AccountId: 011433970860
ContactId: f671b953-ebbc-425e-99c4-aaa0b3dad782
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 462970 ms
Total Talk Time (AGENT): 254478 ms
Total Talk Time (CUSTOMER): 136507 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/f671b953-ebbc-425e-99c4-aaa0b3dad782_20250108T17:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I was calling.
[CUSTOMER][NEUTRAL] I was trying to get clarification on the drug and medicine on my claim and how to file it. If I'm doing maintenance medicine that I'm having to get on a regular, how do I file that?
[AGENT][NEUTRAL] Uh, let me take a look at your policy. I can help you with that. Can I have your name?
[CUSTOMER][NEUTRAL] [PII] Last name [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alright thank you and what's a good call back number in case we disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what's your policy number?
[CUSTOMER][NEUTRAL] Mm, I don't have that out. I don't have it right now.
[AGENT][NEUTRAL] OK, I can search by your social.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, bear with me just a moment.
[AGENT][NEUTRAL] Alright [PII], verify your address and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] OK, thank you for verifying that information and you're calling about uh filing a claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, give me one moment.
[AGENT][NEUTRAL] And so to verify your uh email address.
[CUSTOMER][NEUTRAL] Um, [PII], oh, it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right. And this is for um the drug benefit, right?
[CUSTOMER][NEUTRAL] Yeah, under the cancer policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me a moment to get that policy information pulled up.
[AGENT][NEUTRAL] All right. And this is a verification of coverage. It doesn't guarantee the payment of a claim. Uh, your policy does have the drugs and medicine benefit. Um, that benefit is payable anytime a covered service is received. So if you're receiving chemotherapy, immunotherapy, radiation therapy, or a covered surgery, then, uh, the drugs associated with that treatment would be covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, even for the outpatient, like if I have to take it prior at home?
[AGENT][NEUTRAL] Yes. Uh, that would be considered as well if you've had, uh, one of the cover treatment or procedures during that time frame.
[CUSTOMER][NEUTRAL] OK, how do I file that?
[AGENT][NEUTRAL] So you would uh submit an itemized bill, or if it's a prescription, you want to send in um pharmacy docs, either the receipt that shows the drug name, dates, and charges or itemized statement from the pharmacy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, does it need to be itemized?
[AGENT][NEUTRAL] Uh, as long as it has the name of the drug, the date, um, either that it was filled or, uh, prescribed, and the amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So I've never sent anything in so I can just go back from.
[CUSTOMER][NEUTRAL] August and send them in.
[AGENT][NEUTRAL] Let me take a look at that, cause usually, um, if you file claims, usually, if there was a covered service, we automatically look for drugs to pay. Um, I see that we pay that benefit for uh one drug in July and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The month of August, the benefit was max we paid for 3.
[AGENT][NEUTRAL] Drugs for the month of August. So, um, yeah, anything after that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] After the month of August. I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Anything after September to now mhm.
[CUSTOMER][NEUTRAL] Anything from September to now.
[AGENT][NEUTRAL] Yeah. So, in that case, if you're, if you're sending in, if it's gonna be prescriptions or anything from the pharmacy, you want to send an itemized bill for the treatment that you received during that time frame.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Usually that will have all of the information. So let's say if it was an outpatient visit uh for covered service, then you will send us that itemized bill and also typically have the drug information there as well, but you can send in the pharmacy info as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this is what, this is what's going on. I'm taking medicine and it's called pre-chemo treatment. So how do I, there's no automized bill for that.
[AGENT][NEUTRAL] So, for, let's see, cause it's hard to tell um exactly over the phone without the information, but it sounds if it's pre-chemo treatment, then
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The drug benefit would only apply once you start the chemotherapy.
[AGENT][NEUTRAL] And the drugs that are associated with those treatments. Anything prior to that, if there was no chemotherapy um received, if you didn't have any chemo treatments, then the drugs pre-chemo treatment will not be covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That didn't make sense because I'm taking, I'm having to go pick up the meds and I'm having to take them certain days, you know, during the time of treatment.
[CUSTOMER][NEUTRAL] When I say pre-treatment, I am taking the meds and I do have to pick them up on a regular.
[CUSTOMER][NEUTRAL] So does it make sense?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I would suggest send it in for a review. Like I said, it's hard to, to give a hard yes or no without the actual info um to see if uh if it's a covered drug and, you know, if it'll be payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one other
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one other question, what do I have to do to use the.
[CUSTOMER][NEUTRAL] The hairpiece, the week, um.
[CUSTOMER][NEUTRAL] What do I what do I need to submit to y'all to use that?
[AGENT][NEUTRAL] A receipt for the wig or prescription.
[CUSTOMER][NEUTRAL] OK, a receipt, uh, just a receipt from the actual hair.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right
[AGENT][NEUTRAL] All right. So, yeah, I would suggest any info you have in regards to treatment or services related to the cancer diagnosis. Just send that over to us and uh we go through it and pull out any payable benefits. That way, you, it takes away the guessing um on your end and let us do the work.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, no problem. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] All right. Thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] Mhm. OK.