AccountId: 011433970860
ContactId: 0e21e700-7efb-4b2d-a329-63b978ea1e14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342130 ms
Total Talk Time (AGENT): 132998 ms
Total Talk Time (CUSTOMER): 136827 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/0e21e700-7efb-4b2d-a329-63b978ea1e14_20250228T20:34_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Um, yes, ma'am. I just have a quick question. I am an employee of a school district that offers, uh, APL, the cancer, uh, insurance policy, and I just had a couple questions about it. Are you able to answer that for me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, I can try. And your name is?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And Mr. [PII], uh, what's the name of your group or employer?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and you said you have questions about the cancer policy?
[CUSTOMER][POSITIVE] Yes, I'm, I'm looking at it and it looks uh good and I'm possibly interested in signing up for it.
[CUSTOMER][NEUTRAL] And uh just, just had a question about some things on it.
[AGENT][NEUTRAL] OK, uh, what are your questions?
[CUSTOMER][NEUTRAL] So, so let me ask you this, uh, if I wanted to, to purchase it or get it, am I able to do it now or do I have to wait for an open enrollment period?
[AGENT][NEUTRAL] Uh, that's something you have to contact your group admin, um, and they'll be able to verify when you will be able to enroll if you choose to.
[CUSTOMER][NEUTRAL] OK. If I
[AGENT][NEUTRAL] Your group administrator mhm.
[CUSTOMER][NEUTRAL] OK, so I couldn't enroll in it directly with you guys?
[AGENT][NEUTRAL] No, sir, we only do 3 groups.
[CUSTOMER][NEUTRAL] Oh, OK, OK. Um, let me ask you this, um, I'm looking at the, um, where it says.
[CUSTOMER][NEUTRAL] The lump sum benefit, maximum one per lifetime. Uh, how, how does that work? Does that mean it has insured $5000? Does that mean that this plan only covers up to $5000 and that's it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's just a lump sum amount. So if while the policy was in effect, I mean, and they do check pre-existing, uh, depending on your effective date and when you diagnosed, but if you are diagnosed with internal cancer, there's that lump sum amount that's payable.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. OK. So how does the preexisting uh works?
[AGENT][NEUTRAL] If you receive treatment, were diagnosed or received any kind of medication 12 months prior to your effective date, that is considered pre-existing.
[CUSTOMER][NEUTRAL] OK, alright, so that means that you guys wouldn't pay for anything if it fell in between that time.
[AGENT][NEUTRAL] Um, yes, and then I think, well, let me look on some of these. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there I I believe is a pre-existing, uh, not exclusion, preexisting.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Give me one moment, I'm just gonna pull it up and look at it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, there is a pre-existing condition exclusion period, meaning, um, let's say you are pre-existing, but you're receiving treatment, uh, there is a 12-month period to where from the time you're diagnosed and to that 12-month period has ended to where there are no benefits would be payable until you satisfy that 12-month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and that's um.
[CUSTOMER][NEUTRAL] Like if I were to sign up for this, say if I were to sign up for this in March, and if I were diagnosed with cancer, say in February, I would have to, you all wouldn't pay for anything until after 12 months.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, because that would be pre-existing.
[CUSTOMER][NEUTRAL] OK, OK. All right. So do you all pay anything towards, say, a surgery with uh this particular plan?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] I don't see it um as well.
[AGENT][NEUTRAL] There is a surgery benefit, but um it pays based on the surgical procedure. So I do show a surgical benefit on the plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, cause I, I'm looking at something that says mastectomy, and then it has under mastectomy surgery $25 per surgery. Is that the only surgery that it will pay anything on?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, let me see, it's the only one I'm showing is for a mastectomy, um.
[AGENT][NEUTRAL] Yeah, that's the only one I'm showing, but any other surgeries, I don't see it as being covered.
[CUSTOMER][NEUTRAL] Oh I know.
[CUSTOMER][NEUTRAL] OK, well, alright, well that's all I wanted to know. I was just looking at it, just had a couple questions and was trying to see if it would be beneficial for me if I were to get it or not.
[AGENT][POSITIVE] OK, um, well, well, thank you for calling APL. You have a great day, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] You too. Thank you. Bye bye.
[AGENT][NEUTRAL] Bye.