AccountId: 011433970860
ContactId: 28b5539e-3618-4602-a054-9ca035998ff9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 808719 ms
Total Talk Time (AGENT): 474469 ms
Total Talk Time (CUSTOMER): 214871 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/28b5539e-3618-4602-a054-9ca035998ff9_20250404T14:30_UTC.wav
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[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. My name is [PII]. And um I work for a school district and I have you guys supplemental coverage on my plan. And I was recently on, let's see, I guess [PII], diagnosed with prostate cancer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And I was.
[CUSTOMER][NEGATIVE] Just wondering what I need to do to take advantage of this y'all's insurance that I have.
[AGENT][POSITIVE] Oh, OK. Yeah, for sure, [PII]. I'm sorry to hear that. Do you have a policy number? I'm happy to help.
[CUSTOMER][POSITIVE] That's a great question. Yeah, hang on just a second, um.
[AGENT][POSITIVE] If you don't have it, I can definitely look it up. Not a problem.
[CUSTOMER][NEUTRAL] Would, would, like we have the general um.
[CUSTOMER][NEUTRAL] I don't know where would I find that?
[CUSTOMER][NEUTRAL] With the, so I have the, the card that we get the Blue Cross Blue it's just Blue Cross Blue Shield. I don't know if that will help you.
[AGENT][NEUTRAL] Yeah, that would be your.
[CUSTOMER][NEUTRAL] I don't really know
[AGENT][NEGATIVE] Yeah, that would be your primary, so that's not good, yeah, that's.
[CUSTOMER][NEUTRAL] Main
[CUSTOMER][NEUTRAL] I don't remember getting a card for it because I have it too, but I don't remember us receiving a card.
[AGENT][NEUTRAL] OK, let's just take a look by your um name. What's the last name?
[CUSTOMER][NEUTRAL] Or are they
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] OK. And then, what state do you live in?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if I could verify please your date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And then lastly, um, I need to verify, please, your physical address and email address.
[CUSTOMER][NEUTRAL] Physical address is um [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the email address is [PII] oh wait a minute oh might be my school email. If it's the school email, it's [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, yeah, yeah, that's what we have on here, it looks like. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so.
[AGENT][NEUTRAL] So for this, you wouldn't have gotten a card, so that totally makes sense. Do you want to write down the policy number though?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, just let me know whenever you're ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, uh, policy number is 0252.
[AGENT][NEUTRAL] 5064.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so for this supplemental plan that you have, it is a cancer policy. Claims can be filed 3 different ways. They can be done online. We have an online service center. Um, you can send them in the mail or you can fax them. So really it's just whatever is easiest for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if you wanna do the online service center, I can definitely, um, if it's easiest, I can send you an email with a user guide on how to set that up and then also the claim form. Uh, the web address is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, as far as what is needed for a claim, you would need a claim form every time that you're submitting a claim.
[AGENT][NEUTRAL] Um, those claim forms can be retrieved also from our website. Uh, there's a link there that you'll see. It says claims and forms, and when you click on that, they're all in alphabetical order. Uh, you would be wanting the cancer claim form. That's the one that you would be downloading and submitting.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the claim form, when you get to that, um, it does page one is just complete instructions, so it does tell you um what is needed with along with the claim form depending upon what you're uh submitting for so.
[AGENT][NEUTRAL] Let's see. So like your
[AGENT][NEUTRAL] The plan has a um first occurrence benefit. So if you were wanting to go ahead and file for that, it's a lump sum benefit of $7500.
[AGENT][NEUTRAL] And so it says when filing the claim for an initial diagnosis of cancer, we just need the pathology report with that and then um the diagnosis and then if you had any surgeries accompanying that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What if the surgeries coming with you?
[CUSTOMER][NEUTRAL] So I guess my, my next question is, you having said that, um, I am, my, my, they're they're removing my prostate and the surgery is scheduled for um 3 weeks from today, actually [PII], um, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So just any like.
[CUSTOMER][NEUTRAL] So does that have any bearing on anything or just do just go and do the initial claim or how does?
[AGENT][POSITIVE] So if you'd like to go ahead and file the initial claim for just like the first occurrence benefits, just having that diagnosis, you can absolutely do that.
[AGENT][NEUTRAL] Uh, the plan itself does have, let's see.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] So it does have a surgery benefit.
[AGENT][POSITIVE] And like there's also a benefit on here if you in the future have to have any sort of like radiation, chemo, or immunotherapy.
[AGENT][NEUTRAL] The surgery benefit is just showing $25 per surgery. Um.
[CUSTOMER][NEUTRAL] I don't cover much.
[AGENT][NEUTRAL] It's not a whole lot. It doesn't look like. Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's honestly it's up to you how you wanna do it. Some people file the claims as they go some people just wait and do everything all at once. Um, it's really just personal preference. There's not like a time frame in which that it has to be submitted by.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what about like testing because you've got an MRI and a PET scan, because that's covered under this because there's diagnostic testing and there's follow up and then imaging.
[AGENT][NEUTRAL] Yeah, so for the diagnostic testing, you can definitely submit those and like you can do like if you want to go ahead and submit what you have, you could be submitting one claim form and then you can do the uh paperwork for the initial diagnosis and then you can also go ahead and submit your diagnostic testing. Um, so for any diagnostic testing.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um, for that, we would need just the itemized medical bill and then um.
[AGENT][NEUTRAL] From the provider and then it looks like an explanation of benefits if you have another medical carrier just showing the amounts paid for the service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so the diagnostic testing benefit, it's a maximum of 1 per calendar year, and that's a benefit payment of $50.
[AGENT][NEUTRAL] And then you have a follow-up benefit of 1 per year and that's $100.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you want, I can.
[CUSTOMER][NEUTRAL] Is the imaging.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] [PII] tomorrow.
[CUSTOMER][NEUTRAL] I don't know what. Oh sorry, I, this is his wife. I'm in here. So on the medical imaging so I'm sitting here looking at this on my computer as well. Is the medical imaging not the diagnostic? Is that like MRIs? What is under the medical imaging because he's got MRI and a PET scan as well as just the PSA and um biopsies, etc.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the medical imaging would be MRI, CT, CAT scan, or PET scan.
[CUSTOMER][NEUTRAL] OK, that's what I thought. I just wanted to make sure.
[AGENT][NEUTRAL] Mhm, yeah, and then the diag
[CUSTOMER][NEUTRAL] And the diagnosis would be the biopsy.
[AGENT][NEUTRAL] Yeah, so it would be.
[AGENT][NEUTRAL] It lists diagnostic testing. It says, um,
[AGENT][NEUTRAL] It lists a blood test, a PSA. It says a prostate-specific antigen blood test. If you have that done, that would be covered, or colonoscopy or uh virtual colonoscopy, those would be things under diagnostic that would be covered for that benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I didn't know if like the follow up diagnostic because after the PSA and all of the and then the MRI then they had to confirm that with the biopsy so I don't know if that was follow up. I just wondered what category everything fell under.
[AGENT][NEUTRAL] It would probably be follow-up. Um, yeah, absolutely. So I would submit the original testing, uh, for the benefit of the 50, and then you had to have a follow-up test. I would definitely go ahead and submit it. Um, and then, again, the medical imaging is a separate benefit. So that would be the MRI, CAT scan, or PET scan. So definitely submit that, um, to get that paid out because you get one of those.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A calendar year, so that would just, yeah, go ahead and pay out for 2025 um.
[CUSTOMER][NEUTRAL] A year.
[AGENT][POSITIVE] And then if it's OK I can like I said I can email all this to you if you'd like me to send it to your personal email instead of the email on file I'm happy to do that also.
[CUSTOMER][POSITIVE] Yeah, that would be great.
[AGENT][POSITIVE] Yeah, absolutely. What is your uh personal email address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I will say when you're setting up your account online it's gonna ask you um for your last name it's gonna ask for your social email things of that nature to create the account um you will need to enter all the information that we have on file for the policy so if you'd rather have your personal email on there um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can update that but when you're creating the account, you just need to make sure you use the same exact information otherwise it won't let you create the online account.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I, I mean, you can just leave it the school email, that's fine. I don't see, yeah, just leave it the way the way it is.
[AGENT][NEUTRAL] OK. OK.
[AGENT][POSITIVE] OK yeah not a problem um I'm sending you the online user guide and then also the uh claim form that's needed and so you can download that or print it out, whatever works best for you guys um do you have any other questions or concerns you can think of that I can help with?
[CUSTOMER][NEUTRAL] Oh, no, [PII], your name is [PII], right?
[AGENT][POSITIVE] Uh yep, that's correct, yeah.
[CUSTOMER][POSITIVE] All right, well, um, you've done a great job of answering all our questions and we really appreciate your help.
[AGENT][POSITIVE] Yeah, not a problem. And if you think of anything else, feel free to give us a call. We're happy to help, OK?
[CUSTOMER][POSITIVE] All righty. Thank you.
[AGENT][POSITIVE] Yeah, you're very welcome. You guys take care.
[CUSTOMER][NEUTRAL] Well, you too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.