AccountId: 011433970860
ContactId: 94e04ffd-dfdf-4f3c-99b6-9fd0dda8b09a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 726460 ms
Total Talk Time (AGENT): 292957 ms
Total Talk Time (CUSTOMER): 190674 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/94e04ffd-dfdf-4f3c-99b6-9fd0dda8b09a_20250416T22:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I'm calling to find out about, um, filing a claim. I um, I'm kind of confused about the benefits. I have a cancer policy.
[CUSTOMER][NEUTRAL] And I'm not sure I'm not sure um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What number I need to file a claim?
[CUSTOMER][NEUTRAL] Because it says not your policy number, but I don't have that number that they're asking for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can look up your policy by your last name or your social.
[CUSTOMER][NEUTRAL] OK, uh, [PII].
[AGENT][NEUTRAL] And your first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK. And what uh state are you in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, um, let me see here.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And what is your birth date?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, looks like I found your policy. Um, do you have a good callback number just in case we're disconnected, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. Just need to verify a few other pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, it looks like it might be a, uh, work email.
[CUSTOMER][NEUTRAL] Oh, it would be [PII].
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Oh, or
[AGENT][NEUTRAL] Yeah, it looks like org. OK, and are you trying to um upload claims to the portal or did you have questions about your benefits or how can I help today?
[CUSTOMER][NEUTRAL] Actually both. OK, so I don't have the number. I need the number and also I'm.
[CUSTOMER][NEUTRAL] Um, I, I'm not sure how, how many is it? I don't know what the benefits are. Is it like for preventive, is it $50 per year?
[CUSTOMER][NEUTRAL] For $50 per each exam like Pap smears, mammograms.
[CUSTOMER][NEUTRAL] That kind of thing.
[AGENT][NEUTRAL] Um, let me see. Uh, let me give you your policy number. Um, we'll do that first. Um, your policy number is 252.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 8418.
[CUSTOMER][NEUTRAL] OK, it's just the number I used because it says not your policy number.
[AGENT][NEUTRAL] Oh, when you're setting up the portal, you will have to use your social security number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, I do have to use Social Security, OK.
[AGENT][NEGATIVE] That's unfortunately, yeah.
[AGENT][NEUTRAL] And then, um, let me tell you the email was your, it has to be, it has to match perfectly. Looks like that was, um, let me get back to that.
[AGENT][NEUTRAL] It was your work email that you stated and it's [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] your benefits.
[AGENT][NEUTRAL] OK just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, anything I quote today isn't a guarantee of payment. It's a basic outline of your policy.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I don't, I don't see.
[AGENT][NEUTRAL] A wellness benefit on here. So I've got, have you recently been diagnosed with cancer?
[CUSTOMER][NEUTRAL] No, this is uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It, I'm supposed to, this is like a preventive thing.
[CUSTOMER][NEUTRAL] Um, so it might, what I have, it says that, you know, it gives you get $50 if you do like a mammogram or pap smear or.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And even mentions a bone marrow because I, I did have a bone marrow biopsy done.
[AGENT][NEUTRAL] Um, I, I show that there used to be some other policies that you had, but those have, um, terminated. I just have one policy, which is the group Can policy.
[AGENT][NEUTRAL] Let me make sure I'm not missing anything on here, um, which basically like it has a $20,000 benefit for radiation, chemo, and immunotherapy.
[AGENT][NEUTRAL] Um, there's a benefit for hormone therapy, um,
[AGENT][NEUTRAL] For surgical, uh, surgical services.
[CUSTOMER][NEUTRAL] So this is, this, so I, I don't have the cancer screening benefit rider.
[AGENT][NEUTRAL] OK, I, yes, I'm so sorry. I do see that now. I had to scroll down, so I'm sorry about that. OK, so this cancer screening benefit rider, um, we get 1 per calendar year, which pays out 50. Let me see what if it defines what that is.
[AGENT][POSITIVE] So sorry about that.
[CUSTOMER][NEUTRAL] So when you say one that means out of all the screening you do they only pay for one.
[AGENT][NEUTRAL] Yeah, that's what I'm gonna look up and see if it gives a um.
[AGENT][NEUTRAL] Uh, more defined definition. Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like it's for ovarian and um cervical cancer screening, um, which would be a conventional Pap smear.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] And so yes, it would allow for one test.
[AGENT][NEUTRAL] And pay out $50 once per calendar year.
[CUSTOMER][NEUTRAL] OK, so just one test for not, OK, so not different, OK, so, and I don't know if you know this, but I did have a, a bone marrow biopsy. What would it pay for that?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, so was that in was that because of like a screening, they wanted to do a further follow up or or were they? OK, OK, um, so medical imaging, um, let's see.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, that's a biopsy, so that wouldn't be imaging. Um, let's see.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Based on what I'm reading under your policy, I, I don't see a benefit for that. So you've got your cancer screening benefit rider, which allows for that $50 for the screening. If you needed follow-up diagnostic testing, it would pay $100 per month, and then medical imaging, which a biopsy would, would not be imaging, um, that pays $500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it.
[CUSTOMER][NEUTRAL] Well, I, I think I've seen that, uh, I think I've seen it in the policy with, uh, uh, the.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It allows for a bone marrow transplant. Um, that's under the surgical benefit. It does allow for a bone marrow transplant, and that's a $12,000 benefit, um, but that would be if you had a bone marrow transplant.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me look up bone marrow though, make sure I'm not missing anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because it's on the claim form where you can check off.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see if I have a form.
[AGENT][NEUTRAL] Yeah, I'm looking at the form as well.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so on our cancer claim form,
[AGENT][NEUTRAL] Um, we've got information.
[AGENT][NEUTRAL] He
[AGENT][NEUTRAL] There's some lodging, transportation.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, for this specific policy though, it is specifically uh regarding bone marrow transplant.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then when you do upload your claims, um, we'll need to have the date of service and then something that clearly states what the diagnosis was and then the coding of what procedure you've got like what screening.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The coding.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So usually they can provide you like a claim form, um or a claim. So, cause we need to be able to clearly see what what screening did you have and then what was the diagnosis on that screening.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the charges, of course, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well I'll I'll try to make um upload that and fill it out.
[AGENT][NEUTRAL] OK. Um, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][NEUTRAL] OK, well thank you for calling APL.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Alrighty thank you bye bye.