AccountId: 011433970860
ContactId: b74323cc-c599-4110-9948-19d11cb605ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347149 ms
Total Talk Time (AGENT): 146086 ms
Total Talk Time (CUSTOMER): 133870 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/b74323cc-c599-4110-9948-19d11cb605ce_20250113T18:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling Apo. It's [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey this is [PII] with the care team. How you doing today?
[AGENT][NEUTRAL] I'm doing OK, and yourself?
[CUSTOMER][POSITIVE] Hey, I'm doing wonderful. Um, I just had a gentleman on the line with a question about like what information he needs to submit um for his cancer hormone therapy treatment.
[AGENT][NEUTRAL] OK, um, what's his callback number?
[CUSTOMER][NEUTRAL] Um, yes, his callback number is [PII].
[AGENT][NEUTRAL] His policy number?
[CUSTOMER][NEUTRAL] Uh, his policy number, I'm so sorry. Let me go back. I'm in the claim response, um.
[CUSTOMER][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] I should have been ready. It is 252-856-1.
[AGENT][NEUTRAL] For uh [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, you can go ahead and send them through.
[CUSTOMER][NEUTRAL] OK perfect he just has a question I think more concerning the itemized billing um if it's able to come from his pharmacy, but I will introduce you and you said your name was [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK perfect I'll introduce you when we join, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi [PII], are you still there?
[CUSTOMER][POSITIVE] Yes I'm still here. Hey, I really appreciate your patience so I actually have a Miss [PII] on the line and she is going to take the call over she does um handle those cancer policy and claims and so she's gonna be able to provide you with a little more detailed information on what we would need from you, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hi, Mr. [PII], this is [PII] in the claims department. Um, the rep stated you had a question about um what you would need to send in for your, um, for a claim.
[CUSTOMER][NEUTRAL] Hormone, yeah, for hormone therapy, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The hormone therapy is just appeal.
[AGENT][NEUTRAL] OK, so, um, let me see, hold on one second, uh.
[AGENT][NEUTRAL] Give me 1 2nd, I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, do you know the um name of the hormone pill that you're taking, are gonna be taking?
[CUSTOMER][NEUTRAL] Yes, hold on one second. Let me get you divorce so I can fill it out for you because I, I can't say out of me. OK, it is.
[AGENT][NEUTRAL] OK, I just wanna make sure it's a covered one on your policy, so that's what.
[CUSTOMER][NEUTRAL] Uh, so my doctor prescribe, uh, OK. My doctor prescribed it should be covered no matter what.
[CUSTOMER][NEUTRAL] But anyway.
[AGENT][NEUTRAL] Um, not necessarily because we have a listing of what the, trying to think of the word that, um, the policy covers is based on the, not based on us, but we have a listing that is approved by.
[AGENT][NEUTRAL] I'm sorry, I can't think of the, the name, so we have to go up off of the list.
[CUSTOMER][NEUTRAL] OK, you ready? It's gonna be ORG.
[CUSTOMER][NEUTRAL] O V
[CUSTOMER][NEUTRAL] Y X
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK, yes, so I'm looking in the notes. I think I remember speaking with you back on the [PII], um, and that particular one is not covered on the policy.
[CUSTOMER][NEUTRAL] OK, so what do I tell my, OK, what can I tell my doctor to get it covered in?
[CUSTOMER][NEGATIVE] Switch to another one and then we, we go, go rushing roulette hope that's not covered or can you tell me something I need to be taken.
[AGENT][NEUTRAL] So, um, we have, so, I mean, if you want, I mean, um, so what we do, I mean, we would have to like have like an itemized bill from, to show the procedure codes. But as far as to find out which one is covered, I mean, you can get, I mean, another name from your doctor to find out if there's another one that he can put you on, um, and we can go from there to see because we have a long list of which ones are covered, so I can't just go down the list to let you know.
[AGENT][NEUTRAL] Which ones are covered because there's so many of them.
[CUSTOMER][POSITIVE] Yeah, wow.
[CUSTOMER][POSITIVE] And I guarantee, I guarantee I can go get 10 of them. I guarantee none of them 10 gonna be on that list.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] Like I said, I mean, it's not a listen, this is something that the that's approved by the um.
[AGENT][NEUTRAL] Hold on one second. I'm sorry, I'm still trying to think of the name. It's, it's not our, but it's approved by the, like the, the, the cancer um that we can cover. So it's not just our approval. Like there's a list in the ones that the policies cover and like I said, that particular one is just not on the list.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Wow. OK.
[CUSTOMER][NEUTRAL] OK, and it, and it pays like I guess $50 a month for each prescription, I guess more or less.
[AGENT][NEUTRAL] Uh, let me see what the amount is.
[CUSTOMER][NEUTRAL] And how would I get an itemized bill for?
[AGENT][NEUTRAL] So it, it pays, so it pays um up to 50 per treatment.
[AGENT][NEUTRAL] Up to a maximum of 12 per calendar year.
[CUSTOMER][NEUTRAL] Yeah, so how would I get a out of my bill of that?
[AGENT][NEUTRAL] So, like when you go to the pharmacy, they're able to give you um like the name of the drug.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, ma'am, ma'am, this is my, this is my doctor call. Let me call you back, OK?
[AGENT][POSITIVE] All right, no problem. All right, you have a great day and thanks for calling APL.
[CUSTOMER][NEUTRAL] It's my doctor.