AccountId: 011433970860
ContactId: c1547da2-1de0-4ad9-9365-60ee954e52f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542130 ms
Total Talk Time (AGENT): 223592 ms
Total Talk Time (CUSTOMER): 184619 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/c1547da2-1de0-4ad9-9365-60ee954e52f5_20250102T14:24_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thanks for calling A. It's [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. How are you?
[AGENT][NEUTRAL] I'm doing OK, and yourself?
[CUSTOMER][NEUTRAL] Good. Um, I have an insured on the phone. His name is [PII].
[CUSTOMER][NEUTRAL] And his policy number is 252.
[CUSTOMER][NEUTRAL] 856 1.
[CUSTOMER][NEUTRAL] Um, he was diagnosed with prostate cancer and they're giving him the hormone therapy. Um, I called Cancer earlier. The hormone that they're giving him is not covered, as I was told by a rep.
[CUSTOMER][NEUTRAL] And um I wanted to transfer him over so that maybe we, you all can whatever the list is that you guys look at tell him which hormone therapy drugs are covered.
[AGENT][NEUTRAL] That's a long list. I mean, I don't, I mean, I, I mean, I don't sound good. I mean telling me that. We have a, it's a couple of pages so I can't tell which one but I try to as much as I can.
[CUSTOMER][NEUTRAL] OK. Well, can you, can you double check, can you double check this one?
[AGENT][NEUTRAL] Yes, give me one second. Let me bring up the list, uh.
[AGENT][NEUTRAL] OK, what's the name?
[CUSTOMER][NEUTRAL] It's uh I'll spell it, [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And then I, I would like to transfer him to perhaps help him out know what what some of them, not necessarily all of them, that could be.
[CUSTOMER][NEUTRAL] Um, give him some names.
[AGENT][NEUTRAL] OK, so no, it's not a, it's not a covered, correct.
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] OK. So can you give him um some a few names of the, the drug that is, the hor hormone therapy drug that is?
[AGENT][NEUTRAL] Well, I can probably ask them what other ones that the doctor may be prescribing cause if I give him some, it might not be ones that the doctor can treat him for his um prostate cancer. What's his callback number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, you can go ahead and send them through.
[CUSTOMER][POSITIVE] OK, thank you [PII], here he comes.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Good morning. Thanks for calling [PII] [PII]. Am I speaking with Mr. [PII]?
[CUSTOMER][NEUTRAL] This is he.
[AGENT][NEUTRAL] OK, the rep stated that you had a question about um some hormone therapy.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm wondering why our Govix is not on the list or is not considered even though it's what my doctor prescribed.
[AGENT][NEUTRAL] So, we have a list of like all our um chemotherapy drugs, and that particular one is just doesn't fall up under um a hormone therapy um covered drug that's covered on the policy, on, on our policies. So, I mean, if you excuse me, if your doctor can give you um examples of other ones that he can probably treat you with, we can let you know if those covered, but
[AGENT][NEUTRAL] I can't just tell you which ones are covered because we have so many of them.
[CUSTOMER][NEUTRAL] But you so me, but that one you don't have.
[AGENT][NEUTRAL] Yeah, cause we have a list and like I said, that particular drug is not.
[AGENT][NEUTRAL] It's not covered under hormone therapy.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Mm mm mm.
[CUSTOMER][NEGATIVE] It's, it's gonna seem like y'all find more loopholes not to cover something than it does to cover something, just like with radiation. There's only one radiation machine you go to, but y'all argue about what type of radiation is on the damn out my field.
[AGENT][NEUTRAL] So when it comes to radiation, let me see um if you have submitted some other ones and I can just.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] I submitted the 11th 12.
[CUSTOMER][NEUTRAL] The 12, 13th, 14th, 15th, I think.
[CUSTOMER][NEGATIVE] And then had to have a different receipt, different itemized receipt for both of them.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] So that one, so when you're submitting.
[AGENT][NEUTRAL] To get paid for services, we have to have an itemized bill and the reason being is because let me pull it up and see what you actually submitted in, give me one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 353 9.
[AGENT][NEUTRAL] So yeah, so what you said, we, what you submitted was an EOB and the reason why we have to have the itemized bill is because we have to know what kind of radiation you're getting done. Um, so it's not saying that it's not covered. It's just we have to have the procedure codes, um, and that's basically for any type of claim that we receive, whether it be cancer or any of our other policies. We have to have the procedure code to see what type of service they're being done.
[CUSTOMER][NEUTRAL] Do, do you, do you see the person?
[CUSTOMER][NEUTRAL] Do you see the 3 pending?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Do I see it's pending?
[CUSTOMER][NEUTRAL] Yeah, do you see 3 of them that are pending?
[AGENT][NEUTRAL] So yes, I do show that we received some claims on [PII] um and we just haven't started, we just haven't processed those yet.
[CUSTOMER][NEUTRAL] Yeah, so I had the first one I first I.
[AGENT][NEUTRAL] Those should be processed um in the next few days.
[CUSTOMER][NEUTRAL] You probably couldn't open the seat.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] And you probably can oh I said when I sent the first one it was I guess had a code to it you can't open it. So now I sent one in um it was a wrong receipt.
[CUSTOMER][NEUTRAL] So I had to go to the business department to get a different receipt so I'm hoping the last two that I sent in will be OK because them are the newest receipts with different codes on them.
[AGENT][NEUTRAL] OK, let me see if I can take a look at um what you sent in and and see if they provided code for that date on here.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] And it actually, it should be processed today because it's in one of the examiner's queues already, uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so hopefully, we should know, but like I said, it just
[CUSTOMER][NEGATIVE] It's very frustrating.
[AGENT][NEUTRAL] Yeah, I understand. Like there was just, I mean, um, just going from we have to have, like I said, the procedure codes, um, the item must be with that to be able to determine what type of therapy um that you have done.
[CUSTOMER][NEGATIVE] Yeah, but they keep sending the thing back saying that they keep sending the thing back saying well we already, we this one already been processed. Yeah, but it was processed with the wrong receipt, the wrong out of my receipt, so I'm sending a new out of my receipt with the same the same same charges.
[CUSTOMER][NEGATIVE] It's a different item of my receipt. It's not the same out of my receipt I'm sending over and over and over.
[AGENT][NEUTRAL] Yeah, I understand. Um, so like I said, I'm looking on here, it shows up, like I said, the, the claim is actually in one of the examiner's queues, um, so she should be able to get that processed. Uh, let me see, hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, she should be able to get that process like say either I mean within the next few few days because she already has them um to work on. So I mean if you wanna give us a call back by um probably by Monday or if you have access to the online portal you can keep track of it on there as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright then, so, but, but you're saying my or God or God or govi is not covered under hormone therapy.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] No problem, Mr. [PII]. Was there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, I'll be calling back as usual.
[AGENT][POSITIVE] Alright, no problem. Well thanks for calling April. You have a wonderful day.
[CUSTOMER][NEUTRAL] Alright.