AccountId: 011433970860
ContactId: 62ff40d5-232f-49ac-8bc1-f0a3d13571a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1339250 ms
Total Talk Time (AGENT): 625023 ms
Total Talk Time (CUSTOMER): 447060 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/62ff40d5-232f-49ac-8bc1-f0a3d13571a9_20250410T18:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. Um, I have a policy with APL and I just need to clarify some things. I'm not quite sure. I wanna make sure things are covered, um, and just kind of update you on, um.
[CUSTOMER][NEUTRAL] My changes in my family.
[AGENT][NEUTRAL] OK, let's take a look. Do you have your policy number?
[CUSTOMER][NEUTRAL] I do. It's 00960872.
[AGENT][NEUTRAL] OK, let me pull it up here.
[AGENT][NEUTRAL] All right. And then if I could please verify your first and last name and date of birth.
[CUSTOMER][NEUTRAL] Yes, it's [PII] and the last name is [PII] and uh date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then [PII], lastly, I do need to verify please, the physical address and then email address.
[CUSTOMER][NEUTRAL] Yes, my physical address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, and you needed my email address?
[AGENT][NEUTRAL] Uh, yeah, just the email please.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][POSITIVE] Thank you so much. OK. So, I've got your policy pulled up here. What sort of questions or concerns did you have?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, first of all, it says, cause I actually pulled it up online also, and it says it's a family policy. And, um, my husband passed away, but I didn't think he was covered on it.
[AGENT][NEUTRAL] OK, yeah, it looks like it has um you and also [PII] covered, um, so we can update that if we need to change that. OK.
[CUSTOMER][NEUTRAL] Yeah, he passed away, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Now, will that make a change in the amount that I pay on the policy?
[AGENT][NEUTRAL] Yes, ma'am. Um, I believe that that would have a change in that premium. Um, so, uh, to get him removed, uh, we, I would need to transfer you. We have a different department that handles like the premium amounts and everything, um, but I can definitely answer any other questions you have as far as like in regards to the policy, what's covered.
[AGENT][NEUTRAL] Um, but they could definitely answer for you like what the new premium would be and then they can also, uh, we may need documentation, um, but they would definitely advise you on any of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] So what I wanted to ask, I, I know it's a cancer policy, so to be very honest, I, I'm not working at the same place I was when I initially put this out years and years ago, um, and you know, I just have it deducted automatically from my um account and.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I was looking and I'm thinking, well, you know, I, I looked at a part of it and it said that it covers um cancer.
[CUSTOMER][NEUTRAL] Uh, diagnostic testing.
[AGENT][NEUTRAL] Uh-huh. Mhm.
[CUSTOMER][NEUTRAL] Um, so like mammograms and stuff like that because I just had, within the last year, I had, um, I had to have a mammogram and then they did an ultrasound, um, on the breast after the, the mammogram. Would that be something that would be covered?
[AGENT][NEUTRAL] You know, let's see, medical imaging.
[AGENT][NEUTRAL] Let's see what they.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Usually, they are, um, usually that is something that's covered and usually it is something that you can claim once or twice a year, um, if you have your just in normal mammogram, you know, um, cause it's considered a preventative test. Let's see here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, well, they did uh a normal mammogram and then they did some additional.
[CUSTOMER][NEUTRAL] Um, she wanted to have some additional mammogram pictures taken, and then they did, they decided to do the ultrasound afterwards.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then they actually ended up doing a biopsy as well, a couple of those later.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which were not, they, they were, you know, not malignant or anything, so.
[AGENT][NEUTRAL] So, yeah, mammogram and breast ultrasound are listed under the diagnostic and prevention benefit. Uh, they are listed test. So you would
[AGENT][NEUTRAL] Go back down to the benefits page here.
[AGENT][NEUTRAL] Um, so it looks like the diagnostic and prevention benefit is $45 per calendar year per covered person.
[AGENT][POSITIVE] The follow-up benefit is $45 for one follow-up per calendar year. So you could definitely could submit those um for the uh original mammogram and then the ultrasound, the follow-up, absolutely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can I submit for those online or?
[AGENT][NEUTRAL] So yeah, claims can be submitted either online they can be done. You can send them in the mail or you can fax them. It's really whatever is easiest for you um if you'd like I can give you or I can send you email you whatever is easiest, um, all of the online portal information as far as where you would log in and then upload your documents and you can go back honestly as long as you've had the policy if you wanted to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, uh, I'm sorry. What was that?
[AGENT][NEUTRAL] You could go back for mammograms, like any mammograms that you've had since the policy has been active, you could go back and actually claim if you wanted to.
[CUSTOMER][NEUTRAL] Oh, so I don't, there's not a time limit on it then?
[AGENT][NEUTRAL] No, there's not a time limit.
[CUSTOMER][POSITIVE] Oh, that's awesome.
[AGENT][NEUTRAL] Yeah, so it would just be up to you if, if you wanted to um just get the, you know, documentation for that or, or not.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK, so if they were like separate years then I can definitely, so like the the mammogram that I had done um last year and then the ultrasound that was done last year I can submit for those and then if I can get the documentation for the ones done prior to that I can submit for those years also.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK. And I'm going in for a colonoscopy in May.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] On [PII], I happy [PII], right? So, um, I'm gonna have that done also. That's covered, is it not?
[AGENT][NEUTRAL] Yes, ma'am. So that is another one of those diagnostic prevention benefits and that is a test also listed on there that is covered. Uh-huh.
[CUSTOMER][NEUTRAL] So would I be able to claim for it as well as um for.
[CUSTOMER][NEUTRAL] Uh, a mammogram for this year.
[AGENT][NEUTRAL] Um, I believe it's just one per year, so let me go back down and just double check here. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Regardless of what the test is, it's only one per year.
[AGENT][POSITIVE] Yeah, so it would just be extra work on your part. So I would just submit one or the other because it's only gonna give you a benefit for one.
[CUSTOMER][NEUTRAL] OK, OK, well that would work so far because um and it's still the $45 right?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][POSITIVE] OK, well, I, I guess that answers my question and that's wonderful to find out that I can go further back and um um one of the things that I did, uh, let me ask this, OK, um I had um.
[CUSTOMER][NEUTRAL] Um, my thyroid had to be removed because of thyroid cancer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So would that be covered?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Cause I was hospital, I mean, in
[CUSTOMER][NEUTRAL] I was in the hospital for that to be written.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, for sure. Let's see.
[AGENT][NEUTRAL] So it says,
[AGENT][NEUTRAL] It says it does not include conditions that may be considered pre-cancerous or malignant.
[AGENT][NEGATIVE] Um, autoimmune deficiencies.
[AGENT][NEGATIVE] It doesn't.
[AGENT][NEGATIVE] I don't think it matters.
[AGENT][NEUTRAL] Where it was located at, yeah, I mean, if the policy was active at the time.
[CUSTOMER][NEUTRAL] Well yeah
[AGENT][NEUTRAL] Then, um,
[CUSTOMER][NEUTRAL] Yeah, it was definitely um this would have been in I think it was like in [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Either [PII] or [PII], but
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Did you say if it was um
[CUSTOMER][NEGATIVE] If it was malignant, it wouldn't cover it.
[AGENT][NEUTRAL] It says, let me go back up to that. I was reading from the, the policy.
[AGENT][NEUTRAL] Um, it says,
[CUSTOMER][NEUTRAL] Because I thought the only time that they removed anything was if it was malignant.
[AGENT][NEUTRAL] Yeah, no, no, no. It's saying it does include malignant tumors. No, it says it includes that. No, no, no, yeah. Um, it's saying it does not include or consider precancerous or having malignant potential. Um, so, yeah, no, yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Um, but there is the um hospital benefit on here. So yeah, I mean, you definitely
[AGENT][NEUTRAL] Could go for, so the hospital confinement would, would pay $100 for every day that you were in the hospital. Um, it does have an outpatient or ambulatory surgical center benefit for surgery of $200 per surgery. So that's definitely something that you could uh still have claim on here as well.
[CUSTOMER][POSITIVE] Oh, that's awesome. Thank you so much, [PII].
[AGENT][POSITIVE] Yeah, absolutely, absolutely.
[CUSTOMER][POSITIVE] Well, that's wonderful to know. Um, I cannot tell you.
[AGENT][NEUTRAL] Yeah, no, for sure, and then if you want [PII], what I'll do is it best if I so like I can just email you the online information on how to log in and do a claim and all of that if that's easiest for you.
[CUSTOMER][POSITIVE] That would be awesome if you could do that, yeah.
[AGENT][POSITIVE] OK, yeah, absolutely.
[CUSTOMER][NEUTRAL] And then, and, and then even though my husband actually, I, I don't know why I never realized that he was even on this policy, but um he passed away and actually yesterday was the anniversary of his death. Um, he passed away on [PII].
[AGENT][POSITIVE] Oh I'm sorry.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um so.
[CUSTOMER][NEUTRAL] If there was anything.
[CUSTOMER][NEUTRAL] Uh, um, would he be covered under anything?
[CUSTOMER][NEUTRAL] At that, can I submit for anything um at that point in time?
[AGENT][NEUTRAL] Yeah, my
[CUSTOMER][NEUTRAL] Still, even though he stay on.
[AGENT][NEUTRAL] Yeah, I mean, um, let's see.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't see because I don't know of any time limit on here. I'm double checking cause
[AGENT][NEUTRAL] You know, he was covered during that entire time, so I wouldn't see as to why not.
[AGENT][NEUTRAL] You know, I know that obviously he would be um like the date of termination for him would be the [PII], um, but from [PII], I believe it was [PII] when you instated the policy, it shows he's been on here the entire time, so yeah, I mean, as long as there was was coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] What's actually covered then? I mean.
[CUSTOMER][NEUTRAL] I'm, I'm trying to think, um, because he did not die of cancer as such. Um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But he was in the hospital and um
[CUSTOMER][NEUTRAL] On his death certificate, it said myocardial infarction.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and he had, um, and he had COPD.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, this one, some cancer policies I've seen, do you have an additional like add-on for any sort of like heart attack, stroke, or uh sometimes additional benefits.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, for this, it would just be more so hospital confinement due to cancer.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Cause on the schedule of benefits, um, things covered are like there's prosthesis benefits for hair prosthesis due to cancer treatment.
[AGENT][NEUTRAL] Um, there's a blood and plasma benefit, radiation and chemotherapy. There's a hormone therapy benefit.
[AGENT][NEUTRAL] Bone marrow.
[AGENT][NEUTRAL] Um, an ambulance benefits and then transportation and lodging.
[AGENT][NEUTRAL] There's also.
[AGENT][NEUTRAL] What they call a dread disease benefit.
[CUSTOMER][NEUTRAL] And what is that?
[AGENT][NEUTRAL] I'm not certain. Let's scroll up and see.
[AGENT][NEUTRAL] I've not, let's see, try to see.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So it lists a bunch of different things. Um, Addison's disease, cystic fibrosis, meningitis, multiple sclerosis, multiple muscular dystrophy.
[AGENT][NEGATIVE] Um, Ray's syndrome, Rocky Mountain spotted fever, sickle cell sickle cell anemia, toxic epiderm, some of these I can't even pronounce.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Uh, Whipple's disease, thyroid fever, tuberculosis, to shock syndrome, toxic shock syndrome.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] So yeah, it's got a benefit listed for that.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Does it have one for COPD?
[AGENT][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] Yeah, it's not considered one of those.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Well, thank you so much, [PII]. I really appreciate it and um
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] Yeah, no, not.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think that's all that those are the only questions right now I have, I guess.
[AGENT][NEUTRAL] OK, [PII], let me get you over to somebody in the customer service area that does deal with um getting him removed from the policy though that way you can speak to them about premium and then just what needs to be submitted uh to get him to get him removed off of the policy because there's definitely gonna be uh a change in in the premium, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, as long as it doesn't go up.
[AGENT][NEGATIVE] No, I don't, I don't feel like it should.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, me too.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] All right, well, if you have any other questions or concerns, please feel free to always give us a call, OK?
[CUSTOMER][POSITIVE] OK, thank you so very much.
[AGENT][NEUTRAL] You're welcome. Just one moment please.
[CUSTOMER][NEUTRAL] OK. Uh. You are on hold.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] over in customer care. How are you doing this afternoon?
[CUSTOMER][POSITIVE] I'm doing good. How are you?
[AGENT][NEUTRAL] Good. I have an insured on the line and her husband has passed away. She needs to remove him off the policy. Um, he passed away in [PII], so it's been some time, so she wants some information on that.
[CUSTOMER][NEUTRAL] Mhm. All right. What is the policy number?
[AGENT][NEUTRAL] Policy is gonna be 960872 and we're speaking to a Miss [PII].
[CUSTOMER][NEUTRAL] Alright, and let me just a second while I pull it up.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] All right, I have it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Here she comes if you're ready.
[CUSTOMER][NEUTRAL] You can
[CUSTOMER][POSITIVE] Yes, I am. Thank you.
[AGENT][POSITIVE] Thanks. OK. You're welcome.
[CUSTOMER][NEUTRAL] Hello, good afternoon, Ms. [PII].