied all of my claim on surgery because it said no evidence of disease.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] After they took the tumor out, the tumor bed out, it said no evidence of disease, so you denied all of it. You only paid me $75. So now I'm calling back to make sure I get before I start radiation.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the process on radiation? Do I, you know, do you pay, you know, if I have radiation 5 days a week, do I send once a month, I still send you the bill? Or do I have to have like this month they, I don't start radiation until next Thursday.
[CUSTOMER][NEUTRAL] And I'll have Thursday and Friday in February and then 7 more weeks after that. So are you not gonna pay for February since I only have 2 days of radiation or will you still pay for February because I have 2 days of radiation?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII], we cannot guarantee any payments over the phone, um, but what I can tell you is that it's gonna be the same process as the chemotherapy. So you're gonna just do it at the same way you did the chemotherapy. Um, let me just make sure that it is under that benefit. One moment. I'm pulling your benefits, one moment.
[CUSTOMER][NEGATIVE] Cause on chemo, if I had
[CUSTOMER][NEUTRAL] Once a week
[CUSTOMER][NEUTRAL] For 4 weeks, you paid the same dollar amount as if I only did chemo 1 time a month.
[CUSTOMER][NEUTRAL] So that, that's all I'm asking, is radiation gonna be like chemotherapy? Whether I do it 2 days or whether I do it 30 days.
[CUSTOMER][NEUTRAL] You're only gonna pay one amount.
[AGENT][NEUTRAL] I'm looking for that benefit information. One moment.
[AGENT][NEUTRAL] All policies are different, so I need to go through all the pages on your policy to determine that benefit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, on my copy of your policy, it says radiation, chemotherapy and immunotherapy is the, is the same.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] They're all together.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, I see that. OK. So yes, I got the page pulled up, which is page 22. It is under the same benefits, so yes, it's 1500 per calendar month.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So,
[AGENT][NEUTRAL] So it's gonna be the same.
[CUSTOMER][NEUTRAL] So if I just do the 2 days and then on Friday I receive my bill for those 2 days, I can send that over to you and make my claim. And then March comes around, I do all of my things in the middle of the month, I can do the same thing, send my bill over to you, send the, the claim and so it doesn't matter whether it's 2 days or 30 days, you're only gonna pay that one amount per month.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Per month. Correct, yes.
[CUSTOMER][NEGATIVE] OK. All right. Now, on the APL on all of those bills that I sent you for my surgery, you only paid $75. So why could I not send you a new claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Referencing or, or resending all those bills because I had a mammogram, I had a um CT scan, and I had all of those other things. Why couldn't I send you a new claim form for all of the things that I did on those two days and then you pay me my claim for the, for the year of all those things that I had done.
[AGENT][NEUTRAL] OK, um, again, we do not process over the phone. So, um, in order to be, uh, to for somebody to look into all the paperwork and determine if it's a payment or if it's payable or anything like that, it has to run through the, um, claims department and somebody needs to look at all the documents. I see that the last time that we processed the claim, we did send out that $75. Um, let me check and see what happened to the rest of the items in that list if we needed more information or mhm.
[CUSTOMER][NEUTRAL] Well, she came back, it, it, no, it was a wonderful lady and the need more information, the medical claims unit. And she said because there was no evidence of disease, that meant the chemotherapy and the immunotherapy killed all of the cancer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That they did not pay for the surgery or any of the other things because there was no disease in there.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, so it was not cancerous. So the surgery was not cancerous. So, gotcha.
[CUSTOMER][NEUTRAL] No, they took out the, the dead tumor bed.
[AGENT][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] They took out the dead tumor bed. So now radiation.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] After that devastating blow, because I thought I read your policy front to back a million times. It did not say anything about no evidence of cancer. So, you know, I was devastated when I got the $75 because of the way it, you know, it wasn't worded that way. But again, I'm not saying anything, but
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Still
[CUSTOMER][NEUTRAL] I had all of those other things that you do pay for. Why couldn't I put another claim in?
[CUSTOMER][NEUTRAL] For the mammogram, for all of those other things, and, and receive my payment that way.
[AGENT][NEUTRAL] You can if you want to just go ahead and send for your mammogram, uh, for the diagnostic, um, benefit, it has to be positive cancer, um, if, if it's a diagnostic testing. Um, but for the mammogram since it's a preventative benefit that is separate, so you can go ahead and submit that one if you would like as a separate claim.
[CUSTOMER][NEUTRAL] OK, and then I got scan so that that is payable as well, right?
[AGENT][NEUTRAL] The CT scan will only be payable if it's positive for cancer, because that's a diagnostic testing.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Oh, OK. All right, well, I'll go ahead and start sending my radiation cause I have to do those.
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right. You're welcome. Is there anything else? You as well, Miss [PII]. Thank you for calling APM. You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] All right, thank you very much
[CUSTOMER][POSITIVE] All right have a good day God bless.
[CUSTOMER][POSITIVE] No, ma'am, thank you very