AccountId: 011433970860
ContactId: b37611f5-3c03-4e7a-9238-891e29d34f6a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 750359 ms
Total Talk Time (AGENT): 235408 ms
Total Talk Time (CUSTOMER): 214330 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/b37611f5-3c03-4e7a-9238-891e29d34f6a_20250416T16:30_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, I have a cancer policy through APL, and I have a question.
[CUSTOMER][NEUTRAL] I've talked to someone a few minutes ago about a hospital plan that may have been you. Um, it's [PII].
[AGENT][NEUTRAL] Um, I don't think it was me. Do you have your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do it's 02010635.
[CUSTOMER][NEUTRAL] Retail.
[AGENT][NEUTRAL] OK, thank you, [PII]. Do you have uh your birth date?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's a good callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I just need two more pieces of information, your address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. How can I help you today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] First of all, I can't get into my um account online.
[CUSTOMER][NEUTRAL] Who could you help me with the username if I've forgotten it, or will I need to call a different number?
[AGENT][NEUTRAL] No, I can help you. Um, let me look it up. Let's see.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, it looks like it is [PII] and we've got [PII] capitalized. Everything else is lowercase and then 35.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna try the password. I think it is and see if it will let me in.
[CUSTOMER][NEUTRAL] No, so I can reset my password on here.
[AGENT][NEUTRAL] Yes, there should be an option for that.
[CUSTOMER][NEUTRAL] It sent me a verification code.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm just trying to make sure while I have you on the phone that I can get to the claim forms, but then I do have a question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] My question is about the cancer policy or surgical procedures, does that include skin cancer or no?
[AGENT][NEUTRAL] Um, let's see, the policy you gave me is a hospital indemnity. Do you have a separate policy? Let me see.
[CUSTOMER][NEUTRAL] Well, I have a cancer policy, but I don't have a a card um with a policy number on that.
[AGENT][NEUTRAL] OK, I found it. Let me pull that up.
[CUSTOMER][NEUTRAL] Is it the same policy number or no?
[AGENT][NEUTRAL] Um, no, it's a different one.
[AGENT][NEUTRAL] Uh, that policy is 2,010,610.
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] OK, pull up your policy. Give me one moment.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, yeah, I can see that now I'm logged in online.
[CUSTOMER][NEUTRAL] You retail.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK, so you're checking on skin cancer specifically?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I was over on this side.
[CUSTOMER][POSITIVE] But you know I thank you, yeah.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Did she have a employee.
[AGENT][NEUTRAL] Yes, it does include skin cancer.
[CUSTOMER][NEUTRAL] OK, so the surgery specifically was the nose surgery, MOHS.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And that was done like in, in office, um, the dermatologist's office.
[CUSTOMER][NEUTRAL] Does that still count?
[AGENT][NEUTRAL] Um, let me see, um, anything we, anything I quote is not a guarantee of payment basic outline of the policy. OK, so looks like um.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Where you
[AGENT][NEUTRAL] OK, let's see, sorry.
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] And 98.
[AGENT][NEUTRAL] This is OK, so in one part, it says, let me see.
[AGENT][NEUTRAL] Mm, let's see, schedule. Alright, let me read through this for just a moment.
[CUSTOMER][NEUTRAL] Our
[AGENT][POSITIVE] OK, Benefits for
[AGENT][NEGATIVE] return.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] a lot.
[CUSTOMER][NEUTRAL] Got
[CUSTOMER][NEUTRAL] you.
[AGENT][NEUTRAL] The surgical procedures, and this is under the, your policy certificate should be in your account.
[AGENT][NEUTRAL] Under benefits, um, page 9.
[AGENT][NEUTRAL] Uh, it says that surgical procedures for skin cancer are not covered under the benefit.
[AGENT][NEUTRAL] of outpatient hospital or ambulatory surgical center benefit.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Was it in the doctor's office? Is that what you said?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me make sure I'm not missing anything here. I might have to transfer you to our claims department. They're the ones who they have a deeper knowledge of how a claim would actually process if you submitted it, so let me make sure before I.
[AGENT][NEUTRAL] Get them on the line.
[AGENT][NEUTRAL] Yeah, I'm a little bit confused by this because it references it some in one place and then the other place it says surgical.
[AGENT][NEUTRAL] Skin cancer is not covered. So, um, do you mind if I get you to our claims department? They're familiar with these policies and how they process, so they'd be able to answer your questions.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, is there anything else I can help with though regarding is that the what you were calling for?
[CUSTOMER][NEUTRAL] That's what I was calling for.
[AGENT][NEUTRAL] OK, OK. Hold on one moment, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling ATL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] on the care team. I have a member on the line um for her cancer policy, and I'm confused o[PII] how a claim would process. She's asking about how it processed, so I'm gonna see if you could help me.
[AGENT][NEUTRAL] Or her
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, do you have the policy number?
[AGENT][NEUTRAL] It's 2,010,610.
[CUSTOMER][NEUTRAL] OK, and who's the person on the phone?
[AGENT][NEUTRAL] That's [PII], and I've verified her.
[CUSTOMER][NEUTRAL] OK, and is this claim under who's the claim under?
[AGENT][NEGATIVE] Uh, well, the claim's not processed. She had skin cancer and had the most surgery, MOHS.
[AGENT][NEUTRAL] Um, but so I'm reading in the policy certificate, and this is I'm confused because.
[AGENT][NEUTRAL] When I look up skin cancer,
[AGENT][NEUTRAL] It has under the benefits.
[AGENT][NEUTRAL] That it's covered.
[AGENT][NEUTRAL] But then
[AGENT][NEUTRAL] It it then it has that it's not covered under outpatient hospital or ambulatory surgical center benefit.
[AGENT][NEUTRAL] So I'm not sure, I'm not understanding how, if, if this is covered or not.
[CUSTOMER][NEUTRAL] Sure. Well, I can definitely help her, but I'll just let you know that it is covered under the surgical benefit. So that's why it's not covered under the other benefits cause it's not considered internal cancer, but for surgeries for skin cancer, yes, the surgical benefits are payable. But I can explain that to her.
[AGENT][NEUTRAL] OK, sorry. OK, so will you explain it to me then? So it's, so it just won't pay under the hospital outpatient hospital or ambulatory surgical center benefit?
[AGENT][NEUTRAL] But it will pay under
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, because most of the benefits under this policy are gonna be payable for the treatment of internal cancer. So all those benefits that you see under that schedule, the majority of them, if, if it was internal cancer, um, then yes, those would be covered, um, or we could review those benefits for that treatment. But since skin cancer is not considered internal cancer,
[CUSTOMER][NEUTRAL] The only benefits that are payable is for the actual surgical, you know, for the biopsy and then the removal of the cancer. And those are all under the surgical benefits.
[AGENT][NEUTRAL] OK, OK. All right, that helps me at least know for future reference, but if you don't mind, would you be able to explain that to her?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] And do you have a callback number?
[AGENT][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thank you so much. I appreciate it.
[CUSTOMER][POSITIVE] Thank you for holding this is [PII].