AccountId: 011433970860
ContactId: 2428b74a-6e36-42dd-87a1-76fb2d111ce4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 881080 ms
Total Talk Time (AGENT): 484165 ms
Total Talk Time (CUSTOMER): 235137 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/2025/03/27/2428b74a-6e36-42dd-87a1-76fb2d111ce4_20250327T22:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, [PII], I was just calling to verify um coverage with you guys for myself.
[AGENT][POSITIVE] OK, yes ma'am, I can help you with your um benefits for yourself. Can I please get your name and your policy number?
[CUSTOMER][NEUTRAL] Now my name is [PII]. I don't have a policy number that I don't know that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but you do have insurance with APL, is that right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Ms. [PII], what is your, uh, social, and that'll pull in every policy you have with us.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please uh verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] [PII] [PII] and uh is it [PII] [PII].
[AGENT][NEUTRAL] Thank you. I appreciate you verifying your policy for me. OK, so I'm showing that the policy that you have with us is a group cancer policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you have.
[AGENT][NEUTRAL] This is just to verify your benefits. It's not a guarantee of payment.
[AGENT][POSITIVE] You have a first occurrence benefit.
[AGENT][NEUTRAL] For cancer?
[AGENT][NEUTRAL] Uh, diagnosis.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Of $10,000.
[AGENT][NEUTRAL] Uh, you have a first occurrence benefit for heart attack and stroke, that's $10,000.
[AGENT][NEUTRAL] And then let me look, I'm gonna pull your policy in to see what your benefits are.
[AGENT][NEUTRAL] For your whole policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you can also view this policy if you sign up for our online service center.
[AGENT][POSITIVE] I'll give you that website so at your convenience you can sign up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] It's secured, it's [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And if you go sign up on there, you can also um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] File claims if you need to file claims.
[AGENT][NEUTRAL] Yourself if the facility doesn't do it for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's gonna be just a moment while I get this pulled up.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Computer's pulling it in so I can look at your schedule of benefits.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So radiation therapy, chemotherapy, and immunotherapy, you have a maximum per covered person per 12 month period of $20,000.
[AGENT][NEUTRAL] If you have to have hormone therapy per treatment, maximum up to 12 treatments per covered person per calendar year is $50.
[AGENT][NEUTRAL] A mastectomy, a confinement per day in the hospital confinement. If you have a mastectomy is $50.
[AGENT][NEUTRAL] Per day for uh mhm.
[CUSTOMER][NEUTRAL] Now let me ask
[CUSTOMER][NEUTRAL] OK. So when you say the first occurrence, what does that mean?
[AGENT][NEUTRAL] That means the first occurrence of um diagnosed with cancer. So you would have to send in the pathology report from the doctor stating that you've been diagnosed with cancer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's, that's uh 10K for that and 10K for heart attack, stroke. What, what do you mean 10K? Is that like you pay the doctor's bills up to 10K?
[AGENT][NEUTRAL] No, we send the first occurrence benefit of 10,000 to the member.
[AGENT][NEUTRAL] That has been diagnosed with cancer to help with, help with treatment.
[CUSTOMER][NEUTRAL] OK. And then for radiation, chemo and immunotherapy, if that person goes through those things, you send a benefit of 20K to help with treatment if they're going through those things.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, ma'am. You have a maximum benefit. You have $20,000 per 12 month period to use for radiation therapy, chemotherapy, and immunotherapy. That's not paid to you, that's paid to the facility for the bill.
[CUSTOMER][NEUTRAL] OK, and the
[CUSTOMER][NEUTRAL] OK, and the maximum benefit that you guys pay is 20K.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And that does not include any of that 10K that we mentioned earlier, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And then the um you have hormone therapy, uh 12 treatments at $50. What is the $50? Does that go to the uh doctor's bill?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so the $50 if you do hormone therapy, it's $50 per treatment that goes towards the bills.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And if you get a mastectomy, the mastectomy is $50 for what?
[AGENT][NEUTRAL] You get
[AGENT][NEUTRAL] Uh, per day of hospital confinement while you're having the mastectomy.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And then you have surgery, per surgery, it pays $25.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, if you have to have a pro prosthesis, surgical or non-surgical, you have one device per site, per covered person, per lifetime that pays $25.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, you have ovarian cervical cancer screenings that pays $10.
[AGENT][NEUTRAL] Uh, you have.
[AGENT][NEUTRAL] That first occurrence benefit, the lump sum benefit of $10,000.
[AGENT][NEUTRAL] If you have children, you have a lump sum for eligible dependent children of 15,000.
[AGENT][NEUTRAL] Uh, the heart attack and stroke.
[CUSTOMER][NEUTRAL] And what makes them eligible?
[AGENT][NEUTRAL] If they're diagnosed with cancer.
[AGENT][NEUTRAL] All of this, all
[CUSTOMER][NEUTRAL] How old must they be?
[AGENT][NEUTRAL] They have to just be a dependent on your policy.
[AGENT][NEUTRAL] Uh, the policy will cover dependents up to the age of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], [PII]. Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Uh, and all, all of these benefits are based on cancer diagnosis, except for the screening. The screenings are, you know, preventative.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, if you have a heart attack or stroke, you get that first occurrence lump sum benefit of 10,000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If one of your children has a heart attack or stroke.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They get a lump sum benefit of $15,000.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have a diagnostic testing. Maximum 1 test per covered person per calendar year is $50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you have to have follow-up testing after that initial diagnostic test, you get a maximum of 1 test per covered person per calendar year of $100.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You have medical imaging per test up to per test up to maximum of 1 test per covered person per calendar year we'll pay a maximum of $500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And then.
[AGENT][NEUTRAL] That looks like the benefits for your cancer policy and this same policy that I'm reading will be on your online service center so if you wanted to download it and go over it, you can do that too.
[CUSTOMER][NEUTRAL] OK. And the imaging that you just told me about, is that only for heart attack or is that for the um the above stuff too?
[AGENT][NEUTRAL] DMS. OK, let me, yeah, let me find that. Diagnostic testing, um,
[CUSTOMER][NEUTRAL] The imaging payouts.
[AGENT][NEUTRAL] That's what you're talking about, the diagnostic testing?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. The diagnostic testing is an optional benefit rider that you have for cancer screening.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And is there, what's the payout for that?
[AGENT][NEUTRAL] You get 1 test per covered person per calendar year and they'll pay $50.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK. And uh do.
[AGENT][NEUTRAL] Yes, ma'am. And then if you have to have a follow up test for that diagnostic testing, if they come back and say you need to do a follow up test, we may have seen something like we need to do a follow up test, then that is one test per covered person per calendar year that pays $100.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Do you guys
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK. I guess I was um.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Wondering about the imaging, the imaging test.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Right. Medical imaging per test up to a maximum of 1 test per covered person per calendar year, it pays up to $500.
[CUSTOMER][NEUTRAL] OK. Now, let me ask you, I had a test done last year. Am I able to claim that?
[AGENT][NEUTRAL] Was it a cancer screening test?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I don't know if it's specifically called that, but I had a test and they told me that I had, you know, uh,
[CUSTOMER][NEUTRAL] Something there and they wanted me to go in for a 2nd test. So I went in for the 2nd test.
[AGENT][NEUTRAL] Uh, you could go ahead and file that if it was after [PII].
[AGENT][NEUTRAL] That's when your policy started with.
[CUSTOMER][NEUTRAL] Oh no, it was 4.
[AGENT][NEUTRAL] it was before. OK, so your policy wasn't in effect until [PII].
[CUSTOMER][NEUTRAL] OK, so not even on last year's policy, I wouldn't be able to go back and do that?
[AGENT][NEUTRAL] Let's look and see.
[AGENT][NEUTRAL] Yes, you could, um, the previous year's policy started on.
[AGENT][NEUTRAL] [PII] and ended on [PII].
[AGENT][NEUTRAL] So you could go ahead and file a claim um and send in all the information for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For that claim. You'll, you'll need your um itemized statement from the facility. You'll have to go get that from the facility.
[AGENT][NEUTRAL] On the cancer claim form.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, if you go into the online service center and you click on your uh cancer policy.
[AGENT][NEUTRAL] And you go to claims and forms.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On that first page of that claim form it'll tell you exactly what you need to send in with your claim form or what you can download and then upload.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] It's kind of a good little cheat sheet that tells you everything you need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can you tell me how much I pay a month for this policy?
[AGENT][NEUTRAL] You pay $57.98.
[CUSTOMER][NEUTRAL] OK, 5798. And with this policy, um,
[CUSTOMER][NEUTRAL] For a hospital confinement.
[CUSTOMER][NEUTRAL] It's only, I think it's $4.50 was it $50 per day of hospital confinement? That's the only time you guys pay when you're in the hospital, correct?
[AGENT][NEUTRAL] Right, yes, for 18 hours or more.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I guess I'll just go online for the other one to to.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK cool alright well thank you so much I appreciate it.
[AGENT][POSITIVE] You're very welcome. Is there anything else, Miss [PII], I can help you with before we go?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] anything else
[CUSTOMER][POSITIVE] Uh, no, that's all. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good night and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Goodbye. Oh, I'm sorry, ma'am.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Are you able to give me my, uh, are you able to give me uh the policy number?
[AGENT][NEUTRAL] Yes ma'am, it is 252.
[AGENT][NEUTRAL] 6129.
[CUSTOMER][NEUTRAL] 252-612-9 and it's with uh APL?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Have a good night. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you goodbye.
[AGENT][NEUTRAL] Bye-bye, ma'am.