AccountId: 011433970860
ContactId: cbf4dd42-7631-4039-b130-8ab8a1446373
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321339 ms
Total Talk Time (AGENT): 164331 ms
Total Talk Time (CUSTOMER): 150444 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/cbf4dd42-7631-4039-b130-8ab8a1446373_20250220T23:30_UTC.wav
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[AGENT][NEUTRAL] Calling APO, this is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I've got an insured on the phone. Her name is [PII], and she's been diagnosed with cancer. She had a, well, not diagnosed internal cancer, but we've been reading over her policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, first, let me give you her policy number. It's 252-7823.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And she's been verified and the number she's calling from is a good callback number.
[CUSTOMER][POSITIVE] She had a spot on her head.
[CUSTOMER][NEUTRAL] That they scraped and it came back cancer and she has to um have it removed.
[AGENT][NEGATIVE] So basically skin cancer.
[CUSTOMER][NEUTRAL] And we're reading where, yeah, basically skin cancer, but then there's a part in the policy that says it has to be so deep and so wide, and, and I wanted her to talk with you guys because the cancer um
[CUSTOMER][NEGATIVE] They just confused me and the way the wording is, it's very confusing for me and I wanted to just.
[AGENT][NEUTRAL] Well, basically, um, that means that um
[AGENT][NEUTRAL] If it's so deep and um then it could be considered internal cancer but we wouldn't know until we get the pathology report. And the best rule of thumb when you get calls like that is
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So just let them know that they need to submit the pathology report for a review with the examiner and that kind of like gets.
[AGENT][NEUTRAL] You know, not get off the hook, but we just can't process over the phone and we just can't tell them, yes, this is what it's gonna be because we don't have eyes on the pathology report. So basically, that's what I'm gonna let her know. But just if you have any, any future calls like that, like we just can't, we can tell them what the policy says and that once we get the um pathology report and review it, then we'll know further.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] I thank you [PII]. Thank you so much for teaching me that because I've been sitting here trying to figure it out with her because you know you want them to have help but.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, exactly, yeah.
[AGENT][POSITIVE] Yeah. OK. Have a good day.
[CUSTOMER][POSITIVE] Thank you I appreciate you. All right you too bye bye.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, this is [PII] in the claims department. I understand that you have been diagnosed with skin cancer.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. And that you have a pathology report that you're gonna be sending to us?
[CUSTOMER][NEUTRAL] Yes, I, I, I have, I mean, I've got, they sent me, I went in and they found a spot. They did a biopsy of it and they, it was a basal cell that then I'm scheduled to have removed next week and I'm just curious if this cancer plan covers anything with the skin cancer if it's only internal cancer.
[AGENT][NEUTRAL] All right, so while I pull up your policy, this is a verification of your coverage and not a guarantee for payment. Um, the only thing that is covered for, as far as skin cancer would be the surgery. Um, a biopsy is considered a surgery, um, the removal is considered a surgery, but basically that's it. Internal cancer is, um, if you are diagnosed with cancer, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But everything else, any other cancers, then it will cover like um.
[AGENT][NEUTRAL] Let me see what you have under your plan.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So the procedure that I'm doing to have it removed next week that would since that is a ser considered a surgery for the removal, that is something that I can file a claim on for the actual surgery part.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes. So, um, anesthesia is not covered, um, if you have transportation, but it doesn't look like you have any of that anyways. But um as far as the transportation, but the biopsy um that you had is covered and any other surgeries would be covered.
[CUSTOMER][NEUTRAL] OK, and then the biopsy that I.
[CUSTOMER][NEUTRAL] OK, and then I just do that. I just do then I like I was on the website so I was looking where you could file a claim, so that's where I would send in the stuff to that to the address that I have there and file that after I've.
[CUSTOMER][NEUTRAL] Had the procedure correct.
[AGENT][NEUTRAL] Yeah, because you, if you go to the claim form that's on page one of the cancer claim form, it just lets you know what is all is needed to file a claim and especially to file a claim claim, and that would be the pathology report and the itemized billing for the surgery charges.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, that's what I need.
[CUSTOMER][NEUTRAL] OK, so once I have those things and I'll send those things into you guys, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That is so helpful. OK, thank you so much for your help on this. It's.
[AGENT][POSITIVE] You're so welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, I think that's it so I will just, once I have this stuff done, I will get this stuff sent in.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL. You have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.