AccountId: 011433970860
ContactId: c4d34a13-2881-4bea-9f09-c6c708fbdba8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 626390 ms
Total Talk Time (AGENT): 361973 ms
Total Talk Time (CUSTOMER): 222861 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/c4d34a13-2881-4bea-9f09-c6c708fbdba8_20250519T16:32_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], how are you doing today?
[AGENT][POSITIVE] I'm good, and yourself?
[CUSTOMER][POSITIVE] I'm doing all right.
[AGENT][POSITIVE] Well, that's good. How can I help you today?
[CUSTOMER][NEUTRAL] Well, I
[CUSTOMER][NEGATIVE] I am lost and I don't know if I'm doing the right thing or not. Uh, my name is [PII].
[CUSTOMER][NEUTRAL] And you want my policy number?
[AGENT][NEUTRAL] OK, [PII], what was your last name? I'm so sorry. I didn't.
[AGENT][NEUTRAL] I didn't catch that.
[CUSTOMER][NEUTRAL] [PII] as [PII] in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you. And what's a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And your policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] 23,430
[AGENT][NEUTRAL] OK, that's your group number. There should be another number on your ID card.
[CUSTOMER][NEGATIVE] Oh, I don't, I never, uh, I'm like I said, I never received one. I just don't know where it's at.
[AGENT][NEUTRAL] OK, Mrs. and the insurance is in your name, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, what is your full social please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] No, thank you, you're helping me.
[AGENT][NEUTRAL] OK, so Mr. [PII], I will need to verify several things with you first for security and then also any information that I provide will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you and lastly your email address please.
[CUSTOMER][NEUTRAL] Two kids, well, the number 2 in kids is KIDZ.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For me,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] At [PII].
[AGENT][POSITIVE] OK, thank you. All right, so how can I help you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Last October, I was diagnosed with renal cell carcinoma on my left kidney.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I had all the tests done.
[CUSTOMER][NEUTRAL] Radilogy, all that stuff, and then I had in December I had a
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think that
[CUSTOMER][NEUTRAL] Oh no, I had the surgery in October and December, uh.
[CUSTOMER][NEUTRAL] I had to, uh, I had it removed. I had the surgery to have it removed.
[CUSTOMER][NEUTRAL] There was no
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No residual in January, they checked it again and everything's clear. All the margins are good.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, they did everything correct.
[CUSTOMER][NEUTRAL] So, um
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] I'm looking at uh some somebody says I need to make a claim with my, my insurance company, but I'm not sure if I'm doing the right thing or not.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] I mean, I had no, I had no, no, no can I mean I had no chemotherapy or radiation.
[CUSTOMER][NEUTRAL] I just had the surgery and they got it all out.
[AGENT][NEUTRAL] OK, so, so you're wanting to find out if you should file a claim with APL, is that correct?
[CUSTOMER][NEUTRAL] Uh, am I eligible to file a claim or should I file a claim, or?
[AGENT][NEUTRAL] Since she
[AGENT][NEUTRAL] OK. So you were diagnosed with kidney cancer. Is that correct?
[CUSTOMER][NEUTRAL] Yes, on the left side, renal cell carcinoma is what it was diagnosed as.
[AGENT][NEUTRAL] OK. And then, um, you had surgery, did they remove your kidney?
[CUSTOMER][POSITIVE] No, they just removed the, they just removed the, the tumor and they uh did an ablation and removed the, uh the margins around it, got good margins.
[AGENT][NEUTRAL] Or just the cancer?
[AGENT][NEUTRAL] OK, all right. So, um,
[AGENT][NEUTRAL] Yes, sir. You can file a claim. This is your cancer policy. I can give you the policy number and let, let me look. So let's see. Now, was your cancer a cancer, did they diagnosis as carcinoma in situ?
[AGENT][NEUTRAL] Which means that the
[CUSTOMER][NEUTRAL] Inside too?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know what that means. I'm sorry.
[AGENT][NEUTRAL] That means it's a tumor or tumorous cells that are confined to that organ or tissue where it first developed.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Means where it has not invaded any other organs or tissue.
[CUSTOMER][NEUTRAL] Yeah, just to that.
[CUSTOMER][NEUTRAL] No, it's just that, that kidney only in that that area.
[AGENT][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] They removed the that area of that's it.
[AGENT][NEUTRAL] OK, alright, so just a moment, let's see here.
[CUSTOMER][NEUTRAL] I read the policy. I, I was getting confused on what because it started talking about chemotherapy and, and radiation and I'm like I don't understand.
[CUSTOMER][NEGATIVE] I didn't have any of that and then I kept telling them I don't think I'm eligible for a claim and they said yeah you are.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir. You should file, yes, you should file because you were diagnosed with an internal cancer. So yes, sir, that is something that we can review under this policy even though you did no[PII]
[CUSTOMER][NEUTRAL] I'm not
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Have to have chemotherapy or radiation, yes, so that's still something that we can review to potentially pay benefits on, on this policy. Have you ever set up your profile, Mr. [PII] in your in our portal called the online service center where you can access your policy information and also the different.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, benefits on your policy?
[CUSTOMER][NEUTRAL] Not, not with y'all, but I've done it with my school district and so I can go in and see my policy through my school district, but I don't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just see I don't see the actual I just see the uh what's offered to.
[AGENT][NEUTRAL] Right. You don't see your specific information. So what I'm going to do by doing that, so what I'm going to do, Mr. [PII], is I will send you an email.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That has our user guide um I'm gonna attach that and I'm also I can attach one of the cancer claim forms for you uh that will have all of the instructions on page one as to how to file that claim.
[AGENT][NEUTRAL] There's a lot of bullet points on that first page that tells you the different documents that you would need to submit.
[AGENT][NEUTRAL] For us to review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On this policy to determine if there are benefits payable.
[AGENT][NEUTRAL] Because you do have a first occurrence benefit, which is a lump sum payment of $7500.
[AGENT][NEUTRAL] And that is a maximum of one per cover person per lifetime.
[CUSTOMER][NEGATIVE] See, that's why I'm afraid because I have nothing right now going on. I mean, I'm, I'm, I believe I'm good to go, and I don't want to get down the road and find out that it's, that it's something else came up and it's worse and I'm gonna need.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][POSITIVE] The full blown thing.
[CUSTOMER][NEUTRAL] And then I'm gonna say well I've already used my my one time shot.
[AGENT][NEUTRAL] So the first, yeah, I do understand what you're saying. So the first occurrence benefit, yes, that is a once per lifetime. Um, and then you still, you know, would have your radiation therapy and chemotherapy. That, those different benefits would still exist, but yes, you would have used
[CUSTOMER][NEUTRAL] You know what I mean?
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You would have used your
[CUSTOMER][NEUTRAL] I get it. I understand now.
[AGENT][NEUTRAL] You know, the first occurrence or first time you were diagnosed with cancer, that benefit, yes sir, that would have been exhausted.
[CUSTOMER][NEUTRAL] Oh, that will go away, but I'll still be covered for chemo and radiation and all that stuff.
[AGENT][NEUTRAL] There would still be benefits, yes, available to you since you, because those benefits are not, those benefits, for example, for your radiation, chemotherapy, and immunotherapy, that is for a twelve-month period.
[AGENT][NEUTRAL] So hypothetically, if you were diagnosed in March and you began treatment, say, in April, then you would have your chemotherapy radiation benefit available until the following April. That's a $15,000 per 12-month period benefit.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][POSITIVE] All right. Well, I thank you very much.
[AGENT][NEUTRAL] So, well, you're very welcome. So I'm gonna go ahead and just email you this information so that you'll have the portal which you can go ahead and set it up so you can have access to your personal information for APL and then I'll just include that claim form and if you decide that you do wanna file it, you will have that form that you'll need with all the instructions.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And the email, uh, mister, yes, sir, the email that you're gonna receive from me in just a few minutes is going to be sent to you from care team at [PII] and I will put APL in your subject line so that that's easy for you to recognize.
[CUSTOMER][POSITIVE] Alright, I thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I, I wanted to make sure I got you the right one, so 2 kids for me, but the number 2 and the number 4 are actually numbers, not, not.
[AGENT][NEUTRAL] Uh-huh, uh-huh.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] You're not words.
[AGENT][NEUTRAL] Yes, I have a number, then, yes, uh numeral 2 KIDZ the number 4 [PII].
[CUSTOMER][NEUTRAL] Yes, my daughter gave it to me when she was younger, so I just kept it.
[AGENT][POSITIVE] Oh, that's cute. I like that. No, I like that. I do. I like that a lot. OK.
[CUSTOMER][NEUTRAL] All right. uh.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Well, we just be.
[CUSTOMER][POSITIVE] Alright, I appreciate it thank you very much.
[AGENT][POSITIVE] You're certainly welcome and just be looking for this email just within the next few minutes, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. And again, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Um bye bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.