AccountId: 011433970860
ContactId: c7e37d6e-c354-49b0-b3e0-d57a75e66636
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 774869 ms
Total Talk Time (AGENT): 317419 ms
Total Talk Time (CUSTOMER): 470362 ms
Interruptions: 18
Overall Sentiment: AGENT=2.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/c7e37d6e-c354-49b0-b3e0-d57a75e66636_20250205T19:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, yes, I was calling to ask questions about my cancer policy.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with your cancer policy today. And do you have that policy number handy?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes 1300961.
[AGENT][POSITIVE] Perfect, give me 1 2nd to get that pulled up for you.
[CUSTOMER][NEUTRAL] This is doing enough.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] sure about a lot of things, and I'm sure she's wrong about most of them.
[CUSTOMER][NEUTRAL] not here to have a drink.
[CUSTOMER][NEUTRAL] Get on the barge hit on the bartender. No, I'm not here to hit on the bartender.
[AGENT][POSITIVE] Perfect. And can I have your first and last name please and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you so much, Ms. [PII], and I'm gonna verify some additional information with you real quick. Um, if you could verify with me please, your mailing address on file.
[CUSTOMER][NEUTRAL] No, every time I talk about this.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty and then lastly would just be the email and phone number on file if you could go through those with me.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] Perfect, is that a good number to call you back at, Ms. [PII], if we were to get disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Thank you so much. And all right, let me pull up your policy documents and then we can go over those together. Is there any particular questions you have that I could look into first?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] That so that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I just wanted to see when I can send EOBs in for pharmacy and uh imaging.
[AGENT][NEUTRAL] OK perfect so you're wondering when you can send in those EOBs?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, yeah, so you can send in those EOBs at any time. Do you have our online service center to upload those?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK perfect yeah so at any time you can upload those documents right into our online service center um.
[CUSTOMER][NEUTRAL] In a 3.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Let me see, do you have a copy of our cancer claim form on file that goes over the documentation we need when filing a claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] something.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK perfect yeah so it doesn't matter how it comes in you don't have to submit them all together um but we would eventually just need those documents that are listed on that first page and we'll be able to process anything from there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, I think, uh, unless something changed, uh, has it changed, uh, since last year? OK, um, I know it's like sometime in February is when my claim started over. That's, I guess that that was the question that I needed to ask.
[AGENT][NEUTRAL] No, it has not.
[AGENT][NEUTRAL] Oh, OK, so let me take a look. Um, some of your benefits are, um, based on the calendar year, but your benefits for radiation, chemotherapy, and immunotherapy are on a 12 month cycle, so they start from when you first received them, and let me see if I can find the date you first started those claims.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you that it was um.
[AGENT][NEUTRAL] So it looks like [PII] was the first one we um did oh that was a hormone benefit. I'm not sure if it falls under.
[CUSTOMER][NEUTRAL] one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is that you teach.
[AGENT][NEUTRAL] That same one, let me look for chemo.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I, I, um.
[AGENT][NEUTRAL] OK, it looks
[AGENT][NEUTRAL] [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Um, um, yeah, I apologize for interrupting. I, I did chemo I did intravenous and [PII], and then I've been doing, um, PO by mouth, um, since then, [PII] and [PII] and now [PII]. So I didn't know if the um if the year date changed.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't believe it did because it looks like it's following from [PII] as well, so it looks like it's still the same.
[CUSTOMER][NEUTRAL] Oh really.
[CUSTOMER][NEUTRAL] OK, OK, so you said it was around the [PII] something.
[AGENT][NEUTRAL] The [PII] is what I'm seeing, but I do.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] I really want to double check that.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] To helping cats feel at home with trust and nutrition. No wonder it's the number one dry cat food in [PII]. Come home to catch out.
[AGENT][NEUTRAL] Alright, I wish I could see these benefits different than opening them up individually, but bear with me because I'll go through them with you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, that's your.
[CUSTOMER][NEUTRAL] It's fine.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Get yourself.
[AGENT][NEUTRAL] Um
[CUSTOMER][POSITIVE] You can program helps.
[AGENT][POSITIVE] All right, do you mind, I actually, I'd love to check something real quick. Do you mind if I put you just on a brief hold?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, perfect. Just one moment, please.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling American Public Life. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] with the care team. How are you doing today?
[CUSTOMER][POSITIVE] I'm just fine, thank you.
[AGENT][POSITIVE] Good, I'm glad to hear that. Hey, I have a quick question about a cancer policy. Um, if you could help me out with that?
[CUSTOMER][NEUTRAL] I sure can. Do you have a, a policy number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, policy number is 1300961.
[CUSTOMER][NEUTRAL] I'm sorry, what was that number again?
[AGENT][NEUTRAL] Oh, I'm so sorry, 1300961.
[CUSTOMER][NEUTRAL] OK, give me one minute and let me look that up for you.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me get that policy pulled up.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, I have it pulled up and what is your question?
[AGENT][NEUTRAL] Um, as far as her chemo benefits, it restarts not on the calendar year but from the cycle date of when it was first started, um, and I was wondering, I, I'm wondering, besides going through every single claim and looking for the first one because I've been doing that for a little bit now and I'm not getting anywhere, um, is there a quicker way to see when that started last year so she knows when it resets for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh yes. OK. When you go to CLA HQ.
[AGENT][NEUTRAL] See, oh my gosh, I use that with dental all the time, but I never use it for any of the other policies.
[CUSTOMER][POSITIVE] Yeah, you can use it for this here.
[CUSTOMER][NEUTRAL] And one way you can go, you find it under CLAHQ and you would, now it's chemo, radiation and immunotherapy. So it's all three of those combined. They're not gonna be separate.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Does it, is it all under the benefit name chemo 12M? Is it like the benefit?
[CUSTOMER][NEUTRAL] No, some of them would be um it could be under radiation or it could be under chemo. So the easiest way for you to do.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] is you can either go through all of them and see if there's any other radiation benefits paid out because the policy will pay uh a maximum amount per um period of with the, uh, which is radiation chemo immuntherapy benefit.
[CUSTOMER][NEUTRAL] You know, they're not gonna be separate benefits. So if they had radiation, that benefit is going to be called a uh I think it's R A D I A T and we have a number underneath it. So that's one way you can look, but you'll have to go through every one of them see if they had chemo radiation. Um but another way you can do is, you see where they had that last chemo benefit page.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, which on which one are you on the CLAHQ again?
[CUSTOMER][NEUTRAL] 2 C L A H Q.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then that policy number.
[AGENT][NEUTRAL] So I can see that last one from 171824.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you see, um, they're on that first page.
[CUSTOMER][NEUTRAL] You have a data service [PII] and you have chemo 12M.
[CUSTOMER][NEUTRAL] Take that, go to, and then go to your other screen, another line, type in EOBI.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, EOB and Type in E O B NT in the action field.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And take that claim number where that last chemo benefit either was denied or paid.
[AGENT][POSITIVE] Oh my gosh, and it's right in the notes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, it's supposed to be, not always, so you might wanna go look at the one, you know, there, you know, there may be another claim number that Akima was, but they're supposed to put under EOBNT to let the insured know that benefit period.
[AGENT][POSITIVE] OK, thank you. That helped me so, so much because I was literally opening every claim on the Amtrak and hitting all the lines and trying to check all the dates and I was like there's gotta be a faster right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] And you always, I use that CLA HQ a lot and then you could find the claim number and then go to your you know EOBOI pull the claim number or whatever, you know, that real this CLA HQ really helps a lot. But now on this one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it will start over on [PII], I mean [PII].
[AGENT][POSITIVE] OK, perfect. So I will let her know because she wants to know when it restarts and um perfect. I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] I see that here and I really appreciate it. I that's gonna save me so much time in my whole future.
[CUSTOMER][POSITIVE] Oh, my pleasure.
[CUSTOMER][POSITIVE] Yes, it does.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Glad you called in it.
[AGENT][POSITIVE] Me too, it was getting really gruesome, so thank you so much.
[CUSTOMER][NEUTRAL] Yeah, but it was, I know.
[CUSTOMER][NEUTRAL] Anything else I can help you with, [PII]?
[AGENT][POSITIVE] No, that's all I need today. Thank you so much. You're a lifesaver.
[CUSTOMER][POSITIVE] OK. You're welcome, [PII]. Thank you. You have a good day. Goodbye.
[AGENT][POSITIVE] Take care.
[AGENT][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Provide the right way to important users.
[AGENT][NEUTRAL] Hi ma'am, are you still there with me?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Thank you so much for your patience, Ms. [PII]. Um, so there was a way faster way for me to do that and I just had to learn what it was. I'm so sorry, but I do see here that your benefit period is from [PII]. So your benefits will restart [PII].
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] That's perfect.
[CUSTOMER][NEUTRAL] Oh, OK, OK, wonderful, and um they're gonna try some um in some kind of injections because the chemo left me where I can't walk, um.
[CUSTOMER][NEUTRAL] Without a walker and they're gonna try some injections so I don't know what injections are are if any injections is covered under that policy.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] So I don't see them as as far as injections go being listed as a limitation in your policy. So there's no mention of it in the policy document. I highly recommend going ahead and submitting a claim to see um to see if it is covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] It took.
[CUSTOMER][NEUTRAL] What it is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and um I guess that's it then.
[CUSTOMER][NEUTRAL] That
[AGENT][POSITIVE] Alright, well, Ms. [PII], if you think of anything else at all, don't hesitate to reach out. We're all here to do our best to take care of you.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][POSITIVE] OK, thank you so much. You have a good day.
[AGENT][POSITIVE] My pleasure. Thank you. You take care.
[CUSTOMER][NEUTRAL] Um, bye-bye.
[AGENT][NEUTRAL] Bye bye.