AccountId: 011433970860
ContactId: 4c5e2991-f5c4-4928-91d9-2155ad36bc32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 603940 ms
Total Talk Time (AGENT): 397973 ms
Total Talk Time (CUSTOMER): 158241 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/4c5e2991-f5c4-4928-91d9-2155ad36bc32_20250205T17:35_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII], and I have cancer insurance through my employer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm trying to figure out if some recent testing I had is covered underneath my plan.
[AGENT][NEUTRAL] OK, let's see. First, give me your phone number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, thank you. You have your policy number?
[CUSTOMER][NEUTRAL] Um, no, ma'am, I do not.
[AGENT][NEUTRAL] OK, let's see. Can we look you up?
[AGENT][NEUTRAL] May I have your social security number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's your mailing address?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me 1 2nd to write this down.
[AGENT][NEUTRAL] Alright let me pull it up.
[AGENT][NEUTRAL] What's your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email address?
[CUSTOMER][NEUTRAL] I'm not sure which one's on file. It may be [PII].
[AGENT][NEUTRAL] Yes, ma'am, that's what we got your work on file. All right, and you want to see if would something be covered on your policy? Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes, ma'am.
[AGENT][NEUTRAL] All right. Tell me what, what you need to know.
[CUSTOMER][NEUTRAL] Um, I was wondering, I had to have a, a biopsy.
[CUSTOMER][NEUTRAL] Do
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And well, they did a, they did a uh uh one year screening. They asked me to come back to, to, you know, check to see if I had cells for cervical cancer. And then I had to make another, and that was November of last year. And this year, I had to go back and they actually did a biopsy. Um, is that covered under a cancer screening under my insurance? I mean, under this policy?
[AGENT][NEUTRAL] So, did, was it like a Pap sm or, or let me see, let me tell you what they say covered on the uh wellness, so you can know.
[AGENT][NEUTRAL] Uh, put it up for the benefit for the awareness.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me see, do you have that first cancer screening. OK, you got like a pap smear. So this was like a biopsy, you said, right?
[AGENT][NEGATIVE] The biopsy and it was negative, right? It was negative.
[CUSTOMER][NEUTRAL] Right, so
[AGENT][NEUTRAL] You, you didn't have cancer.
[CUSTOMER][NEUTRAL] Um, I haven't had the results yet.
[AGENT][NEUTRAL] Oh, OK, OK. Now, if it's a positive biopsy, then that would be paid under the surgical benefit and you would have to send in the itemized surgery bill for, uh, for that. But if it's a negative biopsy, it was, it would not.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Be a payable benefit under your screening because it was not a screening. They was testing, they was looking for to see that you have cancer and I'm trying to bring up your, uh, the wellness that's what's covered under the wellness benefits, uh, medical equipment.
[AGENT][NEUTRAL] Miscellan.
[AGENT][NEUTRAL] And they don't have it out. I don't see it on there.
[CUSTOMER][NEUTRAL] Because I was looking at the the plan information and um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So I was looking in, it says the.
[AGENT][NEUTRAL] Here it is right here. Here it is right here. Diagnostic testing. It's mammogram, breast ultrasound, breast thermographic, breast cancer, blood test, colon cancer blood test, prostate.
[AGENT][NEUTRAL] Flexible symmoscope, colonoscopy, a vertical colonoscopy, ovarian cancer blood test, Pap smear, chest X-ray, hemoglobin stool specimen, then prep Pap smear. Those are what would be covered under the diagnostic testing benefits.
[CUSTOMER][NEUTRAL] OK, so like I had one in November and they asked me to come back and do a follow up one and that was this week, but um if they're negative they don't qualify.
[AGENT][NEUTRAL] So you have a biopsy in November. Is that correct?
[CUSTOMER][NEUTRAL] No, and in November I had a Pap smear and then this last week.
[AGENT][NEUTRAL] Yeah, Pap smear would be covered. All you have to do is send in and the wellness claim is easy. It's a wellness claim form out on our website. All you do is fill in your name, your address information, go down on the wellness claim form, choose the type of.
[AGENT][NEUTRAL] Well you had and put the date you had it, put the name of the facility or the doctor name and the phone number and sign and date the form. It's a simple wellness claim form that can be completed and I can send you those. I can email you a wellness claim form if you want me to.
[CUSTOMER][POSITIVE] That would be great. And um like I said, was a wellness, and so I had one in November of last year, and I had one in this year. And um
[AGENT][NEUTRAL] If it's just a pap, if it's just a pap, it would, there's no guarantee to pay over the phone, but if it was just a simple pap, it would be covered. But if it's something where they did it, it's not stated as a pap, then it wouldn't be covered. You said you had a biopsy. You didn't say you had a pap, another Pap smear.
[CUSTOMER][NEUTRAL] So here's what happened in um [PII] and.
[CUSTOMER][NEUTRAL] The end of [PII].
[CUSTOMER][NEUTRAL] I um had abnormal sales, right? And so they told me that I had to come back the next year, right? So abnormal sales in [PII], which I didn't know this was a thing with the insurance also would fall back then. So in [PII], they, they retested me and I had abnormal sales in November, and they did the whole thing and then.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] This last week, they did a colonoscopy where they call that, and they end up doing a biopsy during that.
[CUSTOMER][NEUTRAL] Which, which this was a follow up appointment from the abnormal cells in the first one. Does that make sense?
[AGENT][NEUTRAL] Uh huh, I understand now what you can do is you can send in your documentation along with your paperwork with the claim form, and it can be reviewed if it can be paid, they will process it and if it's not, they'll let you know you'll get a denial saying why that second one would not pay up. I just went over the list of information that is covered on the Pasmith.
[AGENT][NEUTRAL] And then the follow up, let me, let me read what the policy says. Follow up diagnostic test is when a covered person receives an abnormal results from a cover screening test. See the diagnostic testing benefit. We will pay the dimed amount shown on the schedule of benefit for one follow-up invasive screening test, a test involve an incision or a surgery. So yeah.
[AGENT][NEUTRAL] So that might could be paid under the follow up diagnostic testing. Just send in your documentation to verify what you had done. So yeah, that would probably follow up on the follow up diagnostic testing, but the PAP would follow up on just the diagnostic testing like a wellness. So you can do, you can send in both.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, and can you tell me, do I have a, a level 1, a plan one, or do I have a plan two?
[AGENT][NEUTRAL] And let me see, do it says on your thing what you got. Uh, it might not be a level, it just might be what your benefit pays because it's on here, it does not have a level. It does not have a, let me go on, let me go on up to the top. Let me go on to the top of your policy. Do you have access to our internet?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] Our website, yeah, because out there you can read your policy and you can get those claim forms that I was telling you about and you got plan one. You got cancel plan one.
[CUSTOMER][POSITIVE] OK, very good and like I said if you could email me those additional forms I greatly appreciate it.
[AGENT][NEUTRAL] Yeah, I will. Do you want me to email it to the email address that's on the system that you gave me?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I will. I'll email to you now you can't email anything back to the adjuster. You have to add the fax it, upload or mail any claim forms to our office, OK? And let me give you your policy number because I didn't give it to you, but I have it on the email, but your policy number, if you call in the future, you will have it is 025.
[CUSTOMER][NEUTRAL] Uh yes, ma'am.
[AGENT][NEUTRAL] 28619.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and my next question is, is how far back can I file something because if I had uh uh something done in like [PII] and I still have this insurance, can I go back that far is it?
[AGENT][NEUTRAL] Did you have our policy in [PII]? Let me see, because I just pulled up this one. So let me go back, hold on one moment to where I was.
[AGENT][NEUTRAL] And see what what policy you might have had in [PII] because I know you had uh in [PII], let me see what this one was.
[AGENT][NEUTRAL] 02384924.
[AGENT][NEUTRAL] OK, you had this one start [PII]. This policy that you have with us and it terminated [PII] and then the next one came up was the [PII]. So let me see if you have anything in [PII].
[AGENT][NEUTRAL] Let's see, 03. Give me your social one. OK, yeah, [PII]. Yeah, OK, because I've decided I didn't pull up a 2 on you, [PII]. So yeah, that policy number for [PII], if you're gonna file a awareness for [PII], do a separate claim form for that one and that policy number is 023.
[CUSTOMER][NEUTRAL] 0, 2023. I'm online.
[CUSTOMER][NEUTRAL] 0, 2023.
[AGENT][NEUTRAL] 84924.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you, ma'am. I greatly appreciate that and thank and you have a great day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, and I'm gonna email you those claims for me. Thank you for calling American Public Life, and you have a wonderful day. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.