AccountId: 011433970860
ContactId: 8e12656a-6070-4b34-adc6-552cbcc24e98
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 920679 ms
Total Talk Time (AGENT): 611717 ms
Total Talk Time (CUSTOMER): 271101 ms
Interruptions: 4
Overall Sentiment: AGENT=2.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/8e12656a-6070-4b34-adc6-552cbcc24e98_20250121T20:44_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes, [PII], I was calling. I've never used this insurance before.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I have, um, I'm going in for a
[CUSTOMER][NEUTRAL] Breast surgery?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They are diagnosed with, they diagnosed me with um
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Sit too.
[CUSTOMER][NEUTRAL] And so they're gonna do a lumpectomy on me on the [PII], but I've been going to my uh cancer doctor.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But I, I've been paying the bills, so I'm just wondering what kind of benefits do I have through this insurance?
[AGENT][POSITIVE] OK, yeah, I'd love to take a look at that for you. Um, do you have your policy number handy at any?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] By any chance?
[CUSTOMER][NEUTRAL] Yes, uh, my policy number is 709252.
[AGENT][NEUTRAL] Perfect, let me get that pulled up and while I'm trying to pull up the policy, do you mind if I get a good call back number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it'll be [PII].
[AGENT][NEUTRAL] Thank you. And would you be able to verify for me please your first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][POSITIVE] Wonderful, and I am just gonna verify with you some additional information if you could verify with me your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you, and it looks like the only other thing on file to verify if you don't mind, just one last one is that email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][POSITIVE] All right. So, thank you for going through all that with me. Um, I am pulling up your
[AGENT][NEUTRAL] Um, policy documents right now.
[AGENT][NEUTRAL] And so we can look at some of those benefits you have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] What I am seeing here is, um, and I do want to let you know, I I'm sorry, I should have started with this a moment ago, but any benefit information I give you over the phone, I do want to let you know it's just gonna be a verification of coverage, never guarantee a payment.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, what I'm looking at is we have your cancer policy here. Um, it does have a hospital intensive care rider on it, um, so in case you end up in the ICU, um, it looks like you have a critical, yes, well, let's hope that's, as with all these policies.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Oh, I hope not.
[AGENT][NEUTRAL] Rather not need them. Um, we do have a critical illness on here. Um, you do have a diagnostic testing benefit as well. And so we can look into each of these.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] I'm just gonna like read a little bit of this from your benefits section. Um, so your hospital confinement benefit um says that, you know, we'll pay the indemnity amount in your scheduled benefits if you're hospitalized for 18 hours or more for continued treatment of a covered cancer or one of the conditions or diseases.
[CUSTOMER][NEUTRAL] Well, I, let me before you start that, I won't be in the hospital. I'm doing outpatient.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] So it's just gonna be um outpatient and then home.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so we'll skip that one, but know that that you do have a benefit if you get confined to a hospital, OK?
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Um, so you do have certain drugs and medicine that, um, you could be benefited for. Um, it's gonna be for anti-nausea and pain medicine as prescribed by your physician, um, to cover, um,
[AGENT][POSITIVE] I'm so sorry, as prescribed by your physi physician, um, if you're also receiving radiation, chemotherapy, immunotherapy, or covered surgery or bone marrow stem cell transplant, so that's something that could help you. You do have a surgical benefit.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well they told me um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, they gonna do radiation.
[CUSTOMER][NEUTRAL] I will have radiation. They told me probably.
[CUSTOMER][NEUTRAL] Uh, 5 to 6 weeks, I think.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And I do have, now I do have my major medical. I have that.
[CUSTOMER][NEUTRAL] So we'll see what they'll do.
[CUSTOMER][NEUTRAL] And then it then you all will come in.
[AGENT][POSITIVE] Perfect. And it's nice, it is nice having just that little extra to help, um, cause I know.
[CUSTOMER][NEUTRAL] Yeah, it is because right now I've, I've only been out right now I've only been out $430.
[AGENT][NEUTRAL] OK. Well, let's, yeah, try to keep as much money in your pocket as we can. Um, I know you just said you're having your lumpectomy, so there is a surgical benefit, um, for you. So, um, with that, you also have, um,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] An outpatient, hold on, where did it go?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um, oh, we'll get back to it. OK. So you do have the surgical benefit, um, and I don't know how to calculate that surgical benefit, but there is like a set amount, um, for the different types of surgeries, and we can look at that. Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Outpatient hospital or ambulatory surgical center. So if you receive an outpatient surgery, um, there is an indemnity amount that you can receive. Um you have benefits for anesthesia, uh, for your physician, uh, your, if you need blood, plasma and platelets, there's benefits there, um, but they don't include laboratory processes, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You also have radiation, chemotherapy, and immunotherapy benefits. So along with that, um, medication for the nausea and the pain medicine, when receiving the radiation and chemotherapy, you have benefits for the radiation, the chemotherapy, and the immunotherapy themselves. Um, if you need any hormone therapy, there's benefits there. Um, my best guess in this situation, cause you have so many different benefits, is
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] I would go ahead and like any bill you get from your doctor's office or your, the hospital or wherever you go, is I would just um I would just submit claims and I would just send everything.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, and it can be a lot of stuff, but I would just send it all. But because we haven't had a claim on file yet, the first thing we'll need is a pathology report. So we will need your like pathology report with your diagnosis, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I think I, I, I think I already have that they gave me.
[CUSTOMER][NEUTRAL] The pathology report.
[AGENT][POSITIVE] Perfect, um, so.
[CUSTOMER][NEUTRAL] And they gave me all the ones where I had, um, I've had some uh biopsies. I had to have some biopsies and some um when I had biopsies and 2 or 34 mammograms and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I've had um I had to do some sonograms.
[AGENT][NEUTRAL] OK, I would.
[CUSTOMER][NEUTRAL] But my insurance, my main insurance paid most of that except for the $400 right now it's just at $430.
[AGENT][POSITIVE] OK, I would definitely um try to get like all of those um documents and.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Together and like as far as like what you've already have done, because it seems like there's things on there that you probably could have benefits for already, so like, I mean,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just from all the, from everything you've already done so far, like, not including the
[AGENT][NEUTRAL] The um procedure, yeah. But even that aside.
[CUSTOMER][NEUTRAL] But I haven't done the surgery yet.
[CUSTOMER][NEUTRAL] Yeah, the, yeah, the surgery is not to the [PII].
[AGENT][NEUTRAL] Um, I just, it's one of those things like where it just seems like
[AGENT][NEUTRAL] I would send everything, I guess is really what I'm saying, um, even the things you've already had done since, since your diagnosis because you just don't want to miss out on benefits that could, could be paid to you, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now do I, do I, do, do I do that claim, you know, in, in the policy that y'all when y'all first sent me the policy which has been over probably 10 years ago.
[AGENT][NEUTRAL] As they come, and so.
[CUSTOMER][NEUTRAL] It's a claim sheet in there. Do I just put everything on that sheet? or what do I do?
[AGENT][NEUTRAL] Yeah absolutely so um, how, OK, so we do have like an online portal where you can upload claims uh do you feel pretty comfortable with like like using the computer and uploading stuff or have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 00 yeah, oh yeah.
[AGENT][NEUTRAL] OK, perfect. So what I'm gonna do is to your email address, your [PII], I'm going to send you um a copy of our online user guide um and it's going to like show you how to set up um your online portal but then it's also gonna talk to you about like how you can submit claims through the online portal just everything it's gonna show you how to use it and how to get the most out of it.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I'll also include in that email for you a copy of our claims form and you can just type into it so you don't even have to print it. You can just fill it in on the computer, save it as a PDF and upload it um but that online service center is going to be the fastest way to move through your claims to upload all your documents, to send stuff to us, and then you can view your claims in real time, um, and so that is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So beneficial because then you're not like waiting on papers or, you know what I mean? The mail is so slow sometimes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, OK, I can, I can do that. I, I'm, I'm familiar with my computer pretty good.
[AGENT][POSITIVE] Perfect, um, so I'm going to, I'm working on getting this email out to you getting everything downloaded so I can send it your way, um.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Let's see, um, but I would start requesting like all your documentation from your um provider now, so.
[CUSTOMER][POSITIVE] OK, they gave me most, they gave me all of that. The lady I paid some bills today and she said she, when she sent all of that to my email so I have that.
[AGENT][POSITIVE] That's perfect because then it's already like digital and you can just upload it with ease you don't even have to try to scan it all in.
[CUSTOMER][NEUTRAL] What, yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][POSITIVE] That's wonderful. OK, I'm really glad they did that for you, ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, she did, she did that, but the other question is, should I just wait and get all the bills or should I just send them in as I'm getting them?
[AGENT][NEUTRAL] So what I would say is I would recommend at the very least, start with everything you've already done and get your pathology report, because that one takes a while, especially that pathology report, we have an internal doctor who reviews that information. And so it's best to just get that in and get it set where it can be reviewed, and they can do all the stuff they need to do there. And then everything else should be able to process a lot faster, um, once you have that initial diagnosis in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And they show that you, you know, have that positive diagnosis of cancer. And then, so I would recommend at least if you do nothing else, um, get your pathology report in and anything you've already accumulated. And then from there, if you wanna send it in in chunks every couple of months or as it comes, you can do it however it suits you. Um, but they'll already have your original, your initial diagnosis, uh, set up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I can do that.
[AGENT][POSITIVE] Perfect. And so I did just hit send on that email it should be coming out to you with that user guide on how to set up your account and then that claim form for your records on that claim form, that very first page, it's gonna like have literally a bullet point list on what you need to fill out what we need from you, so like your initial diagnosis, any new diagnoses, those sort of things, and you can use it like a checklist to keep track of what documents you have or what documents you need to get.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can do that.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] I just needed to know I never used it, so um.
[AGENT][POSITIVE] Well, let's definitely get your, I mean, I guess, you've had it almost 20 years, so let's get your money worth on it and I'm really sorry that you have cancer and you have to use it.
[CUSTOMER][NEUTRAL] No, well, yeah, I've almost had it that long.
[AGENT][NEUTRAL] Um, but if you know what I mean, that's that's what it's here for, it's here to take care of you and so let's
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Let's get everything that we can get you some benefits back to you to help you out during this time because, you know, you, I don't know. I just feel like you should be focused on recovery, you know?
[CUSTOMER][NEUTRAL] Yep, yep, yep, that's what I'm, I'm doing. I'm just trying to get it all lined up. I was like, let me check on this because I've never used it before so.
[AGENT][POSITIVE] Well, you're doing wonderful.
[CUSTOMER][POSITIVE] I would get that and I appreciate it thanks so much.
[AGENT][POSITIVE] My pleasure. If you start filling stuff out and you get confused or lost or you're not sure what you need, don't hesitate to reach out. We're always here. We're always willing to help and we'll, we'll do our best for you.
[CUSTOMER][NEUTRAL] OK, I'll do that.
[AGENT][POSITIVE] Perfect. Well, thank you so much for.
[CUSTOMER][NEUTRAL] I'll make sure I get all these reports from the doctors.
[AGENT][POSITIVE] Perfect. Yeah, send it all to us. We'll take care of you, OK?
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][POSITIVE] My pleasure. Thank you. You have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Goodbye.