AccountId: 011433970860
ContactId: 3218c74c-34a7-4912-939d-41bb40f33ac4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1164160 ms
Total Talk Time (AGENT): 654940 ms
Total Talk Time (CUSTOMER): 326048 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/3218c74c-34a7-4912-939d-41bb40f33ac4_20250106T18:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was curious. Uh, I do have cancer, I guess insurance, and I'm just, I'm trying to figure out, uh, and I also have breast cancer. I'm trying to figure out what, what is my next steps on what to do cause it's kinda confusing when I look online.
[AGENT][NEUTRAL] OK, let's take a look at your policy. Do you by chance have your policy number?
[CUSTOMER][NEUTRAL] Do I have my policy number? No, but I can easily get it. I, I don't know what website should I go to for that, and I am logged into my benefits page.
[AGENT][NEUTRAL] All right, let's see here.
[CUSTOMER][NEUTRAL] Let me see if I have that out there.
[AGENT][NEUTRAL] I think it does say I just don't recall where it says it. Give me just a second. I can also look it up by your name or social.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Here, OK, so when you're on the, when you're logged in it should show under my coverage it should show the product type and then your policy numbers should be to the right of it.
[CUSTOMER][NEUTRAL] My coverage.
[CUSTOMER][NEUTRAL] And you're talking about the my Benefits [PII]?
[AGENT][NEUTRAL] Yeah, if you're are you logged in? I thought you were logged into the APL like a user site.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, ATL. OK, so I found it last night, but then it's like, how do I get back to it? Oh, I think I found it. No, I did not. OK.
[CUSTOMER][NEUTRAL] APO direct deposit has the same information uh online payment plan form.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sign up or log in. OK, I think I found it. OK, now I'm about to log into it and that was my.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think my username is different.
[CUSTOMER][NEUTRAL] OK, I'm logged in.
[CUSTOMER][NEUTRAL] OK, my policy number is 254.
[CUSTOMER][NEUTRAL] 1205
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] And then if I could just verify your first and last name and your date of birth, please?
[CUSTOMER][NEUTRAL] Um, my first and last name is [PII]. My birthday is [PII].
[AGENT][NEUTRAL] All right, thank you for that. And then what is the uh what is your current address?
[CUSTOMER][NEUTRAL] Uh, my current address is going to be, so I just changed it.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Parksville Drive.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] Alright, thank you so much for that and then it looks like the email address that we have on file is your [PII]. Is that still a good email for you?
[CUSTOMER][POSITIVE] That's right. That's right.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Um, OK, so, um, where you're logged in there and you see your policy information and all of that, if you look, if you scroll down you'll see um a box down below that that says my claims and then it says upload documents um when you click that green upload files button that's where you go to file any sort of claims that you need to file.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, under the policy, so that's where you upload all that information, um, the plan itself, did you kinda wanna go over what that covers?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, I would. Yes, I do.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] And what would I need to upload? Just my diagnosis or?
[AGENT][NEUTRAL] So there is a claim form that you'll need and I can send that to you if that's easiest um it's a cancer claim form.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so when you get this form, page one is simply just instructions as far as like what is needed um you'll need to complete the cancer claim form and then um if you haven't filed your plan offers um a first occurrence benefit.
[AGENT][NEUTRAL] So what that means is that you would need um a pathology report with the initial diagnosis of cancer.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so the plan is gonna pay a lump sum benefit on the diagnosis of $10,000.
[AGENT][NEUTRAL] And then if you have any treatment after that, it's going to pay for radiation, chemotherapy, and it does pay for immunotherapy as well. Um, the longest it'll pay for it is a 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the max max benefit amount on the policy is $20,000.
[CUSTOMER][NEUTRAL] So, once I send them my pathology report of my initial diagnosis, they give me a check of $10,000.
[AGENT][POSITIVE] Correct, for the initial um occurrence. Correct.
[CUSTOMER][NEUTRAL] And then, uh, what if my, my diagnosis was not, you know, like, when was it, does it have to be a time frame when you got the diagnosis?
[AGENT][NEUTRAL] Um, let me see if there's a time frame. Let's see.
[AGENT][NEUTRAL] I don't think there's a limitation.
[AGENT][NEUTRAL] I mean the policy just, yeah, I don't see any sort of limitation.
[AGENT][NEUTRAL] Um first time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the the policy, of course, would have had to have been active at the time.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] You said what?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It says, OK, so for first occurrence, it says.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Correct
[AGENT][NEUTRAL] to be encouraged.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] While the policy is in effect, a covered person can receive a first diagnosis of internal cancer. We will pay up to the lump sum benefit amount. This benefit amount is shown on the schedule of benefits page which I gave you.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] It looks like, yeah, I mean the amount just reduces by 50% once you hit the age of [PII], that's not applicable to you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The date of diagnosis for, uh-huh.
[CUSTOMER][NEUTRAL] Cause what I'm wondering.
[CUSTOMER][NEUTRAL] What I'm wondering is that I got my diagnosis. I can't remember if it was after I got the policy or right before.
[AGENT][NEUTRAL] So, the effective date, yeah, the effective date on your policy is [PII]. So, to get the, get the payment, you, you would have had to have gotten the diagnosis at the time that the coverage was active. If it was prior to active coverage, then it wouldn't apply.
[CUSTOMER][NEUTRAL] So would that still
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So if I got it in August, then I wouldn't get the 10,000. I wouldn't get any money for it.
[AGENT][NEUTRAL] Right, it would have to be [PII] or later.
[CUSTOMER][NEUTRAL] Oh, so, so.
[CUSTOMER][NEGATIVE] OK, OK, so that means that $10,000 does not apply to me. They wouldn't give me any money for it, even though I got it maybe a month beforehand.
[AGENT][NEUTRAL] Not for the lump sum benefit payment. Um, if you've had any sort of like treatment ongoing, you know, like, and been covered, like that stuff would definitely be reimbursable, but the lump sum payment wouldn't be applicable, correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, OK. And I thought, I thought they might adjust it, but they do not.
[AGENT][NEUTRAL] Correct, yeah, I would have to be, yeah, it would not be adjusted, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And then I, so, so with the chemotherapy cause I'm currently doing chemotherapy, what would they do from here with the chemotherapy? Or what do I need to do to
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Let's see. If you're filing a claim for hospitalization, surgery, or chemotherapy, um, it looks like they need the claim form which I'll send to you and then itemized medical bill from your provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then they need explanation of benefits from any other medical carrier showing the amount that was paid by if you have any other primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I my bills from my, from the hospital and it's also including, you know, if my insurance pay for anything.
[AGENT][POSITIVE] Yes, ma'am. Correct. Uh-huh.
[CUSTOMER][NEUTRAL] My primary insurance. Mhm.
[AGENT][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] And they'll reimburse this to me?
[AGENT][NEUTRAL] Um, so they can, so you can have either the um provider themselves file the claims and then they'll be reimbursed or you can file them if you file the claims yourself then the payment comes to you correct.
[CUSTOMER][NEUTRAL] OK, I see. But why would they, uh, OK, because one of my primary insurance, don't they have, they don't have to pay for it, so why would they reimburse my primary insurance?
[AGENT][NEUTRAL] They would reimburse the provider. The provider would be the one submitting your claim on your behalf just like they do to your primary insurance and then your primary insurance pays them, we would be paying them for any residual amount left over after the primary, so.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If they bill your primary 10,000 and then the leftover amounts 1000 then we reimburse them that you know the 1000 that they're billing us for the residual.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] And then any surgeries that I have coming up, would y'all take care of that or that was something that I would be paying back?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So it looks like.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, there is a
[AGENT][POSITIVE] Benefit on here for surgery.
[AGENT][NEUTRAL] Um, it looks like the benefit is $50 a day for confinement in the hospital, and then it looks like $25 per surgery.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's how much I would pay or that's how much I would pay?
[AGENT][NEUTRAL] That's that's how much we would pay that's the benefit amount paid paid out.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And then I was saying something cause I do have breast cancer. I was gonna get both of my breasts removed and get it replaced with breast implants.
[CUSTOMER][NEUTRAL] And they're saying something about reconstructive surgery that you would provide that for
[AGENT][NEUTRAL] Let's see, so they do do.
[AGENT][NEUTRAL] There's a coverage in here for like um prosthesis.
[AGENT][NEUTRAL] But that's not specifically saying reconstruction. Um, let's see.
[CUSTOMER][NEUTRAL] What is that pros.
[AGENT][NEUTRAL] Yeah, so it just shows like prosthesis and ortho benefit and it just states $25 benefit payment towards it.
[CUSTOMER][NEUTRAL] Yeah, I had just, I was just reading this.
[CUSTOMER][NEUTRAL] Um, but it was just under, uh, like, uh, breast cancer.
[CUSTOMER][NEUTRAL] Cause I don't know, cause you said that doesn't that, does that have something to do with the mouth you said?
[AGENT][NEUTRAL] Does it have something to do with what? I'm sorry. Can you ask, ask that again?
[CUSTOMER][NEUTRAL] I'm sorry, I was reading, I don't know, I was reading, um, I can go back to it cause I was reading about the plan, so that's why I'm like um.
[CUSTOMER][NEUTRAL] Cause prosthesis, does it have something to do with the mouth?
[AGENT][NEUTRAL] I don't know if that would necessarily have to do with the mouth. Let me see what the definition, how that comes up. Give me one second.
[CUSTOMER][NEUTRAL] Plan information.
[CUSTOMER][NEUTRAL] This is kind of uh a lot to go through.
[AGENT][NEUTRAL] Yeah, it's a lot of them.
[CUSTOMER][NEUTRAL] Without um
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And is there like uh uh and this is the this is the information line or who am I exactly, what am I exactly, you know, talking to? I'm sorry.
[CUSTOMER][NEUTRAL] Oh, that.
[AGENT][NEUTRAL] So I just work in customer care for American Public Life um we help with eligibility um we have a claims department like if you needed assistance like if you ever had a claim denied, obviously we have people that work in claims that can go over claims with you and give you more detailed information if you ever had a claim denied we needed additional information um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We have people that can help with that so we're basically I'm the first point of contact with the company um just to assist going over plans and things like that if you wan[PII], I mean, do you have a copy of your policy itself?
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] Uh, no, I do not.
[AGENT][NEUTRAL] OK, so let me email this to you because it has.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Scheduled benefits page and that's really what you need because that gives you exactly the breakdown of exactly what's covered, the payment amount um the maximum per calendar year, all that information so that'll be definitely helpful to you so I'm gonna email this to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you so much. And it's kinda hard for me cause I'm not sure what am I asking cause I'm not even sure what this is. I've never seen this before or dealt with, you know.
[AGENT][POSITIVE] Right. No, yeah, I totally get it. So, um, yeah, I mean, really, this should bridge the gap between any cost that you have between your primary insurance.
[AGENT][POSITIVE] Um, and any leftover cost. I mean, that's really the, the benefit of of it is to, if you're diagnosed with cancer, it's gonna bridge the gap, so you're not paying so much out of pocket um to cover treatment and costs and things like that. Some people will honestly um have their providers submit the claims for them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, I see it.
[AGENT][NEUTRAL] And just say, you know, hey, I do have primary insurance, but I do also have this cancer insurance, and they find that having the providers submit the claims on their behalf sometimes are easier, um, like I said, and then the benefit payment if there's anything that you owe, then we would just pay that to them and you wouldn't receive a bill um if the full amount was covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] Um, so yeah, it's really.
[CUSTOMER][NEUTRAL] And the provider are the people at the hospital.
[AGENT][POSITIVE] Yes, correct. The people giving you care, um, the hospital, any doctors you see, appointments, things like that, yeah, that would be whoever's giving you the care.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] See, I did not know this. I did not know what this was exactly.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and you said that you'll be able to email me those uh.
[CUSTOMER][NEUTRAL] My, um, my plan and the claim form.
[AGENT][NEUTRAL] Right, so I'm sending you the um policy now and then I'm also going to send you the claim form and you can go back and file any claims that you need to um like I said, as long as the plan was active at the time of service when you were seen.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK. So from September on out, those are the dates that, OK.
[AGENT][NEUTRAL] Does
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so anything from that date going forward then can be submitted.
[AGENT][NEUTRAL] Um, for, for payment. So if you
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And like I said, the first page um on the claim form is gonna be just instructions as far as what is needed and what you're filing a claim for it'll tell you um exactly what you need to include in it and then it also has our fax number and mailing address as well if you want to fax or mail the claims you can do that. Most people do them online though through that portal.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well, thank you so much. You said, uh I'll just be looking forward to those emails, um, you know, I'm gonna read about it so I just, you know, have an idea of what's really going on.
[AGENT][NEUTRAL] Yeah, no, absolutely, I just sent that email and so you should have that in the next 5 minutes or so, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Well, thank you so much.
[AGENT][NEUTRAL] Anything else I can do for you?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] No, no, you told me.
[AGENT][POSITIVE] Have a good day. Thanks for calling. Uh-huh. Bye-bye.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] You too. Bye bye.