AccountId: 011433970860
ContactId: b560be8e-1bba-4118-b30e-6a0647b92f4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 682789 ms
Total Talk Time (AGENT): 324015 ms
Total Talk Time (CUSTOMER): 315679 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/b560be8e-1bba-4118-b30e-6a0647b92f4e_20250113T16:02_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I just have some questions about uh benefits on my policy please.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits, and may I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected Miss [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] 3206
[AGENT][NEUTRAL] Is that all the numbers you have for the policy number?
[CUSTOMER][NEUTRAL] Uh, well, let me look.
[CUSTOMER][NEUTRAL] Oh that's what it said here.
[AGENT][NEUTRAL] And if you have the card.
[CUSTOMER][NEUTRAL] With a certificate number?
[AGENT][NEUTRAL] Yes, it's gonna be the certificate, yeah. Yes, that, that's what I was gonna say. Yes, mhm.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] A certificate number?
[CUSTOMER][NEUTRAL] OK. 00996553.
[AGENT][NEUTRAL] Thank you. And Ms. [PII], for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And the [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the email address? I'm sorry.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][POSITIVE] OK, thank you. All right, and how may I assist you with the benefits?
[CUSTOMER][NEUTRAL] OK, so I'm trying to get in my policy to the benefit, I mean the amounts pay schedule of benefits. Let me get there. OK, so I think I've had this policy a very long time, but um I guess since I've been retired, I don't, I don't think I've applied for anything, but don't y'all cover like if you have a, a mammogram or something yearly a certain amount that you get reimbursed for that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, let, let me check on your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Yes, you have a um preventative benefit of $50 per year?
[CUSTOMER][NEUTRAL] OK, so, um,
[CUSTOMER][NEUTRAL] I had a mammogram in December, so I could, I could apply for that on that one, correct?
[AGENT][POSITIVE] Mm correct. Mhm.
[CUSTOMER][NEUTRAL] OK. Um, I, I guess I can't go back any further than that, huh, since I've missed, um, I missed it.
[AGENT][NEUTRAL] No, you can, you can. We don't have timely filing limits for the preventative. Um, so, um, so far I see that we have uh paid uh [PII], 2022, and [PII]. Um, let me see if I have one for [PII]. I don't have 1 2019.
[CUSTOMER][NEUTRAL] Oh, I wouldn't have those records, I guess. Yeah, I don't think I would have any anything. What would I need to show that I had that? What would?
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Do you have the doctor's information?
[CUSTOMER][NEUTRAL] Uh, the one who did it.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] So far back. Let me take a minute.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like if you look at the one for [PII], would it say the doctor on that one cause it would probably be the same doctor. I, I don't know if it would have been Doctor um [PII] back at that time that would have ordered it.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Would it be who ordered it or who did it? what facility did it?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Who performed uh the mammogram. Um, mhm, yes.
[CUSTOMER][NEUTRAL] Oh, who, OK, who performed? It would be um [PII] maybe or just [PII].
[AGENT][NEUTRAL] OK, let me
[AGENT][NEUTRAL] Let me check the information you sent for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Because, um, usually what's gonna happen is, um, that you need to send a claim for each one of them, um, because they're wellness claims, um, but yeah, the only thing that it's gonna ask you for is the information of the doctor and um what type of test was performed. So you don't need to send any documents. It's just the claim form that needs to be filled out with the date that you had the, the procedure done.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh the information of the doctor. Um, so let me check here and see what you said on this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and if you can call the doctor and see if he um if he has anything for [PII], [PII], [PII], those three days, I'm sorry, those three years, it looks like they're not here. So if you can find out who did the test for those three years and send it in in the claims, then we can go ahead and consider those. um.
[CUSTOMER][NEUTRAL] OK, OK, now where do I get the claim format?
[AGENT][NEUTRAL] OK. The claim form is in our website at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I can look that up.
[AGENT][NEUTRAL] Uh, you know, OK, so yeah, uh, it looks like the, the provider that you've listed on this one was [PII].
[CUSTOMER][NEUTRAL] Oh, OK, back then that was her, OK.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Mhm. So I don't know if you want to check with her to see an 18, yes, yes.
[CUSTOMER][NEUTRAL] That was in 18
[CUSTOMER][NEUTRAL] That was it.
[CUSTOMER][NEUTRAL] OK. And so when you say it asks for the information, it's gonna be the date of the, of the mammogram and that her information is the doctor.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm. And your signature.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] And that should be it.
[AGENT][NEUTRAL] Yeah, that's all we need.
[CUSTOMER][NEUTRAL] Wow, OK, OK, um, and then let's go back to my schedule of benefits then so that's for one yearly, um, wellness or whatever that what is, OK, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Next evening.
[CUSTOMER][NEUTRAL] So here's my situation. In December, I had a mammogram, and they called me back for additional testing because I saw something. And I had that done uh a week or two ago. Does that, would that second round of testing on this be covered with anything that I have here?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, the follow-up test is covered up $100 and that's one time per calendar year. Um, so yes, um, if they did a follow-up test, um, you can submit that information and we can go ahead and um reimburse for that $100 that you have. Mhm. I see the last time you did the follow-up test was, um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Back in [PII], so you have not requested that one for last year. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And so here's my next question. So I did the follow-up test a couple of weeks ago, and now I have to have a breast biopsy done. So does a biopsy fall under any of this?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Biopsy is usually under surgery.
[CUSTOMER][NEUTRAL] Under surgical benefits, OK.
[AGENT][POSITIVE] Yeah, surgical benefits, correct.
[CUSTOMER][NEUTRAL] So looking down at my benefit amount for that, it says $1 amount a maximum.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Unit dollar amount. I won't have anesthesia, it's gonna be local. So under that surgical, it says unit dollar amount $30 maximum per operation, $3000. So what would I expect if I submit my paperwork for that? Would it be just $30 for a biopsy? Is that what it's saying?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't think that's the unit that they're gonna use or they're gonna perform and uh let me go ahead and go over this, and this is not a guarantee of payment, just a verification of coverage. Um, yeah, the $30 per unit basically is uh is for how big is the, I'm sorry, how big is the surgery, um, and what type of surgery. So, um, it could be up to $3000. Um, we don't know exactly how much they're gonna charge for the surgery, so it could be up to 3000.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] Any range from 30 to 3000, so we're not really sure until we see the paperwork and see exactly what they did and what they charged for.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so for that then if I, if I submit a claim for that, it would it be, I mean like on the others I have to do the date and the doctor, but on this one do I submit more for this so y'all could make that determination? What would I actually submit for this one once I have it done?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so this one is another form that is gonna be the cancer claim form. Um, it's not gonna be the wellness, it's gonna be the cancer claim form. And with the cancer claim form, we need an itemized bill. So we're gonna need the itemized bill and it's a pathology report, so we're gonna need the report, the copy of the report.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] OK, I understand.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let's see, would there be anything else? OK. And then once from that, if, if, if it's positive for cancer and I have to have treatments for that, then that would fall then under, um,
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] I guess, well, not patient care, let's see.
[CUSTOMER][NEUTRAL] of cancer treatment under miscellaneous benefits, I guess. Oh, it says not included.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm, where, where are you seeing that?
[AGENT][NEUTRAL] Are you in the
[CUSTOMER][NEUTRAL] I was looking on my schedule of benefits.
[AGENT][NEUTRAL] OK. Um, no, the pathology again is gonna be under the surgical benefit. It it's, it's just gonna pay under the surgical benefit.
[CUSTOMER][NEUTRAL] Oh, I see. So if I have to have, you're saying if I have to have any treatments after this, then that's where it would fall under?
[AGENT][NEUTRAL] Oh, what type of treatment? Because there's, there's a lot of treatment. What type of treatment you think they probably will put you on there?
[CUSTOMER][NEUTRAL] Oh, I see. Oh, I see there's a cancer treatment benefit with radiation, chemo, and that's where it would fall. OK. I, I understand.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, yeah. It depends on the treatment, but yeah, if they put you in the radiation therapy, chemotherapy, or mania therapy, you have the $20,000 per year or if they put you on a hormone therapy, that's $50 per month up to 12 months, which is a year. Mhm.
[CUSTOMER][NEUTRAL] I got you, OK.
[CUSTOMER][POSITIVE] OK. OK, well, thank you, um, very much. I, I'll see what I can do in finding this information on the mammogram, so I appreciate it. Thank you.
[AGENT][NEUTRAL] Mm. You're welcome, Ms. [PII]. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, I don't think so.
[AGENT][POSITIVE] OK. All right. Well, thank you for calling APL. Have a good day. Thank you. Bye-bye. You're welcome.
[CUSTOMER][NEUTRAL] Mm bye-bye.
[CUSTOMER][POSITIVE] Thank you.