AccountId: 011433970860
ContactId: a709160f-4a3d-47d3-ad19-beb7000ef07b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1112119 ms
Total Talk Time (AGENT): 643325 ms
Total Talk Time (CUSTOMER): 432035 ms
Interruptions: 3
Overall Sentiment: AGENT=1.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/a709160f-4a3d-47d3-ad19-beb7000ef07b_20250317T17:27_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] Hey [PII], let me take you off of my speaker phone.
[AGENT][POSITIVE] No worries.
[CUSTOMER][POSITIVE] Um, there we go. I think you probably can hear me better now.
[AGENT][NEUTRAL] Yes, how you
[CUSTOMER][NEUTRAL] Hey [PII], um, I talked to [PII]. How are you doing?
[AGENT][POSITIVE] I'm great thanks for asking.
[CUSTOMER][POSITIVE] Good. Hey, I talked to [PII] the other day, and uh she was really helpful. And uh I do have a question though. Um, I have a cancer policy for my wife and I, and I have it through my school, and I am about to retire, and I no longer will be having any payments taken out of my check and after.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, it should be August. should be my last check. So it says I can port this policy and I talked to a representative who's a liaison between y'all and the school called Higginbotham who um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Anyway, they said that uh it should cost me the same as what I'm paying now when I retire. I just wanted to validate that.
[AGENT][NEUTRAL] OK, perfect. Do you mind if I get some information and pull up your policy, my friend?
[CUSTOMER][POSITIVE] Yeah, I have everything that Kiki was helpful. I pulled up my certificate number and all that stuff and my schedule of benefits. Uh, I have it all in front of me. Just tell me what you'd like.
[AGENT][NEUTRAL] OK, if you don't mind I'd like to start with your first name and a callback number just in case the call drops.
[CUSTOMER][NEUTRAL] OK. I'm [PII] and [PII] has [PII]
[AGENT][POSITIVE] Perfect and then a good phone number for you my friend?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful. And then somewhere on there it should say like your policy certificate number.
[CUSTOMER][POSITIVE] Yes, I have it.
[AGENT][NEUTRAL] OK, and then that would be next.
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] I know sometimes they drop to 0, but I have 02532534.
[AGENT][POSITIVE] 34. Perfect. Yeah, that 0 is you can give it, you can give it, um.
[AGENT][NEUTRAL] It recognizes it either way, but I looks like I was able to get you all pulled up. I do just have to, I'm sure you've been through this before, but I do just have to go through that verification process with you if you could verify for me your date of birth, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Wonderful. Thank you. And could you verify, I cannot talk today. I'm sorry, your mailing address as well, please.
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][POSITIVE] Wonderful.
[AGENT][NEUTRAL] And then it's just uh one more item because it looks like the phone number you gave me matches the one on file would be that email address.
[CUSTOMER][NEUTRAL] Uh, use [PII].
[AGENT][POSITIVE] Wonderful. Thank you so much for going through that process with me, Mr. [PII]. Um, so as far as portability goes, yes, that information is correct. The premium will be the same, um, as what you're already paying, so we don't change the price or the coverage.
[AGENT][NEUTRAL] Um, what will happen is we'll get notice from your employer that you are being dropped off of their coverage and then we will send you out, it'll automatically generate a letter asking you if you'd like to keep coverage with us, and it's gonna send you out like a form to fill out saying that you want to keep coverage and then a form to sign up for, um, like bank drafts for automatic payments and you can just fill those forms out and I recommend emailing them.
[AGENT][NEUTRAL] Um, that way you always have the originals on file and it's the quickest way to get it done, but I, you'll just email them back to us.
[CUSTOMER][NEUTRAL] OK, I'm writing a notes here email form back for individual coverage.
[AGENT][NEUTRAL] And it might say it on there, but do you want me to give you our email address just in case?
[CUSTOMER][NEUTRAL] OK, hold on. OK, what is your email address? I may have it like you said, but go ahead and give it to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I don't have that one.
[CUSTOMER][NEUTRAL] So I'm gonna read it back it's a [PII].
[AGENT][NEUTRAL] You betcha.
[CUSTOMER][NEUTRAL] OK, yeah, I don't have that one or if I do, I haven't found, haven't discovered it yet, um.
[AGENT][NEUTRAL] No, that's OK. I think when they send out the portability forms it says it in there but just in case it doesn't because it's such I mean a convenient method of sending that form back to us, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cool, um, and then another thing I'm looking through the schedule benefits and stuff is the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, combination of all the doctor visits that we make and specialist visits, is that gonna be later covered under the lump sum benefit?
[AGENT][NEUTRAL] So my understanding is when they put a policy, they don't change anything on it. So everything that is um on there is stays exactly how it appears, but let me pull up that schedule of benefits, so I'm looking at the same thing with you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'm talking about now. I'm sorry. um, yeah, I, I have, I have in front of me. uh I just was confused with the lump sum benefit did.
[AGENT][NEUTRAL] Oh, now, OK, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, my wife has colorectal cancer. We're just diagnosed with it and we're going through the CT scans and the MRIs and meeting with the specialist doctors and things. And I just was, I also read in there and uh after you get over age [PII], it drops to 50%. My wife is [PII], so I guess the 5000 benefits gonna be 2500 then.
[AGENT][NEUTRAL] Yes, that's how I would understand it too. So that first time occurrence benefit for an internal cancer, it's a once in a lifetime coverage for 5000, but it does not take away from any of the other benefits. So your diagnostic testing, your surgical benefits, um, those are all still paid at their benefit amount, um.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Without regard to the first occurrence benefit.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So I guess at some point when we start to accumulate all the bills and things we paid for and we just make copies of doctor's visits, uh, the CT scans, the MRIs and send them all in, and then up to $2500 it would probably be covered if I understand what you're saying.
[AGENT][NEUTRAL] So on this one,
[AGENT][NEUTRAL] So just for being diagnosed with cancer, you'll get that up to 2500 on that lump sum. And I do want to say everything I'm going over. One is a verification of coverage and not a guaranteed payment, um, partly because I don't process uh like cancer claims. So like I can read these policies with you, but I don't actually process them. So I'd hate to like
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I'd hate to give you any like wrong indication. um, I can't guarantee payment over the phone, but that is not the.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I know, I just, whatever the policy says and I understand whoever pays it will make the determination, but as we understand the policy, I guess is what I'm I'm asking.
[AGENT][NEUTRAL] Yes, OK, perfect. I'm glad I just wanna make sure we're on the same page with that, um, but that's not like the max amount you can get so say you, um.
[AGENT][NEUTRAL] That like that's just, you can only receive it once, but then all of your other benefits are still payable. So, um, just for being diagnosed with the cancer, you get that first occurrence lump sum benefit, 5000 or 25, um, over the age of [PII]. But then say you um have
[AGENT][NEUTRAL] A diagnostic testing and that benefit once per calendar year is $50. It's gonna pay out that $50 or you have that medical imaging, um, for up to $500 that's gonna pay out that $500. So, um,
[AGENT][NEUTRAL] Those benefits are not tied to the first occurrence. That's just the lump sum payment, it's maximum once per lifetime, but it doesn't take away from any other benefits payable.
[CUSTOMER][NEUTRAL] So we could, it's possible to uh.
[CUSTOMER][NEUTRAL] I guess it's only one test like if I had a CT test and CT scan and an MRI it's only gonna pay for one of them.
[AGENT][NEUTRAL] Yeah, so with the cancer screening benefit, um, it is going to pay for up to one diagnostic test, up to one follow-up diagnostic test, and up to one medical imaging per calendar year.
[AGENT][NEUTRAL] For you. So if you did all three, if you needed, and this is just diagnostic style, so like they're screening you for cancer. Um, if you did all three, that would, and it costs, uh, especially with that medical imaging, if it only costs $300 the benefit would only be $300. If it costs $550 the benefit would be $500. I don't know if that makes sense. So it's kind of an up to amount. Um, but you could be eligible for $650.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, this is a
[CUSTOMER][NEUTRAL] Um, let me back up, [PII]. My, we're going underneath my, uh,
[CUSTOMER][NEUTRAL] Uh, Medicare Medical Advantage plan with United Healthcare. So they're paying the bulk of things, but I'm out like $250 on each scan, like the CT scan and the MRI. Um, are you saying that I could recover the whole amount even if, uh, UnitedHealthcare paid?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Up to $500.
[AGENT][NEUTRAL] So I know like when you go in for your like wellness check, um, say you go and you get, the only thing that's coming to my brain is a mammogram. um just for going.
[CUSTOMER][NEUTRAL] Is a wellness check like a colonoscopy?
[AGENT][POSITIVE] Yes, that's like that would be a $50 benefit. Even if your insurance covered it just because you went and got it, you could be um your benefit amount on that's up to $50. So this one.
[CUSTOMER][NEUTRAL] OK, so that's how my wife discovered she had the cancers through the colonoscopy, so we're eligible for $50 there, so I need to send in the bill for the colonoscopy then, right?
[AGENT][NEUTRAL] I would, yeah.
[CUSTOMER][NEUTRAL] From the doctor.
[AGENT][NEUTRAL] Absolutely. And with these policies, I see that you've had it with us since September, I mean [PII]. So I would also go ahead and
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see, um.
[AGENT][NEUTRAL] Anything, I would say anything related since [PII]. I would go ahead and
[AGENT][NEUTRAL] Submit. Like I would, I would just assume everything has the possibility of having benefits payable. It's uh it's like my dad always told me to put on a seatbelt better need it and not have, not need it and have it than need it and not have it. Um, it's better to have a claim denied as no benefits payable than to not submit it and have missed opportunities for benefits to be paid.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so assume everything's payable and submit the receipts like for doctors visits, specialist visits.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All that and I.
[AGENT][NEUTRAL] Yeah, I would definitely assume everything has payable benefits and then let us weave through it. And we do that all the time. We can weave through, um, all the paperwork and find everything that has benefits payable for you. And sometimes it might be like, hey, we just need a little more information. Um, so I know when at first you're going to be submitting a lot and you're going to be getting a lot back and you're just going to be taking care of your wife, and it can be confusing.
[AGENT][NEUTRAL] Um, but try to keep a lookout for those things that say like, hey, we just need an itemized bill, or we're just missing something with the diagnosis code because those things we can reprocess once we get and you could be eligible for more benefits payable.
[CUSTOMER][NEUTRAL] So you'll let me know if I need more information in other words.
[AGENT][NEUTRAL] Yes, yeah, it will come back to you on that explanation of benefits and it will have like, um, you know, say like, we just need a diagnosis code um please submit and we will reprocess um it'll say something like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, well, it's, it's good news that I can continue the coverage because I don't really don't wanna work another year. I was afraid that the uh cost would be uh like covering things are usually more expensive, but keeping the policy for the same thing I'm paying right now is, is good news to me, so I appreciate that and um.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] OK. Well, that was my main concern. And uh I think what I'll do is we'll just uh we're only into the first month of uh since she was diagnosed, uh, so I'll just, you know, and after the first surgery that she has, we'll go ahead and then I'll start submitting things so that I don't have to keep doing it every week, which would make it confusing too. Yeah.
[AGENT][NEUTRAL] Yeah, that makes sense and um have you, have you signed up for our online service center yet?
[CUSTOMER][NEUTRAL] No, I don't think I have.
[AGENT][NEUTRAL] No worries, I'm gonna send you um just an email that has the online service center it's like uh our individual user guide it will show you how to set up an account.
[AGENT][POSITIVE] Um, create an account, how you can file all your claims, review your claim status, but it will make getting that information to us so much easier to use. So there's a lot of things that like medical records wise you can just download from the provider's website and their portal and then like save it as a PDF and then upload it onto our portal and get benefits paid um instead of trying to print off all the paperwork, mail it to us, fax it to us, it'll just make things a little easier for you so let me get you.
[CUSTOMER][POSITIVE] I could, I could do that individually then as I get them.
[AGENT][NEUTRAL] A guide for that.
[AGENT][NEUTRAL] Yes, you could, mhm.
[CUSTOMER][NEUTRAL] Alright, so how do I go online to the service center? Is there um.
[AGENT][POSITIVE] Yeah, absolutely, yeah, so the website is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yep, [PII].
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] You have to put [PII] in front of everything.
[AGENT][NEUTRAL] I don't think you have to, but you probably could.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, I'm gonna do that.
[AGENT][NEUTRAL] And I'm putting the link in the, the link will be in the email as well for you, OK?
[CUSTOMER][NEUTRAL] Oh you're sending me an email?
[AGENT][NEUTRAL] Yep it's gonna have that user guide on how to set up everything, how to get started, anything you need to any function now I cannot talk. I'm so sorry, any functionality in there whether it's checking claims status submitting a claim, it's all gonna be in that user guide for you and the link will be in the email, OK?
[CUSTOMER][POSITIVE] OK, cool.
[CUSTOMER][POSITIVE] Thank you for sending it to me I'll look for it.
[AGENT][POSITIVE] And that should be coming to you now absolutely and then perfect as I know we've gone over a lot of information today. Is there any more information I can give you or anything you have questions on?
[CUSTOMER][NEUTRAL] No, no, the big one was uh my concern how much it was gonna cost me and the monthly amount that I've been paying to the school.
[CUSTOMER][NEUTRAL] That we're taking out of my check will continue when I get the forms and uh I email them back to you to continue the coverage so that's good. I don't really wanna work another year so.
[AGENT][POSITIVE] No, I can't blame you. I would want to retire when my retirement was coming up as well.
[CUSTOMER][POSITIVE] So that's good.
[CUSTOMER][POSITIVE] OK, well thank you so much for sharing with me, [PII]. If you see [PII], tell her thank you. She was very helpful to me last week when I called.
[AGENT][POSITIVE] You know, [PII] is one of the best people ever, so thank you. I'll, I'll pass that on. I'm gonna give her all that good news. She's wonderful. She trains me. I love her.
[CUSTOMER][POSITIVE] Yeah, she was so sweet to me on the phone and even offered to pray for my wife, which I thought was fantastic, so.
[AGENT][POSITIVE] Oh, she's the best.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][POSITIVE] OK, well, [PII], I'm gonna look for that email and I thank you for helping me and uh and I'm glad your call centers there. I call and you guys respond and I don't have to talk to somebody in the [PII]. I like that a whole lot.
[AGENT][POSITIVE] Well, we are glad to be here to take care of you that I mean that's like the most important thing we can do is make sure y'all are taken care of so give us a call any questions.
[CUSTOMER][NEUTRAL] Are you on, is your
[CUSTOMER][NEUTRAL] Where are you at [PII]? Where, where is your call center? Where are you guys located?
[AGENT][NEUTRAL] Yeah, so, um, our, our home office is [PII] based, but it used to be in [PII], not [PII], goodness. [PII]. So a lot of us are based out of [PII], but we still have a lot of people also based out of [PII], so we're kind of split, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As a team.
[CUSTOMER][NEUTRAL] So it depends on when I call who I get. I, I may get the call center in [PII] or I may get in [PII] and they wouldn't have a world, they wouldn't know who [PII] or [PII] was if that was the case.
[AGENT][POSITIVE] Oh no, they would because [PII] is not based out of the same home office as I am, um, but we are all on one team together so there's um like a dozen or so of us and we are, we're all on one team and so we all talk to each other every single day we interact, we train each other, we meet with each other in our meetings, they're just online meetings.
[CUSTOMER][POSITIVE] Cool.
[AGENT][NEUTRAL] But we're all one team, so we all know each other here.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Well, thank you very much for the information and uh.
[CUSTOMER][NEUTRAL] Hopefully, uh, I won't have too many bills because hopefully the Lord will intervene and all this will go away fast instead of a year like they're saying, so.
[AGENT][POSITIVE] Well, I definitely wish you the best. I, I wish both you and your wife the best and I hope you're able to just take the time, not have, I'm glad you don't have to work another year and just be there with your wife and be there with your family right now.
[CUSTOMER][NEUTRAL] Anyway,
[CUSTOMER][POSITIVE] Yep, thank you so much for that. All right, [PII], I hope you have a great day. Thank you for being kind to me on the phone and, and maybe I'll talk to you again next time I call. Sounds like I got 1 out of 12 chances.
[AGENT][POSITIVE] It's my pleasure.
[AGENT][POSITIVE] Yes, you do. I will definitely, I'm always here, so I wish you and your wife the best, and if you need anything, we're always a phone call away.
[CUSTOMER][POSITIVE] OK, thank you so much and you have a good day.
[AGENT][POSITIVE] You too take care.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Bye.