AccountId: 011433970860
ContactId: 7be5936e-5420-4420-aab4-2aa85aee5cc9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1175670 ms
Total Talk Time (AGENT): 499213 ms
Total Talk Time (CUSTOMER): 687346 ms
Interruptions: 9
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/7be5936e-5420-4420-aab4-2aa85aee5cc9_20250225T18:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Yes ma'am how are you? um.
[AGENT][POSITIVE] I'm good. How are you doing?
[CUSTOMER][POSITIVE] I'm, I'm hanging in there thanks for asking, uh, about.
[CUSTOMER][NEUTRAL] Uh, my wife works at a school and we got, I guess a cancer insurance policy through you guys.
[CUSTOMER][NEUTRAL] Um, it's been running on it for 2 years or so, and, uh, unfortunately I'm using, I'm gonna need it now, so, uh, I wanted to find out a little bit about it. She didn't know much about it. She just added it on through the school. I have a group policy number and an insured if that helps.
[CUSTOMER][NEUTRAL] Ma'am you still there?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm here, can I get your name please?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] All right, [PII], can I please have a callback number for you, please?
[CUSTOMER][NEUTRAL] Yes, I can. Yes you can. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the policy number, please?
[CUSTOMER][NEUTRAL] I don't know if I have that. I've got the group number.
[CUSTOMER][NEUTRAL] Group policy number, yes, I do 12906.
[AGENT][NEUTRAL] Um, what's the other number that you have?
[CUSTOMER][NEUTRAL] What do you mean what's the other number I have?
[AGENT][NEUTRAL] You said you have 2, you had a group number and.
[CUSTOMER][NEUTRAL] No, no, no, it says, it says group policy number 12906.
[AGENT][NEUTRAL] No, that wouldn't be the number that I need. Um.
[CUSTOMER][NEUTRAL] It's, it's on the phone number that you gave me here let's see, it's on the card.
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] You might
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that the only number that you see on on?
[CUSTOMER][NEUTRAL] Yeah, it's, uh, I mean group policy number, I would think that's it. I mean, it's got verbal I see now it may be under her name. She's the main insured. I'm a beneficiary.
[AGENT][NEGATIVE] No, it's just, it's the number that you gave me is not um.
[CUSTOMER][NEUTRAL] So maybe
[CUSTOMER][NEUTRAL] is not
[AGENT][NEUTRAL] And enough numbers.
[CUSTOMER][NEUTRAL] Uh, this was, this was back we've, we've just renewed it, so you may have changed that. So I mean because it was 2 this is the 22 to 23 1 but it's the same one she's just been renewing it.
[AGENT][NEUTRAL] Yeah, I believe like um that number you gave me. I'm gonna look you um uh let me change the screens. I think that number that you gave me is the actual group itself like when you pull that number up it's gonna pull everybody in the that group up uh yeah so just um one moment.
[CUSTOMER][NEUTRAL] So I don't know if y'all change to.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I understand, yeah, I understand. That's just the only thing that's the sure.
[AGENT][NEUTRAL] OK. Can you spell your last name, please?
[CUSTOMER][NEUTRAL] Well, it's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My wife's the one that bought when it bought it so it may be under her and then I'm a beneficiary of it so it's it's Visa.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Could you please verify your date of birth, your address and email address, please?
[CUSTOMER][NEUTRAL] Uh, mine [PII], [PII].
[CUSTOMER][NEUTRAL] And the phone and the address is [PII].
[AGENT][NEUTRAL] All right, thank you so much for verifying that information. I do have your policy pulled up. Um, you're stating that you were gonna have to use um this policy for a positive diagnosis of cancer and you're just needing to know how to file your claim. Am I correct on that?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, because, yes, um, I was diagnosed in December. I need to find out what's covered if the scanning to see if it was cancer covered or if it's just the effective date. Yes, in starting a claim, yes, so whoever calls me back, those are my issues, yes, ma'am.
[AGENT][NEUTRAL] Oh no, it's not a callback. The only reason why I asked for your callback number is if we get disconnected, you, I can call you right back. Yeah, all right.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 00, OK, yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah, so here, here the, yeah, yeah, I, I don't know if you want me, me to proceed or if you want me to go. So in October I started doing a bunch of scans, um.
[CUSTOMER][NEUTRAL] Because they thought it was something different and then uh they discovered that I have pancreatic cancer.
[CUSTOMER][POSITIVE] Fortunately, they caught it fairly early and I do have a chance to potentially survive.
[CUSTOMER][NEUTRAL] Uh, unlike most, uh, but.
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] But um the scan started, I don't know if I have to, if I, if I get reimbursed, we have, we, we have normal insurance, obviously. And then this I assumed is just uh an additional gap insurance for what, what they don't cover. I assumed it's what it's for or whatever, I don't know. And then uh when they went in and looked in, I had a couple of procedures. I had a procedure where they go in there and they look and they grab a piece of the tumor or the lesion and then they test it.
[CUSTOMER][NEUTRAL] And uh so although I wasn't quote unquote diagnosed with cancer at that moment, it clearly was to determine if I had pancreatic cancer or not. And then they took the piece out, they sent it for a biopsy. The biopsy came back and it was cancerous, and that was [PII].
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEGATIVE] You know, I'm, I'm on, I'm on the back. I'm on the couch doing chemo right now I take home chemo, so it's a pain in the ass. It's a bitch. But yeah, so about 3 months ago I was diagnosed with pancreatic cancer, so I need to know how to go about starting to file those claims. If it's, if you're a reimbursement, my wife isn't very good at this. If you're a reimbursement thing where I pay and then I just send you the bills that I paid and you reimburse me.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, and what you need from the doctor to show that I have pancreatic cancer, how formal you need of something because it's pretty obvious. It's, it's on all my take home paperwork, but OK, so those are kind of the things I need to know. Now I'll let you go and maybe you can explain it to me.
[AGENT][NEUTRAL] OK. All right, so online at [PII] is the website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's a form, there's a cancer claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you, on page one of the claim form, it tells you what we would need for you to file a claim. Page 2 is the actual claim form that you will fill out and submit with your documents. We would need the pathology report first diagnosing cancer, and this information is on that claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, fair enough. I understand.
[AGENT][NEUTRAL] So once, once you um submit that, we would need any itemized billing. So, um, while I pull up your policy, this is a verification of your coverage and not a guarantee for payment. So, um, the benefit that you do have is your internal cancer first occurrence, which is a lifetime benefit. This means that um
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's a $2500. So that's the first internal first occurrence of, you know, being diagnosed with cancer. Then you have um uh imaging which you get one imaging per year. You do have surgical anesthesia. You do have confinement, outpatient facility, which means that um
[AGENT][NEUTRAL] You know, when you go have biopsies or surgeries and you go home the same day, you do, that's a benefit of $400. Your confinement is $200 a day. Um, you do have radiation, um,
[AGENT][NEUTRAL] Chemo, radiation and immunotherapy, which is $15,000 per 12 month period. So I'm gonna explain how that works. So,
[AGENT][NEUTRAL] We would need the itemized billing from the hospital with codes, and we would need, if you had Blue Cross for your primary, we would need the explanation of benefits from Blue Cross because we.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I've been saving those, yeah, so what they paid and what they didn't pay, I understand, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so we pay actual charges, which means that if your hospital um bills Blue Cross 10,000 and Blue Cross pays everything, and Blue Cross pays 5.
[CUSTOMER][NEUTRAL] Except 600.
[AGENT][NEGATIVE] And then they leave you with 2, we were only gonna pay you the 5 and the 2. We're not gonna pay you what was not covered.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So that's how that works.
[CUSTOMER][NEGATIVE] Right, you're not gonna let me, you're not gonna, oh, you are gonna pay me to file and sue.
[AGENT][NEUTRAL] Yes, that's actual charges. Actual charge means what the other insurance paid and what you're responsible for. So that's how that works. If they don't pay, if
[CUSTOMER][NEGATIVE] Oh you're not
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so let me, let me, let me make sure I understand. So obviously insurance companies get a better rate. So if I, or whatever, so on the bill it'll say 12,000. I think it said for my Medport was like, I don't know, 4000 or 600,000, I don't know. And then Blue Cross Blue Shield said insurer rate and they got and they only paid.
[CUSTOMER][NEGATIVE] 2100 and I paid 900 or 21 and I paid 8 so you're telling me what you would actually pay me is the 8 out of pocket that I'm out of pocket plus the 5 or $6000 or whatever I was billed, is that what you're telling me?
[AGENT][NEUTRAL] This is only for, yes, this is only for radiation, chemo, and immunotherapy.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK, so it wouldn't be the port or when they cut out, when they cut out my tumor, that's, that's not it neither.
[AGENT][NEUTRAL] OK. Now, that's the surgery. So, surgery is we pay, um, each surgery code has an amount. It depends on the surgery code that we receive. Um and for surgery, it is um
[AGENT][NEUTRAL] Um, 3 $30 unit dollars, so say for, let me, let me look at a surgery code. I have one on top of my head that I can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, 367 let me see.
[AGENT][NEUTRAL] OK, so 36,590, that is, that code is a port removal. So if you had a port put in, right, and um and they've taken the port out, so 36,590 is the code that they will bill for that port removal. So for that particular code is 55 um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 56 5.62. So your policy states that we will pay $30 per unit. So we do $30 times the 5.62. So that means we were gonna pay $168.60 for that particular one. And then for anesthesia, we pay 25%. So 25% of that 16,860 is what we will pay for anesthesia.
[CUSTOMER][NEUTRAL] All right, OK, now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No matter what the, and this doesn't matter what the insurer Blue Cross Blue Blue Shield paid, right? It doesn't matter. You're gonna pay it no matter what, right? OK, I understand. Even if Blue Cross pays it all, I understand. I got you. OK, here, here's the one question I do have this, this is very informative and I'll get on the website. I'm not an idiot. I'll figure it out myself a little bit.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah. All right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But the only question I did have is when do benefits kick in? Do benefits kick in the moment I, they biopsy and show it's cancer or in the trying to determine if it was cancer or not?
[AGENT][NEUTRAL] So, the, the, the date that we would use for your benefits will be the date that they did the biopsy that they cut, cut you and they took it. So that would be the collection date. If you look at your pathology report and you have a collection date, that is the date that we would use, is your collection date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. No, that's good. So, so I think what you're telling me is the endoscopy where they went down in my stomach.
[AGENT][NEUTRAL] That's the date.
[CUSTOMER][NEUTRAL] And they went down there and they, to, to, to do a sonogram of the lesion cause the scan, they thought it was cancer, but they wouldn't sure. And then they looked and then they took a piece of my, my tumor out and when I came out, the guy looked at me and said, yeah, I'm sorry, buddy. It's, it's a tumor, but they can cut it out. He had good words for me, but, but, but he told me then, yeah, it's a tumor. It hadn't been sent in yet.
[CUSTOMER][NEUTRAL] So you're saying the collection date, [PII] when they collected, when I went through that er that procedure and they put me under, that is the date of coverage, not the date of the actual biopsy, [PII], a week later where I actually got the results, right?
[AGENT][NEUTRAL] So, the biopsy is the date, this, so if you had the biopsy that they took it and they did the pathology on it, that is gonna be the date. The pathology on the tumor is gonna be the date. It's gonna be um yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let's do that one more time. I, I'm not, I'm not making myself clear. So [PII], they went in and took a piece. They looked at it, saw it was a tumor, but it was not malignant yet. They were not sure. They have to send it in.
[AGENT][NEGATIVE] No, no, that's not covered.
[CUSTOMER][NEUTRAL] OK, so then [PII] would be the day when they call me up and tell me, yes, the biopsy results have come back and you are positive it is a a cancerous malignant tumor and you are gonna start seeing an oncologist.
[AGENT][NEUTRAL] So you're saying you got, you got cut on the [PII] and the [PII]?
[CUSTOMER][NEUTRAL] They didn't get, they didn't cut me. Uh, pancreatic cancer is a little bit different. They go down there. It's real hard to find. So when they do scans, they can't really tell if it's a tumor or not. They can, but they can't, you know. And so I, I had a scan in November.
[CUSTOMER][NEGATIVE] They told where they told me and my father had pancreatic cancer. So I have a scan in like [PII], and they say, yes, there's a lesion. We got to go in. We don't know if it's cancerous or not, but there is a lesion. And I knew I had it. I mean, my wife is breaking down crying and everything, and I'm like, I've got it. My dad had died of pancreat cancer. Hopefully, I'll make it longer than 4 months that he did. So then what they do is, but I'm sure it's because
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Insurance because, no offense, because they want to be sure before they pay $1. I had to wait 6 weeks before they would go down there because they had to let the pancreas die down a little bit. I don't know why. I think it's stupid. They should have looked right then so I could start on getting it, but whatever. That wasn't my deal. So
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On [PII], they put me to sleep.
[CUSTOMER][NEUTRAL] And they put, uh, and they stick a scope down my throat, put me in anesthesia, and, uh, and they go in there with a scope and at the end of the scope is uh the thing that they go down there all the way in the edge of your stomach right next to the pancreas and they do a sonogram. They look real close and see what it is. And when they do the sonogram because it's real hard to see in an outer body scan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now they can see, oh yeah, yeah, that's, yeah. OK, that's, that's, that's probably a tumor. But maybe it's not cancers yet. And then they go through my stomach with a little needle. They grab a piece of it and they pull it out and they come out, and they wake me up. And that's when the guy told me, that was [PII]. Yeah, it's not good news, man. It's a tumor, but it's in a place where they can cut it out, you might have a chance. And I'm like, great. And then, but we got to send it to the lab to get confirmation before you go forward with an oncologist or anything.
[CUSTOMER][NEUTRAL] And then [PII] is when I got the, the actual biopsy a week later, it had to go to a lab. They had to make sure it was uh yeah.
[AGENT][NEUTRAL] OK. So [PII], and you, we will have to look at the stuff you send in, but from what you're explaining to me, [PII] would be the date because we would use the date that they actually took the um path to, to, to, to look at. So that's the collection date. So [PII].
[CUSTOMER][NEUTRAL] Yeah, that, that makes sense to me because, yeah, that makes sense because.
[AGENT][NEUTRAL] Not the date that you got the news or you got the confirmation, but the date that they actually took the, yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right, because it was either cancerous or not cancerous [PII], right? I, I, that's what I do, but, but you know, insurance companies try to get out paying, so I thought maybe they, they'd say no, it wasn't cancer yet. We didn't know yet. OK. All right. Well, you have been wonderful. I understand. And oh, let me do the scan thing. I get one scan per year, 11 MRI with.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] So medical imaging is so medical imaging is a CT MRI or um a PET scan. That is once per year. That's $500 once per year and it would, they only pay after your diagnosis. So any, if you had one done after [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so you get one once per year. Um, so, yeah.
[AGENT][NEUTRAL] So as long as you
[CUSTOMER][NEUTRAL] So, OK, no, they haven't done, they haven't done one yet, but before they do surgery they'll do a PET scan and so, so you guys will cover that.
[CUSTOMER][NEUTRAL] And insurance will cover that partly, OK, and that's 5 bills. OK, good, good, and then the um.
[CUSTOMER][NEUTRAL] So you believe that the surgery, the where I was put out to collect the [PII], you believe that will be covered?
[AGENT][NEUTRAL] Yeah, biopsies are biopsies are covered. That is a biopsy. Biopsies are covered cause that is a surgery. Anytime that they um cut, like a cut or whatever, or that is a surgery. A biopsy is considered a surgery unless it's skin cancer, then
[CUSTOMER][NEUTRAL] You think?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We cover skin cancer too, but it's, it's, we pay differently. But um yeah, but that is covered, biopsies are covered.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][POSITIVE] And you do show that the premium was paid, I'm covered for sure, right? You, you do show that.
[AGENT][NEUTRAL] Yeah, you, you're a dependent. You're on here.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, great, great, OK.
[CUSTOMER][POSITIVE] And one more time that website and I'll, and I'll take it from here. I appreciate it.
[AGENT][NEUTRAL] Alright, so the website um is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. OK, all right.
[AGENT][NEUTRAL] Our
[AGENT][NEUTRAL] Now let me give you your policy number as well. One moment, let me.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, yeah, uh, here, let me get on my notes on my phone that way.
[CUSTOMER][NEUTRAL] Um, how do I do a new one?
[CUSTOMER][NEUTRAL] There it is. OK, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, it changes on me damn it. OK, there we go. God darn it. I hate autogra AM.
[CUSTOMER][NEUTRAL] Public, I guess that stands for American public, OK, alright, and the, uh, yes, I'm ready now for the policy number.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] It is 02.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] 52.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 52.
[AGENT][NEUTRAL] 22
[AGENT][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] Policy number 02522250.
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] Alright, you've been very helpful. I really, really appreciate your help. It's been, uh, I did not expect it.
[AGENT][NEUTRAL] Not a problem at all. Is there anything else, Mr. [PII]?
[CUSTOMER][POSITIVE] I, I did not expect to get such a, a good response from somebody because you know, but anyhow it's been, it's really, really you've been really helpful. I really appreciate your help, especially with what I'm going through.
[AGENT][NEUTRAL] 00 well.
[AGENT][POSITIVE] No problem at all. No problem at all.
[CUSTOMER][POSITIVE] Alright, you take care of yourself and I'll call you back if I have any problems. OK, bye.
[AGENT][POSITIVE] Thank you so much for calling ATL. All right, thank you. Have a good day. Bye-bye.