AccountId: 011433970860
ContactId: 3b82d28e-4ea0-49b5-91b2-799aba5611fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 855880 ms
Total Talk Time (AGENT): 368760 ms
Total Talk Time (CUSTOMER): 305145 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/3b82d28e-4ea0-49b5-91b2-799aba5611fb_20250425T20:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII].
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And my claim number, my policy number.
[AGENT][NEUTRAL] OK, first off, uh, well, first off, give me your call back number.
[CUSTOMER][NEUTRAL] Are you ready?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] OK, thank you. And if you want to go ahead and give me your policy number, you can.
[CUSTOMER][NEUTRAL] 1381309
[AGENT][POSITIVE] OK, thank you. And while I'm getting your information pulled up, Miss [PII], how can I help you today?
[CUSTOMER][NEUTRAL] OK, I submitted a claim on the [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] For radiation.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you usually turn the the um.
[CUSTOMER][NEUTRAL] Claims around quickly, so today is the [PII] so I wanted to make sure that there was nothing the only time y'all delay is if I didn't do something right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you're just wanting to check the status on a claim that you filed, is that correct?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. So first off, Ms. [PII], I will need to verify several things with you for security and any information provided would be a verification of benefits and not a guarantee of payment. So first off, if you would please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. The phone number we have for you is the same as the one you gave me, so that is the best number we should have, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you and lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you very much for verifying all of your information, and I like your email address.
[AGENT][POSITIVE] That's cute.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do see Ms. [PII] where we did receive claim information on the [PII], and that has just, it's still in line for review. It has not been reviewed yet. It's typically about 10 business days for review, so it should be within the next couple of days.
[CUSTOMER][NEUTRAL] OK, I just wanted to make sure that there wasn't note there that I didn't do something right because I'm at the end of my I well, I did all my radiation today but not been a real letter last couple of weeks, so I just wanna make sure that I did it right and I didn't do something wrong.
[AGENT][NEUTRAL] Ma
[AGENT][NEUTRAL] Oh, uh-huh.
[AGENT][NEUTRAL] Uh-huh. Yeah.
[AGENT][NEUTRAL] Yes, ma'am. Well, well, as far as right now, I can't say it's not a matter of doing anything wrong, but I just don't have an answer on that since the information, that information that we received on the [PII] hasn't been reviewed yet, but I do see that you had opted in for text notification alerts through our portal. So once that, once it has been processed, you should receive a notification. Now you may not can log in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And see the status when you get that notification because it takes a little bit of time.
[AGENT][NEUTRAL] To get that, you know, like overnight into the system, but you could call us and we could give you the information on it over the phone if you get a text but can't see it in the portal.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes ma'am, yeah.
[CUSTOMER][NEUTRAL] Uh, you know, I wasn't missing anything.
[AGENT][NEUTRAL] Yes, not at this point. I can't say that you were, no, ma'am.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] Yes ma'am alright ma'am, thank you very much then.
[AGENT][POSITIVE] All right. Well, you're welcome. And is there anything else, Miss [PII] I can help you with today?
[CUSTOMER][NEUTRAL] Well, I, you know, I had my, I've done all my chemo. I had my surgery in July in January. Now, now I'm finished with all of my um
[CUSTOMER][NEUTRAL] Radiation. So I still have to have MRIs. I still have to have PET scans and all of that. Can I still submit those bills to you for?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Benefits?
[AGENT][NEUTRAL] Yes, ma'am, provided that once we receive the claim, yes, I would recommend that you submit anything that you have for us to review in the event that it's not already something that's been reviewed for potential benefits. And then, you know, if what you file your claim for the maximum benefit has already been met or used, then, you know, then it would just state that, you know, that your calendar, your maxim benefit your most.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Well, I'm a little confused because.
[CUSTOMER][NEUTRAL] They said, you know, you're, you're listed as having cancer for the rest of your life now. But then when I did my surgery in January, the pathologist reports came back as no evidence of cancer.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, that's excellent.
[CUSTOMER][NEUTRAL] So then you didn't pay any of the benefits for the, the surgery or anything else because this has no evidence of cancer. But you have been paying the radiation.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because, you know, I had to have the radiation. So now, I didn't know if followed through, you know, just cause you, it says no evidence of cancer, you still have to have the MRIs, you still have to have the PET scans, you still have to have all these other things. Does that mean that you won't pay for any of these things now, unless I get cancer again?
[AGENT][NEUTRAL] OK, so your current, OK, let me pull your policy information because I'm a little confused on what you just said, so just one moment, OK?
[CUSTOMER][NEGATIVE] I'm very confused with all. I don't understand a word of it.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] Bear with me just.
[AGENT][NEUTRAL] Uh, and are you referring to your [PII] surgery?
[CUSTOMER][NEUTRAL] Yes sir
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Because my pathologist, my pathology report came back, no evidence of cancer when they took the tumor out.
[CUSTOMER][NEUTRAL] It's, it came back as no evidence of cancer.
[CUSTOMER][NEGATIVE] But I had taken 26 weeks of chemo, which was horrendous. So then I didn't understand why I still had to have radiation after they, they said there was no evidence of cancer. And the, the radiation doctor said, even though they've taken the tumor out.
[CUSTOMER][NEUTRAL] There's not, no, no evidence in that area. You still have little particles that have to be killed by the radiation. He said, so the radiation is, and that's what somebody from APL explained to me, the radiation is still part of the initial right breast triple negative breast cancer.
[CUSTOMER][NEUTRAL] So now I'm asking you, now that the radiation is done.
[CUSTOMER][NEUTRAL] I just still gonna have to have every 3 months you have to have the MRIs every 3 months you have to have the PET you get 1 PET scan a year, you know, but can I submit those bills to you to see the payment towards the.
[CUSTOMER][NEGATIVE] Triple triple negative breast cancer.
[AGENT][NEUTRAL] OK, let me, let me just see.
[AGENT][NEUTRAL] Let me see what I can pull up here.
[CUSTOMER][NEGATIVE] This, see this is so slippery because, you know, I was so devastated when y'all came back and denied my claim for the um surgery. because I had surgery, you know, I actively had, you know, I went through, you know, 26 weeks of chemotherapy. I was in full blown cancer. And then all of a sudden, you know, it's like, oh, no evidence of cancer. I was so devastated by
[CUSTOMER][NEGATIVE] Your policy and the other policy that I have because you said you know you had the surgery but the pathology report back no sir so now we don't pay anything.
[AGENT][NEUTRAL] Right. It does, mhm.
[AGENT][NEUTRAL] Yeah, in your policy certificate, um, Ms. [PII], it does state that surgeries that result in a negative diagnosis of cancer is not covered under this policy.
[AGENT][NEUTRAL] So that it does have that language in your policy certificate.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, what I'm
[CUSTOMER][NEUTRAL] So, because of
[AGENT][NEUTRAL] Uh-huh. Go ahead. Well, I'm still trying to check on your diagnostic benefit, but if you have another question before I
[CUSTOMER][NEUTRAL] OK, so you're still checking. I'm sorry.
[CUSTOMER][NEUTRAL] No, I
[AGENT][NEUTRAL] look further into that.
[CUSTOMER][NEUTRAL] No, cause I, I
[CUSTOMER][NEUTRAL] I couldn't figure out what uh it would fall under it would fall under diagnostic you're right.
[AGENT][NEUTRAL] So give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] And thank you for being patient while I look through this. I just don't wanna overlook anything. I don't.
[CUSTOMER][NEUTRAL] It's OK. You understand it more than I do.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Well, that's not saying a whole lot and I work with it every day. I mean, I mean, you know, they're just complicated. They're very detailed and um
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] These, you know, the cancer policies are, so.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do not see a diagnostic testing benefit on this policy other than your, you know, your, those wellness exams.
[CUSTOMER][NEUTRAL] Mhm. But would the MRI be considered a wellness?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Would scan be considered the wellness?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I don't think so, but I will go back and look at that benefit language in just a moment. Let me, I'm still double checking again, triple checking really.
[CUSTOMER][POSITIVE] Oh I'm sorry.
[AGENT][NEUTRAL] No, you're OK. So no, I do not see.
[AGENT][NEUTRAL] I do not see those tests covered anywhere else.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On your policy. All right, now, let me look at that, let me just go back and look at the diag the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is fine.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So according
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] In.
[AGENT][NEUTRAL] OK, so the way your policy language reads and since you can see this same information in your, in your portal under the diagnostic testing benefit where it's talking about um the screening.
[AGENT][NEUTRAL] It says each calendar year we will pay the amount shown in the policy certificate schedule for each covered person who receives a screening test that is generally medically recognized to detect internal cancer including but not limited to and then it goes on to give you a list of tests, but that verbiage but not limited to yes ma'am, any.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Any tests that you have if they're screening you for um cancer, internal cancer. Yes, ma'am. I would recommend that you file a claim for that for us to review for potential that benefit to be paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I just needed to to know keep a track of.
[AGENT][NEUTRAL] Yes, I would say yes, ma'am, but since it says but not limited to.
[AGENT][POSITIVE] I would definitely include that. I would file it to see if potential, potentially that we could pay benefits for that, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, ma'am. OK, thank you very much, ma'am, for all your help.
[AGENT][POSITIVE] All right. Well, oh, you're certainly very welcome. Is there anything else that I can help you with this afternoon?
[CUSTOMER][POSITIVE] Oh no ma'am. Thank you and you have a great weekend.
[AGENT][POSITIVE] OK, Ms. [PII]. I hope you do too, and thank you again for calling April. Yes, ma'am, and God bless you as well. Thank you.
[CUSTOMER][POSITIVE] God bless.
[CUSTOMER][NEUTRAL] Bye bye.