AccountId: 011433970860
ContactId: c1024463-f1b7-4fcf-84da-43c996f0bd40
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576590 ms
Total Talk Time (AGENT): 189101 ms
Total Talk Time (CUSTOMER): 330612 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/c1024463-f1b7-4fcf-84da-43c996f0bd40_20250123T23:57_UTC.wav
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[AGENT][NEUTRAL] APL this is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hey, [PII], I've got an insured on the back line that has a cancer policy, and she's wanting to know if she has any chemo benefits for her plan.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And if so, how to file um it's 258.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 12.
[CUSTOMER][NEUTRAL] 25 [PII] and just to give you a heads up, she's on an annual draft and it is scheduled to draft this next Friday, so she is active. She's just paid to 11 because there was a mishap with her account information but she is good to go. She's scheduled to to pay for a full year next week.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And she's been verified. Here she goes. Thank you.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Thank you. Mhm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh hello.
[AGENT][NEUTRAL] [PII]? Hi, this is [PII] in the claims department and you're calling to see if you have benefits for chemotherapy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh huh, I, I was told I do have it, but I wanted to see what does it consist of as as proof.
[AGENT][NEUTRAL] You wanna know what do you need to submit to us to file for chemotherapy?
[CUSTOMER][POSITIVE] Uh huh yes ma'am.
[AGENT][NEUTRAL] All right. You would need an itemized bill.
[CUSTOMER][NEUTRAL] OK, and what is the chemotherapy, uh,
[CUSTOMER][NEUTRAL] Because, um, I don't know, I don't know much about it. He just got diagnosed. It's gonna be 2 years and I don't know, um.
[CUSTOMER][NEUTRAL] What is consistent.
[CUSTOMER][NEUTRAL] That that's part of it.
[AGENT][NEUTRAL] So he had, so he has not taken chemo. They're just talking about starting him with chemo. I, I'm kinda confused.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, OK, he, OK, um.
[CUSTOMER][NEUTRAL] OK, he, he didn't have chemother any kind of, I don't, he didn't have any kind of chemo. He only had radiation. So, uh, so chemo is just chemo, right? It's not with radiation?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The benefit, so you can either do chemo, radiation, or immunotherapy for the benefit. If you would like to file a claim for any of those three things, chemo, radiation, or immunotherapy, you would need to submit to us an itemized billing. The itemized billing you would get from the billing department, from the hospital or clinic that radiation was taken.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You will also need to submit to us an explanation of benefits, and that would be from your primary carrier.
[AGENT][NEUTRAL] Um, online at [PII] on the claim form, it does tell you the information that we would need. So if you would go to [PII], go to the cancer claim form, it does list the documents that we would need for you to file for that particular benefit for any of our benefits under the cancer policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, OK, that's what I wanted to make sure what was, um, if the chemo.
[CUSTOMER][NEUTRAL] And radiation.
[CUSTOMER][NEUTRAL] Therapy, uh, is.
[CUSTOMER][NEUTRAL] You know, are they the same process for a claim?
[AGENT][NEUTRAL] Yes. You would, you would need to, for, for that, that benefit is, is called chemo radiation and immunotherapy. So, whether it's chemo radiation or immunotherapy, it will be paid under that benefit and that documents that we need are, would be the same for either one of those um type of um drugs. So,
[CUSTOMER][NEUTRAL] But it's uh.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Clean.
[AGENT][NEUTRAL] Yes, so you would need to submit the itemized billing from the hospital or clinic and the explanation of benefits from your primary care insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, [PII], is there anything else I can go over on your policy?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and what is needed from the primary since he had a radiation doctor, um,
[CUSTOMER][NEUTRAL] Doing
[CUSTOMER][NEUTRAL] You know, the radiation and uh you're talking about the oncologist or his primary.
[CUSTOMER][NEUTRAL] Medical doctor.
[AGENT][NEUTRAL] Wherever he had the radiation done that, you will contact the billing department and ask for an itemized bill.
[CUSTOMER][NEUTRAL] OK. Yeah, because he has separated, you know, I, I mean, uh, separated medical oncologist, doctor, and he had a radiation doctor separated. They weren't the same person doing the same thing.
[CUSTOMER][NEUTRAL] So that's why I wasn't sure who I needed to get it from.
[CUSTOMER][NEUTRAL] Uh, but it's from the radiation doctor then.
[CUSTOMER][NEUTRAL] The one that gave him the radiation treatments, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright then, OK, because that's what I need to make sure. All right then, and uh and that's on like every year?
[CUSTOMER][NEUTRAL] Of uh
[CUSTOMER][NEUTRAL] Of the claim to submit like he he was he started it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Back in [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Of February. Is it still good enough because it's almost coming to February, uh,
[CUSTOMER][NEUTRAL] Being a 2 years in.
[CUSTOMER][NEUTRAL] This year.
[CUSTOMER][NEUTRAL] He got those treatments back in [PII].
[CUSTOMER][NEUTRAL] So is it still gonna be eligible to make a claim if it's almost to the 2 years?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and do I make the claim under the [PII] uh year?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Does it go on the current?
[CUSTOMER][NEUTRAL] Like it happened in [PII]. It doesn't matter which claim form date.
[CUSTOMER][NEUTRAL] Like each policy term, there's a policy term, right? For 23 to 20 for the whole year [PII].
[AGENT][NEUTRAL] You, you, you will need to submit this claim on policy number 229.
[AGENT][NEUTRAL] 2819.
[CUSTOMER][NEUTRAL] Yeah, the one that, yeah, my old one, uh-huh, um, let me get that 1, 2292819 because that's the one when it happened. OK, but do I do it on the year like [PII] is when he had this.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Radiation.
[AGENT][NEUTRAL] What you would do is you would submit those documents and we will review it and then we will let you know what the benefit here is.
[CUSTOMER][NEUTRAL] Oh, I see. OK. So I don't have to worry that it has to be under the policy term of [PII] or [PII]. As long as I submit the paperwork with the claim form, y'all determine where it's going to.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Reclaimed for what year? OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And will that be in my information when y'all figured that out so that way I understand it more how the claims are done on the year it happened or
[AGENT][NEUTRAL] When it's processed, it would, when it's processed, it would give you a benefit year. It is not a year to year, it's a benefit year. So the benefit year is say for instance, is a $10,000 radiation amount. The benefit year would run from [PII]. That is a benefit year. It does not go by calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's a benefit year.
[AGENT][NEUTRAL] So once the claim is, once the claim is processed, then we will let you know what the benefit here is.
[CUSTOMER][NEUTRAL] OK, it's not a calendar and I was thinking it was a calendar that's what I was saying it's from [PII] or it's gonna go from [PII]. That's what I was wondering how it falls, but it's not.
[CUSTOMER][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] It's benefit here, you said, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm writing in my notes.
[CUSTOMER][NEUTRAL] When it's reviewed and determined which year.
[CUSTOMER][NEUTRAL] Review and determine.
[CUSTOMER][NEUTRAL] OK, thank you. And what was your name? I'm sorry?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] [PII]. OK, thank you [PII]. I appreciate it.
[AGENT][POSITIVE] You're so welcome. Thank you so much, [PII], for calling APL and you have a great day. Bye-bye.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] You too thank you bye bye.