AccountId: 011433970860
ContactId: 9bdcee97-4f27-4e5a-b0b5-ace42f3440b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 718119 ms
Total Talk Time (AGENT): 307951 ms
Total Talk Time (CUSTOMER): 339807 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/9bdcee97-4f27-4e5a-b0b5-ace42f3440b4_20250320T13:47_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] Yes, I'm calling because uh I'm trying to do um
[CUSTOMER][NEUTRAL] A claim, um, but, um, like on the, on the um on the website, I only see like um
[CUSTOMER][NEUTRAL] Like claim form for um wellness claim and then the other claim form.
[CUSTOMER][NEUTRAL] I said, um, disability and accident, but um I, I, it wasn't any of that. So, um, my insurance is a cancer insurance, and I was diagnosed with uh uterine cancer and I had surgery of my he his sterectomy done. But um I was trying to fill out the the claim application, but um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, since I just wanna make sure that I'm doing the right thing because it says accident and health plan, it doesn't say.
[CUSTOMER][NEUTRAL] Conscious
[CUSTOMER][NEUTRAL] Is that OK?
[AGENT][NEUTRAL] OK. And did you click on it, did you choose the cancer claim form?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, on, on my end, on my end, and on, uh, on, um,
[CUSTOMER][NEUTRAL] The website, I'm not able to put it just on because I work for 40 ISD so when I go to my benefits, it just have 22 types of claim. It just have the uh.
[CUSTOMER][NEGATIVE] The um disability and it just, I don't know why. I think it's something, they did something wrong because they don't even offer those others, it was just the cancer that they offer to your company and
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you on the, I apologize. I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] And the, the
[CUSTOMER][NEUTRAL] So, so, on, on, on the, on, like I say on the website, you just have like claim form, you click on it and it's the the accident and the other one is wellness claim form. And I'm the um I work for phony ISD I'm on the phony ISD web.
[CUSTOMER][NEUTRAL] Page.
[AGENT][NEUTRAL] OK, so you need to go to the APL it's [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You get the cancer claim form and what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] All right, thank you. Do you happen to have your APL policy number available?
[CUSTOMER][NEUTRAL] Um, yeah. Let me see. It's 025488884.
[AGENT][NEUTRAL] And what is your name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Uh, name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And do you mind verifying your current mailing address and email?
[CUSTOMER][NEUTRAL] Yes, it's um.
[CUSTOMER][NEUTRAL] Uh, the address is [PII]. And what was the other thing?
[AGENT][NEUTRAL] Your email looks like we do have your ISD email on file.
[CUSTOMER][NEUTRAL] Yeah, it's uh that's my uh my work email, but I also have like a personal email which is [PII].
[AGENT][NEUTRAL] Would you like for me to update that to your personal email?
[CUSTOMER][NEUTRAL] Um, that's OK. We can use the work email.
[AGENT][NEUTRAL] OK. All right, thank you. And Ms. [PII], I do see that you do have an active portal account for.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] APL
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So you can go to your APL portal and go to the claim forms.
[CUSTOMER][NEUTRAL] Portal and go to the.
[CUSTOMER][NEUTRAL] Claim forms, OK.
[AGENT][NEUTRAL] And there, and there you'll be able to find your cancer claim form.
[CUSTOMER][NEUTRAL] So, and claim forms.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Now that claim form will have instructions as to what's needed.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, to file for.
[AGENT][NEUTRAL] A cancer diagnosis?
[CUSTOMER][NEUTRAL] Uh, when I do claim forms, uh, like I do signing and register.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEGATIVE] Like, I do, I, I already signed in and then I, I do claim form and it's like, it locks me out.
[AGENT][NEUTRAL] It may take you back to the just the public the, it's not a private account for a [PII].
[CUSTOMER][NEGATIVE] Yeah, like it takes me out of my account and then it says claims and forms.
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] We get it, filing a claim, OK.
[CUSTOMER][NEUTRAL] And then say, um,
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] On the bottom it says like signing to file a claim and then I go sign in, but the same thing happened.
[AGENT][NEUTRAL] Well, if you go to [PII].
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] There is a can you can go to the claims and forms on our public website at [PII].
[CUSTOMER][NEUTRAL] Oh, it's not [PII]?
[AGENT][NEUTRAL] Not on our public website, it's just [PII].
[CUSTOMER][NEUTRAL] Oh, OK. [PII].
[CUSTOMER][NEUTRAL] [PII], maybe that's what.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it looks, it looks the same.
[AGENT][NEUTRAL] Yes, ma'am. It's gonna be very similar and there'll be a a section called the claims and forms section.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you'll click on that and the cancer claim form is the 2nd claim form listed under that claims and forms section.
[CUSTOMER][NEUTRAL] Uh, I think, I think it took me to the same one.
[CUSTOMER][NEUTRAL] OK, download the appropriate. Let me see if it is. OK, OK, I think I found it, yeah.
[AGENT][NEUTRAL] OK. And it does have instructions on the first page as to what's needed to file for cancer diagnosis.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK, now, let me ask you something. So, I just had my surgery done on, on Friday.
[CUSTOMER][NEUTRAL] But, um, so,
[CUSTOMER][NEUTRAL] Um, they waiting on, I do have labs, like the first lab, where, where they um um they found uh the cancer, but um.
[CUSTOMER][NEUTRAL] So he, he, the doctor [PII]d that he was gonna take everything out and then send it to the lab. Now 2 weeks after my surgery, I have an appointment and he said that it is when he's gonna determinate if he um need to get uh radiation and chemo and chemo or both or one or whatever, um, I'll need. Do I wait until that appointment to file the claim or I just can just file the claim for the
[CUSTOMER][NEUTRAL] Cancer.
[AGENT][NEUTRAL] Yes, you can file the claim for the cancer now. Go ahead and send that pathology report.
[AGENT][NEUTRAL] For, for your diagnostic, or did he do a biopsy or anything? Or was it?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, he did, uh, yeah, it was a Pap smear first and then it was a sonogram and then it was a biopsy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you have any itemized bills for those services, you can submit those with your pathology report. And then when you go back in 2 weeks or at that 2-week appointment,
[AGENT][NEUTRAL] Um, you know, just.
[AGENT][NEUTRAL] He'll have your plan of action or maybe they got it all and you won't have to do anything.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] What.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But because it is it is, is it different, uh, the benefits amount is it different when you get radiation or it's the same thing?
[AGENT][NEUTRAL] So on your portal, if you ever want to view your policy benefits, you can click on the policy number.
[AGENT][POSITIVE] And you can view your benefits. I'm gonna look and see what your benefits are real quick for you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So usually chemo, radiation, and hormone therapy is all lumped under one benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm pulling up your policy certificate. Bear with me just one second.
[AGENT][NEUTRAL] So your radiation therapy, chemotherapy, or immunotherapy is covered up to $15,000 per 12-month period. So that is from your start date of your treatment.
[AGENT][NEUTRAL] Uh, for 12 consecutive months with the maximum we can pay is 15,000.
[CUSTOMER][NEUTRAL] OK, depending on how many you get and all that.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, once we receive that pathology report, you do have what's called a first occurrence benefit, that is upon the diagnosis of cancer of $7500. Now all of that is verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And of course, you do have a medical imaging uh benefit and a follow-up diagnostic test.
[AGENT][NEUTRAL] So be sure just to file for those. You said MRI and did you say CT or, I mean, ultrasound?
[CUSTOMER][NEUTRAL] Uh, sonogram and biopsy, ultrasound, yeah, ultrasound and, and biopsy.
[AGENT][NEUTRAL] So be sure to send in the the itemized bills with those with diagnosis codes.
[CUSTOMER][NEUTRAL] Oh, OK. OK. So I guess I'll be able.
[AGENT][NEUTRAL] And I do see
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] To find them on my, on my chart, right, on my shirt and.
[CUSTOMER][NEUTRAL] Like the, the doctor had to give me those codes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so on the pathology report, that's going to be your diagnosis.
[AGENT][NEUTRAL] And then the itemized bill for your ultrasound and biopsy, that would be from your doctor.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would need the diagnosis codes for those as well.
[CUSTOMER][NEUTRAL] OK, the, so the doctor will be able to give me that?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, on, on, when I do that on, on one claim I can put like everything what it was done, or I have to fill up a claim for each item.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am, just one claim for diagnosis. So once you submit this initial information, you will not have to fill that claim form out again for this uh diagnosis of cancer. You would just send us in the itemized bills for treatments or
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Whatever um itemized bill you might receive due to that diagnosis of cancer.
[CUSTOMER][POSITIVE] OK, OK, OK, thank you for your help.
[AGENT][POSITIVE] It's been such a pleasure to assist you, Ms. [PII]. Is there anything else I can help you? Oh, and I was gonna tell you, I see your direct deposit has been activated, so any benefits will go directly to your bank account.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK. OK. Thank you.
[AGENT][POSITIVE] It's my pleasure. Anything else I can help you with today?
[CUSTOMER][POSITIVE] No, right now. Thank you for your help.
[AGENT][POSITIVE] Thank you for calling APL. Hope you have a wonderful day and get to feeling better. Mm thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thanks you too.
[CUSTOMER][POSITIVE] Thanks. Bye-bye.