AccountId: 011433970860
ContactId: 3a157147-ec2a-4f04-b9a4-06a4e84fcb0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1020200 ms
Total Talk Time (AGENT): 614202 ms
Total Talk Time (CUSTOMER): 259193 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/3a157147-ec2a-4f04-b9a4-06a4e84fcb0d_20250501T13:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Good morning. So I was trying to reach the cancer department. I'm so sorry.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] No cancer department is not open.
[CUSTOMER][NEUTRAL] Um, but I have a.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I have an insured. He wants to know what his policy, um, covers. I'm sorry.
[AGENT][POSITIVE] Oh, OK, yeah, for coverage, I can help.
[CUSTOMER][NEUTRAL] Um, the policy number is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it is 784-005.
[CUSTOMER][NEUTRAL] Mr. [PII].
[AGENT][NEUTRAL] And um did you verify anything on him?
[CUSTOMER][NEUTRAL] I did verify all the information. Um, his callback number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, alright, I'm ready for him. Well, let me pull the policy really quick. Let me have at least that ready.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you said the cancer, you said when you said the cancer, um, queue was closed, is that what you said?
[AGENT][NEUTRAL] Yeah, the cancer to is closed. Uh, it comes to us unless like it's a claim on like they're, um, they needed somebody in claim support. That's the only thing that we have claim support which um is only for claim discussion if they need like additional information, but yeah. Mhm, yep, it is close.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Is it the same? I never just another question. OK, never mind.
[AGENT][NEGATIVE] Well, it's gonna be cancer disability, um.
[AGENT][NEUTRAL] HR is closed, um, yeah, so far the only thing that is open right now is that link, I think.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's good to know.
[AGENT][POSITIVE] All right, so I got it pulled up. Thank you.
[CUSTOMER][POSITIVE] Thank you, so one moment thank you.
[AGENT][POSITIVE] You're welcome. You too have a good day.
[AGENT][NEUTRAL] Good morning. This is So the care team. Is this Mr. [PII]?
[AGENT][NEUTRAL] Or Miss Miss. OK. All right.
[CUSTOMER][NEUTRAL] Yes, so it is.
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][POSITIVE] Hey, that's pretty, that's a pretty deep voice for a miss.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, just write
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] I'd be scared of her if I were you.
[AGENT][NEUTRAL] Yes, and how may I assist you today? Um, you was transferred over to us from Metlink. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, I'm calling about my cancel policy. I've been trying to read over, but I really don't understand it. I'm trying to see exactly what's covered. Uh, I've been, I've been going to see a urologist for a little high, uh, PSA. It's getting a little bit high, so I'm trying to see exactly.
[CUSTOMER][NEUTRAL] What's covered under there? I mean, uh, I'm looking at the benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So if I'm, uh, if I'm, if they tell me I, I have cancer, uh, what would be the first thing would happen? Is there some kind of uh benefits uh that come with that if I'm confirmed with colon, uh, prostate cancer or something like that?
[AGENT][NEUTRAL] OK, um, let me go ahead and just run over the benefits because um I'm not sure if you have the documents, but it's gonna be the same information that you, that we send you if you have it, um, but basically, um, let me go ahead and go to the beginning of this page really quick.
[AGENT][NEUTRAL] So they have not say that you have cancer, it's just, just in case, correct?
[CUSTOMER][NEUTRAL] Right, and I'm going to testing right now, so.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Got you. OK, all right, yes, you just want to be prepared.
[CUSTOMER][NEUTRAL] I don't think I don't think I.
[CUSTOMER][NEGATIVE] I'm praying I don't have it. I don't think I do.
[AGENT][NEUTRAL] Yeah I understand. I understand. OK, alright, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer and it looks like you have um.
[AGENT][NEUTRAL] The first initial uh cancer, um, finding that it is a benefit, um, that if they find internal cancer, you get a lump sum of $10,000. So that will be the first thing, um, in order to get that benefit, we're gonna need a pathology report and we're gonna need a claim form, OK?
[AGENT][NEUTRAL] So those two are the initial findings of cancer and that's for internal cancer.
[CUSTOMER][NEUTRAL] So when you say
[CUSTOMER][NEUTRAL] Oh, when you say internal cancer, yeah, that's something like prostate, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that's definitely possible. Mhm, yes.
[CUSTOMER][NEGATIVE] Oh, OK, I, I, I hope I never collect that money. I don't, I don't want it.
[AGENT][NEUTRAL] Mm yeah, I understand. I understand it's just to be prepared. It doesn't mean that, yeah, that we wanted. We just need to be prepared for anything.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and then we have uh several benefits that you have under this policy. Um, it's quite a few of them, so I'm just gonna go over um.
[AGENT][NEUTRAL] Try to go over all of them. So it looks like you have hospital confinement. So if you have to be admitted to the hospital, um, we cover $200 per day for the 1st 30 days, and then if you have to be there more than 30 days, it's $400 per day after.
[AGENT][NEUTRAL] Um, and it doesn't have a limit of uh how many days after that, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You also have benefits for medication.
[CUSTOMER][NEUTRAL] You say
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you say after 30 days is, uh, how long?
[AGENT][NEGATIVE] $400 per day and it doesn't have a limit of days after that.
[CUSTOMER][NEUTRAL] OK, thank you. OK, I'm trying to follow you and understand how these benefits are written, written out. I'm looking at, OK, but go ahead. I'm, I, I, I understand it now you've explained as well, so go.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, good. All right, so we have drugs and medicine benefits per confinement. So while you're in the hospital admitted, um, the medicine that is provided to you is paid at $200 per confinement and this is during the whole duration of the confinement. Um, so if it's 30 days, 60 days, that is the confinement. If you're admitted more than once, um, then that's a second confinement, OK?
[AGENT][NEUTRAL] So it's per confinement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and you also have benefits for outpatient drugs and medicine, which is $50 per prescription and that's up to a maximum of $100 per month. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you have surgery benefits. Um, so the surgery benefits is based on units, but the maximum per operation is 3000.
[CUSTOMER][NEUTRAL] That's for surgery.
[AGENT][NEUTRAL] That's for surgery. Mhm.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] OK. Um, you also have a 2nd or 3rd surgical opinion benefit, so if you need to go and see a doctor just to make sure that that is the route you wanna take or if you want to look at it into more surgeries. Um, you have a $300 per diagnosis of cancer.
[AGENT][NEUTRAL] And a $300 additional if you need a third opinion, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] So you have a benefit for the facility if you need to have a surgery. The first one was for the surgery itself. The second one is for the hospital or the facility where they do the surgery.
[AGENT][NEUTRAL] And that's $400 per day, um, the surgery is performed, so for the surgery date.
[CUSTOMER][NEUTRAL] So if that's uh if you, if you have to be hospitalized.
[AGENT][NEUTRAL] No, that one is basically if you have to go to a, usually when they do a surgery, they charge you for the, the the place which is the facility, the hospital or the surgery center. They sur uh they charge you for the surgeon and then they charge you for the anesthesiologist. So those three charges you're always gonna have. So this one is for the facility.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, OK, I understand that now, yeah, that was me because I, I was reading over that. I just didn't understand, but now that you explained it, I understand it.
[AGENT][NEUTRAL] OK. All right. And then the anesthesia is 25% of the amount paid for the surgery. So basically if we uh paid a
[AGENT][NEUTRAL] 2500, so we'll pay 25% of that 2500 towards the anesthesia, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So, um, you also have benefits for attending physician. Uh, this is why you hospitalized. Sometimes the doctor needs to go and check up on you and they have an additional charge. Um, so that is that 40 day um benefit that you have is for the doctor just to go and check on you. They charge for that. So that's $40 per day and that's uh based on the confinement, so it's based on the days that you're there, so it's just $40 per day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you also have the inpatient special nursing service benefits. So if um you have a special nursing or a special nurse that takes care of you and is appointed by your doctor if necessary, then we cover $150 per day.
[AGENT][NEUTRAL] And it's based on the days of the confinement as well, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So that's, that's what inpa.
[AGENT][NEUTRAL] Yeah, that's what inpatient is, is that you're hospitalized, you're admitted.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so you also have benefits for protasis. If it's a non-surgical protasis, it's $150 per device. Um.
[AGENT][NEUTRAL] And this is a one time per lifetime, so it just covers one time during the whole time of the policy, OK. And then if you have a surge, uh, go ahead.
[CUSTOMER][NEUTRAL] When you say
[CUSTOMER][NEUTRAL] When you say per device, like what type of device, uh, that was one of them that confused me.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The pertussis, they are not um
[AGENT][NEUTRAL] They're not surgical. It's basically something that is put outside of the body instead of inside of the body.
[CUSTOMER][NEUTRAL] OK, OK, OK, yeah.
[AGENT][NEUTRAL] Uh, mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, that was the best definition.
[AGENT][POSITIVE] All right, I'm thinking about another one, but now that's the best one, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you have the surgical implantation. If it's a surgical implantation, then it's gonna be 1500 per device, OK?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, and then let's see.
[AGENT][POSITIVE] Yeah, you also have uh benefits for hair potass and your hair. It's $150 per lifetime.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you have blood plasma and plaid benefit, which is 150 per day up to a maximum of 7500 per year.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You also have radiation, chemo, and immunotherapy.
[AGENT][NEUTRAL] And this one is a combined benefit. We do pay actual charges up to 15,000 for 12 month period, um, meaning that um we're gonna need the primary insurance information because we don't pay more than what they pay, that's what actual charges means.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. So if they pay 12,000, that's what we're gonna send you they pay 20,000, you have a maximum of 15, so you're gonna get 15, OK.
[AGENT][NEUTRAL] All right. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You also have benefits for, let's see, lab work. Mhm. OK.
[CUSTOMER][NEUTRAL] And I kind of understand.
[CUSTOMER][NEUTRAL] I understand the rest of those, uh.
[AGENT][POSITIVE] OK, good, good.
[CUSTOMER][NEUTRAL] Yeah, I understand everything, yes, uh, the initial.
[CUSTOMER][NEUTRAL] Well, I go back to uh what you first said the $10,000 you you have internal.
[AGENT][NEUTRAL] Yeah sure. OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I didn't see that listed in there.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] It's in the top part. It's gonna be on their plan description.
[CUSTOMER][NEUTRAL] Where's that listed at?
[CUSTOMER][NEUTRAL] That would be on the what now?
[AGENT][NEUTRAL] It's gonna be on the plan description. If you're looking at the electronic paperwork, it's gonna be on page 6.
[CUSTOMER][NEUTRAL] 86. OK, let me go to 6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm almost 6.
[CUSTOMER][NEUTRAL] Plan description preexisting.
[CUSTOMER][NEUTRAL] Uh, let's see, I'll pay 6.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see hospital confinement.
[CUSTOMER][NEUTRAL] Impatient
[AGENT][NEUTRAL] Mm, that's why you see on page 6. You don't see pay policy schedule in the top.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] This may be a different form that I'm looking at what you're looking at. We were looking at the same form of page 6. I don't see that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's gonna be basically page 6, literally like 1234, like uh go back to the beginning and just count 6.
[CUSTOMER][NEUTRAL] Yeah, I see page 6.
[AGENT][NEUTRAL] OK, it's gonna be
[CUSTOMER][NEUTRAL] It's talking about hospital concern.
[AGENT][NEGATIVE] No, it's gonna be in the bottom page 3, but literally, if you go to the beginning of the booklet, it's page 6.
[CUSTOMER][NEUTRAL] OK, let me try that
[CUSTOMER][NEUTRAL] OK, I see plan description.
[AGENT][NEUTRAL] OK, so it's gonna be a writer, critical illness writer.
[CUSTOMER][NEUTRAL] OK, I see it I see it.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] So the internal, so this $10,000 that's paid directly to me.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and I guess that's for bills and if you can't work and all that stuff, right?
[AGENT][NEUTRAL] Correct, yes. That's for your treatment for for just anything that you're gonna need to start off because we still pay for the treatment for the chemotherapy and everything, but that's just to start off. Mhm. Yeah, it's a payment, it's an amount that is sent to you. Like it's like an indemnity.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Well, I can tell you now, I don't ever want this sent to me.
[CUSTOMER][NEGATIVE] I hope I never that's, hey, that's 1 $10,000 I never wanna make.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] I.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I understand, I understand.
[AGENT][NEUTRAL] Yeah, that is, that's gonna be the first thing. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, I kinda understand everything that since you've explained it. I had a PSA, uh, so for me I guess I just need, I know they give a what is it $30 for filling out the form or something like that, file a wellness claim for.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For wellness? Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm, yes, let me, let me check on that benefit. I go all the way. Let's see margin.
[AGENT][NEUTRAL] OK, screening, cancer screening follow up and let's see.
[AGENT][NEUTRAL] That's the medical imaging.
[AGENT][NEUTRAL] OK, so that's $60 per year per covered person. Mhm, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well, thank you, you've answered everything.
[AGENT][POSITIVE] All right. You're welcome.
[CUSTOMER][NEUTRAL] Uh, I
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today? Any other questions? any other concerns?
[CUSTOMER][POSITIVE] You have answered every concern I've had.
[AGENT][POSITIVE] All right, that's good. I'm glad I was able to help you, Mr. [PII]. You have a good day.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.