AccountId: 011433970860
ContactId: 235bc3bb-2c16-4609-8c5a-c506332a12e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 861000 ms
Total Talk Time (AGENT): 411973 ms
Total Talk Time (CUSTOMER): 320016 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/235bc3bb-2c16-4609-8c5a-c506332a12e4_20250129T18:38_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with the care team. How are you doing today?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm so wonderful. Thanks for asking.
[CUSTOMER][NEUTRAL] So, I have a gentleman on the phone. He has a cancer policy with us. His policy number is 456751.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, his name's [PII], and I, he recently was diagnosed with cancer. He had questions on his, um, policy. I talked to him about his benefits, um, and I see on here he has a dread disease rider, but I'm not showing anything. He doesn't have a policy cer really. He has like an old backdated one, but I'm not showing anything that lists what those dread diseases are or what would be on that.
[CUSTOMER][NEUTRAL] Um, as a writer and he wanted more information on that and I didn't know if you were if you had information about that.
[AGENT][NEUTRAL] OK, um, I could assist, uh, most likely I'll just have them to send in a claim for us to review the information as far as specifics, but yeah, go ahead and send him over.
[CUSTOMER][POSITIVE] OK perfect I am.
[CUSTOMER][NEUTRAL] Going to do that and you said [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Alright, I'll introduce you when we join, OK?
[AGENT][POSITIVE] OK, good deal.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi, Mr. [PII], are you still there with me?
[CUSTOMER][POSITIVE] I am. Hey, thank you so much for your patience so I actually um have Miss [PII] on the line and she handles our cancer policies a little more closely than I do so I think she might be able to benefit you greatly in offering you information on that. I'm gonna hit send on the email that I was creating for you, so be on the lookout for that and [PII] is gonna take on over, OK?
[CUSTOMER][POSITIVE] OK, thank you. My pleasure. Thank you, Mr. [PII]. You take care.
[CUSTOMER][POSITIVE] You too, thank you. OK.
[AGENT][NEUTRAL] Hello Mr. [PII]. My name is [PII] in the claims department. How are you today?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][POSITIVE] I'm good, thank you. I understand you had some questions about your benefits.
[CUSTOMER][NEUTRAL] I did, yes, kind of what it paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, um, and what in particular did you have questions about?
[CUSTOMER][NEUTRAL] Well, first of all, the cancer policy policy itself, can you go over again what benefits it has for me. I have been diagnosed with prostate cancer.
[CUSTOMER][NEUTRAL] I've had multiple doctor's visits that my insurance has paid some on and I've paid some on, of course. I had a PET scan that.
[CUSTOMER][NEUTRAL] Was paid by insurance and me both. And right now we're just uh by recommendation of my doctor who's also will be the surgeon, we're gonna monitor my PSA numbers for a while and go from there.
[CUSTOMER][NEUTRAL] And I was just wondering what benefits my cancer policy has and how do I access them if I have any benefits that would pertain to this.
[AGENT][NEUTRAL] OK, sure I can help you with that and um also um let's see, this is a verification of coverage so it doesn't uh guarantee the payment of a claim.
[AGENT][NEUTRAL] I do show that you have the cancer policy where um
[AGENT][NEUTRAL] The benefits amount, it, it depends on what services or treatment you've received and um will be determined based on the information on the claim once you submit that to us. Um, I do show that you have the coverage uh for the cancer and specified disease benefit and uh chemo, radiation therapy, immunotherapy, which pays a maximum of $10,000 per year.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Or radiation or chemo.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, or immunotherapy.
[CUSTOMER][NEUTRAL] Aminotherapy, OK.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Just looking to see um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As far as
[AGENT][NEUTRAL] The policy certificate that showed this policy effective [PII]. So I have limited information as far as the benefit specifics. I would have to um do some things on the back end to have an electronic copy of your policy certificate added to uh the system in order for us to view it.
[AGENT][NEUTRAL] And so that'll take a little time. Um, but in the meantime, you can submit your claim. Um, we will need a pathology report showing the diagnosis of cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the itemized bills for any um treatment or procedures you've had related to that cancer.
[CUSTOMER][NEUTRAL] OK, treatment or procedures?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, um, what does this, uh, disease writer?
[CUSTOMER][NEUTRAL] What does it include?
[AGENT][NEUTRAL] Let me see if I can get that information.
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So looking at the specified disease, uh show that there's a dread disease.
[AGENT][NEUTRAL] Uh, that is covered under the policy along with any diagnosis of cancer.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] So some examples of the covered um.
[AGENT][NEGATIVE] Diseases under that writer.
[AGENT][NEUTRAL] Bear with me just a moment. I'm trying to get that information.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To see if I can just get more specifics as I stated I don't have your uh policy certificate to read, so I'm just looking to see if there's some base information I can find regarding this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so just looking at the base policy, some of the examples of coverage under the specified disease is showing uh meningitis, diphtheria, smallpox, uh, scarlet fever, sickle cell anemia, uh, typhoid fever.
[AGENT][NEUTRAL] But I would suggest if you have any other um
[AGENT][NEUTRAL] Diagnosis that you want to file for, I would suggest you sending in that information and it gives us a chance to see uh exactly what's going on and we'll be able to determine if that is something that's considered under your policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because it is a range of um specified diseases. Um, yeah, I would just suggest sending that information over to us. And therefore, you'll have a clear cut answer based off of your diagnosis and um so on and so forth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now did I hear you say that the diagnosis of cancer was covered underneath the specified disease also?
[AGENT][NEUTRAL] The, the policy is cancer and specified disease. So the cancer diagnosis um would not be under that writer. That is, uh, your policy covers the cancer diagnosis.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, I thought I, I thought I heard you say that the cancer was under that also, so OK.
[CUSTOMER][NEUTRAL] OK, well, um, can you continue looking for that original paperwork and then either call or send in my email the details that you found with it?
[AGENT][POSITIVE] Absolutely, yes, sir. I'm gonna start the process now to have um
[CUSTOMER][NEUTRAL] Is that possible?
[AGENT][NEUTRAL] Uh, research of the backlog for this policy to have it added to get an electronic copy of it. Once that is completed and received, uh, I'm sure it'll, it'll take some time to locate the actual um individual policy. But I can assure you that once we have that, I will, um,
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Set a reminder to send it to you send a copy to you, uh, via email if you prefer or by mail.
[CUSTOMER][POSITIVE] I, I would like both actually if it's possible.
[AGENT][POSITIVE] OK, yeah, absolutely I can do that and just confirm your email address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, yep, and that is what we have on file. uh, so I'll go ahead and start that process now. Um, from my experience with the older policies, it typically can take a couple of weeks before we have that electronic file. Uh, so just to give you an idea of the time, you know, so you won't be looking around for it just to kind of give you an idea there but um.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm starting that process now and as soon as I get notification that the electronic file has been added to your policy, I'll get that sent to you via email and mail.
[CUSTOMER][NEUTRAL] OK. I have one other question.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] This all started back oh.
[CUSTOMER][NEUTRAL] I'm trying to remember, I have to go back to some of my paperwork, but around September when I was diagnosed in [PII], I think.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so it's been kind of an ongoing thing and this and that's come up. And also, I've, I've had another issue going on. I've had a shoulder surgery recently. So one of my question was, I'm still, there's no time limit of me filing any of this as far, as far as getting too far away from my original diagnosis date, is there?
[AGENT][NEGATIVE] Not at all.
[CUSTOMER][NEUTRAL] OK, because I have my uh pathology report and then.
[CUSTOMER][NEUTRAL] I, I'm on I've got some.
[CUSTOMER][NEUTRAL] Bills and some explanation benefits.
[CUSTOMER][NEUTRAL] That it says to gather.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But as far as my policy itself, I really won't expect no payment towards anything if I'm not doing.
[CUSTOMER][NEUTRAL] Uh, chemo or radiation or immunotherapy, correct?
[AGENT][NEUTRAL] I cannot say that um with certainty because I don't have
[AGENT][NEUTRAL] Your schedule of benefits because there are some benefits um under this policy as a base, but I'm not sure what exactly you have selected for your coverage. So it's a possibility that there can be some benefits payable, but again, I won't have that information until um I can view the policy, the individual policy.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Totally understand that makes sense and you may have that in the next 2 or 3 weeks possibly correct?
[AGENT][NEUTRAL] Yes sir, but in the meantime you can send that information, your claim uh documents over to us as well.
[CUSTOMER][POSITIVE] All righty
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I, I think you've answered about everything I can think of right offhand, and I appreciate it.
[AGENT][NEUTRAL] No problem, Mr. [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] I believe that's all the other lady said she was gonna send me a claim form to my email.
[CUSTOMER][NEUTRAL] And information to the portal there.
[CUSTOMER][NEUTRAL] And then so if she does that and then you send me my um.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Information here in 2 or 3 weeks whenever it gets rounded up that's be great.
[AGENT][POSITIVE] All right, good deal and yep, I do see the notes there that uh claim form um and OSC information sent to your email. So yep, I'll get on that now to get your policy certificate and you'll receive that um as soon as I have it.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] No problem, Mr. [PII]. Thank you for calling. Go ahead.
[CUSTOMER][NEUTRAL] I, I
[CUSTOMER][NEUTRAL] I have one other question. I'm sorry.
[AGENT][POSITIVE] Sure, no problem.
[CUSTOMER][NEUTRAL] I'm in [PII] I'm in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there offices that a person if they needed help can can go to and get help or is this on the phone and portal access only?
[AGENT][NEGATIVE] No, unfortunately it would be only online or by phone.
[CUSTOMER][NEUTRAL] OK, I'm just gonna ask.
[AGENT][POSITIVE] OK, but yeah, feel free to give us a call any time, um, and any one of our representatives will be able to assist you.
[CUSTOMER][POSITIVE] OK, well thank you for your help.
[AGENT][POSITIVE] No problem, Mr. [PII]. Thank you. Thanks for calling ATO. You have a great day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thanks bye bye.