AccountId: 011433970860
ContactId: 1a362de7-51e4-4b12-9e12-9a959c8c5166
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 652409 ms
Total Talk Time (AGENT): 293630 ms
Total Talk Time (CUSTOMER): 218919 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/1a362de7-51e4-4b12-9e12-9a959c8c5166_20250103T15:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hey [PII], I just had a um biopsy, a breast biopsy. Thank gosh it was benign, um, but I have, I didn't know what my premium might pay on that, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Yes, OK. We can definitely take a look to see. Um, OK, so you did have a biopsy. Uh, they determined it was not cancer though, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, got you. Alright, um, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and [PII], if, uh, can I get a good call back number from you really quick in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] No, I'm looking. I have my little packet here but I don't, I don't.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That's OK. I can start using your social.
[CUSTOMER][NEUTRAL] OK, alright, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK. I'm just gonna verify some information really quick, [PII]. Can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. Happy almost birthday.
[AGENT][NEUTRAL] And then can I get, can I get your mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. uh, looks like it is a Yahoo account.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][POSITIVE] Got it. OK. Thank you so much for verifying all that. All right, bear with me just a moment. Let me get your policy pulled up here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. So per your policy, it does say uh diagnostic surgeries that result in negative diagnosis of cancer are not covered under this benefit.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But I but I do have.
[CUSTOMER][NEUTRAL] An outpatient, uh, it was an outpatient surgery.
[CUSTOMER][NEUTRAL] Well I don't know, I, I'm on the phone. Go, go play with [PII].
[AGENT][NEUTRAL] Um, let me see this.
[CUSTOMER][NEUTRAL] And then I also, you know, I did the.
[CUSTOMER][NEUTRAL] So now cancer screening follow up and then diagnostic and prevention benefit, I do have those too.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But it says outpatient hospital ambutory surgical cancer benefit.
[AGENT][NEUTRAL] OK, let me take a look here.
[CUSTOMER][NEUTRAL] It's on schedule a payment.
[AGENT][NEUTRAL] Yes, I see the surgical benefit. Let's see.
[AGENT][NEUTRAL] Surgical operation is performed on a covered person for a covered diagnostic, diagnosed cancer.
[AGENT][NEUTRAL] We pay that. That's what I'm, I'm thinking that it's not. Um, I can get some clarification though, um, under the surgical benefit, that is what it states, so, on a, a performed on a covered person for a covered diagnosed cancer. Um, but let me, if you don't mind, um, I'll put you on a brief hold, [PII], and, uh, reach out to a different department, um, just so that we can get clarification on that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me, can I ask you something, um, what, what forms am I gonna need? I don't see any forms in this thing.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Uh, to file a claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The only form that you would need is for since this is a cancer policy it would be our cancer claim form um you can get that on our on our website it's [PII] and you can, OK.
[CUSTOMER][NEUTRAL] Hold on, hold on, let me see. [PII].
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Public
[AGENT][NEUTRAL] Yes, so that's our just public website so that's got all of the claim forms there you can download them. I will say, um, do you have access to a uh desktop or a laptop computer, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Not right this second. I'm gonna have to charge mine. um, I just have a laptop.
[AGENT][NEUTRAL] Well it doesn't not at the moment um I just meant, uh, that is typically the quickest and easiest way to file claims as well is going to be through our online portal which it's the same web address but it's got the word secured with an ED in front.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's secured. [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Secure. [PII] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and so you would create an account using that information we just verified and then you can upload um the claim information from there it gets to us much much quicker.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] OK, um, and then give me one moment I'm just gonna put you on that hold while I get some clarification on this for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Sing.
[CUSTOMER][POSITIVE] Good afternoon. Thank you for calling A or good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[CUSTOMER][POSITIVE] I'm just fine, thank you.
[AGENT][POSITIVE] Glad to hear it. Uh, just had a quick question for you. I'm 99% sure I know the answer to this, but just for good measure. Um, I have an insured on the line with a cancer policy. She had a biopsy done, um, surgery that resulted in, of course, it was not cancer. Um, she was believing it would be covered under the outpatient surgical benefit, but everything I see on the policy except for that section states that if it resulted in them not being diagnosed with cancer, it would not be covered.
[CUSTOMER][NEUTRAL] Correct. And there's no benefit payable if it is not a positive diagnosis of cancer.
[AGENT][NEUTRAL] Is that right?
[AGENT][NEUTRAL] That's what I thought.
[AGENT][POSITIVE] That's what I thought. OK, OK, I appreciate you verifying that. Thank you, bye bye.
[CUSTOMER][POSITIVE] You're welcome. Uh-huh. Thank you. Bye-bye.
[AGENT][POSITIVE] All right, [PII], so sorry about that wait are you still there?
[CUSTOMER][NEUTRAL] Well, well
[CUSTOMER][NEUTRAL] Yeah, it's OK. That's OK.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Oh yeah, I'm here. I'm here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, OK, so I did get clarification on that and so yes, that is correct. Um, if it resulted in it not being uh diagnosed cancer, then it's not covered under this policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, well then I have a question on oh what page is the benefits on oh I just was there.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh hold on.
[CUSTOMER][NEUTRAL] Oh hold on, what page benefits.
[AGENT][NEUTRAL] Oh you're fine.
[CUSTOMER][NEUTRAL] I'm looking.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Oh, it was here somewhere. OK, here, here, here. So I think maybe I'm just looking, it says I could possibly be uh benefited through the AAA and triple C.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The 75 per calendar per year, 75 for one follow up per year, and then it's 300 per.
[AGENT][NEUTRAL] Oh, yes.
[AGENT][NEUTRAL] You're looking at the um
[AGENT][NEUTRAL] But, uh, excuse me, hang on, the um schedule of benefits is that the page that you're looking at?
[CUSTOMER][NEUTRAL] Are you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so if you go and I'm of course I'm looking at your policy online so I'm hoping these page numbers are the same, um, if you go to page number 8.
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Where the beginning of the page should be surgical benefit that should be the beginning of that page.
[CUSTOMER][POSITIVE] Yeah, I got it.
[AGENT][NEUTRAL] Do you see that? OK. So on there, if you look at that sentence, it's uh for a covered person with diagnosed cancer and then it does state that if it, um, there's a couple paragraphs down, um, diagnostic surgeries that result in a negative diagnosis of cancer are not covered under this benefit.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, but like it just said you know I can I can do the med medical imaging benefit because I did that twice.
[AGENT][NEUTRAL] Yes. Absolutely. Those are gonna be more um preventative diagnostics. So mammograms, uh, Pap smears, colonoscopies, things like that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, that's
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, alright, well I will try to do this secured. If not, I'll just do paper but um I will try to go somewhere that.
[AGENT][POSITIVE] If you have any questions with it feel free to let us know um we'll help you out it is definitely easier um and it'll get it to us much quicker as well and you don't have to worry about mailing anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got you. OK, alright, well thank you so much for your help.
[AGENT][NEUTRAL] Alright, yeah, did you have any other questions for me, [PII]?
[CUSTOMER][POSITIVE] That's it thank you.
[AGENT][POSITIVE] Alright, yeah, thanks for calling [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.