AccountId: 011433970860
ContactId: dd391892-08a6-4fbf-b80a-a9562d5df992
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 886239 ms
Total Talk Time (AGENT): 320030 ms
Total Talk Time (CUSTOMER): 310773 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/dd391892-08a6-4fbf-b80a-a9562d5df992_20250418T18:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi [PII], my name is [PII]. I have, uh, the APL, and I understand there's some sort of extra cancer writer, and I wanted to know what was involved with that.
[CUSTOMER][NEGATIVE] Because I have, I've been diagnosed with cancer.
[AGENT][NEUTRAL] Well,
[AGENT][POSITIVE] Oh, OK. Yeah, I'm happy to check on that. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] Well there's two numbers there's the in hospital and outpatient. I'll give you the outpatient, I suppose, 024.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 78752.
[CUSTOMER][NEUTRAL] M as in Mary. L as in Lima 8.
[AGENT][POSITIVE] OK, thank you so much. Let me pull this up.
[AGENT][NEUTRAL] And then if I could verify, please, uh your name and date of birth?
[CUSTOMER][NEUTRAL] Uh, my name is [PII] [PII].
[AGENT][NEUTRAL] Thank you. And then Mr. [PII], can you verify please, your physical address that we should also have on file?
[CUSTOMER][NEUTRAL] Um, it's [PII].
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] OK. Let me just pull your policy certificate here and we can take a look at it and any writers that were added.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So it looks like the writer, the purpose of this, it does not supply um drugs or anything like that. It only is covering
[AGENT][NEUTRAL] Um, treatment in the facility.
[CUSTOMER][NEUTRAL] What about like consultations with specialists? Like normally with uh Blue Cross there's a $35 copay. If it's for cancer, do they pick that $35 up or is it only for a procedure?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if it says anything about the actual visit.
[CUSTOMER][NEUTRAL] There's, you know, you know what understand what I'm saying.
[AGENT][POSITIVE] Yeah, absolutely, absolutely.
[AGENT][NEUTRAL] So it looks like.
[CUSTOMER][NEUTRAL] Because what APL does is.
[AGENT][NEUTRAL] The benefit for the cancer is for the treatment.
[CUSTOMER][NEUTRAL] Mhm. So
[AGENT][NEUTRAL] Um, so it's not, it wouldn't, it would just be for the treatment, not the office visit. I don't know.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then it looks like the secondary that you have with us, just without the additional writer on it.
[AGENT][NEUTRAL] It's pretty much the same as far as it does cover treatment but not the physician office visit fee.
[CUSTOMER][NEUTRAL] So this is above the regular secondary. For example, I have a PET scan coming up that has an out of pocket with Blue Cross for 500. My experience is that um
[CUSTOMER][NEUTRAL] The secondary with APL we're gonna pick up 300 of that remaining of that 500. Does that sound right?
[AGENT][NEUTRAL] Correct, yeah. Cause like a PET scan would be considered like um imaging or treatment. Yes. Yes.
[CUSTOMER][NEUTRAL] OK. So for cancer treatment, what is the cancer part pick up?
[AGENT][NEGATIVE] So they can't
[CUSTOMER][NEUTRAL] And you can use that as an example too.
[AGENT][NEUTRAL] Yeah, so, yeah, exactly, um.
[AGENT][NEUTRAL] So on the that portion of it, the outpatient benefit maximum is $300 per day per covered person per calendar day.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, so that's the, that's the usual secondary, um.
[CUSTOMER][NEUTRAL] What extra features does the cancer writer have in that case or for any of the subsequent treatments?
[CUSTOMER][NEUTRAL] You know, surgery, radiation, whatever.
[CUSTOMER][NEUTRAL] I was thinking maybe from what you said that the regular secondary picked up 300 and because it was cancer maybe they picked up maybe the cancer writer picked up the rest or maybe I don't know what it is.
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] Yeah. So the, the secondary itself really, in the beginning part of it is just for the hospitalization and hospital benefit, and then any sort of like treatment in hospital. And then when you scroll down, that's the portion where you're talking about like the additional writers that have been added on.
[AGENT][NEUTRAL] So, the outpatient benefit maximum, the $300 per cover day per calendar day is gonna apply to any sort of treatment that you're receiving for cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I'm fine. I understand that and, and that's I've been dealing with this, so that's what I was expecting. I'm trying to figure out what extra benefit that the cancer gets cancer life gets you.
[AGENT][NEUTRAL] The cancer writers giving you the additional benefit of the $300 per covered day. Um, without the writers on there, the plan would have just been for hospitalization.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] That's interesting, um.
[CUSTOMER][NEUTRAL] Well, I guess I, I guess I've been dealing with the cancer so long I don't remember.
[CUSTOMER][NEUTRAL] Before that, so, so you're saying for outpatient services without the cancer thing you APL doesn't pay?
[AGENT][NEUTRAL] When you look at the policy certificate for just the med link, it's showing, and that's the secondary.
[AGENT][POSITIVE] It shows benefits for uh the in-hospital.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] In hospital, um, in hospital treatment, and that's it. That's the base policy.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Before a year ago.
[CUSTOMER][NEUTRAL] A little, a year and a half ago, I didn't have cancer, but I still had neurology problems and I had
[CUSTOMER][NEUTRAL] Not PET scans, but I had.
[CUSTOMER][NEUTRAL] Various scans, um.
[CUSTOMER][NEUTRAL] And I always thought that APL picked up $300 of that and you're saying that it only picks up the $300 if you have the wire is is that.
[CUSTOMER][POSITIVE] Correct, my understanding you.
[AGENT][NEUTRAL] C
[AGENT][NEUTRAL] Correct, yeah, because the writer benefits in your policy are further down, and that's what you're seeing where you see that outpatient benefit maximum $300 per covered person per day.
[AGENT][NEUTRAL] And then down below, it shows that you have like urgent care, surgery, um, physical therapy, and then, yeah.
[CUSTOMER][NEUTRAL] OK, um, and what about the benefits for in hospital because I'm gonna be in the hospital also.
[CUSTOMER][NEUTRAL] Is that what is the extra benefit?
[CUSTOMER][NEUTRAL] What is the benefit for APL for if you're.
[CUSTOMER][NEUTRAL] In a hospital.
[AGENT][NEUTRAL] The in-hospital benefit maximum is $3000 per covered person per uh per confinement.
[CUSTOMER][NEUTRAL] For what?
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEGATIVE] So you're saying if I have an out of, you know, a co-pay, whatever you call co-insurance for Blue Cross Blue Shield that leaves me with $4000 out of pocket that APL will pick up $3000 of that.
[AGENT][NEUTRAL] That's the max that we're gonna cover for, yeah, deductible, co-pay, co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's very interesting. Um, and, and is there something extra though that due to the cancer?
[CUSTOMER][NEUTRAL] So far it doesn't sound like the cancer.
[CUSTOMER][NEUTRAL] Wired says anything extra but maybe I'm not understanding it.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yeah, I'm looking here, sorry.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No my earpods are.
[CUSTOMER][NEGATIVE] No, sorry.
[AGENT][NEUTRAL] So yeah, when I look at
[AGENT][NEUTRAL] The
[AGENT][POSITIVE] Additional benefits further down.
[AGENT][NEUTRAL] All those benefits are for an outpatient or it looks like emergency room.
[AGENT][NEUTRAL] Type situation.
[AGENT][NEUTRAL] Um, let me see what the, so surgery in a in a hospital outpatient facility or freestanding surgery center, it looks like there is that, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] The surgery benefit would only be applicable if it were considered, it looks like on an outpatient basis. The writers down below don't, I'm not seeing anything additional here if you're considered like on an inpatient basis.
[CUSTOMER][NEUTRAL] So there's nothing extra.
[CUSTOMER][NEUTRAL] There's nothing extra on the cancer with in hospital only for outpatient and the outpatient would be.
[CUSTOMER][NEUTRAL] If I didn't have cancer, the outpatient wouldn't pay, but because I have cancer, it's been 300. I'm trying to.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Get an idea of.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What is
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, for now I'm having consultations and it sounds like you're pretty sure that it doesn't pay anything and I didn't think it did for office visits.
[AGENT][NEGATIVE] Yeah, unfortunately, I don't see that.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is the cancer writer information that you can send me that I could read this for myself?
[AGENT][POSITIVE] Yeah, absolutely. I can send it to you in the US postal mail or I can email it to you really whatever is more convenient for you.
[CUSTOMER][NEUTRAL] Oh certainly email it, um, do you have my email on file?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I believe so. Let me just verify that. Let me see what we have here. Oh, actually we don't, I apologize. So you can give me a good email when you're ready.
[CUSTOMER][NEUTRAL] Probably not.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] like my name.
[CUSTOMER][NEUTRAL] Then [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So I will definitely um email all this information to you so then that way you have it Mr. [PII] for your records it's much easier like you had said to to reference that so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need me to check on anything else for you today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you.
[AGENT][POSITIVE] You're very welcome thanks for calling APL.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Bye-bye.