AccountId: 011433970860
ContactId: 10e9fedd-5aef-437f-b599-61effd30d09a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 896780 ms
Total Talk Time (AGENT): 561612 ms
Total Talk Time (CUSTOMER): 267138 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/10e9fedd-5aef-437f-b599-61effd30d09a_20250429T20:02_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, I have a policy for cancer benefits and I'm calling to see if you can look at my policy and see exactly like what plan level I have.
[AGENT][NEUTRAL] OK, I can go over the benefits, sure. May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnect then, Miss [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] No, I don't remember ever like getting anything with the number on it.
[AGENT][NEUTRAL] OK, that's fine. I can do a name search.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And that's uh [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII], OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I have your address, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. And for security, may I have your date of birth and email address on file?
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[CUSTOMER][NEUTRAL] And I don't know if you have my work or personal email, but you can try [PII].
[AGENT][NEUTRAL] Personal.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect, yes, thank you.
[AGENT][NEUTRAL] Alright, so let me go ahead and pull the benefits really quick. One moment.
[AGENT][NEUTRAL] Mm OK. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And let's see. OK. We have um cancer plan 3.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see, so with this one you have several benefits. Let me just go down to the benefits.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And you can also view all this information if you go to our website at [PII] and you register, you'll be able to see all this information as well, OK? Um, OK. So you have radiation therapy, chemotherapy, and immunotherapy, um, 15,000 and that's the maximum cover per person for 12-month period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you have hormone therapy which is $50 per, um, that one is gonna be per treatment up to 12 treatments per year.
[AGENT][NEUTRAL] Um, you also have, let's see.
[AGENT][NEUTRAL] Mm OK. So you have this cancer screening benefit rider which is diagnostic testing in which it covers 1 test per year, $50 and this is for preventative. Um, you also have a follow-up testing, um, that's $100 and that's also 1 per year if they send you for a follow-up.
[AGENT][NEUTRAL] And then you have the medical imaging benefit. The medical imaging benefit is following the diagnosis of cancer. So if, if they find cancer and they had to do like a CT scan or MRI or anything like that, then that's $500 OK?
[AGENT][NEUTRAL] You also have, I'm sorry, you have a question?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh no I was just wondering like when you say diagnostic testing, what exactly are you referring to what types of testing would that be?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Preventative, um, mammogram, um.
[AGENT][NEUTRAL] Um, let me see. Pap smear, um, chest X-ray.
[CUSTOMER][NEUTRAL] Like a CT scan or?
[CUSTOMER][NEUTRAL] Would a CT scan be that or would that be medical imaging?
[AGENT][NEUTRAL] The CT scan will be a medical imaging. Now, the medical imaging will only pay if it's positive for cancer.
[CUSTOMER][NEUTRAL] Right, OK, so, um.
[AGENT][NEUTRAL] Mhm. Yes, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the other ones are like more like preventative, like a yearly checkup, like breast ultrasound, breast um cancer blood test, uh colonoscopy, those types, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm OK. Um, you also have benefits for surgery. Let me come back to that one.
[AGENT][NEUTRAL] OK, so surgery is covered to a maximum per operation of 3000.
[AGENT][NEUTRAL] Anesthesia.
[CUSTOMER][NEUTRAL] So what does that mean? $30 unit dollar amount, what does that mean?
[AGENT][NEUTRAL] OK, so the, the surgery is based on units. Um, that information is usually sent or, you know, it's provided whenever you have the surgery. Um, it is calculated by unit, but the maximum is 3000. Um, that's just information based on the surgery that they're doing, like if it's a large surgery, a small surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then we have the anesthesia which we pay 25% of that 3000.
[AGENT][NEUTRAL] Um, you have the bone marrow transplant, which is the 6000.
[AGENT][NEUTRAL] Um, stem cell transplant, which is 600 and that's per lifetime. The bone marrow is also per lifetime. Um, you have pertussis, um, if it's a surgical implantation, it's 1000 and that's per lifetime. If it's um.
[AGENT][NEUTRAL] The non-surgical is 100 and that's per lifetime.
[AGENT][NEUTRAL] Um, you have cancer treatment evaluation and consultation, which is 750 and that's one time per lifetime as well. Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have the evaluation, consultation and travel and lodging, which is 350 maximum of 1 per covered person per lifetime.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so how do I document those travel and lodging ex[PII]?
[AGENT][NEUTRAL] OK, for those, um, travel and lodging, what we do is we usually use the address that is on the provider's itemized bill and compare it with your address, the address we have on the system for you, and that's how we calculate. It has to be either 50 or 100 miles. I can check and see which one is this one in a minute.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then so you do mileage and then do you do like hotel if we have to.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Stay in a hotel, so just save your receipt or whatever.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, for the lodging you need to receive your receipt, yes, whenever you check out the paper that they give you in the checkout, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, um, let's see. You have 2nd and 3rd surgical opinion, which is $300.
[AGENT][NEUTRAL] For diagnosis of cancer. Uh, go ahead.
[CUSTOMER][NEUTRAL] OK, so for that do I just turn in like what the where we went to the doctor like what do you?
[AGENT][NEUTRAL] For which one
[CUSTOMER][NEUTRAL] For the 2nd and 3rd surgical opinion.
[AGENT][NEUTRAL] Yes, um, you have an itemized bill. The itemized bills should indicate that it's a second opinion or a third opinion for a surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. And that's what we base it off.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see, so you have um 300 for a second and then you have uh 300 for a third.
[AGENT][NEUTRAL] OK. And then you have drugs and medicine and this is per confinement, so it's when you're hospitalized and they are uh giving you drugs and medicine, then we cover $150 for inpatient. And if it's outpatient, in and out, it will be $50 per prescription.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the maximum outpatient per month is 150.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, um, you also have be go ahead.
[CUSTOMER][NEUTRAL] So I, I
[CUSTOMER][NEUTRAL] I see the next one down like a skip you can skip the hairpiece and then transportation and lodging how is that different than up there where we talked about.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Consult evaluation or oh that's for evaluation or consultation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I, yes, that's it. Yes, this one is just for an evaluation or consultation. They believe they think you have cancer, they just wanna make sure that it's correct, um, you know, so that will be the evaluation or consultation right there. So if they send you to another place just to, to evaluate your our consultation, then that's when you get that one, the first one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The second one is more like if you have to go, let's say 100 miles from where you live to have a chemotherapy, radiation therapy, then that's, that's gonna be that benefit for transportation and lodging, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] And that's also for the family transportation and lodging.
[CUSTOMER][NEUTRAL] OK, I, I think I'm following along with you so like we don't have to go step by step with all the other ones um underneath the the the bottom of that list it talks about internal cancer first occurrence benefit rider. Do I have that benefit?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, let me go, let's see there's.
[AGENT][NEUTRAL] Let me go here. OK. Yes, that's gonna be under the, the first page which says cancer plan benefits. Um, you do have a first occurrence benefit. Uh, if you have internal cancer, it's gonna be 5000 and that's one per lifetime. If you have a heart attack or stroke, it's gonna be 2500.
[AGENT][POSITIVE] And that's also one time per lifetime. Mhm. And you also have an additional benefit that I saw here in the bottom, which is for, it looks like critical intensive care. You also have intensive care per day 600, um, step down unit is 300 per day, maximum of 45 days. This intensive care benefit is not only for cancer, it's for any intensive care, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm. So yeah, if you want to put any, it's not just cancer, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What about what and what's the definition of a step down unit?
[AGENT][NEUTRAL] Um, step down unit is whenever they um.
[AGENT][NEUTRAL] Basically, they have you in ICU and
[AGENT][NEUTRAL] There is a step down unit which um is still ICU but it's not on that place where they have you hooked to all the machines. It's another place um where they're like observing you before they move you to a regular room.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Regular room OK, um, so let me ask you this, I mean.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEGATIVE] Um, my husband does have a tumor on his, on his kidney that, uh, we have been going to consultations for and, and everybody and, and we've been told that he is gonna need surgery for this, but they're not doing uh.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] A biopsy in advance they're they're sending, they're doing the surgery and then they're sending it out to pathology so I just need to wait until we get the pathology report back and then you know if it says it's definitely cancer then I submit for everything at one time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, yes, that will be the best way of going, yes, because since it's, right now it's not um indicated that it is, it is cancer. So if um if you send without the pathology report, we're gonna need that pathology report to determine cancer, so yes.
[CUSTOMER][NEUTRAL] OK, hypothetically if it comes back noncancerous then I, you know, benign, I could still, uh, file for the consultation travel expenses.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or no?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I believe so, but let me check on that. Let me, let me get a little bit more information on this one, OK? I think that that's it. Mhm.
[CUSTOMER][NEUTRAL] Well, you know what, it's OK. I'll just, I'll just cross that bridge when we get to it, you know, because I mean they're pretty positive it is but again until, you know, they send it to pathology, you know, they're, they're guest, you know, they, they just don't know for sure so um we'll just, I can just hold off on that because I'll be surprised if it's not, but you know I guess you always run that chance so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, OK, well, I, I had this page, but it was just unclear to me, you know, what of it applied to me, so, um, I appreciate you, you know, giving me more information.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] You're welcome. And if you need like additional information, if you want to know exactly what is covered under that, you can go to the page like it's gonna be like page 34 and it's gonna have benefits and it's gonna give you a little bit more detail about what is that for. So you can go to that benefit page and it will break it down a little bit better and explaining to you what can you use that for, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there any way you could email that document to me?
[AGENT][NEUTRAL] It's the same one that you're looking at. It's just page 34, but um.
[CUSTOMER][NEUTRAL] Well, the paid what I the document I'm looking at only has.
[CUSTOMER][NEUTRAL] Um, 8 pages.
[CUSTOMER][NEGATIVE] So I don't, I don't have what you're looking at.
[AGENT][NEUTRAL] 00, OK, so.
[AGENT][NEUTRAL] OK, so yeah, I can do that and let me just go ahead and.
[AGENT][NEUTRAL] Um, so send it to your [PII] account. Yes, I can do that.
[CUSTOMER][NEUTRAL] Mhm, yes ma'am.
[AGENT][NEUTRAL] OK, I'll go ahead and do that in a minute. Is there anything else I may help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] Awesome alrighty.
[CUSTOMER][NEUTRAL] No ma'am, not today thank you.
[AGENT][POSITIVE] OK. You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye.