AccountId: 011433970860
ContactId: ae6d4725-4200-46ac-a093-391d31d1d89d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373769 ms
Total Talk Time (AGENT): 195565 ms
Total Talk Time (CUSTOMER): 118401 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/ae6d4725-4200-46ac-a093-391d31d1d89d_20250214T13:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, my name is uh [PII], ma'am.
[CUSTOMER][NEUTRAL] I have insurance with y'all.
[AGENT][POSITIVE] I'm so sorry.
[AGENT][POSITIVE] I'm so sorry. Could you please give me your name again?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Hi Mr. [PII], how can I help you today?
[CUSTOMER][NEUTRAL] Yes, I was gonna ask you a question. I gonna have a radiation treatment and do y'all cover radiation treatment?
[AGENT][NEUTRAL] OK, so you have a question, Mr. [PII], regarding radiation treatment under your policy, is that correct?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, sir. I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][POSITIVE] Oh, OK. I'm so sorry. Thank you. And your policy number?
[CUSTOMER][POSITIVE] That's not bad.
[CUSTOMER][NEUTRAL] Uh, let's see here 2.
[CUSTOMER][NEUTRAL] 566-030
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] Cause I gotta have 9 weeks of that.
[CUSTOMER][NEUTRAL] And I'm trying to get them to see how much it's gonna cost me.
[CUSTOMER][NEUTRAL] To have that radiation treatment for 9 weeks.
[AGENT][NEUTRAL] OK, so any information that I do provide for you today, Mr. [PII] will be a verification of benefits and not a guarantee of payment. Also, I will need to verify several things with you first for security purposes. So first off, if you could please verify your date of birth.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] ZIP code [PII] [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, thank you. The phone number that we have for you is the same as the one that you provided for me. So again, that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you. And lastly your email address and it does appear to be your work email.
[CUSTOMER][NEUTRAL] Yes ma'am, it should be the [PII] or [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying your information. OK, so on your policy, which I can see that you have now set up your profile on the online service center, Mr. [PII], so you do have access to all of this information in your portal. There's a full copy of the policy in there and it has a schedule of benefits with your different cancer treatment benefits and their benefit amounts.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] You do have a radiation, chemotherapy and immunotherapy benefit.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It is a maximum of $20,000 per covered person per 12 month period.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how did I just, when I get the bill, I send it to y'all.
[AGENT][NEUTRAL] Yes, sir, you would need to send your claim form along with the bills, the itemized bill that includes the diagnosis, you know, it should have the diagnosis code along with your treatment dates and yes, the bill amounts.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you will also need to provide us a copy of your primary insurance company's explanation of benefits. On that first page of the claim form that we emailed you, Mr. [PII], it does have all of the instructions for what you would need to submit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On a claim forms, OK, because I know I, I, uh, email that stuff out to you all about.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Oh God, I, I, I faxed it back to y'all, and I don't know if y'all got it or not yet back. The information and stuff when I first went, I found I had cancer and everything like that.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] And I went to see uh the biopsy and I have to pay $500 down. I paid that out of pocket then they take $120 for me every.
[CUSTOMER][NEUTRAL] Every month.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I send that in too.
[CUSTOMER][NEUTRAL] So y'all receive all of that?
[AGENT][NEUTRAL] I can check that for you. Just one moment.
[AGENT][NEUTRAL] Just one second, Mr. [PII].
[CUSTOMER][POSITIVE] Take your time, yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I do show that we did receive some information on [PII], and that information is still in line for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But y'all say y'all do pay up to radiation treatment 20,000 for one year, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] For a 12-month period. Yes, sir. So from the time, mhm, so from the time it's not a calendar year benefit, it's a 12-month period. So for example, if you start in March, then it would go to next March exa for example.
[CUSTOMER][NEUTRAL] 12 months, yeah, OK, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So when I pay for the first treatment, radiation treatment, send all that to y'all and I just get a refund, uh.
[AGENT][NEUTRAL] We will review the claim for benefits, Mr. [PII], yes, and then if benefits are payable, yes sir, that is correct.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, what about sending money to them? How do I go about doing that? Well y'all can just do it. I just submit the claim to y'all and y'all just send them the money.
[AGENT][NEUTRAL] It would have to be according to how the the claim form is completed with the assignment of benefits to go to the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Otherwise, they are paid to whomever files the claim.
[CUSTOMER][POSITIVE] OK then. Thank you, ma'am.
[AGENT][POSITIVE] You're certainly welcome. And is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No, that was it. Thank you, ma'am.
[AGENT][POSITIVE] OK, well, you're welcome, Mr. [PII] and I thank you again for calling APL and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Yes, sir. Thank you. Bye bye.