AccountId: 011433970860
ContactId: 10822a62-3dfc-443d-8510-538596921350
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 612159 ms
Total Talk Time (AGENT): 277595 ms
Total Talk Time (CUSTOMER): 265313 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/10822a62-3dfc-443d-8510-538596921350_20250603T19:06_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am. My name is [PII].
[CUSTOMER][NEUTRAL] I have let me get in a quiet area please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I have a a cancer policy with y'all.
[CUSTOMER][POSITIVE] And I was diagnosed with cancer, so I wanna make sure that I have everything I need when I send in a claim.
[AGENT][NEUTRAL] OK, well, I can definitely assist you with the policy and claims. And Mr. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the um your policy number, I'm sorry, I was gonna say email address.
[CUSTOMER][NEUTRAL] Uh, OK, I'm gonna, I got a 02290937. Does that sound like it?
[AGENT][NEUTRAL] It does. Um, let me try this one. Hold on one second.
[AGENT][NEUTRAL] Yep, and that's it. And I just need you to verify your date of birth, your mailing and email address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mailing address is [PII]. What else you needed?
[AGENT][NEUTRAL] And your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And let me see.
[AGENT][NEUTRAL] Alright, so I have the policy here. It's been active since [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if you have, I'm just waiting for the breakdown to populate here.
[AGENT][NEUTRAL] OK, so you do have the um first occurrence rider um for internal cancer. If there is a positive diagnosis, um, once we get everything and we review it, um, the policy will pay you directly, um, a lump sum of $10,000 and then, um,
[AGENT][NEUTRAL] Depending on like your um treatment or services that are needed, um, the policy will pay.
[AGENT][NEUTRAL] Um, up to $10,000 per 12-month period towards uh radiation, chemotherapy, or immunotherapy.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, if you did need like if you did a diagnostic test and then had needed to have like follow-up testing, the policy will pay $100 for that first um diagnostic test, and then it'll pay another $100 for like your follow-up, um, like if they said, OK, we saw something, but we need to go in and see, you know, look some more for that follow-up, it'll pay up to $100 and then if you had um
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like medical imaging after they gave the diagnosis, then the policy will pay up to $500 for the imaging after the um diagnosis of cancer for a maximum of 2 tests per calendar year. So you can probably use all of those and then you also have the surgical benefits, um, transportation, lodging.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, do you have a breakdown of your policy?
[CUSTOMER][NEUTRAL] What, what, what would the.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I do actually, uh, the lady at Hub International is a, a company, uh.
[CUSTOMER][NEUTRAL] Policy I guess uh we go through Hub International for our insurance and she had emailed me a copy of the policy last week.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And she also sent me a claim form, but the claim form was very vague for the cancer.
[AGENT][NEUTRAL] Yes, the, the cancer claim form is very vague, except it'll show like the lodging and the transportation. Um, so that form is more so like, um,
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] That's what you'll use for all of your treatments and everything. If, if the transportation or the lodging doesn't apply, it's OK, we just need the cancer claim form and then the documents. But if you're doing like um the testing or it needs to be specified, then you would use the wellness claim form for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because it lists the different like tests you can pick from.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Yeah, yeah, that, that was, I'm looking at it now is basically uh transportation and lodging and uh.
[CUSTOMER][NEUTRAL] And they had uh that was about it. So I guess really what I, what I need to know is to, to start a claim. Uh, I've had uh imaging done. I've had some biopsies. I had uh.
[CUSTOMER][NEUTRAL] Lymph node removal. I had a CAT scan, uh.
[CUSTOMER][NEUTRAL] I had a chemo port put in uh last week. I had several things done fixing to get some more imaging uh Thursday and hopefully start some chemo soon so I just was more make sure that I have everything I need as of now to turn in with my claim so I don't, uh.
[CUSTOMER][POSITIVE] So I can get it going as quickly as possible.
[AGENT][NEUTRAL] OK. Well, yes, um, all we'll need is the claim forms in any, um, time you're filing just your claim form. If you're wanting to like prove the diagnosis, then the pathology report is needed. Outside of that, it will just be the claim form and the um like the billing.
[CUSTOMER][NEUTRAL] OK, now the, the, the claim form is this the only claim form you have is the capture claim form that has the uh.
[CUSTOMER][NEUTRAL] Basically patient's name, social security number, and then is that transportation and lodging is that the only claim form that I need or do you have another claim form that I need to file?
[AGENT][NEUTRAL] Um, so that's the one that show that that's the one that you'll use for everything except like the the specific testing because the testing is on the wellness claim form.
[CUSTOMER][NEUTRAL] OK, where, where would I get a what?
[AGENT][NEUTRAL] But everything else
[CUSTOMER][NEUTRAL] Where would I get a wellness claim form? is that something you can send me?
[AGENT][NEUTRAL] Yeah, I can email that to you if you like.
[CUSTOMER][NEUTRAL] On the email.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Yes, I'll go ahead and email you the wellness claim form and then for everything else, you would use that cancer claim form, you would just put like an NA or like a line through the transportation and the lodging if you're not using that.
[CUSTOMER][NEUTRAL] OK, so for the original diagnosis use the claim form that you spoke of right then and just uh I just need a pathology report is that all I need to send with that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] pathology report and the billing.
[CUSTOMER][NEUTRAL] To get
[CUSTOMER][NEUTRAL] And the billing
[AGENT][NEUTRAL] Uh, the itemized bill from the, if it was the hospital or the doctor's office, whoever the provider was.
[CUSTOMER][NEUTRAL] OK, but did the uh pathology report?
[AGENT][NEUTRAL] Mhm, that.
[CUSTOMER][NEUTRAL] Or just a doctor with the diagnosis.
[AGENT][NEUTRAL] No, no, it has to be the pathology report.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the claim form and the itemized billing.
[CUSTOMER][NEUTRAL] So I don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me ask you a question you might can answer you might not.
[CUSTOMER][NEUTRAL] If I send the claims form with the pathology report.
[CUSTOMER][NEUTRAL] What difference does it make if I have cancer that's covered? What difference does it make, uh, how much I had to pay or whatever, what?
[CUSTOMER][NEUTRAL] So the, the, to me that what I understood the original, the original, uh, diagnostic, uh, when they diagnose you.
[AGENT][NEUTRAL] Wait, say that again.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And and y'all say yes this is something we cover.
[CUSTOMER][NEUTRAL] That $10,000 check comes to me, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so what, what, what do you need billing for? I guess is my question.
[AGENT][NEUTRAL] Well, the pathology report just is just showing the diagnosis. If something is still owed to the provider, you're giving the billing so that we can pay it, so you don't get the bill.
[CUSTOMER][NEUTRAL] Uh, I, I really don't.
[AGENT][NEUTRAL] The, the reporting and
[CUSTOMER][NEUTRAL] Uh, my understanding, my.
[CUSTOMER][NEUTRAL] My my understanding was.
[CUSTOMER][NEUTRAL] With this policy that whatever it was the check come directly to me.
[CUSTOMER][NEUTRAL] So you're saying that's not a fact?
[AGENT][NEUTRAL] It does not all the time. That's not a fact. The, like for the first occurrence benefit, yes, that comes to you, but if you have an ambulance bill, that's not gonna go to you, that's gonna go to the ambulance or chemotherapy that doesn't come to you, that goes to wherever you got chemo.
[CUSTOMER][NEUTRAL] OK, but the, the, the, the original for the original diag diagnosis that comes to me and everything else y'all would disperse, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I think that's all I need now if you could send me that wellness claim form so I can get that stuff going, I will get the pathology report and um.
[CUSTOMER][NEUTRAL] I don't know if I got any billing with that or I hadn't really had any billing with that so uh I don't know what to do about that.
[AGENT][NEUTRAL] Well, for that one you can just give the pathology report and the claim form if you don't, if there was no billing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good. Well, if you send me that, uh, wellness report, I'll get all this stuff going, and if I have any problems I'm gonna call you back.
[AGENT][NEUTRAL] All right, Mr. [PII]. Well, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] I think that's it thank you.
[AGENT][POSITIVE] All right. You're welcome. Thanks so much for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.