AccountId: 011433970860
ContactId: ebbe3551-d66b-46b9-8f24-67baeb9445a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1168369 ms
Total Talk Time (AGENT): 375394 ms
Total Talk Time (CUSTOMER): 283207 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/ebbe3551-d66b-46b9-8f24-67baeb9445a6_20250612T21:56_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, see, I've been diagnosed with uh skin cancer, a sar sarcoma, I believe uh.
[CUSTOMER][NEUTRAL] How, how does, I know it's not internal, how does that work? How, how are you paid? What do I need to turn in, whatever?
[AGENT][NEUTRAL] OK, um, who am I speaking with?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you what's a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] And do you have your policy number with you?
[CUSTOMER][NEUTRAL] I, well, hold on just a minute, I think, uh, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I believe it's 633-155 and you.
[CUSTOMER][NEUTRAL] 633155.
[AGENT][NEUTRAL] Let me look
[AGENT][NEUTRAL] And what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm not showing that one as your policy.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Would you like me to look you up by your social?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] With what now? I'm sorry, what?
[AGENT][NEUTRAL] With your Social Security?
[CUSTOMER][NEUTRAL] You can, yeah, um, [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me just a moment to look that up.
[CUSTOMER][NEUTRAL] Can you find it?
[AGENT][NEUTRAL] All right, um.
[AGENT][NEUTRAL] And what did you say your date of birth was? I'm so sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the address that we have on file?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much for verifying that with me.
[AGENT][NEUTRAL] Let me look up your policy and see what all you would need.
[AGENT][NEUTRAL] You will fill out the uh claim form, the cancer claim form, which you can find in our online portal or if you don't have an online portal you can go to [PII] claims and forms and then there's a cancer form that you can uh download and fill out. It will have a list of all the um papers you might need, including some examples.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me go ahead and look up your policy and see what you need for your skin cancer.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] What does skin cancer, what does it pay? Does it just pay the actual cost or?
[CUSTOMER][NEUTRAL] Or you know, to the doctor and all or how does that work? I know it's different from internal cancer.
[AGENT][NEUTRAL] Yes, and I'm unable to see um all of your policy documents so I will need to put in a request um to get your policy documents uploaded um to its entirety. I am seeing your original policy benefits.
[AGENT][NEUTRAL] Um, and this is just a verification of benefits and not a guarantee of coverage?
[AGENT][NEUTRAL] Uh, it looks like you're allotted chemotherapy and radiation treatment up to
[AGENT][NEUTRAL] Uh, $10,000.
[AGENT][NEUTRAL] Per calendar year with a hospital benefit of up to $400 that's a daily hospital benefit.
[CUSTOMER][NEUTRAL] But how does it work for skin cancer? It's different. I skin cancer different, but I mean, you know, I mean, this, uh,
[AGENT][NEUTRAL] You also
[AGENT][NEUTRAL] Then your internal.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's different from internal, is it not? I, I mean, you know.
[AGENT][NEUTRAL] It is, it is different, so internal will be the ones that would um.
[AGENT][NEUTRAL] That are uh inside as skin cancer is going to be an external cancer. Um, I'm not able to pull up your policy just yet, so I will need to
[AGENT][NEUTRAL] Go ahead and get in a ticket for that, um, but I can give you a list of everything that you would need to fill out a claim. It, you will still, uh, file the same cancer claim form as you would for an internal or an external.
[CUSTOMER][NEUTRAL] Is that the doctors, what the doctor says and every pathologist and all that, is that what you're talking about?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Right. And um do you have a pen and paper so I can give you your policy number?
[CUSTOMER][NEUTRAL] Uh, hold on, I'm on my cell phone. Hold on just a minute. I hope it hold on let me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I've had this policy a very long time. Give it to me, please. Give me the policy number.
[AGENT][NEUTRAL] OK. It's 6, can you hear me?
[CUSTOMER][NEUTRAL] Hello? Can you hear?
[CUSTOMER][NEUTRAL] Uh-huh, I can hear you.
[AGENT][NEUTRAL] OK. It's 633.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] 158.
[CUSTOMER][NEUTRAL] OK, that's almost what I gave. I had 633-155633158, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it doesn't pay.
[CUSTOMER][NEUTRAL] I just didn't know the difference in internal cancer and skin cancer, but the payment was.
[AGENT][NEUTRAL] Yes, and I'm unable to look into your policy. I'm unable to look in your policy document to see uh what your policy defines each one as. Um, I am putting a request in so that I will be able to see your uh policy certificate. Um, but in the meantime, I do have that cancer claim form, uh, and I can give you uh what all information you need to send in. Is that OK?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, when you have the claim, uh, when you have the claim form, you'll complete, um, all of the statements of the insured, that would be you, um, so that is section A.
[CUSTOMER][NEUTRAL] OK, go ahead, I'll write.
[CUSTOMER][NEUTRAL] I think I have a claim form already I believe I have one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I would go ahead and um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Download a new claim form because it's they it's probably it could have been updated since the last time you you printed one and we have our mailing address and everything on there as well mhm.
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] Can you mail me one, please? Can you mail it to me?
[AGENT][NEUTRAL] Sure, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but I can go ahead and give you what you need and then, uh, I can get ready to send you that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you will complete um your the statement that I mentioned earlier, that's sections A through D.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Section E isn't required, but it will help um the the processing, uh, go a little bit quicker.
[AGENT][NEUTRAL] You'll also need any sort of um documentation such, such as a pathology report.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, which shows that there was a surgery including biopsies or any uh new or initial or the initial diagnosis of cancer. So you will need that pathology report.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if you had any hospitalizations or surgery, um, or any type of, uh, therapy, chemotherapy or immunotherapy, radiation therapy or anything like that.
[AGENT][NEUTRAL] You will want the itemized bill.
[AGENT][NEUTRAL] From each provider that you saw, an itemized bill will have procedure codes on them. Sometimes you might have to ask for that. Um, sometimes they'll just give you a bill.
[CUSTOMER][NEUTRAL] I that that's the itemized bill from the doctor.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, if you had any surgeries or anything like that, you'll want an itemized bill with the procedure codes.
[CUSTOMER][NEUTRAL] Um yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you'll also want.
[CUSTOMER][NEUTRAL] If you would send me
[AGENT][NEUTRAL] Oh yeah, go ahead, um.
[CUSTOMER][NEUTRAL] OK, go
[CUSTOMER][NEUTRAL] No, you go ahead, that's OK.
[CUSTOMER][NEUTRAL] Also want to what?
[AGENT][NEUTRAL] Um, I was gonna say you also want the explanation of benefits. So if you have a primary insurance carrier and you're filing a claim through them as well, showing that some benefits were paid, um, if your primary insurance paid any benefits towards any of these services, they will typically send you a copy of an explanation of benefits showing what was paid. You'll need to send that in as well when filing a claim for this one.
[CUSTOMER][NEGATIVE] But why do you need to do that when it, when y'all pay?
[CUSTOMER][NEGATIVE] You don't, I mean, you pay besides what my insurance pays, don't you?
[AGENT][NEUTRAL] Right, but if you have another insurance that you're billing to as well or you're filing claim for as well, um, if they pay benefits on top of what your benefits are, we just need to show that um some benefits have been paid to you if you're filing under multiple insurances.
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Well, I, it would be it, I just have um medical insurance, you know, I don't have any other.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Anything else other than medical insurance, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, if you would mail me that form please, I appreciate it thank you no.
[AGENT][NEUTRAL] All right. Give me just, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It depends on for 2nd or 3rd opinion.
[AGENT][NEUTRAL] I'm sorry, you're breaking up. What did you say?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They pay for.
[CUSTOMER][NEUTRAL] 2nd or 3rd opinion, you know, diagnosis, 2nd or 3rd.
[AGENT][NEUTRAL] I wasn't
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I wasn't, I wasn't able to pull up that section of your policy, so I am putting in a ticket so that we'll be able to see all of your policy online. I was unable to see all of that. That's why I wasn't able to give you any of that information, um, so give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello? Are you still there?
[AGENT][NEUTRAL] Uh, yeah, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm looking for that claim form.
[AGENT][NEUTRAL] All right, let me see what's going on here.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Where is your office now? Y'all not in [PII] anymore, is that?
[AGENT][NEUTRAL] No, we're in we're in [PII], which is why I suggested you get a new, uh, claim form because it'll it'll have all of that information on there.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, let me see here.
[AGENT][NEUTRAL] All right, let me get this done and then we'll be good to go. Uh, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mail it to me, OK? Just mail it to me. You have my address, thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. You.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][POSITIVE] Oh, that's all. Thank you, ma'am. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So uh
[CUSTOMER][NEUTRAL] So yeah.
[CUSTOMER][NEUTRAL] uh.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I, I, I'll move right on.
[CUSTOMER][NEGATIVE] Uh but I didn't get up this.
[CUSTOMER][NEUTRAL] You know, but we did. I was going in the.
[CUSTOMER][POSITIVE] I like.
[CUSTOMER][NEUTRAL] you'll.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] that.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEGATIVE] He drove somebody. I don't thank you for.
[CUSTOMER][POSITIVE] But if you don't do it, I like it.
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][POSITIVE] They you got for me.
[CUSTOMER][POSITIVE] Well, I guess I do. I would say the way that the way that they vote and bring me to my back.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] What is what is.
[CUSTOMER][NEGATIVE] Be off.