AccountId: 011433970860
ContactId: f661a5a5-7a48-4724-a535-e8a87fd8d4ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1013669 ms
Total Talk Time (AGENT): 437793 ms
Total Talk Time (CUSTOMER): 314781 ms
Interruptions: 6
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/f661a5a5-7a48-4724-a535-e8a87fd8d4ad_20250102T14:10_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII]. What is considered hormone therapy?
[CUSTOMER][NEUTRAL] so.
[AGENT][NEUTRAL] First, do you have a policy with us, [PII]? If you do, what's the policy number?
[CUSTOMER][NEUTRAL] I don't have it offhand. How can we get it.
[AGENT][NEUTRAL] What's your social?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, could you repeat that a little slower, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I thought we just verifying information.
[AGENT][NEUTRAL] Yeah, I have to verify you.
[AGENT][NEUTRAL] Before we can proceed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], what kind of policy do you have? Is it a cancer policy?
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] They.
[CUSTOMER][NEUTRAL] and you
[CUSTOMER][NEUTRAL] Your
[CUSTOMER][NEUTRAL] But they all have one thing.
[AGENT][NEUTRAL] And [PII], what's your date of birth and your complete mailing address, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] At the
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And you were asking what is hormone therapy?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And what, what is it being taken for, the therapy?
[AGENT][NEUTRAL] Have you been diagnosed?
[CUSTOMER][NEUTRAL] Cancer of prostate.
[CUSTOMER][NEUTRAL] Yeah, prostate cancer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm trying to figure out how to file a claim different from my radiation, so I don't, I, I think the hormone therapy take a pill.
[AGENT][NEUTRAL] Yeah, that's a question for your oncologist. Um, I think there's different types of, you know, injection or maybe pill, but the definition in your policy, it says it's the use of manipulation of hormones, uh, natural or synthetic to prevent growth of malignancy.
[CUSTOMER][NEUTRAL] OK, now how do I file a claim on that?
[AGENT][NEUTRAL] So, so this will be.
[AGENT][NEUTRAL] So if you're gonna send a claim in yourself, uh, we require the American Public Life Cancer claim form.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, we'll need the pathology report first diagnosing the cancer.
[AGENT][NEUTRAL] And then the itemized bill for, for any treatment that you may have or surgeries that you may have.
[CUSTOMER][NEUTRAL] Mhm, right.
[CUSTOMER][NEUTRAL] OK, I understand that, but, OK, ma'am, I'm seeing that, uh, OK, I'm sending it, uh, OK, I'm already doing that for like the radiation. So how do I make it from the, the hormone therapy?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So how, what was the second part of the question?
[CUSTOMER][NEUTRAL] How do I get that
[CUSTOMER][NEUTRAL] I said I already sent, I'm already sending it in for the radiation therapy is that what you just said. So, but how does the hormone therapy fit in there?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so is it a prescription that they're giving you or is it like an injection?
[CUSTOMER][NEUTRAL] Prescription.
[AGENT][NEUTRAL] Give me one moment. I'm looking at your policy and see, uh, you may have to send in the, when you get your prescription filled, there is an itemization that they can give you. It'll usually say how many pills are prescribed for a certain period of time, that's usually on there as well.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I have that. I have.
[AGENT][NEUTRAL] The name of the
[AGENT][NEUTRAL] OK, send that in.
[CUSTOMER][NEUTRAL] OK, now what about the itemized bill for that there's no itemized bill for that.
[AGENT][NEUTRAL] Yeah, so it's just the, the, when you get a prescription, they give you like a, they can actually do a printout for you and it'll have the information.
[CUSTOMER][NEUTRAL] Mm, I haven't.
[AGENT][NEUTRAL] That I just stated, the type of drug. It'll give you the name of the drug. If it's 3090, the count of the drug, the charge, the date it was prescribed or dispensed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The name of the pharmacy?
[CUSTOMER][NEUTRAL] OK, so do I send them in individually or do I send them in the group?
[AGENT][NEUTRAL] So, so they can provide that printout to you.
[CUSTOMER][NEUTRAL] Do I need to send them in in the group or send them in individually cause I got one like 9, 10, 1.
[AGENT][NEUTRAL] It's up to you. Yeah, it's up to you. You can submit them however you choose.
[CUSTOMER][NEUTRAL] OK, if I pay, uh, like only $10 for a one and receive $10 back?
[AGENT][NEUTRAL] Let me look at your hormone therapy benefit and give me one moment, let me read the hormone therapy part of your policy as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm reading the hormone therapy definition in your policy and it says that we'll pay the indemnity amount shown on the schedule of benefits, and I'll get that information, uh, per calendar year when the covered person receives hormone therapy treatment prescribed by a physician, this benefit is payable for treatment subject to the maximum number of treatments shown on the schedule of benefits. This benefit covers the drugs and medicines onl[PII]
[AGENT][NEUTRAL] It does not include um associated administrative processes. This benefit does not include any anti-nausea or pain medications or administration thereof of any drug or medication covered under the radiation therapy, chemotherapy, or MDL therapy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I wanted to read that. Give me 1 2nd.
[AGENT][NEUTRAL] Hormone therapy for treatment up to a maximum of 12 treatments per covered person per calendar year. Um, I'm gonna place you on a brief hold. It's $50 per treatment, up to 12 treatments per covered person per calendar year. And I need to verify if the treatment is, is a pill form or is it an injection. What's all covered under that. Give me a brief moment, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey [PII], no long time no talk to.
[AGENT][NEUTRAL] I have a question about um a cancer policy regarding the hormone therapy uh treatment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me give you the policy number.
[AGENT][NEUTRAL] It's 25252.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 856 1.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I just wanna know, he's taking hormone therapy for prostate cancer and I was reading the definition and everything to him. The type of treatment, can it be a pill that they prescribed or does it have to be like an injection or something?
[CUSTOMER][NEUTRAL] It can be a pill and it would have to be on our list, the name of it, um, as we can make sure that it is the hormone. Give me one minute, let me get that list pulled up. Do you know the name of the drug?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I didn't ask him, but I can.
[CUSTOMER][NEUTRAL] OK. You, uh, I don't know if you have access, but you could go into the library at the SharePoint. Oh, you don't? OK, OK. Well, let me see something here. Hold on, let me.
[AGENT][NEGATIVE] Yeah, we don't, we don't have claim stuff anymore, no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna, while you look for that, I'm gonna place you on a brief hold and get the name of the drug.
[CUSTOMER][POSITIVE] Oh, great. That sounds good. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Can you give me the name of the drug?
[CUSTOMER][NEUTRAL] All right, all right, all right. OK, hold on just a minute.
[AGENT][NEUTRAL] Spell it for me.
[CUSTOMER][NEUTRAL] OK, only because my pictures and be fine in a call.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh awesome.
[CUSTOMER][NEUTRAL] Uh, hold on one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, it is O R G O V Y X.
[CUSTOMER][NEUTRAL] 120 mg.
[AGENT][NEUTRAL] OK, you said O as in Oscar, R as in Randy. Did you say Z as in zebra?
[CUSTOMER][NEUTRAL] No, G as in George, O as in ocean.
[AGENT][NEUTRAL] T as in
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] V as in Victor. Y as in Yarn. X as in X-ray.
[AGENT][NEUTRAL] Got it. OK, give me one moment OK?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Hey [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it's spelled O Oscar, RG.
[AGENT][NEUTRAL] O V Victor Y X.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 120 mg.
[CUSTOMER][NEUTRAL] OK, OK. Give me one minute. Let's see see if it came up yet.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] There it is, right there, copy of the prescription when filing a claim for medications prescribed for chemo hormone.
[AGENT][NEGATIVE] Oh, that's pain.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So he would just send in that prescription.
[CUSTOMER][NEUTRAL] OK, give me one minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's saying no on our sheet.
[AGENT][NEGATIVE] That is not covered.
[CUSTOMER][NEUTRAL] That it's not a covered drug.
[AGENT][NEUTRAL] Not a covered drug.
[CUSTOMER][NEUTRAL] That's what it's saying, saying on our sheet that it's not a covered drug.
[CUSTOMER][NEUTRAL] You may have to go and talk to um
[CUSTOMER][NEUTRAL] [PII] a little bit more or?
[CUSTOMER][NEUTRAL] You know, the uh the examiner, but I'm showing that it's not covered on our drug.
[AGENT][NEUTRAL] Drug list, OK.
[CUSTOMER][NEUTRAL] Yeah, yes, I'm not sure. Let me look at another area hold on here.
[CUSTOMER][NEUTRAL] Let me look at this other.
[CUSTOMER][NEUTRAL] Let me make sure that's the right list before I move forward because they change things all the time and they don't always tell me, hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's showing that it's not a covered drug.
[CUSTOMER][NEUTRAL] That's the only list. I did pull up the right one and the only one, and yes, it's showing that it's not a covered drug.
[CUSTOMER][NEUTRAL] Not a covered hormone.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All righty. All right, thank you. But if it was, he would just send us a copy of the prescription that he receives from the that it'll print out. OK. OK.
[CUSTOMER][POSITIVE] OK. OK, thank you. Um.
[CUSTOMER][NEUTRAL] Right. Yeah, yeah, the little printout that will have the date it was filled, the name of the drug and how much it was charged. Yeah, but it's showing now that it's not, not considered a hormone drug or any other drug for the chemo radiation and your therapy even.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, but there's not a list of that in their policy of the covered drugs or ho.
[CUSTOMER][NEUTRAL] No, it doesn't it, no, cause it doesn't, it changes all the time cause there's so many new drugs, so they'll never have a list of any of those drugs.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] OK. OK. All [PII]. Thank you, [PII].
[CUSTOMER][POSITIVE] You're welcome. Thank you. Bye-bye.
[AGENT][NEUTRAL] Uh huh bye bye.
[AGENT][NEUTRAL] Thank you for holding, Clifton. OK, so you would submit a copy of the, uh, the pharmacy they're aware. It's a printout that they can give you. Of course, it'll have the pharmacy name, the count, or the, the number of pills, how often it's prescribed. It'll have all that information on that printout. But I went further and I was checking to verify if this drug is covered under your policy, and I was informed that it's not, not a covered hormone therapy uh pill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Under the policy.
[CUSTOMER][NEUTRAL] Really? How's that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But how is that, ma'am?
[AGENT][NEUTRAL] It's just per your policy.
[AGENT][NEUTRAL] So if you want to speak to that area, if you want to speak to that area, I could transfer you and perhaps they can give you a list of, of the, the ones that are.
[CUSTOMER][NEUTRAL] You know I can deter
[CUSTOMER][NEUTRAL] Yeah, but I
[CUSTOMER][NEUTRAL] OK, yeah, that'd be fine.
[AGENT][NEUTRAL] Or names of ones that are. OK. Would you like for me to do that?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling HLS [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII]. This is [PII]. How are you?
[CUSTOMER][NEUTRAL] I'm doing OK, and yourself?
[AGENT][NEUTRAL] Good. Um, I have an insured on the phone. His name is [PII].
[AGENT][NEUTRAL] And his policy number is 252.
[AGENT][NEUTRAL] 856 1.
[AGENT][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.
[AGENT][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.
[CUSTOMER][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 as much as I can.
[AGENT][NEUTRAL] OK. Well, can you, can you, can you double-check this one?
[CUSTOMER][NEUTRAL] Yes, give me one second. Let me bring up the list, uh.
[CUSTOMER][NEUTRAL] OK, what's the name?
[AGENT][NEUTRAL] It's, uh, I'll spell it, [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][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.
[AGENT][NEUTRAL] Um, give him some names.
[CUSTOMER][NEUTRAL] OK, so no, it's not a, it's not a covered, correct.
[AGENT][NEUTRAL] Have
[AGENT][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?
[CUSTOMER][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?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII], it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, you can go ahead and send them through.
[AGENT][POSITIVE] OK, thank you, [PII], here he comes.
[CUSTOMER][POSITIVE] You're welcome.