AccountId: 011433970860
ContactId: c9d67063-b94b-4514-8345-b75ab3c65bea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 882960 ms
Total Talk Time (AGENT): 658109 ms
Total Talk Time (CUSTOMER): 241043 ms
Interruptions: 5
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/c9d67063-b94b-4514-8345-b75ab3c65bea_20250217T14:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling. This is [PII]. With whom am I speaking and how may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh, my name is [PII], ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I was calling to see if y'all get the information about a bill. I was Friday. I talked to a guy on the phone. He was talking to another lady. He faxed some stuff over for you. I want y'all receive it already.
[AGENT][NEUTRAL] OK. What's your policy number?
[CUSTOMER][NEUTRAL] Uh, let me think, I think it's 256.
[CUSTOMER][NEUTRAL] 6030.
[AGENT][NEUTRAL] OK, and what's a good call back number for for you in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Give me one moment to get your policy pulled up and then I'm gonna have you verify some information and then I'll check to see if we received that information that you said was faxed over one moment.
[CUSTOMER][NEUTRAL] OK. Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you already verified your name. What's your date of birth followed by your physical mailing address?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] 99965 physical mailing address I think it's uh [PII].
[AGENT][NEUTRAL] OK, and what is the email address we have for you on file?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, so thank you for verifying that information for me Mr. [PII]. So I do see that we did receive some information on [PII], which was Friday, and it's in line for processing, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Anything else I can help you with?
[CUSTOMER][NEUTRAL] I got a letter from you I said other stuff was in processing too. So how long does this take, man?
[AGENT][NEUTRAL] Oh yeah, I see you.
[AGENT][NEUTRAL] I see you sent something on [PII] as well. So it usually can take up to 15 days from the date of receipt excluding holidays and weekends, OK? So they should be getting to that day pretty soon. Yes, sir. OK. Cause what's gonna happen is when they pull uh maybe this week, but what'll happen is because you have this older piece of mail.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so far.
[CUSTOMER][NEUTRAL] I should be like next week somewhere like that.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] They're gonna, when they pull your mail, they're gonna pull everything for you. We don't just pull one piece. So they're gonna pull everything for you. So, but um, so it'll basically go by [PII], so you should be getting close when we look at the calendar.
[AGENT][NEUTRAL] Yeah, today is 12 days, so it'll be this week, OK?
[CUSTOMER][NEUTRAL] Oh, so would that be like if I get anything that like something in the mail or I know I fill out the form I got sent to you my uh routing number and checking account number y'all send me a thing to fill out to have a direct deposit.
[AGENT][NEUTRAL] Did you send that back in with the documents that we currently have for you that's waiting to be processed? Is it in there?
[CUSTOMER][NEUTRAL] I gotta send that back in, yeah. I, I can send that to y'all don't fax it to y'all today.
[AGENT][NEUTRAL] Yeah, cause
[AGENT][NEUTRAL] Well, you need to do that today. I would say make sure you get that done, OK? But it's not a guarantee that your direct deposit is gonna be accepted. Now let me ask you this, uh, because we have to have so many days to process it and it just depends. Sometimes it does get pushed through when they process your claim, sometimes they don't. But let me ask you this do you have the online service in our account?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yes I have that. I can't remember what it was. What's the name of the online service account I forget what it was. Can you give it to me again?
[AGENT][NEUTRAL] Uh, you have to, you, you created a username and password?
[CUSTOMER][NEUTRAL] Yeah, I can't find it on my computer. I was trying to, I used to have it on my phone. I been like this in the flow. Could you email it to me? Could you email it to me again?
[AGENT][NEUTRAL] OK. OK. So it's, yeah, yeah, yeah, yeah. OK, so I'm, I'm just gonna let you know.
[AGENT][NEUTRAL] I can't email that, but I can tell you what it is. It's just [PII].
[CUSTOMER][NEUTRAL] [PII]. [PII], got you.
[AGENT][NEUTRAL] Yes, and you, uh huh and click on log in and put in your username and password. Now I'm telling you this to tell you that's the fastest way to get your direct deposit you put it in yourself and it comes over immediately, OK? versus a piece of paper, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, AM what now? [PII]?
[AGENT][NEUTRAL] [PII] mhm alright.
[CUSTOMER][NEUTRAL] What? Say it again, ma'am.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you, ma'am.
[AGENT][NEUTRAL] Yes. Anything else I can help you with today, Mr. [PII]?
[CUSTOMER][NEGATIVE] So if I get something and you don't know how much it was, I know, uh, I gotta pay $400. I don't pay in cash. I got, uh, go to the doctor. I can't be running test on me if I got in my bones and how far the spread. I gotta take $480 but I'm doing it on my own. So I did just fax that to y'all too.
[AGENT][NEUTRAL] Well, let me go, let me take a look, let me take a look at something. No, because this is, um, uh, let me, let me take a look at what this policy covers first of all, give me one second. OK, so here's the issue that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You're gonna run into. Um, so you were diagnosed with cancer when?
[CUSTOMER][NEUTRAL] Uh, basically back in December or January.
[AGENT][NEUTRAL] December or January. So your policy has an effective date of [PII].
[AGENT][NEUTRAL] Because your policy has not been in force for one year, meaning you have not had this policy for one year, it's gonna be subject to preexisting. So that's gonna hold up your claims process and because whoever's assigned this claim is gonna have to investigate preexisting. So that means you're gonna get paperwork for all the doctors you saw prior to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1120 25 during the 12 months prior. So that just will mean [PII] which it seems like this diagnosis is going to fall in.
[AGENT][NEUTRAL] If it's determined that it's preexisting, this policy will not cover anything for preexisting until it's been enforced after one year.
[AGENT][NEUTRAL] But again,
[CUSTOMER][NEUTRAL] So basically I gotta wait a year for to use it.
[AGENT][NEUTRAL] You have to turn your paperwork in for us to review everything. So the pathology report that diagnosed you with cancer. Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I did that.
[CUSTOMER][NEUTRAL] I did all that.
[AGENT][NEUTRAL] So, yeah, so if you were seen prior to that effective date, that's what's going to happen then preexisting will be uh will apply to your policy.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So full existence, preexisting won't apply to it like.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] No, it will. If you were seen 12 months prior to, it will, and if you look on your uh policy certificate, but again, I'm just telling you what this policy covers and what the rules are and what the pre-existing rules are, but you still should file your claim so everything will be on file and it does say pre-existing condition period in your policy certificate 12 months.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Preexisting exclusion 12 months. So again that means we investigate 12 months prior to the uh the effective date if it's found that you were seeing for this condition, then it's determined to be preexisting, then you have to wait 12 months for the policy to be enforced for 1 year at least before we begin to uh make payment on benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Also, basically, I might not get anything at all to pay for my cancer insurance. I do it out of pocket then, right?
[AGENT][NEUTRAL] Yes, because what type of tests were you saying you was gonna have today?
[CUSTOMER][NEUTRAL] Uh, not tomorrow, Wednes they gonna run and shoot this stuff to me to see if it's spread it through my body.
[AGENT][NEUTRAL] OK. Um, I'm looking at the benefits on your policy.
[AGENT][NEUTRAL] Um, it does not even look like you. Well, yeah, you have an imaging benefit. So if that's a MRI or CT, a cat or a PET, that's something that would be considered.
[AGENT][NEGATIVE] And is pay the benefit, but, but again, that's gonna be subject to preexisting.
[CUSTOMER][NEUTRAL] Yeah, I gotta do that. That's a pack.
[AGENT][NEGATIVE] So if it's determined to be pre-existing, then nothing will be paid for the 1st 12 months. The lump sum benefit that you have of $5000 if it's determined to be uh pre-existing, that will never be paid for this diagnosis.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because it, it would have occurred.
[CUSTOMER][NEUTRAL] So basically I'm looking at out of pocket everything.
[AGENT][NEUTRAL] I guess so.
[CUSTOMER][NEUTRAL] To go get my chemo and everything, that's out of pocket. Oh we got.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] That's gonna hit me real hard. That's so.
[AGENT][NEUTRAL] Yeah, cause you do have a, you do have a $20,000.12 month period for chemo. But again, all this is subject to pre-existing.
[AGENT][NEUTRAL] And it, it, it, you know, from where you were diagnosed, uh, the dates you've given me, that's, that's in the range of, um, is, is, you know, it's more than likely gonna be pre-existing, but we don't process claims over the phone. That's why I want you to, I'm just telling you what your benefits are, what it says about preexisting, how preexisting works, but you still should file a claim and let the claim go through the process and.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Go that route, OK?
[CUSTOMER][NEUTRAL] OK, I understand that. So basically what you basically I'm not just saying I need to find something else just in case y'all don't pay for anything.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] You know, um, I don't know, I don't know if you have, uh, a facility that you're going to, if they have a social worker that can assist you with, uh, some other type of insurance that may help pick up your balance, you know, uh, for your chemo and radiation. That may be something you want to talk to the, the social worker on site.
[CUSTOMER][NEUTRAL] That's what it looks to me.
[AGENT][NEUTRAL] To see what may be able to help you just in case you have to wait one year for this one. Because, just because you have to wait 1 year, I know that's, you know, you're looking at that as, oh, that's bad, but there are still certain things. I'm a, I'm a cancer survivor, OK? So there are still certain things that have to be done 5 to 6 years after being diagnosed.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it is.
[AGENT][NEUTRAL] So what am I saying to you that you're still gonna be getting medical imaging, PET scans, CT scans, MRI's that's something that's a part of the workup after you've been diagnosed with cancer that they continue to follow you on. So that is $500 twice a year. You do have that benefit of $500.02 times a year. So even if it was pre-existing, that's something that would still be in place. If you had to have a surgery.
[AGENT][NEUTRAL] Um, you know, God forbid, you know, hopefully, you wouldn't be still receiving chemo at that time, but if you were, then chemo would be eligible.
[CUSTOMER][NEUTRAL] Because I know about that they're gonna do radiation on me. They already said that they do the radiation treatment on me. I I had it 5 days a week for 9 for 6 for 9 weeks.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] For 9 weeks, OK.
[CUSTOMER][NEUTRAL] And I think that's between, between 9, I think that's like 50 6 $7000 just for that alone.
[AGENT][NEUTRAL] Oh yeah, it's, it's, it's, it's, it's, it's, it's expensive. Yes, yes. But like I said, I would strongly advise that, you know, you speak with uh the social worker on site to see um what else you may be eligible for. Sometimes there may be state things that can assist you. Sometimes the, the, they, they, sometimes they, and we don't know this, you know, I say a lot of us don't know this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I found from my own personal experience that pharmaceutical companies, a lot of times, the ones that make the drugs, have a program and pick up your balance. So, you know, don't, you know, don't throw in the towels. Still file your claim with us and then whatever, whatever chemotherapy drug that they're putting you on, you know, check with the maker of it. If it's a Lexion, if it's uh uh um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, Pfizer, whoever it is, they have, they all have programs where you can sign up and they'll pick up your balance, OK?
[CUSTOMER][NEUTRAL] Well, I have medical insurance due to my job through the school.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] And I think they told me once I get up to a certain amount, then they pay up to 80% of it.
[AGENT][NEUTRAL] Yeah, once you get to 100%, yeah, and it's gonna, well, well, uh how much radiation and chemo costs, you're gonna hit the out of pocket max is what's gonna end up happening and when you hit the out of pocket max, they're gonna start paying out 100% for you, your main insurance.
[CUSTOMER][NEUTRAL] That's what they told me that, yeah, so well, like I said, I, but I would get a letter from y'all and let me know if I would be able to get anything or not from y'all.
[AGENT][POSITIVE] Yeah, that's how it works.
[AGENT][NEUTRAL] Yes, absolutely, absolutely. And I'll tell you what, um, I'll tell you what, Mr. [PII], I'm [PII] and I work in the cancer department, OK? So, um, you know, if you have any other questions, just call and ask to speak to me, um, but, um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah. Once someone gets assigned uh your claim to work, like I said, I do know based off the, the date, date, they're gonna wanna know who you saw 12 months prior for this condition. Nothing else, you know, sometimes people get confused and they put, you know, all kinds of doctors they saw only for whatever you was diagnosed for. So if it was kidney cancer, we
[CUSTOMER][NEUTRAL] I know my doctor gave to.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] I saw him last year back here during the summertime and he was like,
[AGENT][NEUTRAL] So do
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, it was like a 3. something, he said, and it went up again and it went up kinda high, yeah, yeah, and that's what he referred me over to him. This was last year.
[AGENT][NEUTRAL] So your PSA, OK, your PSA.
[AGENT][NEUTRAL] OK. So this, this is what you can do too. Since you're going to um I would suggest, because you don't want anything to be held up anymore asking you for anything. You can write on a piece of paper, just make sure it's legible, or if you wanna type it up, type up who you saw from [PII]. And that was that doctor you just told me?
[AGENT][NEUTRAL] And then he referred you to a urologist.
[CUSTOMER][NEUTRAL] Well, I go out there and get that from them.
[AGENT][NEUTRAL] Uh-huh. Well, you can get your, you can get your medical records from him if you want to just do it that way and you could just have it faxed over to us. You can do that too. So I will, I will have all that done so that, and what did you, he referred you to a urologist?
[CUSTOMER][NEUTRAL] I get the paperwork from there for free.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, that's what I'll do then.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And then get the medical records from the urologist. All you need is that, that time frame I just said. We don't need anything else. So, you know, just from [PII]. And go ahead and fax that in.
[CUSTOMER][NEUTRAL] Well, I did fax that over to y'all.
[AGENT][NEUTRAL] Oh, is it with the paperwork you already sent? Oh, OK, OK, well then that's good.
[CUSTOMER][NEUTRAL] I did fax it over to y'all.
[CUSTOMER][NEGATIVE] You the paperwork I send you back on the [PII] that says all my stuff and I talked to you all this what day I talked to him, what they had, what month he sent me over there. Uh, I got an appointment on the [PII] to see him again. That's why I said they run this stuff to me. And then I got an appointment to see the uh radiation doctor on [PII]. They're gonna tell me they gonna start my treatment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK. All right. OK. Well, we'll just wait for that to be assigned and they'll look at it and hopefully they won't need anything else, OK? But if they do, they'll notify you via the mail. Mhm. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Some sometimes we I share something from me like a letter in the mail saying that I got it, I didn't get it right.
[AGENT][NEUTRAL] Well, you won't get a letter in the mail that fast because you know mail takes a little bit to get to you, but your claim should be processed by this week. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Yes, sir. All right. You take care. Anything else I can help you with?
[CUSTOMER][POSITIVE] Alright thank you ma'am appreciate you.
[CUSTOMER][POSITIVE] Oh, that's it, thank you.
[AGENT][POSITIVE] Alright, and if you need anything just call back and ask to speak to [PII], OK? Thank you for calling APO. Have a great day bye bye.
[CUSTOMER][POSITIVE] OK, thank you, man.
[CUSTOMER][NEUTRAL] You too.