AccountId: 011433970860
ContactId: 7c3a5548-1c12-4fa5-a5f7-2e44127f6642
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 626880 ms
Total Talk Time (AGENT): 318880 ms
Total Talk Time (CUSTOMER): 237517 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/7c3a5548-1c12-4fa5-a5f7-2e44127f6642_20250326T18:08_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Um, I was calling because my employer have my, um, cancer policy through you guys, and I was just trying to figure out the next steps because I did have a mammogram and um ultrasound done and now I need to go in for a biopsy.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right, I can help you with that. What is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] 521
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the policy number for the patient, um, your policy number? I'm so sorry.
[CUSTOMER][NEUTRAL] That's OK, um, the policy number is
[CUSTOMER][NEUTRAL] 254
[CUSTOMER][NEUTRAL] 021 9.
[AGENT][NEUTRAL] All right, thank you, Ms. [PII] and what is your date of birth and current mailing address, please?
[CUSTOMER][NEUTRAL] Date of birth is [PII] and the address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And so you're wanting to know if it's covered to have a biopsy or a mammogram or ultrasound?
[CUSTOMER][NEUTRAL] Well, I already did the mammogram and ultrasound. I forgot that I even had this policy, um, and they have me scheduled for a biopsy next week.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so I just didn't know like what you guys would need going forward or how any of that.
[AGENT][POSITIVE] Sure. Well, it would be my pleasure to assist you.
[AGENT][NEUTRAL] And Ms. [PII], what is your email address, please?
[CUSTOMER][NEUTRAL] Uh, my personal email is [PII].
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right thank you I appreciate that verification. So I see you have an active portal address you can go to that portal and go to the claim form section.
[AGENT][NEUTRAL] And there is a claim form for cancer.
[AGENT][NEUTRAL] Uh, claims. So you would choose the cancer claim form.
[AGENT][NEUTRAL] Complete that form, and there are instructions as to what documents are needing, or needed to file a claim. Now, we will need the itemized bills with the diagnosis codes and you can get that from your doctor or where they perform the mammogram and ultrasound and from the surgeon who's doing the biopsy.
[AGENT][NEUTRAL] And then, um.
[CUSTOMER][NEUTRAL] OK, and when I look.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] No, you're OK. So when I was just looking at some of that online, um, I click on like you said, the cancer form, um, and it popped up and it was wanting stuff like mileage or lodging, and that was pretty much it. That was on the form.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And there wasn't anything else that I can see unless I'm just in the wrong spot online.
[AGENT][NEUTRAL] Oh, let me check that.
[AGENT][NEUTRAL] Bear with me just so I'm gonna bring it up. Let's look at it.
[AGENT][NEUTRAL] So it is the cancer claim form. Now, that mileage is just a way to file for your mileage.
[AGENT][NEUTRAL] That's not all that's needed. Um, it would say.
[AGENT][NEUTRAL] On page on the first page, there are instructions and it'll tell you to complete the statement of insured sections A through D as in Delta.
[AGENT][NEUTRAL] Is applicable to your claim.
[AGENT][NEUTRAL] And then we'll need a pathology report from the pathologist from your biopsy and itemized medical bills from each medical provider with the diagnosis codes.
[AGENT][NEUTRAL] And for if you were having to go over 50 miles, the lodging and transportation, that is how you file for that benefit is under your lodging or transportation. So.
[AGENT][NEUTRAL] Um, and if, if you're not traveling over 50 miles, you don't have to complete that portion.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's just a way to submit for that if you do need that benefit.
[AGENT][NEUTRAL] So we don't have documentation needed for um the transportation other than the itemized bills from the treatment facility with the physical address on it and then you would.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah, I'm not having.
[CUSTOMER][NEUTRAL] I'm not having to drive that far. I mean it's just right here in town, but what I'm saying is like, I'm looking at the form again and all they asked for.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] And I'm on page 2. It asks like for my information, then it says Part B is about the patient. Part C is not local transportation and family member lodging.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then that's it. That's at the bottom, and then you just sign the bottom. There's nothing else.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And then sign the bottom of page 4. Yes, ma'am?
[CUSTOMER][NEUTRAL] Is that the right form?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] I was like, cause I was like, uh, I don't need anything for lodging or anything like that. So I was like, I don't know that this is right, then.
[AGENT][NEUTRAL] Yeah yeah.
[AGENT][NEUTRAL] It is the correct form and then on the first page will be the documents needed for different services like you'll need the itemized bill for the biopsy from your surgeon and then we'll need the pathology report.
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] Yeah, cause all I've done so far is the mammogram and the ultrasound and I.
[CUSTOMER][NEUTRAL] So do, do our policies like cover any of the mammogram or ultrasound that needed to be done, or is it like you pay for it and then get reimbursed or is it even covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, do your mammogram, uh, diagnostic testing is covered. That's for your screening if you did a mammogram and then they possibly called you back for an ultrasound.
[AGENT][NEUTRAL] And that a follow up.
[CUSTOMER][NEUTRAL] They just did it on the same day.
[AGENT][NEUTRAL] On the same day.
[AGENT][NEUTRAL] So a follow-up diagnostic testing is covered.
[CUSTOMER][NEUTRAL] Yeah, cause I already.
[AGENT][NEUTRAL] Did they do it in the same appointment time?
[CUSTOMER][NEUTRAL] Yes, because, um, I was already feeling the mass, so that's why they went ahead and did the mammogram and ultrasound the same day.
[AGENT][POSITIVE] I got you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Got you. So.
[CUSTOMER][POSITIVE] Um, and then they sent it back to my doctor and uh they've helped me get set up to do an appointment next week because it's like 3 different masses that they need to biopsy.
[AGENT][NEUTRAL] OK. And so just send in that itemized bill for the mammogram and ultrasound.
[AGENT][NEUTRAL] And I see you have that online account as well. You can actually click on your policy number and it will download your policy and you can view the benefits covered.
[AGENT][POSITIVE] Now, if it comes back with a positive diagnosis code, that's why we need that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, cancer diagnosis. That's why we need that pathology report because you have a lump sum benefit uh for a diagnosis of cancer.
[AGENT][NEUTRAL] So that would be payable with the pathology report. And then, of course, any procedures or treatments, always send in the itemized bill with the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, now let's say if I go through with the biopsy next week and it comes back it's not.
[CUSTOMER][NEUTRAL] Malignant. Um, is there anything to that point that's still like covered with like the.
[CUSTOMER][NEUTRAL] The diagnostic for or what I've already paid that is that still covered for you guys because I already know like that's gonna be a lot.
[AGENT][NEUTRAL] Your, your diagnostic testing will be. Yeah. Your diagnostic testing will be covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, surgical benefit, I would submit that, whether it comes back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, non non-cancerous, go ahead and submit that and let them review it to see if it could be covered.
[AGENT][NEUTRAL] But most of the benefits on your policy are for a positive uh diagnosis of cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just wanted to be sure because I know some work a little different than others and I was looking at.
[AGENT][NEUTRAL] Right.
[CUSTOMER][MIXED] You know, trying to see if I can find a different policy. And then I was like, let me just see what I have through work cause I don't remember if I took one out or not. I mean, I'm glad I did, but I'm like, man, I feel like I would have had better coverage with some of these if I had taken it out on my own cause some of these I'm like, that doesn't seem like a whole lot that's covered or not, but everybody does it different, so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, and I will say that um your policy has been active since [PII]. So if you happen to have had any screenings performed for [PII], you can also submit for that wellness benefit for [PII] if it was after [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I appreciate your help. I'll go online and get those at least started. Um, I don't have any itemized bills like from the mail yet, but if I had to pay for some of the, uh, mammogram and ultrasound up front.
[CUSTOMER][NEUTRAL] But I can always get a request that to get that uh paperwork so that way I can get turned in.
[AGENT][NEUTRAL] That's
[AGENT][POSITIVE] That's right. And they'll be happy to assist you. They should, you shouldn't have any problems getting an itemized bill with diagnosis codes.
[CUSTOMER][POSITIVE] Thank you so much for your help. I appreciate it.
[AGENT][POSITIVE] It's been my pleasure to assist you, Ms. [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that was all thank you so much.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you