AccountId: 011433970860
ContactId: 97ba69e8-e875-40e0-a29b-5d91a6bf5d4e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1049770 ms
Total Talk Time (AGENT): 430559 ms
Total Talk Time (CUSTOMER): 340474 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/97ba69e8-e875-40e0-a29b-5d91a6bf5d4e_20250311T16:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK. [PII], I'm [PII], and I'm calling for my husband, [PII]. And he has recently had surgery where they discovered a bladder cancer. And I'm trying to see if this
[CUSTOMER][NEGATIVE] Um, cancer policy won't pay anything on this.
[AGENT][NEUTRAL] OK, I can definitely help you with the coverage. Um, Ms. [PII], may I have a good contact number in case we're disconnected and then the policy number if you have it?
[CUSTOMER][NEUTRAL] Yes, OK, my number is [PII].
[CUSTOMER][NEUTRAL] And I have 2 policy numbers here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4457614
[CUSTOMER][NEUTRAL] And then 457612.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] And I don't know why I've got 2 written down.
[AGENT][NEUTRAL] It's OK. Hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Let me see which one.
[AGENT][NEUTRAL] OK, so you're on the policy as well. So I just need you to verify um your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII].
[CUSTOMER][NEUTRAL] And what else did you need from me? They had [PII].
[AGENT][NEUTRAL] The mailing address.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy, oh, hold on, it didn't come. I thought it was gonna come up. OK, there it is. So the policy ending in 614 is no longer active as of.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And that was what the
[CUSTOMER][NEUTRAL] First occurrence, is that what that was?
[AGENT][NEUTRAL] Um, well, yeah, it, it was still a cancer policy, but yes, first occurrence was on here as well.
[CUSTOMER][NEUTRAL] Mhm. OK, the 457-612 is active.
[AGENT][NEUTRAL] So that was
[AGENT][NEUTRAL] Yes, that became effective on [PII].
[AGENT][NEUTRAL] I'm sorry, [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then let me get the benefits for you. Hold on one moment.
[AGENT][NEUTRAL] Just waiting for the benefits to come up here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold? I'm just getting the benefits.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What is happening? Let's go.
[AGENT][NEUTRAL] Daily hospital expense, 140.
[AGENT][NEUTRAL] S.
[AGENT][NEUTRAL] This is the breakdown?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So this is 8 mean.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] And a breakdown is this?
[AGENT][NEUTRAL] OK, that's what I'm on. So what's this one?
[AGENT][NEUTRAL] That's the surgical benefit.
[AGENT][NEUTRAL] Where is the whole doggone thing?
[AGENT][NEUTRAL] Oh man.
[AGENT][NEUTRAL] I'm gonna have to put it together.
[AGENT][NEUTRAL] OK, lump sum, 15,000 PDOS.
[AGENT][NEUTRAL] Um, 140 daily hospital benefit for the cancer.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's a heart disease.
[AGENT][NEUTRAL] That's it.
[AGENT][NEUTRAL] Curation 7500 is this per calendar year?
[AGENT][NEUTRAL] Yeah I'm sure I got everything. That's a daily hospital expense, 140. I got that.
[AGENT][NEUTRAL] I think this is it.
[AGENT][NEUTRAL] Because everything is actual charges.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] This is it.
[AGENT][POSITIVE] All right then, we gonna go with it.
[AGENT][NEUTRAL] Because that's just surgery.
[AGENT][NEUTRAL] OK, so 4 and 9, remember that cause that's the schedule page is lower.
[AGENT][NEUTRAL] OK, yeah, this is it. And then the surgery, that's the one on online. All right.
[AGENT][NEUTRAL] Hello, Mrs. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So it was about um 22 pages that I had to go through to get the benefits for you, so I apologize, um.
[AGENT][NEUTRAL] So the policy has a daily hospital benefit, um, which will pay $140 per day.
[AGENT][NEGATIVE] There is a lumps.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A daily hospital benefit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I pay a $140 daily hospital benefit.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] There is, there's also a lump sum, um, which is the first occurrence that you were talking about. Um, it would pay up, the policy will pay up to $15,000 for, um, with a positive diagnosis. So you'll just need the pathology report for that. And then um once we receive it, we can go ahead and process for the first occurrence of the lump sum. It's the same thing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, I'll.
[CUSTOMER][NEUTRAL] A lump sum of 15 up to $15,000.
[AGENT][NEUTRAL] 1000. Yes, ma'am. Well, no, 15,000 is the lump sum, so it is 15,000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] And then, um, there's also a chemo and radiation um treatment.
[AGENT][NEUTRAL] It's up to $7500.
[AGENT][NEUTRAL] Per calendar year?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, there are special nurses services, nursing services, um, attending physician, uh, services for in the hospital, the doctor that, um, he's gonna see drugs administered with, um,
[AGENT][NEUTRAL] Drugs administered with cancer idal chemical substances, there's a benefit for that, um, ambulance, transportation.
[AGENT][NEUTRAL] Um, there's a surgical and anesthesia benefit if surgery is needed.
[AGENT][NEUTRAL] Um, home recovery.
[AGENT][NEUTRAL] Um, skilled nursing, it's a lot of different, um,
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Benefits. Hold on, let me see if there's another page.
[CUSTOMER][NEUTRAL] Can you send me a copy of that?
[AGENT][NEUTRAL] Oh, yes, ma'am. Would you like me to mail it or like email it to you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'd like you to mail it to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's the [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK. Yes, ma'am, we certainly can um mail this to you.
[CUSTOMER][NEUTRAL] OK. All right. Let me ask you this. He, he's already had the surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can, can you send me the forms to fill out?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] For the, like the claim form?
[CUSTOMER][NEUTRAL] For that.
[CUSTOMER][NEUTRAL] Yes, the claim form for the surgery because this is saying they will pay some on the surgery, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, as long as the policy was active on the data service, um, and it, it, this has been active since [PII], so, yes, ma'am, even if you had older
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, they had the.
[CUSTOMER][NEUTRAL] Yeah, he had, uh, he had the surgery [PII].
[AGENT][NEUTRAL] OK, um, and even if you had older, um, claims that you want, you can literally go back to [PII] if you have them on file.
[CUSTOMER][NEUTRAL] Oh, OK. OK. But the, on the surgery, they should pay some. OK. And I don't know if they actually call the treatment they're going to give him chemo or radiation, but it is treatment for
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The bladder cancer. The bladder cancer had not invaded the bladder wall, and they'd say bladder cancer can come back. And so he needs to take the treatment to keep it from coming back.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so then yes, I would um definitely file the claim for that and see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I don't really know what they call this treatment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I don't, uh, so I need to find out is that.
[AGENT][POSITIVE] The best, the best thing to do would be um,
[AGENT][NEUTRAL] You know, when they ask you for your insurance information, go ahead and give them the insurance information and then let them know that you have this cancer policy and give them our policy number or well, yeah, the policy number with us and then our phone number so that we can verify benefits with them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, so.
[AGENT][NEUTRAL] And then they'll also file the claim, so you won't have to.
[CUSTOMER][NEUTRAL] Give them
[CUSTOMER][NEUTRAL] Oh well.
[CUSTOMER][NEUTRAL] I don't know whether they will or not.
[CUSTOMER][NEUTRAL] Uh, because, I mean, see, I've had cancer before and I had to file my own claims.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] That's terrible.
[AGENT][NEUTRAL] Well, I would at least try because some providers will um go ahead and file the secondary. If they don't, then yes, you do, of course, have the option to file on your own.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so can you send me like these benefits and also uh a claim form.
[AGENT][POSITIVE] Yes, ma'am, and I'm gonna mail the claim form to you as well as the um certificate with all of your benefits on it.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So I understand that you're not guaranteeing any payment, but they should, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, well,
[CUSTOMER][NEUTRAL] Pay some
[AGENT][NEUTRAL] I mean, just from the benefits and him having surgical benefits, I mean it and the lump sum.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It could be, it should be paid out. I mean, of course, you know, I can't guarantee it until we uh process it, but he does have those benefits.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, OK, I know, and I can't.
[CUSTOMER][NEUTRAL] Remember in the past.
[CUSTOMER][NEUTRAL] He had um
[CUSTOMER][NEUTRAL] Prostate cancer, but I don't remember if they paid anything back then. Do you have access to files to see?
[AGENT][NEUTRAL] To see if a claim was paid.
[AGENT][NEUTRAL] When
[CUSTOMER][NEUTRAL] When he had uh prostate cancer, and I can't tell you what there.
[AGENT][NEUTRAL] I mean, like what
[AGENT][NEUTRAL] Like, do you remember like what year?
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I guess I can
[CUSTOMER][NEUTRAL] Maybe I need to do some research and see if I can find.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Yeah, if you can get a data service for us, we can definitely research and take a look because you've had policies with us since [PII], so which policy it would be under, we, yeah, we really wouldn't know, but we can see if we have the data service, we can see which policy was active at that time.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] All right, so I guess you've answered my questions. You're going to send me.
[CUSTOMER][NEUTRAL] The benefits that's available on this policy and you're also gonna send me a claim form, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And and
[CUSTOMER][NEUTRAL] I need to give this Doctor [PII], [PII], um, tell him that we do have a cancer policy and see if they will file a claim.
[AGENT][NEUTRAL] Yes, ma'am, and if they, if
[CUSTOMER][NEUTRAL] And give
[AGENT][NEUTRAL] If they haven't
[CUSTOMER][NEUTRAL] Give them y'all's phone number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And then we'll
[CUSTOMER][NEUTRAL] What else do I need to do?
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] We'll go ahead and verify the benefits with them, uh, once they call and then uh we can let them know how to file the claim as well.
[CUSTOMER][NEUTRAL] OK, OK. I mean, it's just so much going on, you know, I don't know what to do.
[AGENT][POSITIVE] Well, you're doing the best you can and you're getting all the information you need, so that's all you can do right now.
[CUSTOMER][NEUTRAL] OK. All right. So I can expect, uh, I can expect that information probably within a week.
[AGENT][NEUTRAL] And give yourself some grade.
[AGENT][NEUTRAL] We say a week, um, but you know, it's the, it's the mail, so definitely at least a week.
[CUSTOMER][NEUTRAL] Yeah, I understand the mail.
[CUSTOMER][NEGATIVE] It's not good right now.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] All right thank you you've been most helpful.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] That's, that's all I can think of right now. If I think of something else, I call back.
[AGENT][POSITIVE] All right. Well, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.