AccountId: 011433970860
ContactId: c625e4c6-e1a5-4d5d-ab37-74a57ea839dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1123339 ms
Total Talk Time (AGENT): 582960 ms
Total Talk Time (CUSTOMER): 396094 ms
Interruptions: 8
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/c625e4c6-e1a5-4d5d-ab37-74a57ea839dd_20250328T14:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, my dad just recently was diagnosed with cancer, and he has a cancer policy with you, so I'm trying to, to help him fill out the paperwork for um to get started on the claim. Can I ask you a couple of questions just as to the process?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course, yeah, I can answer any questions you've got uh what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] My dad's name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then [PII], uh, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Do you have that policy number?
[CUSTOMER][NEUTRAL] I do it's 445-110.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, is [PII] available that I could speak with him?
[CUSTOMER][NEUTRAL] Um, I can call him. You need permission to talk to me.
[AGENT][NEUTRAL] Um, it's completely up to you, so I can answer questions as to, um, information that we need and how to file claims. Uh, I just wouldn't be able to go in depth as to specifically what's in the policy or current claims or anything without [PII]'s permission.
[CUSTOMER][NEUTRAL] Yeah, let me
[CUSTOMER][NEUTRAL] OK, let me, I, I'll get him on real quick and get him to, to give you that permission. OK, just one second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got you, uh huh.
[CUSTOMER][NEUTRAL] OK, are you there?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. Um, my dad is on the phone. The daddy, it's under [PII], um, yeah, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah hi [PII] how are you?
[CUSTOMER][NEUTRAL] Uh, well, I'll be better.
[AGENT][NEUTRAL] I can imagine. I'm sorry. I'm just gonna verify some information really quick. Um, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think it's uh [PII].
[AGENT][NEUTRAL] Yes sir that's it all right and then do we have your permission to speak with [PII] on your behalf?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Please do. Uh, she's helping me out. I just don't feel like going through it all right now.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] I understand. All right, well, I appreciate you verifying all of that. Thank you.
[CUSTOMER][POSITIVE] Thank you for helping.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK. Um, so I guess we don't really even know where to start. Uh, he was diagnosed with squamous cell carcinoma and has had surgery to remove a tumor and they have planned, he's had several appointments about 4 hours away, um, at the, at the hospital that specializes in this. And um so he's made several trips back and forth. He would have some mileage and then they've got 7 weeks of radiation planned up there.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] OK. Alrighty.
[CUSTOMER][NEUTRAL] So I think you know we already have a diagnosis. I just don't know exactly what you need from the hospital, what you need from us.
[AGENT][NEUTRAL] Mhm of course yeah and um I'll go through uh all of the information that we need how you can get that to us I'm getting his policy pulled up right now just so I can get you some exact information now I will say before we go any further, uh going forward as you are not listed under the account [PII], um, we can send.
[AGENT][NEUTRAL] Or you could get it online whatever's easier a um third party authorization form uh that [PII] can fill out and that way you can speak with us without having, you know, we wouldn't have to keep calling him that permission that he gave was just going to be for this single phone call so going forward just you know if if you know you're going to be the one handling this, I would recommend uh getting that form to us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I can find that on your website?
[AGENT][NEUTRAL] Just so that we can
[AGENT][POSITIVE] Yes, or I can email it to you, uh, whatever you prefer.
[CUSTOMER][NEUTRAL] That's fine. You can email it. You can email it to him and he can forward it to me or you can email it to me either one is fine.
[AGENT][NEUTRAL] OK, sure, yeah, OK, I can send it to that email that we've got, um, alright, let me go ahead and do that now before I forget, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There we are, OK, alright, I've got that up um OK so um as far as sending claim information to us, do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so, um, typically the quickest and easiest way to get claim information to us is going to be through our online portal so I can send I can also send an email that uh has the policy if you don't have a copy of that just so you've kind of got a visual reference of what is and is not covered dollar amounts, frequencies, things like that, um, and in that email I can include a link to our website.
[AGENT][NEUTRAL] Uh, it really does not have much support for mobile devices, so it would have to be on a desktop or a laptop, um, so he would enter in all of that information that we just verified, including that same email, um, his social, all of that to create the account and then from that main page there's a spot where you can upload information it gets to us very quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, typically it might take about 7 to 10 business days for it to process, and you can view that status on the website or of course you're more than welcome to give us a call as well.
[CUSTOMER][NEUTRAL] I think he has an account because I see I just I don't know I don't know he's changed his password a couple of times but I I see that he's got a couple of user names and passwords here written down. I do have a copy of his claim.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] I can check that.
[AGENT][NEUTRAL] No, no, that's OK.
[AGENT][NEUTRAL] OK, I can check to see if he did.
[AGENT][NEUTRAL] OK, give me one.
[CUSTOMER][NEUTRAL] OK, now what I have is a copy from like it's old with his claim have would not have changed, would anything have changed over the years as far as what's in this policy?
[AGENT][NEUTRAL] Oh, the policy? No, um, so the last I've got, yeah, so this has been active since [PII], uh, so yes, it's, it's going to be the same policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] OK, and he absolutely has uh created an account already on our website. Awesome did you need that user name?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][POSITIVE] Yes, yes, OK, perfect.
[CUSTOMER][NEUTRAL] OK, I have it.
[AGENT][POSITIVE] All right, awesome. OK, so I will say the first thing that we need before anything else is going to be that original pathology report from the first diagnosis of cancer. So we would need that before um we were able to process anything else.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] And from there he gets us uh like an initial payout based off of that diagnosis like what type of cancer it is. So he gets a flat rate if I understand correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, um.
[AGENT][NEUTRAL] Yes, there's a first occurrence benefit. um, I'd have to go and find that exact amount but yes uh there would be a lump sum benefit, um, let's see.
[AGENT][NEUTRAL] So for just about everything uh that he would go so like any kinds of surgeries or anything like that that he receives, we would need the itemized statement.
[AGENT][NEUTRAL] That shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then that's
[CUSTOMER][NEUTRAL] So basically uh we would we get that like where they filed it through his regular health insurance or should we ask the hospital for that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can get that from the provider. I would get it from the provider that would, uh, wherever he went for treatment. So yes, the hospital or a physician's office, wherever he went for treatment, they'll have that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the only other thing that we would need is um you did say I'm sorry you did say he was receiving a chemo or radiation?
[CUSTOMER][NEUTRAL] Radiation, yes.
[AGENT][NEUTRAL] Yes, OK, so for that benefit, in addition to that itemized statement with those codes we would need the explanation of benefits from his primary insurance and again the provider will have that that's essentially just going to be showing what his major medical uh contributed to that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that's only going to be for chemo and radiation. We don't need that EOB for uh anything else.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then for the oh I'm sorry go ahead did you have another question?
[CUSTOMER][NEUTRAL] Mileage. I was gonna ask you how we do the mileage.
[AGENT][NEUTRAL] Yes, yes, right, so I do see the transportation benefit here let's see.
[AGENT][NEUTRAL] Mileage allowance 15 cents per mile. OK, awesome um so for that what you'll easiest way would be uh whenever you're filling out the initial claim form of course mention that in the claim form and then we'll be able to kind of piece together of course his home address and then on the uh on my statements that you have we'll be able to see the address and how far he had to travel um did he require lodging or anything like that or was it just the drive?
[CUSTOMER][NEUTRAL] Yes, lodging. It was 4 hours away, so he stayed a few times. Mhm.
[AGENT][POSITIVE] Lodging was as well.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I don't know is that is that part of this?
[AGENT][NEUTRAL] I'm going to see if lodging is a benefit on here. Um, I do see the travel, but um, let me check all our cancer policies are all very different as this one is a bit older. I'm not 100%, so bear with me just a moment. I know some of them do. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Well, it doesn't look like lodging is going to be a benefit on this one. I think it's just going to be the travel or the transportation rather.
[AGENT][NEUTRAL] But yes, as long as you.
[CUSTOMER][NEUTRAL] OK, yeah, that's all I saw but there was a hospital stay. No, you'll get all that from the itemized statements and you'll just calculate all of that. We don't need to kind of point out anything.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Not at all, um, the only thing I would say as far as pointing out is again on that initial claim form just point out that you know travel was required.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Now just a couple of generic questions. This is not dependent on how much his health insurance pays. This is totally separate? OK, so like if his if his health insurance covers the radiation like 95%, you're not just gonna pick up the other 5%, you're gonna pay your payout no matter what.
[AGENT][NEUTRAL] Of course
[AGENT][NEGATIVE] Not at all.
[AGENT][POSITIVE] Yes ma'am, that's correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm actually going to look at this one, chemo radiation in or out.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it does pay actual charges, but I'm not seeing the exact amount. Give me just a moment.
[CUSTOMER][NEUTRAL] It looked like up to $500 but it was the actual cost, yeah.
[AGENT][NEUTRAL] Per day, yes, it's a daily allowance. OK, I see again, I'm sorry some of these are very different some just have a yearly allowance max, uh, so this one is daily. OK, so yes, it would pay up to that 500.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So whatever they bill the um whatever our health insurance pays on that, you will pay that same amount to him.
[AGENT][NEUTRAL] Because we do still need that the original itemized statement as well, yes, um, so from whatever the actual hospitals bill was and then the explanation of benefits from the primary, I know it's a bit confusing.
[CUSTOMER][NEUTRAL] Um, up to $500.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, yeah, I got it.
[CUSTOMER][NEUTRAL] Alright, and are you able to look up what that initial occurrence amount is based off of the.
[AGENT][NEUTRAL] The first occurrence?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, let me take a look.
[AGENT][NEUTRAL] OK, I know the base amount is 1000. Let's see, hang on just a moment.
[AGENT][NEUTRAL] And schedule.
[AGENT][POSITIVE] Sorry, it is really thinking about it. OK, here we go.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, so it is that $1000 that is the first occurrence benefit.
[CUSTOMER][NEUTRAL] It's not based off of the type of cancer, it's just $1000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Alright and um so I I'm assuming that you're like we just file this in pieces we need to go on and start the initial one and then he hasn't done radiation yet OK.
[AGENT][NEUTRAL] However you prefer.
[AGENT][NEUTRAL] That is however you prefer the um biggest thing is of course before anything else we do need that pathology report um so once we have that you can upload this information however you'd like there's no timely filing limit so there's not a rush, you know, you have to get it to us within a specific time frame.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, I know depending on the frequency, uh, some people that get chemo or radiation very regularly, uh, they'll wait and just kind of do it all monthly or every other month, um, so that you could do that however you'd like that's completely up to you.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and um.
[CUSTOMER][NEUTRAL] Do you so every I can see everything through the portal like whenever you process the claim or whatever I can see that and then do you is there a place to do like a automatic deposit or do you just mail a check?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Absolutely. OK, so yes, on that website, um, there's a spot where you can set up direct deposit uh if for some reason you're not able to find it, we also do have a form for that as well um and if you'd like just for good measure I can go ahead and include that in this email as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that'll be fine. OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right, well that sounds good. I don't, I don't know.
[AGENT][NEUTRAL] But yeah, otherwise it would be a paper check sent in the mail.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I don't know that I have any more questions, um, at the moment we will, I will get the original pathology report and kinda get this started so that you.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You know, have it on your radar. He's, he's gone through a a very um.
[CUSTOMER][POSITIVE] Big surgery already, so probably be a good idea to go on and get that, that part started. He just hasn't done the radiation yet.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][POSITIVE] OK, all right, well we will get started on this and I appreciate your help um.
[AGENT][NEUTRAL] Alright, you're very welcome. If you have any other questions, I know it's very confusing and a lot going on.
[CUSTOMER][NEUTRAL] Hey, I
[CUSTOMER][NEUTRAL] I've been, I've been eavesdropping. I've been eavesdropping, uh, uh, I, I was wondering, uh, when y'all were talking about lodging, I've got to be in [PII] for 7 weeks of radiation and it's 225 or so miles. Uh, do we get any help with that?
[AGENT][NEUTRAL] Yes, absolutely, um, I think I could go back to that benefit, but I believe it was 15 cents a bow, um, but yes, as I was telling her just on that initial, uh, claim form then where when you go for that treatment and you're uploading that information, you'll just mention of course that there was travel expenses that you did have to travel that far. We'll be able to calculate from of course your home address to the address of the facility that you went to.
[CUSTOMER][NEUTRAL] Is that one way?
[AGENT][NEUTRAL] It would be both.
[CUSTOMER][NEUTRAL] 15 cents per mile both ways, yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Your policy just doesn't have a lodging clause, it's only transportation. OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But they'll pay that that transportation back and forth, you know, as many times as you go back and forth. OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I've been several times I got that road memorized.
[CUSTOMER][NEUTRAL] Do you have any more questions today? No, that's.
[CUSTOMER][POSITIVE] Uh, I appreciate y'all working with me.
[AGENT][POSITIVE] Absolutely again if you think of anything else uh don't hesitate we know it can be really confusing and overwhelming so we're here to help however we can.
[CUSTOMER][POSITIVE] Yeah, we'll get it.
[CUSTOMER][POSITIVE] I appreciate it. We're gonna get through this. Leave you alone.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] You don't need to worry about that, but yes, you're gonna get through it, um, so I will send that email just as soon as we get off the phone so you can keep an eye out for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But you don't need the policy though, do you? Did you need the policy still? Or you said you have that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a copy, uh huh, I have a copy if it hasn't changed.
[AGENT][NEUTRAL] OK, so, OK, so I'll just send that 3rd, that third party authorization form and then uh I'll go ahead and send that direct deposit form as well just in case.
[CUSTOMER][POSITIVE] OK, well thank you very much I appreciate it mhm.
[AGENT][POSITIVE] Alrighty. You are very welcome. Thank you, y'all have a great day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Yes sir, thank you. Bye bye.