AccountId: 011433970860
ContactId: 38ae615e-5740-407f-8dfe-9c5cb9715455
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2387000 ms
Total Talk Time (AGENT): 1342110 ms
Total Talk Time (CUSTOMER): 617228 ms
Interruptions: 11
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/38ae615e-5740-407f-8dfe-9c5cb9715455_20250430T17:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, um, I need to know how to file a claim or what's covered under my husband's, um, policy.
[AGENT][NEUTRAL] OK. Are you also covered under this policy?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so you have some questions regarding filing and how to file a claim and also benefit information?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, and what benefits are available under his policy?
[AGENT][POSITIVE] OK, yes ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] This is [PII]
[AGENT][POSITIVE] Thank you, Miss [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the policy number, please.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, let's see.
[CUSTOMER][NEUTRAL] I don't have it. I've got.
[CUSTOMER][NEUTRAL] Called up on the.
[CUSTOMER][NEUTRAL] My laptop but I don't see anything.
[CUSTOMER][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] Here we go.
[CUSTOMER][NEUTRAL] Policy
[CUSTOMER][NEUTRAL] Contact
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Can I give you his name?
[AGENT][NEUTRAL] Uh, what's his full social security number, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Give me just a moment please to see if I can locate his information.
[AGENT][NEUTRAL] And which policy are you inquiring on today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, I guess it would be the cancer policy.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] So I will have to verify several things with you first for security purposes and also any information that is provided would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your husband's name and date of birth and then your date of birth.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 17
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Also, and then your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The home mailing address.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file, uh, well, what would that be for Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the last thing to verify is his email that we would have on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] OK, what I need to know is we've never filed a claim on these policies.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. He's been diagnosed with cancer, has had surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, fixing to start treatment, so we just don't know what's available for this policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and let me look at something so.
[AGENT][NEUTRAL] I'm going to make a request to have your policy information made viewable to you. Are you logged into the online service center? Is that what you were stating?
[CUSTOMER][NEUTRAL] Well, I don't know if I'm logged into the right thing, so what do I need to be logged into?
[AGENT][NEUTRAL] OK, so I.
[AGENT][NEUTRAL] Well, I can only provide that information to Mr. [PII] since he's the primary policy holder. Is he there? OK, if he can authorize me to speak to you regarding that for this one phone call, I'll be happy to do that.
[CUSTOMER][NEUTRAL] OK, he's right here.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, here he is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is [PII] asking.
[AGENT][NEUTRAL] Hi, Mr. [PII]. This is [PII] with APL. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing good.
[AGENT][NEUTRAL] Good. So I was um needing to get, since you are the primary policy holder, we have to get your authorization in order to be able to do certain things with anyone else, even though [PII] is also on the policy. So do you authorize me to provide her the information on how to
[CUSTOMER][NEUTRAL] I don't have to.
[AGENT][NEUTRAL] Uh, log in to your online account with APL.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right. Yes, sir. But again, for security purposes, there are certain things that we can only do with you unless, you know, we get your verbal permission for that phone call.
[CUSTOMER][NEUTRAL] She's my wife.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK. Well, thank you very much. I'll be happy to speak back to Ms. [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Yes, sir. You're welcome. Have a nice afternoon.
[CUSTOMER][NEUTRAL] I'm on the line.
[AGENT][NEUTRAL] OK, Ms. [PII], so I see that someone has created a profile under the in the online service center. So are you logged into that?
[CUSTOMER][NEUTRAL] OK, I'm on the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] At [PII]?
[CUSTOMER][NEUTRAL] Now what do I need to log in just.
[CUSTOMER][NEUTRAL] So I'd start from the beginning.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] OK, so I think the easiest way so that you can have access to see where to kind of go to get different things is go to our main website at [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Ampublic.com.
[CUSTOMER][NEUTRAL] A M
[AGENT][NEUTRAL] Public
[CUSTOMER][NEUTRAL] Pub.com.
[AGENT][NEUTRAL] [PII]. Mhm. And let me know when that page pulls up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so at the top of.
[CUSTOMER][NEUTRAL] That is the one I was on.
[AGENT][NEUTRAL] OK, but there's, so I'm gonna show you where to get your claim forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Unless you've already found the cancer claim form. I'm also from this one page, you can get to the portal and you can also get your claims documents.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So don't click anything but do you see where it says claims and forms?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we're gonna come back there but that's where your claim form is located just to the right of that do you see where it says sign in?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] If you click on sign in, it takes you to the login page for the online service center.
[AGENT][NEUTRAL] So first off, let's, let me show you about the claim form. So go ahead and click on claims and forms.
[CUSTOMER][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] For some reason I just got out of that.
[CUSTOMER][NEUTRAL] OK, what did you say WW OK here it is again.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So you're just gonna click where it says claims no ma'am, don't click that yet. First we're gonna find your claim form. I'm gonna show you where your claim form is.
[CUSTOMER][NEUTRAL] OK, sign in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let's do that first, so claims and forms.
[AGENT][NEUTRAL] Click on that then scroll down the page.
[CUSTOMER][NEUTRAL] OK, I did.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] About midways down, you're gonna see where it says in big bold black letters claims, forms, and policy change documents.
[AGENT][NEUTRAL] Just below that.
[CUSTOMER][NEUTRAL] I don't see that.
[AGENT][NEUTRAL] It's gonna
[CUSTOMER][NEUTRAL] How far down?
[AGENT][NEUTRAL] About Middleways.
[AGENT][NEUTRAL] You're gonna see where it says mail, paper form, fax documents, come on down a little more.
[CUSTOMER][NEUTRAL] Claim forms and policy change documents.
[AGENT][NEUTRAL] Uh-huh. OK. Scroll down just a little bit farther, and you're gonna see where it starts listing out the different claim claim forms in alphabetical order. Can the cancer claim form should be the third one that you see. And out to the right, there's a blue button that says download form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just click that.
[AGENT][NEUTRAL] And that should download and open up your cancer claim form.
[CUSTOMER][NEUTRAL] OK, it did.
[AGENT][NEUTRAL] Alright, so that first page of that claim form has all of the instructions.
[AGENT][NEUTRAL] For completing the form and the additional documentation that will be necessary to submit for us to review so you can use that as your checklist per se, all those bullet points.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, at the bottom of page one.
[AGENT][NEUTRAL] There is a mailing address, there's our [PII] phone number, and then there's a fax number that's a secured fax line.
[AGENT][NEUTRAL] OK, the claims can be submitted to us either via uploading them directly into the portal which we're gonna go to next.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Faxing or mailing, we cannot accept claim forms via email.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so now that's where your claim form is. Do you have any questions on that?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so let's go back to that main page.
[AGENT][NEUTRAL] The [PII]. This time you're gonna click on the sign in link.
[AGENT][NEUTRAL] And let me know once that page has pulled up for you.
[CUSTOMER][NEUTRAL] In the back line.
[CUSTOMER][NEUTRAL] Log in
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] Is that what I'm looking for?
[AGENT][NEUTRAL] Yes and you're gonna click on the link that says log in or sign in. Oh, have you already done that? Are you on the online service center page?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I am now.
[AGENT][NEUTRAL] OK. So yes, ma'am, right there you'll put the username in.
[AGENT][NEUTRAL] And since Mr. [PII] did provide me authorization to provide you that, the name, the, or do you already know the username?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][POSITIVE] I've got it up, yeah.
[CUSTOMER][NEUTRAL] It popped up
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you'll just, um, OK, because, yes, all right.
[CUSTOMER][NEUTRAL] And the password.
[AGENT][NEUTRAL] And then you'll just, mhm, that's.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now I can email a user guide for the portal Miss [PII] to Mr. [PII]'s email that's on file and in addition to that user guide giving instructions for setting up the portal.
[AGENT][NEUTRAL] It also tells you that.
[AGENT][NEUTRAL] Gives you some additional information on uploading documents.
[AGENT][NEUTRAL] Um, adding in direct deposit information.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So I'll be I will send that to his email address and that email that I'm gonna send will come from care team.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I will put APL.
[AGENT][NEUTRAL] Oh, in the subject line so that that's easy to recognize as not being junk mail.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'll do that as soon as we get off of our call.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so now you know where to log in and also to get your claim form.
[AGENT][NEUTRAL] And so
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When you're logged into the portal, you should be able to see his policy or y'all's policy number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK. I need for you to please try and click on it.
[AGENT][NEUTRAL] Is it a different color?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] It's uh
[AGENT][NEUTRAL] Like a blue maybe OK, see if you can click on that to download and see what policy downloads or what information downloads.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you see how many pages? Yes, ma'am. Uh-huh. Can you see how many pages that document is?
[CUSTOMER][NEUTRAL] In a PDF form.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, I don't let me see.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 5 maybe.
[AGENT][NEUTRAL] 5
[CUSTOMER][NEUTRAL] 5
[AGENT][NEUTRAL] OK, so what I'm gonna do is I'm gonna send a request to have the full policy information made viewable to you if it's all you can see is 5 pages. Can you tell me like what the information consists of that you're able to see?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, when both our children went off.
[AGENT][NEUTRAL] Uh-huh, OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 41
[CUSTOMER][NEUTRAL] That's the only thing I see.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] It's got 5 page. I, I, is it a letter?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's just a letter
[CUSTOMER][NEUTRAL] Let's see. Yeah.
[AGENT][NEUTRAL] OK. So that's what I was going cause I can see that letter, but I'm gonna make sure that you can see all of your benefit information as well.
[CUSTOMER][NEUTRAL] Yeah, I have letters.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I do not see any download of a policy.
[AGENT][POSITIVE] OK, so yes ma'am, I'll send that request um just as soon as we hang up so that that can be made. Now that's gonna take probably a few days to get that done for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but it will be, it should be viewable.
[AGENT][NEUTRAL] Very soon.
[AGENT][NEUTRAL] Now today's Wednesday. I mean that could possibly it may be by the end of the week, but if not, it should be by the first the middle part of next week.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me see what this is.
[AGENT][NEUTRAL] Yeah, do you have more than one link for your cancer policy, the 784-039 number?
[CUSTOMER][NEUTRAL] 590359
[CUSTOMER][NEUTRAL] Is that what you said?
[AGENT][NEUTRAL] That's gonna be a different no, the cancer policy is 784-039.
[CUSTOMER][NEUTRAL] No, OK, I don't have.
[CUSTOMER][NEUTRAL] That one.
[CUSTOMER][NEUTRAL] Let me see here.
[CUSTOMER][NEUTRAL] 039.
[AGENT][NEUTRAL] Yes, ma'am. 784-039.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right, all I see is the letter.
[AGENT][NEUTRAL] That's the only thing, OK.
[CUSTOMER][NEUTRAL] For under that mask.
[AGENT][NEUTRAL] OK. All right. That's just what I wanted to verify. I, I, I also see that letter, but again, I, I didn't know if you could see more than that or not, but I will, I will get that taken care of for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] No, I don't see anything else.
[AGENT][NEUTRAL] OK, it would be right there. You won't have to look I mean it would be.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, it would be close. OK. All right. So do you have other questions at the moment that I for me?
[CUSTOMER][NEUTRAL] No, I don't see it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I could try and answer for you?
[CUSTOMER][NEUTRAL] Other than just, just in, yeah, and just in general.
[CUSTOMER][NEUTRAL] What is covered?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Under this policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So give me just a moment to get that information.
[CUSTOMER][NEUTRAL] I mean I don't know what it pays or.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] And it's, it's just still loading for me.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Should I like, you know, when I give them my regular health insurance card.
[CUSTOMER][NEUTRAL] Should I give him this policy number?
[AGENT][NEUTRAL] I mean you can ask them if they will file any additional policies, you know, I mean sometimes with especially cancer treatment, they will have, you know, people that assist patients and their families in filing claims, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] You, so, I mean, I would recommend at least asking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If, if they would help with that. Um, but if not, again, that page one is gonna tell you everything that you would have to get to submit a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so this policy, I mean, it has a lot of different benefits.
[AGENT][POSITIVE] It has benefits for hospital confinement. Uh, there's surgery benefits.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see about your first occurrence benefit. There's, so for the radi for example, is, you did say he's going to be having radiation, chemo or immunotherapy?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that benefit.
[CUSTOMER][NEUTRAL] See, uh.
[AGENT][NEUTRAL] Radiation, OK. So for that benefit, the three of those are combined, radiation, chemo, and immunotherapy. And that benefit is actual charges up to $15,000.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Per a 12-month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's, so for example, that's, again, that's a 12-month period. That's not a calendar year. So, if he were to start treatment hypothetically, for example, [PII], then that that $15,000 benefit.
[AGENT][NEUTRAL] Would be through [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Um, there are benefits, again, there's a lot of benefits. So I mean, I'll be happy to go over those with you, but
[AGENT][NEUTRAL] It's a lot of them. I mean, and they're alphabetized.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll see when you're able to see, but it goes all the way through the alphabet A to Z, and then it has A, A, B, B, C, C, and DD. So there's a, there's just a lot of benefits. Um.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And I'm still trying to get them all to fully load.
[CUSTOMER][NEUTRAL] So if I uh file a claim I file it after.
[CUSTOMER][NEUTRAL] Each treatment or?
[AGENT][NEUTRAL] That's entirely up to you. We will have to have the primary insurance's explanation of benefits.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] As well. Um, some people find it easier to file as they go to not have to be so, you know, to get so much together. And then some people wait, that's all in your preference because we don't have a filing time, a timely filing limit. So whichever is easier for you. Now, with the diagnosis of cancer, you could go ahead and file your um initial claim.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] In which we will have to have a copy of the pathology report.
[AGENT][NEUTRAL] Uh, that was, that diagnosed the cancer.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the benefit on this policy.
[AGENT][NEUTRAL] OK, again, give me just one moment. I don't know why I'm having trouble getting it to load part of my information.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] make sure
[AGENT][NEUTRAL] Do you mind letting me place you on a brief hold, Miss [PII]?
[CUSTOMER][NEUTRAL] That'll be fine.
[AGENT][POSITIVE] OK, great. Thank you so much. I will be right back with you, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] And thanks for calling AP. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. I'm not transferring a call to you, but I do need for you to please help me with the policy before I give these people an amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] 784-039. The last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] So he has been diagnosed with cancer. And looking at this policy certificate, I don't like these old policies.
[AGENT][NEUTRAL] OK, when I'm looking at PIBFT, it says the base benefit package on CPA 22. OK, it's 15,000.
[AGENT][NEUTRAL] And critical illness is 7500. I'm looking at the policy certificate.
[AGENT][NEUTRAL] And it doesn't say 15,000 anywhere that I've been able to locate anyway.
[AGENT][NEUTRAL] So I don't want to tell her what.
[CUSTOMER][NEUTRAL] OK, so you're looking, cause it's, so for the critical illness rider is um 7500 and there's an additional 7500. That's where the 15 is probably what you're saying. Let me see here. Let me pull up the policy.
[AGENT][NEUTRAL] Hey, look at PI BST, so that, that's confusing.
[AGENT][NEUTRAL] Because it shows $150,000 as the base benefit and then a $7500 critical illness rider.
[AGENT][NEUTRAL] And this policy says internal cancer benefit amount 7500.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] Yes, I see the internal, yes, and then the 15, let me take a look here.
[AGENT][NEUTRAL] So
[AGENT][NEGATIVE] And then it didn't even give me the critical illness benefit amount in the policy certificate.
[AGENT][NEUTRAL] Or not that I can find.
[CUSTOMER][NEUTRAL] Which that's the 7500.
[CUSTOMER][NEUTRAL] The 7500 is the um critical illness benefit.
[AGENT][NEUTRAL] And maybe if you
[AGENT][NEUTRAL] So it's it, so the PIBFT where it says 15,000, that's actually not the cancer benefits.
[CUSTOMER][NEUTRAL] Um, I'm looking at the.
[CUSTOMER][NEUTRAL] Cause it looks like he, the coverage that he has breaks down into different benefits here.
[CUSTOMER][NEUTRAL] Hold on here.
[AGENT][NEUTRAL] I just don't wanna tell them wrong. I, I mean, on these cancer policies, especially these old ones.
[AGENT][NEGATIVE] That are when PIBFT is useless in relation to the policy certificate.
[AGENT][NEUTRAL] The last thing I want to do is to tell people, you know.
[AGENT][NEGATIVE] Wrong benefit information they've got enough on their plate.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] It should give the dollar amount though, but it is not for.
[AGENT][NEUTRAL] On page 6 of 4, I'm looking on page 6 of 49 on this old.
[CUSTOMER][NEUTRAL] Yeah, that only tells, it tells that they have the level 2.
[AGENT][NEUTRAL] And then right below that. Mhm. And then it says internal cancer benefit max 7. Yeah, that does not.
[CUSTOMER][NEUTRAL] And then it has a critical illness.
[CUSTOMER][NEUTRAL] It's a 7500.
[CUSTOMER][NEUTRAL] Let me see something real quick.
[AGENT][NEUTRAL] That doesn't, that's confusing. That doesn't say that that's the critical illness benefit amount. That says that's the internal cancer maximum benefit amount.
[AGENT][NEUTRAL] Uh uh.
[CUSTOMER][NEUTRAL] Do you know if their condition is for cancer?
[AGENT][NEUTRAL] Yes, it is. He's been recently diagnosed, about to be going under surgery, radiation. Yeah. So I don't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then that would be the benefit of the 7500.
[CUSTOMER][NEGATIVE] Being diagnosed with cancer.
[CUSTOMER][NEUTRAL] Looks like it seem like it's a page that might be missing in it. Let's see.
[CUSTOMER][NEUTRAL] That's why I'm scrolling here.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] At the certificate.
[AGENT][NEUTRAL] And these policies.
[CUSTOMER][NEUTRAL] Cause they normally give additional benefits amounts, and I'm not seeing that this one is. It's only given at 7500 which that will be the initial benefit for being diagnosed with cancer.
[AGENT][NEUTRAL] Especially when you can
[CUSTOMER][NEUTRAL] Do you mind if I put you, oh no, here it is. No, I see it. He's the schedule page back here, page 23.
[AGENT][POSITIVE] Yeah, there's a lot of benefits.
[CUSTOMER][NEUTRAL] Page 23, there is a bit of it.
[CUSTOMER][NEUTRAL] Yes, so the, so him being initially diagnosed with cancer is the 7500. Then on page 23 of the pilot certificate, it breaks down what the benefits pays as far as other cancer treatment for hospital hospital confinement, drugs, and things of that nature.
[AGENT][NEUTRAL] Well, hold on.
[AGENT][NEUTRAL] OK. So, how do they get the critical ill where's the critical illness benefit?
[AGENT][NEGATIVE] Because that's very misleading on PIBFT.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is in the back of the rider.
[CUSTOMER][NEUTRAL] Um, of the policy which it pays that one time benefit.
[AGENT][NEUTRAL] So does he
[AGENT][NEUTRAL] I mean, I found the schedule.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so he's gonna get 7500 before being diagnosed with cancer and another 7500 under the for a total of 15,000, right?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] Mm, so, no, no. So for being diagnosed, no.
[CUSTOMER][NEUTRAL] For being diagnosed with cancer, he's getting the 7500 and then the policy breaks down into the other benefit being if he has other treatments. But just being diagnosed with cancer is the 7500.
[AGENT][NEUTRAL] OK, well then PIBFT is wrong.
[AGENT][NEGATIVE] That's not correct information.
[CUSTOMER][NEUTRAL] So, yeah, so it'd be, I, I think it's showing the, the 1500 as far as cause if it's another condition, like if he had a heart attack or something like that, then it'll pay the 7500 and then if it's cancer, it'll pay the 7575.
[AGENT][NEUTRAL] Well, this is critical illness. OK, it's still Dana.
[CUSTOMER][NEUTRAL] So he won't get 2 7500, so it'd be one benefit for 7500.
[CUSTOMER][NEUTRAL] And then it covers whatever other er treatment that he's received and then those the policy outlines those how much it pays up to.
[AGENT][NEUTRAL] Alright, so this, OK, so I'm gonna tell them it's the 70, OK, I'm not even gonna get it. OK, any deeper than that.
[AGENT][NEUTRAL] OK, cause I'm still confused on that, the way PIBFT is.
[AGENT][NEGATIVE] That is, that makes no sense because it shows RCA 15,000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then a rider under that for cancer of 7500.
[AGENT][NEGATIVE] That's misleading as all can be.
[CUSTOMER][NEUTRAL] Mhm. Yup.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I mean, is that not confusing to you? Do you mean,
[CUSTOMER][NEUTRAL] So the, so, well, it's, so what is it, I guess let me explain it like this where it's confusing. OK, so as far as the RCA, um, the RCA.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That actually refers to.
[AGENT][NEUTRAL] The base.
[CUSTOMER][NEUTRAL] The radiation and chemo.
[CUSTOMER][NEUTRAL] The radi radiation and chemo pay up to 15,000.
[AGENT][NEUTRAL] Yeah, I saw that because I've already given her that. OK.
[CUSTOMER][NEUTRAL] And then the critical illness and that comes into play as the 7500, but it'd be for either or either for a cancer diagnosis or a critical illness diagnosis. Yeah.
[AGENT][NEUTRAL] That comes into place as the diagnosis.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] So the critical illnesses for cancer that they have, so it only would pay 7500 for their initial, initially being diagnosed with cancer. And then the 15,000 is in regards to their max that the policy pays out as far as radiation and chemo. Does that make sense now?
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Yes, but so this policy is different in other, the other cancer policies and the fact that hypothetically, so he's diagnosed with cancer, that's a $7500 benefit this time. But then if he were to have some other type of critical illness,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Other than cancer, would he be eligible for that?
[CUSTOMER][NEUTRAL] Yes, such as like a, yes, such as a heart attack or things of that nature which is outlined back it breaks down which other critical illnesses would fall within that category.
[AGENT][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] A heart attack or stroke or things like that.
[AGENT][NEUTRAL] OK, alright, so let, OK, let me just provide her this and then I'm gonna order this policy to be made viewable in the OSC because she can't see this information right now anyway, but I'm, and I'm gonna do that. OK, [PII], well thank you for looking at that for me and helping me understand that a little better.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] OK. All right, thanks as always.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Mm, you're welcome.
[AGENT][NEUTRAL] All right, [PII]. bye.
[CUSTOMER][NEUTRAL] Mm bye.
[AGENT][POSITIVE] Ms [PII], thank you so much for holding for me, and I apologize about the delay. OK, so on this benefit, so I had given you what the calend or 12 months rather benefit period is and benefits for the radiation and chemo or immunotherapy treatment.
[CUSTOMER][NEUTRAL] OK, that's fine
[AGENT][NEUTRAL] The benefit for the diagnosis of cancer is 7500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that is something that if you wanted to go ahead and submit for, you know, to include your
[AGENT][NEUTRAL] The pathology report, diagnosing the cancer?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And again, on the page one of that claim form, it's going to give you like kind of different scenarios in which you would need to provide.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] If he has surgery, if he, you know, it's gonna tell you that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, but again, those are the, the big benefits. There are a lot of benefits. Are there other specific benefits that you would like for me to look up for you at the moment?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, I can look it up once I get started.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Cause that's gonna be a, yeah, so I mean, you know, there's, there's lab work benefits, um.
[AGENT][NEUTRAL] There's, Lord, if he were to have to, if you were to have to travel a long way, more than 50 miles away from your home for treatment.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] More time.
[AGENT][NEUTRAL] More than 50.
[CUSTOMER][NEUTRAL] Oh, OK, it's 100 miles to each treatment.
[AGENT][NEUTRAL] OK, so there would be, so you know, you can put there are transportation and lodging benefits on here.
[AGENT][NEUTRAL] Um, that we would pay, that pays for mileage on transportation, and that was 50 cents a mile up to a maximum of $1500 per round trip and the benefits for transportation are paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Up to 12 round trips per calendar year.
[AGENT][NEUTRAL] That would be the max.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There is a a lodging benefit of $60 per day and that's up to 90 days per calendar year. So what you're gonna need to, when you're able to see your benefits, again, the chemo and radiation benefit, that is for 12 months.
[AGENT][NEUTRAL] Some of the benefits are per calendar year.
[CUSTOMER][NEUTRAL] Right, uh-huh.
[AGENT][NEUTRAL] OK. So that verbiage, um,
[AGENT][NEUTRAL] You know, just pay close attention to that. Obviously, you can call us back with any questions when you're able to see it, but there are um.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's some home health benefits if he were to ever have that.
[CUSTOMER][NEUTRAL] Right
[AGENT][POSITIVE] Again, there's just a lot, so I'll be happy to look up anything that you may have a question on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, I think I've got it with if I get started with the diagnosis and the lab reports and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Transferring to different doctors and all that.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Started out at once, they sent us to another and then then they sent us.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Where we had surgery and everything.
[AGENT][POSITIVE] Mhm. So, you can file for all of that. Again, I keep saying this, but that first page of that claim form is so helpful. And when you call the hospital to get the itemized bill, you know exactly what to say to them, you know, make sure it includes the diagnosis and that type of thing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was sitting here reading all that while I was on hold so.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] And again, thank you for your patience.
[CUSTOMER][NEUTRAL] It explains quite a bit.
[CUSTOMER][NEUTRAL] So I should be expecting the policy on email.
[AGENT][NEUTRAL] I didn't
[AGENT][NEUTRAL] Well, no, not on email. You'll be able to log into the portal like you did. And when you click on your policy number instead of just seeing that letter that you can see about the, your children aging out, you'll be able, you should be able to see your policy information, and again it will have each benefit, the name of the benefit, the benefit amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then there will be definitions of like what is considered a hospital confinement, for example, that's, that's the first benefit that's listed. It's A and it says hospital benefit about $200 per day, the 1st 30 days, $400 per day after. There is a definition of what hospital confinement.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is considered.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the definitions for all of your terms are actually gonna be in your policy before that schedule of benefits page.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Just for, just for reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But again if you have any questions on any of it once you, you know, call us back and we'll be.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Very happy to go over any additional information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That sounds very good.
[AGENT][NEUTRAL] OK, alright, well I'm going to go ahead then and send that email to Mr. [PII]'s email address and again it's gonna come from [PII] and I will put um.
[AGENT][POSITIVE] [PII] in the subject line so that that's easily recognizable.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think that
[CUSTOMER][POSITIVE] Helps me quite a bit.
[AGENT][POSITIVE] OK, well, it has been my pleasure in speaking to both of you today and I hope that you both have a very nice afternoon and if that's all I can help you with at the moment, thank you both again for calling APL.
[CUSTOMER][POSITIVE] Thank you very much. Thank you.
[AGENT][POSITIVE] You're very welcome. Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye-bye.