AccountId: 011433970860
ContactId: 0df2179a-f233-43a6-b2a9-4b5e4b722ac5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 717840 ms
Total Talk Time (AGENT): 412669 ms
Total Talk Time (CUSTOMER): 177350 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/0df2179a-f233-43a6-b2a9-4b5e4b722ac5_20250509T18:37_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Even
[CUSTOMER][NEUTRAL] Yeah I was calling to see uh what my um plan covers as far as like.
[CUSTOMER][NEUTRAL] Things that I have for my cancer treatment.
[AGENT][POSITIVE] OK, I can help you with your coverage.
[CUSTOMER][NEUTRAL] And how to go about that?
[AGENT][NEUTRAL] Go about like filing a claim?
[CUSTOMER][NEUTRAL] Yeah, filing a claim and, and I'm not even sure like what what this coverage will uh help me with.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Just how the policy works altogether. OK, I can definitely help you with that. And may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yeah, [PII].
[CUSTOMER][NEUTRAL] And that phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Um, not sure what the policy number is. Um, let me see if I can send it.
[AGENT][NEUTRAL] OK, I can look your policy up with your social if you like.
[CUSTOMER][NEUTRAL] OK, um, my social is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to come up here.
[AGENT][NEUTRAL] OK, here we go. It just popped up. Hold on one moment.
[AGENT][NEUTRAL] And [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Uh, birth is [PII] and the email on file is uh [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. So I'm just waiting for your benefits to populate here. Hold on one moment.
[AGENT][NEUTRAL] And if you'd like, I can email you a copy of your policy breakdown, but um it covers for like your treatment. So if you ever need radiation, chemotherapy, immunotherapy, um, the policy will pay up to $10,000 a year towards those expenses. Um, if there ever is a positive diagnosis of cancer, you do have the first occurrence benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, which would pay to you a lump sum of $2500. Um, for that, the pathology report would be needed and um just the billing.
[AGENT][NEUTRAL] Um, you also have
[CUSTOMER][NEUTRAL] OK, uh, what do you mean by, what do you mean by billing?
[AGENT][NEUTRAL] Like the billing from that day, like if you go to the hospital and they do a test, there's a, there's going to be a bill attached, like, you know, from that day or doctor's office.
[CUSTOMER][NEUTRAL] Like,
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So it has to be the bill from the day that they gave me my diagnosis?
[AGENT][NEUTRAL] It's more so the pathology report, but um there is billing for that day as well, but if you send the pathology report, it should be OK. So most of the times with our claims, we ask for whatever you're filing for, so like your pathology report and then the itemized bill to go with it. So I don't want to say to negate the bill and then it's denied.
[AGENT][NEUTRAL] Um, but I know the pathology report is what showing the diagnosis, so I would say to send, we usually say to send them both, but I mean if, if you prefer one over the other.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, um, you also have surgery benefits, um, anesthesia benefits, um.
[AGENT][NEUTRAL] If, if you ever are confined to the hospital, um, the policy will pay up to $100 for the 1st 30 days and then $200.31 days plus um per day.
[AGENT][NEUTRAL] Um, there's also, um, if you were to go to a cancer treatment center, um, hold on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I should say like this, if you are within 50 or if you're more than 50 miles from a, you know, where you receive the treatment, you can file for mileage um for you and a family member. There's also um lodging, like if someone was to go with you, if you needed treatments, um, there's lodging for you and an adult family member, um.
[AGENT][NEUTRAL] The benefits are the same for transportation and lodging for you and your family member.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. So I got diagnosed in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and I've never used my, my benefits, so I don't know, do I need to go all the way back to [PII]?
[AGENT][NEUTRAL] Well, let me see when the policy became effective.
[AGENT][NEUTRAL] Then we'll know, hold on one second. Well,
[AGENT][NEUTRAL] So to be honest, you've had, you've had a cancer policy with us since [PII]. So depending on like the exact date of service, like your very first policy with us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, was effective from [PII]. So I can give you the policy numbers and the dates that they were effective, so you can see which one you need to file under, you know, once you get that data service.
[AGENT][NEUTRAL] Would that help?
[CUSTOMER][NEUTRAL] So is the policy not current anymore?
[AGENT][NEUTRAL] No, no, no. So you have an active policy. What I'm saying is, so you've had, you've had a total of 3 policies with us. They're all cancer policies.
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So depending on your date of service, I don't know where it will, once you get the date of service, we'll be able to know which uh policy to file under because that will be whichever one was active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, I was diagnosed in [PII].
[AGENT][NEUTRAL] April, OK, so then yes, you use your very first one and I can give you that policy number.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's 177.
[AGENT][NEUTRAL] 50.
[AGENT][NEUTRAL] 49
[AGENT][NEUTRAL] So you really can go back, um, I can give you a second policy too and depending on the, you know, what you're wanting to file for, you'll just use whichever policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, when was the second policy, when did it change over? Do I get a new policy every year?
[AGENT][NEUTRAL] So that
[AGENT][NEUTRAL] No, um, the policy, like the product names have changed so that it just generates a new policy number.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, OK, so GC 14 was the first one we did that one, so GC.
[AGENT][NEUTRAL] 14C. OK, so the second one is 238.
[AGENT][NEUTRAL] 0018.
[AGENT][NEUTRAL] And that was effective from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the active one now um is 252.
[AGENT][NEUTRAL] 5481.
[AGENT][NEUTRAL] And this has been effective since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you'd like, did you, um, would you like me to email you a copy of your, like your coverage?
[CUSTOMER][POSITIVE] Yeah, that would be helpful, um.
[CUSTOMER][NEUTRAL] What do I need to do? I'm gonna be going to MD Anderson in [PII], which is definitely more than 50 miles, um, and I'm gonna need lodging. Um, what form do I, do I need to fill out a form or?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, so for lodging you.
[CUSTOMER][NEUTRAL] What, what requirements.
[AGENT][NEUTRAL] For lodging, you'll just fill out the, so when I send you your um breakdown of your benefits, I'll also attach um the cancel claim form because you'll need that to file the claims. But attach with the form, you'll just submit like the invoice from the hotel.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it'll show like when you checked in and everything in the total.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do I need anything um for the, uh, from the doctor to prove I went there for it?
[AGENT][NEUTRAL] Like for transportation or just for the lodging?
[CUSTOMER][NEUTRAL] Yeah, well, for either one.
[AGENT][NEUTRAL] Um, for the
[AGENT][NEUTRAL] For the lodging, no, you just need your, the hospital, I'm sorry, the hotel invoice, but for the um transportation when you submit the itemized bill, it'll usually they have their like name of the facility and address and everything at the top, and we just compare it to your address and get the miles.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so wait until I get the itemized bill from the doctor.
[AGENT][NEUTRAL] So you have
[CUSTOMER][NEUTRAL] Before submitting for transportation.
[AGENT][NEUTRAL] Yes, well, really, you have two options. If you wanted to give your doctor like your policy number and our phone number and have them call and verify benefits, they can file the claims on your behalf, so you don't have to do all this. But yes, if you prefer to file the claim, yes, you'll have to wait till after the billing comes out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there anything uh specific on the itemized bill that has to show or does it just have to show the um the uh address?
[AGENT][NEUTRAL] Um, so for transportation, it'll have to show the address, but it'll also need the diagnosis codes.
[AGENT][NEUTRAL] The procedure codes?
[AGENT][NEUTRAL] And all charges.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then let me go to your email.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And the email that we have on file is, is your I'm sorry, your work email. Did you want me to change that to personal or you're OK with your school email?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, it, you can change it. No, you can keep it to my school email for now. That's fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So I'll send you your um policy breakdown and a copy of the cancer claim form um in case you do decide to file the claims on your own, you'll have it there.
[CUSTOMER][NEUTRAL] OK, and the file for that lump sum, um, with the pathology report, is there another, uh, form or do I just use the claim form?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, you'll use the claim form each time you're filing the claim and then attach whichever documents you want to be reviewed.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Was there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, I think that was it.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL and I hope you have a good weekend.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye bye.