AccountId: 011433970860
ContactId: 0d9217b5-c44c-4abe-9fb2-68f59b0efa57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 576530 ms
Total Talk Time (AGENT): 371904 ms
Total Talk Time (CUSTOMER): 241022 ms
Interruptions: 8
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/0d9217b5-c44c-4abe-9fb2-68f59b0efa57_20250422T22:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], and I'm on my uh dashboard and it has my group cancer insurance, but it shows that something lapsed, and I don't understand how it lapsed if it's been coming out of my check for over a year and so I was wondering if you could help me.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely I can get that pulled up and make sure that that's accurate and what's going on. um [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, 238-9665.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alright, just gonna verify some information really quick, [PII], uh, can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. The last thing I need is the email address we've got on file for you.
[CUSTOMER][NEUTRAL] I believe it's [PII].
[AGENT][NEUTRAL] That is correct. Thank you so much for verifying all of that, [PII]. OK, so this, it is a bit confusing and I apologize for that. So the policy number you gave me, it is, I know, uh, the policy number you gave me, it did terminate, um, [PII]. However, you do still have a cancer policy with us. It's the same thing.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] It just got a new policy number assigned to it and so that one was effective basically since that one left so there was no lapse in coverage or anything like that um that one was effective as of [PII] yes and it is currently active.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so maybe because that's when I renew my insurance, so maybe that's OK. I was just making sure because I didn't file all my claims yet.
[AGENT][NEUTRAL] Yes, and this was a, I saw [PII] and then I saw the kind and I was like, oh yeah, I remember this whole thing.
[CUSTOMER][NEUTRAL] Oh, OK, good, cause I didn't file all my claims that would have fallen up under that old one. I just got around to settling down enough to file old claims.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh yeah, no, you're fine. Well, and even so, um, even if you, you like, uh, you said if you have older ones that were during that time of the older policy, there's no timely filing limit. So even if you, you know, that you can get them to us as whenever is convenient for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Now, I have one last question. I couldn't find in my um policy. Um, do I have hospital stay coverage?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Like, on here I looked and the only thing I could find is for a mastectomy and my daughter didn't have one of those, but she had um
[CUSTOMER][NEUTRAL] What you call lymphoma. And she was in the hospital for 3 weeks. So I was wondering, do they, is that hospital stay covered and do I have to file something for that?
[AGENT][NEUTRAL] OK, that's
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Well, and of course, I was going to ask, I know it sounds silly, but um I was going to ask if it was indeed for cancer. Um, I know there can be a bit of confusion where that's concerned.
[CUSTOMER][NEUTRAL] Yes, he had lymphoma.
[AGENT][NEUTRAL] OK, give me just a moment. Let me get this pulled up. Sorry, they're all pretty different as to what is and isn't covered. Most of the time there is um hospital benefit, yes, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Or even surgical benefits as well. So give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, she's finally where I can do this kind of stuff. I'm like way behind.
[AGENT][NEUTRAL] Oh no that's that's understandable and that's why we of course don't have a uh um.
[AGENT][POSITIVE] Timely filing limit, you know, so you know you can get to it whenever is convenient for you.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So this is going to, uh, um, I'm so sorry, by the way, um, just so that I understand correctly, the surgery that she had that she had to be hospitalized for, was that the, was it a biopsy that she had?
[CUSTOMER][NEUTRAL] It wasn't surgery. It wasn't surgery. She had to be hospitalized because she got the bone marrow transplant and she was in the hospital for 3 weeks. Yeah, and so I was just trying to.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] Yeah, that's what I was saying, so it wasn't, it's none of this stuff that's here, so I just wondered if it was covered.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Right. OK. I do not believe that is under this policy. I think the only surgical benefits that this policy has are going to be for that, of course, initial biopsy and then like you saw the mastectomy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, OK. Now, what does internal, internal cancer first occurrence mean? What does that mean?
[AGENT][NEUTRAL] That's so um that that excuse me.
[AGENT][NEUTRAL] Uh, that benefit, it's a one-time benefit. And of course, it can be for anyone under your policy, one-time lump sum that you would receive simply for being diagnosed with cancer. So, in order to file any claims, the first thing we would need is going to be that initial pathology report, um, you know, where they found the positive diagnosis of cancer.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So once we have that, then we would get um now let's see, but this was for one of your children so the lump sum for eligible dependent children that is a $15,000 lump sum benefit um and then of course thereafter you can submit any other claims um for anything else as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so where do I, because I'm, I, I, I'm sorry, I have so many questions. I know it's time for you to get off, but I just got home. So where do I upload the pack, huh?
[AGENT][MIXED] No, no, you're fine. You are perfectly fine. It's, it's confusing.
[AGENT][NEUTRAL] I, I said I completely understand it's confusing, yes.
[CUSTOMER][NEUTRAL] The pathology so I gotta get a pathology report. Where do I upload something like that?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So on the website on the actual portal I believe it's on the main page closer to the bottom I think they might have changed it recently, but I think that's still where it's at um there's gonna be a little box that says uh upload uh documents or something like that upload claim information so you can submit it there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yeah, I saw the one that says my claims upload documents. Do you put it there? OK, so it said claims, that's what threw me off.
[AGENT][NEUTRAL] Yes, yes, yes ma'am, yes, absolutely, absolutely, um, so, uh, any information that pathology report, of course you can get that uh from the provider if the provider is willing because again they're all very different I don't you know some are you know some might be able to do this or not but they could also send it to us as well if it's easier for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so that's why I need the pathology report because I finally put in the bill.
[AGENT][NEUTRAL] We've got a fax number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and so once I get the pathology report I just put it in the upload document.
[AGENT][NEUTRAL] Well, mhm.
[AGENT][NEUTRAL] Yes ma'am, that is correct, and I will say as well if you weren't aware, um, I always like to try to let people know there is an option, uh, for you to set up direct deposit on the website as well, um, so in that case, you know, obviously you'd get that money much quicker, go directly into your bank account, otherwise we would mail a paper check to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh no, no, no, nobody got time for that. OK, I'll do that.
[AGENT][POSITIVE] See, you're just like me. You are just like me. I know some people they're like, you know, they don't want their banking information. I'm like that's solid, whatever you prefer, but I'm all about that quick and convenient and safe.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, I'm I get my money and then the final thing is it has to file a wellness claim, and that's where I would file her PET scan reports, correct?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Absolutely, yes, and that goes mhm that's for anyone under the policy as well that that's simply a diagnostic test, um, you know, to screen for cancer so you or anyone else under your policy, um, if you've had a mammogram breast ultrasound.
[CUSTOMER][NEUTRAL] Because it does, OK.
[AGENT][NEUTRAL] Colonoscopy, um, uh, Pap smear I believe is also covered. Yes, Pap smears are covered. So yes, and that's one diagnostic testing benefit per calendar year for each member. So anyone has anything like that, you can absolutely file those as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, I had that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you said mam oh colonoscopy. I had both of those. I didn't know. I thought it was only the person that had the cancer. OK, so I need to update.
[AGENT][NEUTRAL] No, no, so this is yeah.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, cause I need, I need to recover.
[AGENT][NEUTRAL] And then of course um
[AGENT][NEUTRAL] I imagine she after that PET scan, um, I imagine it required a follow up diagnostic test. Maybe not sometimes they catch it like right there, um, but if she had a, OK, yes, so she had a follow up, there's also a benefit for that as well. So you know if they found something that looks off or they need to do further testing, that's a separate benefit as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] It does every time, every time.
[CUSTOMER][NEUTRAL] OK, OK, so what I'm gonna do to be safe is just file everything and let them decide what goes and what doesn't.
[AGENT][NEUTRAL] That's always what I recommend to everyone as these are incredibly confusing and overwhelming um you know there's not the worst we're going to say is no sorry that's not covered best is you know you get money for that so.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Exactly, and it doesn't take long now that you just upload stuff, so it looks like I just have a little more work to do. Thank you so much for being patient this close to going home time. I really appreciate it.
[AGENT][POSITIVE] Oh, you are perfectly fine.
[AGENT][NEGATIVE] No, absolutely, it's very confusing. Did you have any other questions for me?
[CUSTOMER][POSITIVE] You have a great day.
[CUSTOMER][POSITIVE] No, you answered them all and pluck gave me some extra information. Thank you. Have a great day.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] I should try to.
[AGENT][POSITIVE] You too thank you. Have a good night. Bye-bye.
[CUSTOMER][NEUTRAL] OK, bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.