AccountId: 011433970860
ContactId: 118a5260-c019-4a24-a403-376cdbcfa4b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1014729 ms
Total Talk Time (AGENT): 471299 ms
Total Talk Time (CUSTOMER): 298938 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/118a5260-c019-4a24-a403-376cdbcfa4b2_20250311T21:03_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]. My name is [PII], and I'm trying to call in for a name.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Oh, that I don't have ma'am.
[CUSTOMER][NEUTRAL] It's still my work, so I, I don't think I ever got it or if I did, I don't know what I do with it.
[AGENT][NEUTRAL] OK, is it a claim for yourself or you calling, are you the OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am. No, no, no, it's for me. Me, myself, and I.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can look it up by your social. Do you have your social? you can give it to me?
[CUSTOMER][POSITIVE] OK. Of course. Yeah, whenever you're ready.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, thank you so much. Give me one moment, let me take a look and see what I can find here.
[AGENT][NEUTRAL] OK, I've got your policy here. Can I please have your date of birth and address, [PII]?
[CUSTOMER][NEUTRAL] Yes. Uh [PII]. My address is [PII].
[AGENT][NEUTRAL] Alright thank you let me see any claims have been.
[CUSTOMER][NEUTRAL] No, I've never claimed anything.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] That's gonna be 02526522.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Alright, I'm sorry I interrupted you looking up.
[AGENT][NEUTRAL] No, that's OK. And so, did you have a claim that was submitted that you were needing to check on?
[CUSTOMER][POSITIVE] No, no, I'm starting everything right now.
[CUSTOMER][POSITIVE] I want to start everything right now.
[AGENT][NEUTRAL] OK, and so did you need kind of help on how to file the claim?
[CUSTOMER][NEUTRAL] Yes, yes. I, I, I've never done this before. Uh, um.
[CUSTOMER][NEGATIVE] I'm just a little overwhelmed right now.
[AGENT][NEUTRAL] OK, so there are a couple different ways that claims can be submitted um they can be done online we have an online service center that you can do it through um they can be sent in the mail and then they can also be faxed so it's really whatever is easiest for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so did you want me to give you information on like the online service center or would you rather? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am. And in the mail too.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, our web address is going to be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you get to the website, you're gonna see on the top right hand side of the page, there is a link there to click that says sign in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Once you get there you're gonna see an option for a new user you're gonna click new user to create a login since you've never logged in before.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, once you do that, there's gonna be some different options. You're gonna click the first one that says I'm an individual with an APL insurance policy.
[AGENT][NEUTRAL] And then click next.
[CUSTOMER][NEUTRAL] Individual with insurance policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, when you get to the next portion, it's gonna ask for your information. It'll ask for your last name, social, zip, email, and date of birth. Now the email that you have on the policy is your first [PII]. So you need to make certain that you put that email in unless you want to change it.
[CUSTOMER][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] Is that what you said?
[AGENT][NEUTRAL] You just wanna make sure that you put in the same email that you have on file and the email on yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am, but
[CUSTOMER][NEUTRAL] But the one I have on file is [PII].
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] No, it's your [PII].
[CUSTOMER][NEUTRAL] Oh, OK, not the more it's cause, um, on my regular email, it, it's [PII].
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] No, this is your this is your full name, it looks like.
[CUSTOMER][NEUTRAL] So that's why I was
[CUSTOMER][NEUTRAL] OK, well, the more is [PII] is part of my full name. That's why I was asking. So it's [PII], I'm sorry. Let me, if you can repeat it again, I'm sorry, I'm, I'm a little slow.
[AGENT][NEGATIVE] Yeah, so it's silly.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Oh, so it is gonna be used, um, that's what I was asking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that is, yeah.
[AGENT][NEUTRAL] And then just put in your date of birth and you should be able to click next to create a username and password.
[CUSTOMER][POSITIVE] OK awesome awesome OK.
[AGENT][NEUTRAL] Once you get in there you're gonna see a green button that says upload documents that's where you're gonna upload all of your claims information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The other thing that you're gonna need is the claim form. Um, claims and forms can be found on our home page um if you'd like I can send that to your email or you can download it from our site. It's really whatever is easiest for you.
[CUSTOMER][NEUTRAL] No, if, if, uh, the busy, the better way is to my email.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So once you get the claim form, um, page one is gonna be complete instructions as far as like what is needed with the claim. It's all gonna depend on what you're uh filing for as far as what documentation may be needed for the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, once the claims have been submitted, generally they take about 5 to 7 days to process, and you'll get updated information. Um, once the claim's been processed, you can also check online to manage them as well, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have any other questions or concerns that you can think of, [PII]?
[CUSTOMER][NEUTRAL] Yes, how much am I covered for?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Let me pull your policy certificate and take a look here.
[AGENT][NEUTRAL] So the plan itself, um, covers, if it has a first occurrence benefit, a lump sum for internal cancer, which is 10,000, and it's the same for heart attack and stroke.
[AGENT][NEUTRAL] And then it does cover radiation therapy, chemotherapy, and immunotherapy up to 20,000 in a 12-month period.
[AGENT][NEUTRAL] And then there's some diagnostic testing that is also covered, um, one per year. It looks like $50 for diagnostic. Follow-up diagnostic testing is a $100 benefit amount.
[AGENT][NEUTRAL] And then any medical imaging following the diagnosis of cancer, you're permitted up to 1 test per calendar year and that's a benefit payment of 500.
[CUSTOMER][NEUTRAL] What was that last month 500?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What was that? I'm sorry.
[AGENT][NEUTRAL] It's for medical imaging, uh, following a cancer diagnosis, you're permitted one test per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Anything else?
[AGENT][NEUTRAL] Um, it does have a benefit for hormone therapy. Um, it pays $50 per treatment, up to a maximum of 12 treatments per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It has a mastectomy benefit. If you have a mastectomy, uh, it's going to give it.
[CUSTOMER][NEUTRAL] Is vasectomy or when?
[AGENT][NEUTRAL] Mastectomy.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] What is that? Uh, can you spell it out, I'm not understanding that one.
[AGENT][NEUTRAL] It's M as in Mary, A as in apple, S as in Sam, T as in Tom, E as in Edward, C as in cat, T as in Tom.
[AGENT][NEUTRAL] O as in Oscar, and yeah.
[CUSTOMER][NEUTRAL] My sister.
[CUSTOMER][NEUTRAL] OK. OK. I, I'm sorry. I just, I, I, I, I don't think I've heard that word before, so I was like, what, what, what? I'm sorry, I can't know how your brain doesn't connect it? And how much was that?
[AGENT][NEUTRAL] If you have that, um, hospital confinement benefit is $50 per day.
[AGENT][NEUTRAL] Surgery is $25 per day.
[AGENT][NEUTRAL] And it will pay $25 for any prosthesis one time per lifetime.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's $25 right? But this is one time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $25.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One time.
[CUSTOMER][NEUTRAL] Only
[CUSTOMER][NEUTRAL] OK. Is there anything to cover the hospital, uh uh uh stay?
[AGENT][NEUTRAL] Um, it looks like the only benefit for hospital confinement is if you were having a mastectomy. I don't show any other hospital benefits on the plan.
[CUSTOMER][NEUTRAL] And you said the 10,000 was the initial of you're diagnosed with uh with cancer, right?
[AGENT][NEUTRAL] Correct, yeah, that's the benefit amount for the initial diagnosis of internal cancer.
[CUSTOMER][NEUTRAL] OK. And then, uh,
[CUSTOMER][NEUTRAL] 20,000 if uh
[CUSTOMER][NEUTRAL] If you have to uh have radiology or chemo, right?
[AGENT][NEUTRAL] Well, that's the most it's gonna pay in a 12 month period. Yeah. So you would submit, you would submit your claims for the treatment of radiation and chemo, and then we would reimburse up to 20,000. It's not gonna pay out just a lump sum. OK.
[CUSTOMER][NEUTRAL] In one year.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I, I, I, no, I understand, but the 10,000 is gonna be a lump sum?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Internal cancer, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Um, and is it only radiology and chemo? Is there anything else like the other treat because the doctor was saying they're having new, these last 5 years, they've had new, um, you know, better things for cancer.
[CUSTOMER][NEUTRAL] Was that covered also, that medicine or, or treatment that they would send me on?
[AGENT][NEUTRAL] Immunotherapy is covered under the 20,000 umbrella.
[CUSTOMER][NEUTRAL] Well, you know.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Hormone therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, that helps me a lot because I've never, you know.
[CUSTOMER][NEGATIVE] I'm a little overwhelmed.
[CUSTOMER][NEUTRAL] And I've never done this before.
[AGENT][NEUTRAL] Yeah, it's a lot of, a lot of information for sure, um.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Yes, yes, yes.
[AGENT][NEUTRAL] So I would definitely print out the claim form, look over it because there are some portions, um.
[AGENT][NEUTRAL] If you have any questions about, I don't know if you're gonna have to travel or anything like that for any sort of treatment, but there's a portion on there that talks about transportation also, so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So far, no, cause I'm here in [PII] and I'm here in the hospital in [PII], so as far as I know, I'm not being sent anywhere um.
[CUSTOMER][NEUTRAL] But you know, I, I'm still waiting on the results from the doctor, so I don't know what's going on exactly. I just know I've been diagnosed or, um, you know, temporary diagnosed because the results are still not in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] So I want to start this as soon as possible so I can
[AGENT][POSITIVE] Yeah, for sure.
[CUSTOMER][NEUTRAL] You know what I'm saying, cause I don't know. I, I don't know.
[AGENT][POSITIVE] Yeah for sure so um the email is on its way to you for the, uh, claim form and then once you're ready to start submitting stuff if you have any concerns or questions you can always give us a call too we can help.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] OK, thank you so much. Do you by any chance have an office here in [PII] that I would be able to go to somebody to help?
[AGENT][POSITIVE] Yeah, you're welcome.
[AGENT][NEUTRAL] No, unfortunately, we don't. Most of our stuff is based out of [PII] or [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh, I'm, I'm, um, [PII]. Do you all have, uh, like walking basis where somebody can help you fill out the forms?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] No, no, they don't, unfortunately, they closed those offices. Yeah, it's all remote now.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Oh my gosh, but you know what I mean, cause I'm not gonna lie to you. I'm a little slow. Not, not slow mentally, but you know what I'm saying, like this is so overwhelming and there's so many technical, uh, terms and, and information that I'm feeling like I, I, I, I, I would like somebody to walk me through the answering this question.
[AGENT][NEUTRAL] Yeah, so what
[CUSTOMER][NEUTRAL] But that's why I was asking that.
[AGENT][NEUTRAL] Yeah, so I would just say um once you're ready to start submitting stuff if you can have somebody help you that would be great but maybe give us a call once you're ready to start submitting and then if you need clarification we can have a claims examiner walk through it on the phone with you to tell you exactly maybe what's needed if you're not sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, awesome. And then uh you said it's uh normally once you all get it, it's 5 to 7 days, right?
[AGENT][NEUTRAL] Mhm. Correct, yeah.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] All right. Well, I think, uh, I can't think of anything else.
[AGENT][NEUTRAL] OK, [PII], yeah, if you think of anything just give us a call, OK?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] All right, thank you so much for your assistance. I really, really appreciate it.
[AGENT][POSITIVE] Yeah, you're welcome. Take care.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.
[CUSTOMER][NEUTRAL] Well, that's true.