AccountId: 011433970860
ContactId: 68d0ee4a-ec27-4184-9019-99d6277f6270
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1354160 ms
Total Talk Time (AGENT): 620705 ms
Total Talk Time (CUSTOMER): 286462 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/68d0ee4a-ec27-4184-9019-99d6277f6270_20250205T18:28_UTC.wav
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[CUSTOMER][NEGATIVE] I went to the wrong place. Yes sir.
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is uh [PII].
[AGENT][NEUTRAL] And how can I help you?
[CUSTOMER][NEUTRAL] Uh, I was, uh, you need my claim number?
[AGENT][NEUTRAL] Uh, let me
[CUSTOMER][NEUTRAL] My account
[AGENT][NEUTRAL] Spell your first name for me.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And do you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, it's 256.
[CUSTOMER][NEUTRAL] 6030.
[AGENT][NEUTRAL] OK. Now, let me have your phone number in case we're disconnected, I can call you back.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me pull up your account, get you verified, and then we can proceed, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can verify your date of birth and mailing address?
[CUSTOMER][NEUTRAL] [PII] mailing address [PII] zip code [PII] [PII].
[AGENT][NEUTRAL] Mhm and your
[AGENT][NEUTRAL] Yeah, that's fine. I showed the physical address and what is your email address?
[CUSTOMER][NEUTRAL] Hey, let's see is it [PII]?
[AGENT][NEUTRAL] Looks like your school email address.
[CUSTOMER][NEUTRAL] OK, B is [PII].
[AGENT][POSITIVE] OK, thank you for that. And how can I help you today?
[CUSTOMER][NEGATIVE] Uh, the day they, they gave me the wrong information, I faxed some stuff off, but they had it gone through the thing I feel like was Allstate insurance and y'all with Allstate too, right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Oh you're not. OK, what happened was they sent me to, I send the information to the wrong people.
[AGENT][NEUTRAL] OK. You mean your claim information?
[CUSTOMER][NEUTRAL] So I'm gonna pass it back here.
[CUSTOMER][NEUTRAL] Yes ma'am, and on the claim information what all do I need ma'am?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so are you, what are you trying to submit? What type of, is this a cancer policy?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Cass, ma'am. Casa, yes, ma'am.
[AGENT][NEUTRAL] OK, so you would submit the itemized bills and then there's a APL claim form that you'll need to complete. Did you complete that already or no?
[CUSTOMER][NEUTRAL] I'm at the, uh, can you send it to me again because I only see 3 sheets to fill out. How many sheets I'm supposed to fill out?
[AGENT][NEUTRAL] So let me pull up the cancer claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sounds like you may have. It's, let's see, page 1 is your demographic information 23. So it's a total of 3. So the first one you complete your name, your address, and all of that. And then the second page was just something for you to read. The third page was a read as well, but you had to sign the bottom of it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the first page that's tried everything. It's OK. So, uh, the first page is to fill it out. The 2nd page is to read it, and the 3rd page is to find it.
[AGENT][NEUTRAL] Is that what you completed?
[AGENT][NEUTRAL] Huh.
[AGENT][NEUTRAL] Yeah, it's something for you to read it's an authorization and you've given us permission to request medical records if we need it to.
[CUSTOMER][NEGATIVE] OK, I have the medical records. Like I said, I will tell y'all from the, uh, I got, I got diagnosed with cancer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I, and I went and did the uh biopsy last week and that's when they told me I had it.
[CUSTOMER][NEUTRAL] And I got to go see him again. I went to see him yesterday and he wants me to come back. They're gonna shoot the dye in me to see if the cancer is spread and they're gonna do a bone thing on me as well, a bone scan. And then I guess I got to go back again and start getting my radiation treatment.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. OK. So,
[CUSTOMER][NEUTRAL] So how much would it cover for all that, ma'am? What about me having this?
[AGENT][NEUTRAL] OK, let me, let me pull up your policy. And page one, do you still have page one of that claim form?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, page one will give you instructions on what documents to file depending on what benefit you're trying to claim.
[AGENT][NEUTRAL] Um, I know we will need the pathology report first diagnosing the cancer.
[CUSTOMER][NEUTRAL] OK, I got that.
[AGENT][NEUTRAL] And then, have you had any type of surgeries yet? I know you said you had a biopsy.
[CUSTOMER][NEUTRAL] And I got the paper for that.
[AGENT][NEUTRAL] OK. Any surgeries yet?
[CUSTOMER][NEUTRAL] Mm, I just did the biopsy. That's the only surgery I had.
[AGENT][NEUTRAL] OK, so far, OK.
[AGENT][NEUTRAL] So, I'm pulling up your policy here.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I want just like that.
[AGENT][NEUTRAL] So it covers, you know, radiation, chemo, and therapy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] There's a surgical benefit rider, um, anesthesia.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, transplants, bone marrow, stem cells, um, hospital confinement, um, outpatient facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, attending physician. So if you're confined in a hospital or admitted, you know, doctors will come and see you. There's a benefit for those attending physicians. Um, there is an extended care facility, home health, hospice care. Uh, there is, you have a miscellaneous benefit rider.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Cancer treatment center, evaluation or consultation. OK, that's not included.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if you wanted to get a 2nd or 3rd opinion, that's covered. Drugs and medicine is covered. Transportation.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Play the transportation part.
[AGENT][NEUTRAL] Yeah, so let me look at the definition. I think it has to be 50 miles from your place of residence.
[CUSTOMER][NEUTRAL] Oh yeah, OK.
[AGENT][NEUTRAL] Um, to be considered under the transportation, but I'll go back and look at the wording under that, under transportation.
[AGENT][NEUTRAL] Uh, there's a family transportation and lodging benefit as well.
[AGENT][NEUTRAL] Um, blood, plasma, and platelets are covered, amulets, whether it's ground or air.
[AGENT][NEUTRAL] Um, inpatient inpatient special nursing services, outpatient special nursing services, um, physical, speech, let's see, and occupational therapy.
[AGENT][NEUTRAL] Um, audio therapy and psychotherapy is covered.
[AGENT][NEUTRAL] And then this policy has a lump sum benefit, um, and that benefit is uh one time per person per lifetime. So once we receive the pathology report, that benefit can be issued to you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] You that is the one time business, the one time thing.
[AGENT][NEUTRAL] It's $5000.
[CUSTOMER][NEUTRAL] 0 $5000 OK.
[AGENT][NEUTRAL] Uh huh and then once we receive you know the itemized bills for the other services, um.
[AGENT][NEUTRAL] Then the other claims will be reviewed. Do you have other insurance?
[CUSTOMER][NEGATIVE] I just had medical issues with the school.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it a primary insurance or what type of insurance is it?
[CUSTOMER][NEUTRAL] Just when like I go see the doctors and stuff like that.
[AGENT][NEUTRAL] OK. All right. So,
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK. So again, on page one of the uh cancer claim form that you received, be sure to look at that cause that give you some detailed instructions on what documents you need to send to us. So for instance, whenever you uh may be hospitalized or you have a surgery or if you have any type of chemo radiation, if that be, hopefully not, um,
[AGENT][NEUTRAL] Then we require the itemized bill from each medical provider, from each medical provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that means like from the hospital, from the surgeon, from the anesthesiologist, we'll need one from each of those entities. And then if you have other coverage, hmm.
[CUSTOMER][NEUTRAL] Do they have to send
[CUSTOMER][NEUTRAL] I have to send them over. Do I have to send them over or are they fax it over to y'all?
[AGENT][NEUTRAL] So that's a communication that you would have with your healthcare providers uh to verify if they could send the claims to us on your behalf.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if the providers send the information to us, [PII], and there is what they call a um assignment of benefits, you give them assignment of benefits that means that when we process the claim we can issue the benefit to your healthcare providers.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and if you do have other insurance, um, it also states, uh, the explanation of benefits from your other medical carrier showing the amounts allowed and paid for each service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Um, let me go back up to the.
[AGENT][NEUTRAL] Uh, definitions for the transportation.
[AGENT][NEUTRAL] See, I think it's 50 miles.
[AGENT][NEUTRAL] From your place of residence.
[CUSTOMER][NEUTRAL] Excuse me, I. Yes, ma'am.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, in case I have that radiation treatment, would that cover anything too as well?
[AGENT][NEUTRAL] Yeah, radiation, chemo and Miotherapy. Um, this, I believe.
[AGENT][NEUTRAL] Is um
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][POSITIVE] OK, take your time, ma'am.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I I will stop.
[CUSTOMER][NEUTRAL] You in turning late?
[AGENT][NEUTRAL] Still looking.
[AGENT][NEUTRAL] So for radiation therapy, chemotherapy, and amniotherapy, uh, the benefit is 20,000 and it's uh a maximum per covered person per 12 months. So, you know, depending on the month that you start, if you start in March, then it's to, to March of the following year.
[CUSTOMER][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Of course, so I started.
[AGENT][NEUTRAL] So a 12 month
[AGENT][NEUTRAL] Yeah, it's not calendar year, it's a per 12 month period.
[CUSTOMER][NEUTRAL] So 20,000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me go back to the transportation to see if I can capture the distance.
[CUSTOMER][NEUTRAL] Do you need like gas receipts and stuff too as well, ma'am?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] What will happen if um we'll review the, if you should have to have any type of the 3 therapies, they would, uh that itemized bill, they would take the address from the facility where you have your treatment and Mapquest it to your
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Resident address to determine the mileage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And the transportation benefit applies to whenever, if you should, if you have any radiation, chemo and immunotherapy. And it does say.
[AGENT][NEUTRAL] Um, and then, you know, bone marrow, stem cell transplant or surgery due to cancer, OK, and or surgery due to cancer in a hospital that, that is at least 50 miles away from the covered person's residence, so it is 50 miles.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Now you said the 20,000, that's like, it's like so much money a month.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I just want lump sum.
[AGENT][NEUTRAL] So the lump sum is gonna be the 5000. The 20,000 is not a lump sum. That's as you incur.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just pay that each month.
[AGENT][NEUTRAL] Well, it's as you like if you have radiation treatment or chemo or immunotherapy, whichever one of those three, when that, once that's done, um, we would get an itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so that's, you don't get a lump sum 20,000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And uh
[AGENT][NEUTRAL] And that's about it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So anything I get from them, just fax it over to y'all.
[AGENT][NEUTRAL] If you're submitting the claims yourself, yes, but you'll need to get um an itemized bill uh from them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and that's a, a detailed itemized bill which will show, you know, the date of service where you had it done, um, and I can actually give you the four names if you have a pencil and paper to write this down.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I got that already, the stuff for the bills and see what one of the things is, uh, when I first went to do the biopsy.
[AGENT][NEUTRAL] Oh, you already have it, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] They charged me too. I gave them $500 so I'm making the other ones out in $110 a month to August.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To pay that bill off, so I need to send that in too.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, send in that itemized bill.
[CUSTOMER][NEUTRAL] OK then.
[AGENT][NEGATIVE] So not a balance due statement, you know how they send you something in the mail and say this is what you owe.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We, it's not bad. You'll have to request their itemized bill and let them know that you need the itemized bill to send to your insurance company.
[CUSTOMER][NEUTRAL] OK, I got that. So I will call them today and give me our fax number so they can send it over to y'all.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And then as you incur any expenses then just send the, you know, just send us the the itemized bill for review.
[CUSTOMER][NEUTRAL] OK. So when I fax all this off to y'all, I just, I'm gonna send everything I get from them to y'all so y'all can see when I went had the biopsy and they got the doctor's report and everything on there.
[AGENT][NEUTRAL] Mhm. Make sure we have the pathology report because we can't proceed without that. OK, showing the date that you were.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, that's on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know how long does it take for y'all to start on everything, like 2 weeks, 3 weeks.
[AGENT][NEUTRAL] I mean, our processing time is 7 to 10, um.
[AGENT][NEUTRAL] Days, thereabout.
[CUSTOMER][NEUTRAL] OK then.
[AGENT][NEUTRAL] You know of course if we have to request additional information that'll extend it because we'll need, you know, if we need to request additional information from you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, then if you do that, just let me know and I'll get it for you.
[AGENT][NEUTRAL] Right, so you'll receive correspondence whenever your claim is uh processed it you'll receive an ELB in the mail, um, make sure you pay close attention to those, um, and read, you know, because they're gonna be, it's an explanation of benefits. It's just basically how we process your claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You just called a what now?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you know additional information is required, it's gonna be on that document.
[CUSTOMER][NEUTRAL] Do I have to have a checking account for y'all to send me this stuff or y'all just mail it out?
[AGENT][NEUTRAL] We mail it to the address that you verified.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, are you talking about uh your benefit payment?
[CUSTOMER][NEUTRAL] Yeah, like you said, the $5000 lump sum, that's, that's in the.
[AGENT][NEUTRAL] So if you want it to be set up on direct deposit, there's a form that I can send you instead of sending your benefit out via mail or in a check if you want it direct deposited there's a form that we can, OK, send you and uh let me get that real quick.
[CUSTOMER][NEUTRAL] OK then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I want direct deposit.
[CUSTOMER][NEUTRAL] I'll tell you what, just mail it to me. It'd be better that way, just mail it to me.
[AGENT][NEUTRAL] OK. OK. All right. OK. Did you have any other questions?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh no, ma'am. So get all that to you y'all just start on that y'all just send me something mail like a letter or something saying when I would get it or something like that.
[AGENT][NEUTRAL] You know, you'll receive a copy of the explanation of benefits and if there's a benefit that's payable, uh, then a check will be attached to the ELB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You have a good day.
[AGENT][NEUTRAL] All righty. Anything else, [PII]?
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] Alright, thanks for calling.
[CUSTOMER][NEUTRAL] Can I email it to y'all too, like that I thought she sent me a portal or something. I guess it like me to upload and send it to y'all that way too.
[AGENT][NEUTRAL] Well, you cannot email it. Email is not a secure way to submit your documentation. Now, did she send you something to upload it online?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, uh huh.
[AGENT][NEUTRAL] They're they're an online service center.
[CUSTOMER][NEUTRAL] Mhm. Oh, some photo she sent me, yes, ma'am.
[AGENT][NEUTRAL] Right. Have you created an account yet?
[CUSTOMER][NEUTRAL] No, I'm gonna go ahead and create the account. How do you create the account, I just seen a bunch of stuff on there.
[AGENT][POSITIVE] OK, I can help you set it up if you have time to do it.
[CUSTOMER][POSITIVE] Um, can I call you back later? I'll lock it back in and you can have me set up then. Alright, thank you then.
[AGENT][NEUTRAL] Yeah, that'll, yeah, that'll be fine. That'll be fine.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] Alrighty, thanks for calling APO [PII]. Have a good day. Take care.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] You too you too you too.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I don't know if you're aware, but I still think I have you on the line.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hi, [PII], can you hear me?
[AGENT][NEUTRAL] I'm gonna go ahead and disconnect the line.