AccountId: 011433970860
ContactId: ce70d475-7d98-4454-b915-bc70e5add84d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 618289 ms
Total Talk Time (AGENT): 366376 ms
Total Talk Time (CUSTOMER): 182840 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/ce70d475-7d98-4454-b915-bc70e5add84d_20250604T14:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. I've got, um, Miss, uh, [PII]. She's with NAS. She was working with Roxy and Misty. [PII] was the last person that talked to her about a claim for Miss [PII]. Um, let me give you the policy number. It's 257-093-0.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you said it, what was her name? Sorry.
[AGENT][NEUTRAL] The caller.
[CUSTOMER][NEUTRAL] Um, [PII], yes, [PII], she's with our NAS hot list.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Oh, I think we just made a payment on a claim from [PII].
[CUSTOMER][NEUTRAL] Yeah, I see that.
[AGENT][NEUTRAL] So last week.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] So what she, what she needing what's she calling about?
[CUSTOMER][NEUTRAL] OK, is it OK to?
[CUSTOMER][NEUTRAL] She just asked for [PII] because that's the last person that she talked to.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And with this group if they ask for somebody we automatically transfer them over if they're on the hot list.
[AGENT][POSITIVE] Missing not a problem.
[AGENT][NEUTRAL] No, yeah, that's fine. I was just trying to see since [PII] had already spoke to her that um like if she was available cause she would already know what's going on, but um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me pull up the notes real quick. Have you verified her? I'm assuming you have.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so she recently called to explain carcinoma in 2 stated that it is stage 0 and it's not spread.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Not covered under internal cancer.
[AGENT][NEUTRAL] them with definitions to email.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thanks, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Goodbye.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] I can now.
[CUSTOMER][NEUTRAL] Hello. I can now. Sorry, I had muted it. I'm there like, hello, can't you hear me? hello.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, I was holding for Misty because I spoke to her yesterday on this claim. Is she not available?
[AGENT][NEUTRAL] She's not. Um, so, I, I, I am.
[AGENT][NEUTRAL] So, um, I, I can help you if you would like or I can have [PII] contact you back if you would rather speak to [PII]. She's just not available at this time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you in, are
[CUSTOMER][NEUTRAL] [PII], are you in in cancer?
[AGENT][NEUTRAL] Um, yes, I, I do work in cancer.
[CUSTOMER][NEUTRAL] OK, so here's the question. So yesterday, yesterday [PII] and I spoke, I'm [PII] from NAS, by the way, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, [PII] and I spoke yesterday. There's a claimant that filed a cancer claim and the broker was all up in arms because she didn't get the
[CUSTOMER][NEUTRAL] The uh lump sum benefit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So in talking to [PII], she explained to me that because it was in Suru and it had not spread, no chemo or radiation was was um prescribed, yada yada, it is not payable, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, having said that, the lady is going into surgery.
[CUSTOMER][NEUTRAL] Um, tomorrow.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm assuming to have to have.
[CUSTOMER][NEUTRAL] Something else removed. I'm not quite sure, but the question posed to me was whether any post-surgery benefits would be payable under her policy, specifically in a case where the surgery is due to the breast cancer in situ.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So that is a good question. Let me go in and look at her surgical benefit to see if it has any exclusions for that specific um scenario.
[AGENT][NEUTRAL] So let's see here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So surgical benefit. So she does have a surgical benefit. So that's
[AGENT][NEUTRAL] We just need to make sure that it covers inset too, OK.
[CUSTOMER][POSITIVE] Please dot, dot your [PII]'s and cross your T's cause this broker is relentless.
[AGENT][POSITIVE] Yes, ma'am. I, I will definitely do all that I can and make sure we have a definitive answer.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK. You're very welcome.
[AGENT][NEUTRAL] OK, so under the surgical benefit.
[AGENT][NEUTRAL] It states that when a surgical operation is performed on a covered person for a covered diagnosis of cancer, skin cancer, or for reconstructive surgery due to cancer, then we consider benefits. Um, diagnostic surgeries that result in a negative diagnosis are not covered under the surgical benefit. It would be more like a screening. Um, let's see.
[CUSTOMER][NEUTRAL] OK. Say that again. Diagnosis surgery.
[AGENT][NEUTRAL] Diagnostic surgeries that result in a negative diagnosis of cancer.
[AGENT][NEUTRAL] So if they're going in to for diagnostic purposes, not therapeutic purposes, not because, you know,
[CUSTOMER][NEUTRAL] In other words, in other words, I thought.
[CUSTOMER][NEUTRAL] In other words, like uh removing a uh a lump that they think could be cancer.
[AGENT][NEUTRAL] Correct. Um, if it results in a, excuse me, in a negative diagnosis, it's not covered under that benefit. So, the surgical benefit would
[CUSTOMER][NEUTRAL] Under the cancer surgical benefit?
[AGENT][NEUTRAL] Yeah. Under the surgery benefit, it would not be.
[AGENT][NEUTRAL] Because the surgery is specifically for treatment related to cancer, yes. So, like a mastectomy or, you know, they go in and remove a lump, it is cancer. That's obviously therapeutic. Like we're wanting to get rid of that, so they go in and do that. Um, even skin cancer, you have positive skin cancer, they remove it, that's covered. So anything that results negatively as far as like
[CUSTOMER][NEUTRAL] Cancer.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, cancer is concerned, then it's not covered under surgery. Mhm. Um.
[CUSTOMER][NEUTRAL] It's not then it's not.
[CUSTOMER][NEUTRAL] OK, but if it's in situ, should, in situ doesn't make a difference because if it's still cancer, they just, it wasn't spread, then it would still be covered under the surgical benefit.
[AGENT][NEUTRAL] Right. And I'm going to um like confirm.
[AGENT][NEUTRAL] Let's see, for the purpose of benefits under this router, that's the first occurrence. I'm gonna look at our definition of cancer to see like if it has any um exclusions there as well regarding, because in the policy, you know, it just says cancer. Well, you know, in situ, while it's early stages, it is still cancer. So,
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] But uh looking at our definition, I do want to confirm that like when it comes to.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] The definition that it doesn't exclude in situ for some reason.
[AGENT][NEUTRAL] OK, so the disease which is manifested by malignancy in which there's uncontrolled growth, function or spread of cells in any part of the body. This includes cancer institu and malignant tumors.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, it includes cancer instituitu. So our definition of cancer includes in-situ. It's just for the first occurrence. That is where there was, it's not that it's not cancer, it's just that it doesn't meet the definition for internal.
[AGENT][NEUTRAL] Because it hasn't spread. So, it would be covered under surgery.
[CUSTOMER][NEUTRAL] You're talking about, you're talking about, you're talking about for the lump sum.
[AGENT][NEUTRAL] Yeah, for the lump sum. So the Cancer Institute because, right. So, and I know that Misty explained that. I saw her note on that. So she explained that. So, but it is included in our definition of cancer, which under the surgical benefit, it's just states that surgeries for like when an operation is performed for a covered diagnosis of cancer, and in situ does meet that definition.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So just strictly based off the information that I have in this call.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, it would be considered, you know, I can't obviously I can't guarantee payment because we don't have any of that yet, but based off of her having in situ, if that is what the surgery is for, then we would consider benefits, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] It, the only time we would not cover benefits again, is if it's a diagnostic surgery to remove an additional lump or something like that, and it results in a negative diagnosis of cancer. So it would just depend on what's going on there. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. I appreciate it.
[AGENT][POSITIVE] You're very welcome. Let us know if you need anything else.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] You have a great day, [PII].
[AGENT][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] All right. Bye-bye.