AccountId: 011433970860
ContactId: f7f9fdb1-669c-4924-a9d4-a20c2e3ff6eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1031469 ms
Total Talk Time (AGENT): 567637 ms
Total Talk Time (CUSTOMER): 253964 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/f7f9fdb1-669c-4924-a9d4-a20c2e3ff6eb_20250314T14:22_UTC.wav
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[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling to check on my benefits with y'all.
[AGENT][NEUTRAL] OK, I can help you with your benefits. Can you please give me your policy number?
[CUSTOMER][NEUTRAL] I don't have my policy number.
[CUSTOMER][NEUTRAL] I can give you all my other information, but I couldn't find my policy number.
[AGENT][NEUTRAL] OK, I can look
[CUSTOMER][NEUTRAL] You can look it up.
[AGENT][NEUTRAL] OK, I can look it up with your social.
[CUSTOMER][NEUTRAL] OK, [PII], excuse me, [PII].
[AGENT][NEUTRAL] OK, let me look it up real quick.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and let me get to the other screen real quick.
[AGENT][NEUTRAL] And then also can you verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And then one last verification, can you give me your email address?
[CUSTOMER][NEUTRAL] Oh sorry it's [PII].
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] It looks like I have your um work email.
[CUSTOMER][NEUTRAL] OK, it's [PII]. Yes, cause I have this through work. Yeah, that's it. [PII].
[AGENT][NEUTRAL] OK, yes ma'am.
[AGENT][NEUTRAL] OK, thank you and if our call happens to get disconnected.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Is that a good call back number for you, the one the phone number that you gave me? OK.
[CUSTOMER][NEUTRAL] Yes it is.
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Let me pull up your policy certificate real quick so I can give you benefit information.
[AGENT][NEUTRAL] On me just a second for the computer to pull it in.
[CUSTOMER][NEUTRAL] OK, and in just a second, is it OK if I let you talk to my son who's here about all this?
[AGENT][POSITIVE] Yeah, absolutely, if that, um, as long as I have your consent, that's fine, yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you guys both there?
[CUSTOMER][POSITIVE] Yes, we're here we're both here.
[AGENT][NEUTRAL] Oh, OK, OK, I'm sorry. All right. And this is just to verify your benefits.
[CUSTOMER][NEUTRAL] We were both waiting on each other, I think.
[AGENT][NEUTRAL] I think so too. OK, this is to verify benefits and it's not a guarantee of payment, so you, this is your cancer plan benefits and also you can also see um what I'm looking at.
[AGENT][NEUTRAL] If you go to our uh website, the online service center, it's a direct portal to your policy. Let me give you that address too because you can also file claims from there.
[AGENT][NEUTRAL] It's um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's [PII]
[CUSTOMER][NEGATIVE] You're breaking up.
[CUSTOMER][NEUTRAL] I'm sorry, you just, you were breaking up. What's that again?
[AGENT][NEUTRAL] [PII] [PII]
[CUSTOMER][POSITIVE] OK, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And what's my policy number?
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Let me get that to you real quick.
[AGENT][NEUTRAL] Your policy number is 253.
[AGENT][NEUTRAL] 3866.
[CUSTOMER][POSITIVE] 386-62533866. OK, perfect. Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. OK, so reading the benefits from your schedule of benefits, um, you have radiation therapy, chemotherapy, and immunotherapy. Maximum per covered person for a 12-month period is $10,000.
[AGENT][NEUTRAL] You have hormone therapy um per treatment up to a maximum of 12 treatments per covered per per calendar year of $50.
[AGENT][NEUTRAL] You have um miss.
[CUSTOMER][NEUTRAL] Of how much
[CUSTOMER][NEUTRAL] 50,000 you said?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] $50 per treatment.
[AGENT][NEUTRAL] Yes, maximum up to 12 treatments per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, you have, if you have a mastectomy.
[AGENT][NEUTRAL] You have um a confinement per day.
[AGENT][NEUTRAL] In the hospital of $50.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Sur per surgery, you have $25.
[AGENT][NEUTRAL] Surgical or non-surgical prosthesis, maximum of 1 device per site per covered person is $25.
[AGENT][NEUTRAL] You have ovarian cervical cancer screening of $10.
[AGENT][NEUTRAL] Uh, you have a, well, we just went over that. It's in there twice, prosthesis and orthotic benefit of surgical or non-surgical of $25.
[AGENT][NEUTRAL] OK, so you have internal cancer first occurrence lump sum benefit is $2500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's a maximum of.
[CUSTOMER][NEUTRAL] $2500.
[AGENT][NEUTRAL] Yes, it's a maximum of one per covered person per lifetime.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have cancer screening benefit rider on this for diagnostic.
[AGENT][NEUTRAL] You get 1 test per covered person per calendar year of $50.
[AGENT][NEUTRAL] A follow up diagnostic testing, the maximum of 1 test per covered person per calendar year of $100.
[AGENT][NEUTRAL] Medical imaging per test up to maximum of 1 test per covered person per calendar following the diagnosis of cancer is $500.
[AGENT][NEUTRAL] And then you also have a surgical benefit rider. Um, unit dollar amount is $30 maximum per operation is $3000.
[AGENT][NEUTRAL] Bone marrow transplant plant maximum per covered person per lifetime is $6000.
[AGENT][NEUTRAL] Stem cell transplant, maximum per covered person per lifetime is $600.
[AGENT][NEUTRAL] Your surgical implantation for prosthesis, maximum 1 device per site per covered person per lifetime is $1000. Non-surgical, it does not include a hairpiece. Maximum 1 device per site per covered person per lifetime of $100.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You also have uh.
[AGENT][NEUTRAL] Patient care benefit rider that you got on this policy for hospital confinement per day of hospital confinement is $100.
[AGENT][NEUTRAL] Outpatient facility per day surgery is performed as $200.
[AGENT][NEUTRAL] For the attending physician per day of hospital confinement is $30.
[AGENT][NEUTRAL] Dread disease per day of hospital confinement is $100.
[AGENT][NEUTRAL] If you have to go to an extended.
[AGENT][NEUTRAL] Care facility per day up to the same number of hospital confinement days is $100.
[AGENT][NEUTRAL] A home healthcare per day up to the same number of hospital confinement days as 100.
[AGENT][NEUTRAL] Hospice care per day up to a maximum of 365 days per covered person per lifetime is $100.
[AGENT][NEUTRAL] A US government charity hospital or an HMO maximum per day of hospital confinement is $100.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so, just as a question, so she one, almost to the day 1 year ago, she was diagnosed with an ovarian cyst that was malignant. Um, and so that was surgically removed, hospital confinement for several days. Is she passed the point to where she could submit a claim for those things?
[AGENT][NEUTRAL] Absolutely not no sir um so we do not have a timely filing limit for our claims so as long as you were covered on the date of service you can file a claim at any time.
[CUSTOMER][NEUTRAL] Being a year out
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that is that all done on that secured a public website?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and what kind of documentation do you guys typically require for those claims?
[AGENT][NEUTRAL] She's going to need um to get uh initial uh diagnosis of cancer.
[AGENT][NEUTRAL] She'll have to get the pathology report for that?
[AGENT][NEUTRAL] And then um I'm gonna go into the website and pull up the claim form because it has a little cheat sheet on the claim form that tells you that first page will do everything that you need to send in with your claim.
[CUSTOMER][NEUTRAL] Oh, does it? OK.
[AGENT][NEUTRAL] Um, she'll need the pathology report, uh, with the initial diagnosis, an itemized bill from each medical provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] An explanation of benefits from the major medical insurance, medical carrier.
[AGENT][NEUTRAL] If if you have one.
[AGENT][NEUTRAL] Uh, itemized invoices if you have travel and lodging, uh, and that's for 50 miles or more away from your home.
[AGENT][NEUTRAL] The operative report.
[AGENT][NEUTRAL] For the surgery.
[AGENT][NEUTRAL] And any uh copies of the prescription?
[AGENT][NEUTRAL] For chemotherapy, hormone therapy, or pain and anti-nausea medicines?
[AGENT][NEUTRAL] And then you'll also need to fill out the cancer claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when you go into that online service center that first page will tell you all the things that I just.
[CUSTOMER][NEUTRAL] All of that
[AGENT][NEUTRAL] Yes, that way if you get lost, you can go back and refer to it.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] Perfect. Um, and so again with that being said, so that, that would be a like a retroactive claim. So we, she is going in for, we unfortunately have test results again that are more than likely going to result in hormone therapy and do we are all the claims retroactive or can they be started now prior to it sounds like they all need documentation and it's retropaid.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. The only thing that's retro paid is anything before the date of today. Um, you just send in your claim. The claims examiner will process the claim. And then now, if she needs hormone therapy, you send those in, um, each day of service that you have your hor hormone therapy unless you wanna like, uh we have some people that hold them for a little while, for like a month and they send a month in at a time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, um, and then I think probably my last.
[CUSTOMER][NEUTRAL] Well, 22 questions. So one, the if, if, OK, so when we submit all of that information, do we have to like identify what what we're trying to claim or does the claims person kind of read through it and say oh she's eligible for like the medical imaging she's eligible for all of that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claims examiner will look through all of that based on the information sent in for the claim and based on what policy certificate reads.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK, and then I this is my last question, so when, when or if that is ever approved, um, is that money sent directly to her account or is it applied to.
[CUSTOMER][NEUTRAL] A bill or how how is payment done for those things?
[AGENT][NEUTRAL] So if you're filing the claim yourself and no medical uh facility is filing of course if the medical facility files it'll go to the medical facility um when an individual files it'll go to the individual and you have an option in that online service center to have it direct deposited if you would like and it'll be cut in a check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. OK, I said I have 11 question. The last question, um.
[CUSTOMER][NEUTRAL] What is the typical approval or denial on a claim? Is it like 30 days or how long can it typically be expected once everything is actually submitted?
[AGENT][NEUTRAL] Right, once we get everything that we need for the claim, it takes about 15 days to finalize the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um, I'm sorry, the, so on the secured a in public to make an account we just need the policy number or is there anything else that we need specifically to start that account?
[AGENT][NEUTRAL] You'll just need to go in that first um page you're gonna sign up.
[AGENT][NEUTRAL] There's a new user.
[AGENT][NEUTRAL] And then the 2nd page you're gonna click on I am an individual with an APL policy.
[AGENT][NEUTRAL] And then you uh will figure out what you want to use for your username and password and then you're in.
[CUSTOMER][POSITIVE] OK. All right. Well, I think that is what we needed, um, but I do appreciate you taking the time to go through all that with us.
[AGENT][POSITIVE] Not a problem at all. I enjoyed talking with you guys and I'm so happy I was able to help you um make some sense of it all um and look if you guys get in there and you feel like you need extra help, just call us and we'll walk you through it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK will do thank you so much I really appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome. Uh, you're so welcome. I hope you guys have a wonderful weekend. Thank you for calling APL. All right, bye bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too.