AccountId: 011433970860
ContactId: 2ef540c7-7c4a-4bfb-ac62-817d2435d0a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471000 ms
Total Talk Time (AGENT): 164600 ms
Total Talk Time (CUSTOMER): 218607 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/2ef540c7-7c4a-4bfb-ac62-817d2435d0a3_20250324T17:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is um [PII] and I have a cancer insurance with y'all. I was just trying to clear up some confusion that I have on my end. Um, my husband.
[CUSTOMER][NEUTRAL] Uh, got his diagnosis in the year [PII], so I was told I had to pay on this insurance one full year before I could start claiming, and so, um, I'm gonna start making claims. I just got confused, um.
[CUSTOMER][NEUTRAL] So I thought I had to do an initial claim to show you the paperwork that he had cancer, like the pathology report and all that, and I did that and it said, you know, y'all, y'all can't pay, pay me on that. And I understand that, but I thought I just had to do that before I could start claiming um his chemo treatments that he gets.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, the initial diagnosis is not needed, uh, if you're just gonna be claiming like, yeah, the treatments and stuff like that. So you can just, um, yeah, you can file the claims or for the treatments, um, as you go, absolutely.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, OK, cause I did send the initial diagnosis and I didn't know, well, now I know, you know, you, y'all can't pay me for that because it was a pre-diagnosis and I, I knew I had to pay on it a full year. So I was like, well, I, I thought they needed it anyway, so I had went and got all that paperwork. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] No, no worries.
[AGENT][NEUTRAL] Oh, I'm sorry. Yeah, no, so yeah, it'll just be um for the treatments that you're wanting to get um any benefits for.
[CUSTOMER][NEUTRAL] Right, right, and he does also have a um permanent ostomy bag and so would I be able to make claims on the equipment, all the supplies he has to have for that or no?
[AGENT][NEUTRAL] Um, if you would like, I'm happy to take a look at the policy and just double check to see what's exactly covered on it. Do you by chance have the policy number?
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Can you spell the last name, please?
[CUSTOMER][NEUTRAL] My last name is [PII]
[AGENT][NEUTRAL] And you're on the um are you on the plan as well?
[CUSTOMER][POSITIVE] Yes, I'm the one that has the plan.
[AGENT][POSITIVE] OK, great. All right.
[CUSTOMER][NEUTRAL] It's under me. Mhm.
[AGENT][NEUTRAL] OK. And then what state do you live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you, [PII]. And then just in case if something happens on the call, do you have a good call back number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, thank you. So, I believe I've got your policy here. What is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it does list medical equipment. It says maximum one benefit per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that shows the benefit amount of $150.
[CUSTOMER][NEUTRAL] OK. And so,
[CUSTOMER][NEUTRAL] So cause he got diagnosed uh in [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So I paid on it for the full year, so I, I am able to claim his chemotherapy starting as of [PII], correct?
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Is the way I'm understanding it. OK. And so, cause he went into remission, but what they needed is the initial diagnosis, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, exactly. Uh-huh.
[CUSTOMER][NEUTRAL] Right. OK. OK.
[CUSTOMER][NEUTRAL] All right. Cause he had to start chemotherapy again in um [PII]. cause he, he was in remission for three months and then he started again in [PII]. But I can only start from his chemos from [PII], correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct, yeah. And then this will cover a maximum of a 12-month period up to $20,000 for any sort of radiation or chemotherapy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what does that mean? Like, what is?
[AGENT][NEUTRAL] So whichever is exhausted first, if he had it for, let's say, a straight 14 months, the plan would only pay for 12 months of it. But if the 20,000 is exhausted before the 12 months, then that's the most it's gonna pay, meaning if his chemo treatment, you know, if the 20,000 is exhausted in 6 months, then that's all it's gonna pay.
[CUSTOMER][NEUTRAL] OK, and so.
[CUSTOMER][NEUTRAL] I'm gonna claim [PII] because he gets chemo treatments every two weeks.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I'm gonna claim for [PII] and then.
[CUSTOMER][NEUTRAL] Um, I was told to claim on one certain policy number for [PII], and then for the treatment he's received this year, I have to do it on another, the other policy number is what I was told.
[AGENT][NEUTRAL] Yeah, so that would be, yeah, that would be correct. Yeah, because the one I located that's active started in [PII] of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, so even though the other one says lapsed, that's the one I'm gonna use for [PII].
[AGENT][POSITIVE] Right, because that was the one that was active at the time of service, correct, yes ma'am.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right, well.
[CUSTOMER][NEUTRAL] I just got all confused cause I'm like, I think I need this initial cause the other lady I spoke to, she's like, yes, your initial diagnosis and now I got confused, so I went ahead and sent it anyway, but OK.
[AGENT][POSITIVE] That's OK, no worries, yeah, it happens all the time, no worries. Better to usually send what you think you need and not need it versus having to go find something that, you know, you didn't have so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Right. OK. All right. Thank you so much.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else I can do for you?
[CUSTOMER][POSITIVE] No, ma'am, that'll be it. Thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.