AccountId: 011433970860
ContactId: 4bb68be2-efa9-4c16-aba7-b72f38076d3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 803080 ms
Total Talk Time (AGENT): 437513 ms
Total Talk Time (CUSTOMER): 250240 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/4bb68be2-efa9-4c16-aba7-b72f38076d3d_20250129T18:27_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, yeah, my name's [PII], and I have a policy with y'all, cancer policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I was diagnosed, um, I, I believe back in September of prostate cancer.
[AGENT][POSITIVE] I am so sorry to hear that, [PII].
[CUSTOMER][NEUTRAL] And anyway, I was going, I need, I um, I've had this policy for over 20 years, through my work.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I don't know how to file anything for it. I'm trying to, I looked at your website which I don't have a computer in front of me. I'm on my phone.
[CUSTOMER][NEUTRAL] But I'm trying to figure out and get some assistance in trying to file a claim.
[AGENT][POSITIVE] OK, absolutely. I would love to help you with that today.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I have my policy number here.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] Perfect. What is that?
[CUSTOMER][NEUTRAL] It is 004.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 567-51.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, let me get that pulled up for you.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And Mr. [PII], could you verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm just gonna have you verify a couple other bits of information and then I can help you with um what we need to do on a claim. Would you be able to verify for me your mailing address please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so as far as filing a claim goes, oh, and hold on, I'm so sorry. I should have checked this first. Would you be able to verify your email address for me please, sir?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, I appreciate that that is what I have here, um, so as far as filing a claim goes, um.
[AGENT][NEUTRAL] What I can do for you is I can email you out a copy of our claim form and.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] It is I, in my opinion, extremely helpful um because that first page of the claim form is going to go over like any supporting documentation we're going to need and you can use it almost like a checklist and just follow along with it like as you're getting the documents you need to not lose your place so I recommend like crossing things off as you grab them or get them.
[CUSTOMER][NEUTRAL] Yeah, but
[AGENT][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh, you're cutting out a little bit. I'm having a little bit of trouble understanding you. I think you're on speakerphone probably.
[AGENT][POSITIVE] Yes, let me switch real quick for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is that better for you, sir?
[CUSTOMER][NEUTRAL] Possibly hm.
[AGENT][POSITIVE] OK, I'm so sorry. I was getting complaints that my headset sounded funny, so I switched the speaker. So I'll do whatever sounds best for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's about the same, but we'll do the best we can I guess.
[AGENT][POSITIVE] OK, I'm so sorry about that. So, um, what I was saying is that cancer claim form, um, it's really beneficial in the fact that it will
[CUSTOMER][POSITIVE] That's all right.
[AGENT][NEUTRAL] Kind of tell you step by step everything you need when you're submitting a claim and so you can kind of use it like a checklist um to make sure you're getting all the right documents and that you have them.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what I'll do is I'll get that put in an email for you and then you can just follow along on that one, to gather your documents you will need your itemized bills from the hospital, explanation of benefits from your primary insurance, and then if it's your first time um filing due to the cancer, um, we will need a pathology report as well.
[CUSTOMER][NEUTRAL] I have that, yes.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Um, my, I have another question, huh?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you know I have I have went to.
[CUSTOMER][NEUTRAL] 2 or 3 different doctors, you know, to explore avenues and to get, make sure we're on the right path and then I've had.
[CUSTOMER][NEUTRAL] Um, scans at the hospital. So each doctor in, in the hospital all be like a separate claim. We'll I'll submit a claim for each one. Does that sound correct?
[AGENT][NEUTRAL] You can actually um submit all of your information at once with this one claim form and then we'll just read through it all.
[CUSTOMER][NEUTRAL] OK, so like if I get them I'll have to get them to send me some itemized bills.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I've got some of my EOB, my explanation of benefits, but I can probably access them through my insurance and try to weed through them. But this could wind up being a considerable.
[CUSTOMER][NEUTRAL] Amount of paperwork, you know.
[CUSTOMER][NEUTRAL] And so that's what this is gonna all be mailed.
[AGENT][NEUTRAL] So you do have the option to mail it um we do have an online portal um that I can send you a user guide for how to set up and how to use but you can just upload your claim document so if you are able to go on through your major medical, your website and download copies of your EOBs, you can just upload them straight to our.
[CUSTOMER][NEUTRAL] You know, envelope possibly.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Portal without having to print them out mail them fax them anything like that and then likewise I know a lot of the hospitals and facilities these days have online portals where you can access billing documents and you can download those and then upload them through your online portal as well um which might save you some paper.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I, I can try like I said, I don't have a computer at home.
[CUSTOMER][NEUTRAL] And I'm off work right now because I've had a shoulder surgery, but I'm going back in a week or so. So I can use my work computer quite a bit, but, uh.
[CUSTOMER][NEUTRAL] I'm just trying to figure out how to get this started. It's, uh, I, uh, I, uh, it's kind of what, what are some of the things this company, your insurance pays for?
[AGENT][NEUTRAL] Oh yeah, I'd love to look up some benefits and tell you about them today. Um, I do want to let you know though, any benefit information I give over the phone is always just a verification of coverage, never guarantee of payment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and I'm pulling up your policy documents right now so I can go over those with you, my friend.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Yeah my pleasure.
[AGENT][NEUTRAL] All right, so it looks like what I'm seeing on here is we have chemotherapy and radiation benefits, um, and it looks like your benefit amount on that one goes up to $10,000. You also have hospital benefits. It looks like if you are in a hospital confined to a hospital, days 1 through 10, um, offer a $70 benefit and days after.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Day 10 days 11, and after offer a $50 benefit per day.
[AGENT][NEUTRAL] Um, and then.
[AGENT][NEUTRAL] I am.
[AGENT][NEUTRAL] I believe that's all I'm seeing listed on here, but let me keep scrolling through.
[AGENT][NEUTRAL] Yes, so it is, and then you also have a dread disease writer, um, which I would need some more time to find additional information, but it's um for when you're diagnosed with what's considered a dread disease, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it looks like for your cancer palsy itself, it's that hospital benefit and that chemotherapy and radiation benefit.
[CUSTOMER][NEUTRAL] So, so I'm correct me, I'm just gonna say this back so I totally understand.
[CUSTOMER][NEUTRAL] That policy I have as far as cancer only pays on radiation, chemotherapy, or stays in the hospital.
[AGENT][NEUTRAL] That's what I'm seeing on here, yes, sir.
[CUSTOMER][NEGATIVE] So the diagnosis itself doesn't pay anything and then my out of pockets where I have paid my uh um part of my expenses, I don't pick up none of that.
[CUSTOMER][NEUTRAL] For doctor visits and scans.
[AGENT][NEUTRAL] So I'm not
[CUSTOMER][NEUTRAL] er and biopsy.
[AGENT][POSITIVE] Showing any benefits listed for that? No, I am showing on my side just that hospital and the limited chemo and then, but I mean I'd always recommend submitting a claim like I'm a big fan of, you know, it's like wearing a seat belt you better have it and not need it than need it not have it. I'm a big fan like I send claims all day um instead of missing out on a benefit that could have been considered payable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um, so you're sending them that portal information and that claims form to my email you said?
[AGENT][NEUTRAL] Yes, yes, sir. Um, and so I have [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Alright perfect I am hitting.
[CUSTOMER][NEUTRAL] And that rider that
[AGENT][NEUTRAL] The dread disease writer, yeah, I definitely the the policy information I was looking on that had mentioned the dread disease writer didn't list what those dread diseases were, so I might just need some more time to look into that, but I could.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Definitely.
[AGENT][NEUTRAL] If you don't mind hanging tight a second, I can, I can look into that a little more for you.
[CUSTOMER][NEUTRAL] That would be great if you don't mind.
[AGENT][NEUTRAL] Absolutely let me put you on just a brief hold, OK?
[CUSTOMER][POSITIVE] That'll be fine thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Fer.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] with the care team. How are you doing today?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][POSITIVE] Yeah, I'm so wonderful, thanks for asking.
[AGENT][NEUTRAL] So, I have a gentleman on the phone. He has a cancer policy with us. His policy number is 456751.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, his name's [PII], and I, he recently was diagnosed with cancer. He had questions on his, um, policy. I talked to him about his benefits, um, and I see on here he has a dread disease rider, but I'm not showing anything. He doesn't have a policy cert really. He has like an old backdated one, but I'm not showing anything that lists what those dread diseases are or what would be on that.
[AGENT][NEUTRAL] Um, as a writer and he wanted more information on that and I didn't know if you were if you had information about that.
[CUSTOMER][NEUTRAL] OK, um, I could assist, uh, most likely I'll just have them to send in a claim for us to review the information as far as specifics, but yeah, go ahead and send him over.
[AGENT][POSITIVE] OK, perfect. I am.
[AGENT][NEUTRAL] Going to do that and you said [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, I'll introduce you when we join, OK?
[CUSTOMER][POSITIVE] OK, good deal.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi, Mr. [PII], are you still there with me?
[CUSTOMER][NEUTRAL] I am.
[AGENT][POSITIVE] Hey, thank you so much for your patience. So I actually um have Ms. [PII] on the line and she handles our cancer policies a little more closely than I do so I think she might be able to benefit you greatly in offering you information on that. I'm gonna hit send on the email that I was creating for you, so be on the lookout for that, and [PII] is gonna take on over, OK?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] My pleasure. Thank you, Mr. [PII]. You take care.
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] Hello Mr. [PII]. My name is [PII] in the claims department. How are you today?
[CUSTOMER][POSITIVE] I'm good how are you? I'm good thank you. I understand you had some questions about your benefits.
[CUSTOMER][NEUTRAL] I did, yes, kind of what I paid.
[CUSTOMER][NEUTRAL] All right.