AccountId: 011433970860
ContactId: 53e3f339-0b53-49c2-8f31-398e2759ebea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1118729 ms
Total Talk Time (AGENT): 558203 ms
Total Talk Time (CUSTOMER): 405608 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/53e3f339-0b53-49c2-8f31-398e2759ebea_20250109T21:50_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. Um, I, I have a policy with you all and I have been diagnosed with cancer again.
[CUSTOMER][NEUTRAL] And I am just needing to ask some questions about some of the things that you will need from me.
[AGENT][NEUTRAL] The things that we'll need from you is that what you said? I'm sorry.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, yeah, we can get your policy pulled up and take a look. uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Let's see, I just had that right here. Let me see.
[CUSTOMER][NEUTRAL] I'm sorry got it all here. Let me see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm pulling up everything that that.
[CUSTOMER][NEUTRAL] OK, my policy number is 92.
[CUSTOMER][NEUTRAL] 882 7.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alright [PII], just gonna verify some information really quick uh can I get your date of birth please?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Perfect. And last thing I need is the email address that we've got on file for you. Uh, looks like it is through an organization.
[CUSTOMER][NEUTRAL] Um, so let's, let's put it to my personal email because our school does not use American Public Law anymore so I just have been doing it myself and that is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the email that we have currently?
[CUSTOMER][NEUTRAL] Um, it may be [PII], [PII].
[AGENT][POSITIVE] Yes ma'am, thank you for verifying that. OK, and what would you like that email to be?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] Um, no, [PII].
[AGENT][NEUTRAL] Oh OK there were no digits?
[CUSTOMER][NEUTRAL] No digits.
[AGENT][POSITIVE] OK, where did I get that? I'm so sorry.
[CUSTOMER][NEUTRAL] No, that's OK
[AGENT][NEUTRAL] OK, so I read it back.
[AGENT][NEUTRAL] OK. Well, I appreciate you verifying that information. I'll get that changed for you. Um, all right. So this was, um, you said you were diagnosed again, so you did previously have cancer before?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am, I have.
[AGENT][NEUTRAL] Excuse me, I'm sorry.
[CUSTOMER][NEUTRAL] I have been diagnosed before.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So first thing that we would need before anything else, [PII] is going to be that pathology report um from the physician.
[AGENT][NEUTRAL] You can get that from the provider um you do have a couple of ways you can send that to us um I will say the quickest and easiest generally the easiest way to get that information to us is going to be through our online portal have you created an account on our website before?
[CUSTOMER][NEUTRAL] Well, I just now tried to and it didn't let me and I bet it's because of my email address.
[AGENT][NEUTRAL] Probably yes ma'am. OK, so let me, I did just change it. Let me make sure that change took effect. Let me give me just a moment.
[AGENT][NEUTRAL] OK, um, are you able to get it, uh, give it another try while we're on the phone?
[CUSTOMER][NEUTRAL] Uh, let me try that and see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Oh great, it's gonna let me.
[AGENT][POSITIVE] OK awesome yeah I might have just needed a minute to uh reflect the change for that email.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] So I'll finish setting that up.
[AGENT][POSITIVE] Yes, and so if you ever forget your uh username you can always give us a call and we'll be able to recover that very easily for you. You need your username if you ever forget your password, um, so they work hand in hand that way.
[AGENT][NEUTRAL] Once you're in there's going to be a spot that says at the main page to upload documents and you can simply upload that pathology report and then future claims as well you can upload there um and you know as they come I'm I'm sorry if this is repeated information I know you you've filed claims with us in the past but um you can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, no, uh, it's been a long time.
[AGENT][NEUTRAL] OK yeah so I will say as well um do you have a desktop or a laptop computer [PII]?
[CUSTOMER][NEUTRAL] Well, um, I have my work computer with me because I'm having treatment right now, about 7 hours from my home, so, um, I can use that.
[AGENT][NEUTRAL] OK, the reason I ask is our website really doesn't have support for mobile devices like phones or tablets so if you upload claim information it would have to be on a desktop or a laptop computer um as for everything else I think you should still be able to view claims status and such from like a phone or a tablet it's just the upload has to be on a computer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] I don't wanna overload. I'm sorry. I'm kind of just spilling info.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, no, no, I'm, I'm making notes as we're talking. I'm, I'm just writing on a paper so I can get it all straight.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Gotcha. OK.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK, so I will work on getting that pathology report sent to me and upload that to the computer and then um I noticed I had on paper I bet you have it online um this um.
[CUSTOMER][NEUTRAL] The form that you fill out.
[CUSTOMER][NEUTRAL] Oh it's that called um.
[CUSTOMER][NEUTRAL] It was called the claimant statement.
[CUSTOMER][NEUTRAL] Is that something that I don't, it's a form C101?
[CUSTOMER][NEUTRAL] Is that something I still need to?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Might be a bit I'm not sure how old that might be um if you'd like you can get them on the website but I can also email you a copy of the claim form, bear with me just a moment, of course you can make multiple copies that way um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And it depending on the browser that you're using you could uh like Google Chrome I think would probably be the best. I'm not sure what you're using right now but you can use that browser to fill out the uh form online and then you can save it that real quickly and then just upload it that way.
[CUSTOMER][POSITIVE] OK good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] Oh perfect.
[AGENT][NEUTRAL] Yes, do you want me to go ahead and send that to you?
[CUSTOMER][POSITIVE] Sure, that'd be great.
[AGENT][NEUTRAL] OK, and then if you'd like again because I know it might have been a while um I can also send you a copy of your policy if you need it um that way you just I'm, I'm a very visual person. I like going back and looking, but it does go very in depth as to what is and is not covered, uh, dollar amounts, frequencies, things like that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, great. Yes, that would be good. I, I have my policy, but I don't know if it's current.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see, um, most likely I'm not seeing any changes since, um, [PII], um, so that's up to you if you'd like me to send that back to you or not.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK.
[CUSTOMER][NEUTRAL] Oh, well, no, that's all right. Don't, you don't have to. I don't think so. I think I have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I do have this guy right here. I brought that with me and um so basically it's gonna cover uh mileage.
[CUSTOMER][NEUTRAL] And that mileage. So like I have traveled from 7 hours and I'm staying with my daughter and then from here, I'm traveling into [PII] every day for treatment. So do I count my mileage uh from home to here and then from here to my treatments each day?
[AGENT][NEUTRAL] So you don't have to calculate it yourself or do anything like that. um, what generally happens when if you mention it, just mention it on the claim form, um, and then what we'll do is when we get the claim information from wherever you're receiving treatment, we'll be able to see of course how far it excuse me, how far away it is from your home address, and then we'll automatically get that for you.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] All right. And it doesn't cover um meals or, or anything like that?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEGATIVE] It doesn't cover uh the cost of meals or anything like that.
[AGENT][NEUTRAL] No, it is simply um transportation and then lodging if that's required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And how about the treatment itself? Is there any reimbursement at all for the radiation?
[AGENT][NEUTRAL] Radiation, absolutely. Um, so that radiation, um, radiation chemo and immunotherapy are all kind of bundled into one benefit. So that benefit amount is $500 per calendar month.
[AGENT][NEUTRAL] Goes towards that
[CUSTOMER][NEUTRAL] OK, and what do you need from me as far as for the documentation on the radiation?
[AGENT][NEUTRAL] So for that um we would need uh of course the itemized statement and you could get all of this information from your provider wherever you're going for treatment that shows uh itemized statement that shows any diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then is your uh major medical or your primary medical, are they uh assisting at all?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am, they are.
[AGENT][NEUTRAL] OK, OK, so then we would also need the explanation of benefits showing what uh from your primary insurance and all that is is basically just showing us what they helped with um and again your provider wherever you're at for treatment, they will have all of that information.
[CUSTOMER][NEUTRAL] OK, and on the automatic statement that needs to show the diagnosis and I'm sorry I missed the last part of that.
[AGENT][NEUTRAL] Oh sorry, procedure codes, diagnosis and procedure codes, yes.
[CUSTOMER][NEUTRAL] Procedure code. I know.
[AGENT][NEUTRAL] And that's going to be for any kind of.
[AGENT][NEUTRAL] Claim really um as far as like treatment is concerned it's going to be all of that information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Does it cover, like, I've had, I've been down here like 5 times in the last 2 months. Does it cover um the biopsy or the PET scans or MRIs?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, excuse me, yes, um, so as long as these policies are very specific, of course, to cancer. So for example if um you had a biopsy and it had showed that it was benign, uh, wasn't actually cancer, then we would not be able to pay benefit if they did, and of course they found out that it was then yes we would absolutely pay that benefit.
[CUSTOMER][NEUTRAL] You'll cover all of those things.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, so I need to get anonymous statement with the.
[CUSTOMER][NEUTRAL] With the biopsy results and the procedure code I guess OK and the same for so.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, then I had an MRI I came down for an MRI.
[CUSTOMER][NEUTRAL] Um, this, and then I've had two PET scans previous to that. The PET scans were kind of misleading. They, they were not saying cancer, but the MRI did say cancer and then the biopsy did say cancer. Do those PET scan, um, trips count also?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me just a moment. I do see a medical imaging benefit, but I don't know that I actually.
[AGENT][NEUTRAL] Pays anything. I know you have a diagnostic and prevention benefit, um, and that goes for, um, let's see, [PII] uh is also active on the policy, so, um, any sort of preventative diagnostic tests or anything like that, like, uh, colonoscopies, um, those are covered, we'll pay a benefit of $50 per calendar year for those tests. Uh, let me check this one though because there's a separate medical imaging benefit.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, yeah, so it looks like um the medical imaging benefit just says $0 so I'm, I guess that just means it's not going to be covered unfortunately.
[CUSTOMER][NEUTRAL] OK. All right. So maybe, I mean, mainly, it needs to be the pathology report and the, the biopsy and the radiation.
[AGENT][NEUTRAL] Yes, um, before we can do anything we do need that pathology report, um, and frankly whatever you can think you can absolutely look through, um, this policy, but if there's something you're not sure, um, if the verbiage isn't clear, go ahead and submit whatever you have, you know, worst case we're going to say is that's not covered best case we pay a benefit so.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, right, OK.
[AGENT][NEUTRAL] And I will say I know it's a bit um what is it about 41 pages um for the policy. I um I'm trying to see I hope it's the same as what you're seeing you, your best friend on this policy is going to be the schedule of benefits pages from what I'm seeing, it begins at page 20.
[CUSTOMER][POSITIVE] All right perfect.
[AGENT][NEUTRAL] Just after 19 it's a few pages but it's just clear cut and dry um benefit dollar amount and frequency and then most of the other pages are going to be more uh definitions and what specific things mean.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Got it, got it, yes, yes, I see that here. OK, perfect.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK awesome
[CUSTOMER][POSITIVE] Perfect. All right, that sounds great. Well, I will get um what I can get here while I'm at [PII], uh, as far as these other things and then whenever.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Probably about, not long after I get back home in a few more weeks, 2 or 3 weeks, maybe I'll start getting the ELBs for the treatments. Do you need the ELBs for all the treatments?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] If there's, if they can apply to it, yes, um, if not the really biggest one I think is the, for the chemo and radiation.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, but whatever else could be applied to it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. OK.
[AGENT][NEUTRAL] And that you also have the option I'm again I'm sorry if this is repeated information but there's not a timely filing limit so I mean obviously I know you want to get reimbursed but it's not like you know we have to have it in a specific time frame so don't worry, don't stress about that um you can also, I know a lot of people, especially if you get uh radiation or chemo uh very often.
[CUSTOMER][NEUTRAL] Uh huh OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, what a lot of people do is they kind of let it build up and then they'll file all of them at once or a lot of them at once, um, but you, you can do them one at a time if you prefer, it's completely up to you, but you can there is a, uh, file size limit for how much can be uploaded at once on our website, but you can do that as many times as you could break it up and that's perfectly fine if that's easier for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alrighty, that sounds great. That sounds great. Well, I will get this, no.
[AGENT][NEUTRAL] OK, I'm sorry I know that was like information overload. Did you have any questions for me at all?
[CUSTOMER][NEUTRAL] Uh, no, I think, um.
[CUSTOMER][NEUTRAL] I think that is mainly what I was concerned about is making sure I got all of my ducks in a row while I was here and pick them up personally and take them home with me and then maybe in a in a month I'll have the rest of the.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, paperwork on the ELB part of things to where I can send that all at one time and that would be good.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Alright, perfect. Well this helps me a whole bunch and I really appreciate your time explaining all this to me.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Oh yeah, yes ma'am you have any other questions? because again I know it's confusing and stressful already don't hesitate to give us a call back we'll do what we can to help.
[CUSTOMER][POSITIVE] OK, well I appreciate it very much.
[AGENT][POSITIVE] Yes ma'am, I sure hope everything goes well and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Thank you, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Uh-huh. OK, bye bye.