AccountId: 011433970860
ContactId: fd050490-1bdd-4b73-bbad-f574a062858e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 783419 ms
Total Talk Time (AGENT): 399951 ms
Total Talk Time (CUSTOMER): 236025 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/fd050490-1bdd-4b73-bbad-f574a062858e_20250616T21:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am. I, um, I have insurance through y'all. I have no idea what, which benefit it is. Uh, my wife has just been diagnosed with
[CUSTOMER][NEUTRAL] Um, a brain tumor that they're gonna have removed in about a week. Um, so I'm not even sure how to start this process. There, it hasn't been 100% confirmed that it's cancer, but it is very likely based on the, we're at [PII] [PII] in [PII], and based on what they're saying is most likely it is, they, they can't, they won't know for sure until they take it out and they know exactly what the next step, yeah, it's gonna be.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the biopsy it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but I know I have insurance with you. I just don't know if it's the, uh, plan one or two. I know it's a family plan. I know I've had it for a few years, um, and stuff, so I don't know where to start.
[AGENT][NEUTRAL] OK. And
[AGENT][NEUTRAL] Uh, what's your name?
[CUSTOMER][NEUTRAL] My name is [PII] or [PII].
[AGENT][NEUTRAL] And what's a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have any of your policy numbers with you?
[CUSTOMER][NEUTRAL] I think I do. It's with Burleson ISD.
[CUSTOMER][NEUTRAL] Is it a 5 digit number?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Or is it more than that?
[CUSTOMER][NEUTRAL] Yeah, I have a group policy number. It's 5 digits.
[AGENT][NEUTRAL] OK, what is the, well the
[AGENT][NEUTRAL] That's probably your group number. Um, does it say a policy certificate number or uh benefits number, anything like that on the card?
[CUSTOMER][NEUTRAL] Yeah, that's what it is.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Inpatient, outpatient benefits?
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] I don't necessarily have a card to be honest with you.
[AGENT][NEUTRAL] Oh, OK, that's OK. Um, and you're the primary policy holder, correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, what is your social and I can look it up that way.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Did you say [PII] or [PII]? I'm sorry.
[CUSTOMER][NEUTRAL] It's neither is [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] I knew I heard something, but I knew I didn't get it right, so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me just a second.
[AGENT][NEUTRAL] And can I get you to verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the address that we have on file for you?
[CUSTOMER][NEUTRAL] Should be [PII].
[AGENT][NEUTRAL] OK, thank you so much. It does look like you have a cancer policy with us. Um, did you want me to give you that policy number and you can write it down?
[CUSTOMER][POSITIVE] Yeah, if you don't mind, I appreciate it.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] It's um are you ready?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, it's 02.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] 521-902.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So 02521902
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Is that right? Which one is it? Is it? I don't know what the difference is anyway. I know there's two options. There's plan 1 and plan 2. Which one do we have?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] There's this level one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Alright, and would you like me to go over some of the benefits that you have for this?
[CUSTOMER][NEUTRAL] I, I don't even know what to go over to be honest with you. I just, we, we just left the neurosurgeon and we're just like, OK, I, I knew I had a plan and I pulled up the what information I could find, but I couldn't get to my detailed information because I'm in [PII] and um I just, what do I need to do is my first question.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, here's what um I would do is I would go I would create an online portal account that way you're able to access all of your policy documents so that once you're ready, um, you can look and see everything that this policy has to offer you and it's all laid out right there in print with benefit amounts and everything um if you'd like I can send you an email of how to get that started so that you don't have to uh work.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And um I have uh [PII]. Is that still the one you'd like to use? OK, so when you do create an online account, it's not gonna say this in the email um you will need to use that email that we have on file.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And when you go to the website to um create a new account.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll click on insured because that's that's who you're filing for um or creating an account for an insured only fill out the boxes that are required, which is just your last name, email, and date of birth. Um, I wouldn't fill out all of the extra stuff um I've been hearing that some people are getting some error messages that way um so only fill out what's required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then that way you'll also be able to see all of your policy documents um.
[AGENT][NEUTRAL] And anything like you if you do end up filing a claim you can file a claim online through that service center you can check the status of those claims and again if you if you don't understand how the the claim is if it gets denied or anything like that or if it needs more information, you can still give us a call and we can still go over it with you but um this way you'll have it right there um in a way to access it.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] So I'm assuming I file claims after the fact or before the fact?
[CUSTOMER][NEUTRAL] Like right now, like I said.
[AGENT][NEUTRAL] Um, since this is a cancer policy, I believe if she had some medical testing done, it could be covered. I have the policy pulled up. Let me see.
[AGENT][NEUTRAL] Um, like it does have plan, uh, it does have amounts for after, should it be diagnosed as cancer. It does have benefit amounts for that. Um, and then,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That I can go back and claim certain things?
[AGENT][NEUTRAL] Right and we don't have timely filing limits so if you are ever waiting on any of the paperwork or anything like that um we don't have timely filing so as long as the policy was active at the time of service, uh, we will honor those benefits, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You do have diagnostic testing and follow-up testing covered on here. And then um medical imaging testing such as MRI's or uh PET or CAT scans, anything like that. Um, those are covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, we've had several already.
[AGENT][NEUTRAL] Well, those are covered um following the diagnosis of cancer. However, the diagnostic testing for the cancers, um, obviously, it's to diagnose cancer. Those will be paid regardless, um, such as a mammography or anything like that. Um, but should she end up getting cancer and needing, um,
[CUSTOMER][NEUTRAL] It's like
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Any sort of imaging, testing, MRI's or anything like that, uh, they will pay a benefit for that. It does have like a surgical benefit amount and some anesthesia.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But probably not for her surgery next week.
[AGENT][NEUTRAL] It does have surgery on here, but I believe it has to be after.
[CUSTOMER][NEGATIVE] We won't be able to get anything.
[AGENT][NEUTRAL] Uh, cancer has been found.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEGATIVE] So it won't go back and pay for this initial surgery.
[AGENT][NEUTRAL] I don't believe so, but let me double check.
[CUSTOMER][NEUTRAL] Because, because they, they, because of the size of it, they're, they're not gonna do a biopsy, they said it just, it has to come out.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And because of the aggressiveness, all the different tests they did, and because of the blood flow and all this stuff that I don't know how to explain, they said it has to come out like now.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] It looks like that there is a follow-up diagnostic testing benefit, um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm trying to decipher it from this, uh, a lot of it is dealing with breast cancer, so I'm trying to weed out that. Um, but there is a follow-up diagnostic testing and it does say, uh, that we'll pay the indemnity amount shown um for one follow-up invasive screening test, which is a test involving an incision or surgery. Um, that is, uh, a benefit amount of um of, uh, I believe it's $100.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For the follow up testing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but as for surgery before the fact.
[AGENT][NEUTRAL] It looks like it will need to be for the diagnosis of cancer.
[CUSTOMER][NEUTRAL] Well, I, I'm, I'm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So all the stuff right now, it's not gonna cover anything until they officially say it's cancer and then everything after that, they'll cover a lot of that.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I mean, I'm, I'm being very general, yeah.
[AGENT][NEUTRAL] Right, right, and I get that.
[CUSTOMER][NEGATIVE] Alright, it won't go back and reimburse me for everything leading up to it.
[AGENT][NEUTRAL] Right. I would still contact, uh, I would still check with your, your primary medical insurance as this is supplemental, and I would see if your primary will pay for any of that up until then.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well they'll pay for some but.
[CUSTOMER][NEUTRAL] Alright, um, send me the link and then I'll.
[AGENT][NEUTRAL] And give me just
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We'll start the process.
[AGENT][NEUTRAL] Alright, and just to make sure I have [PII].
[AGENT][NEUTRAL] And I am sending that.
[AGENT][NEUTRAL] Now, if you don't see it within 5 to 10 minutes, I would check your spam, um.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But then once you, once you register, um, it will be for the primary insurance holder, um, and use that email that we sent, I sent that uh form to or that uh link to and only fill out the required information and then you'll be able to see your policy documents and everything like that. Um, once you get your policy document, to have all of the numbers and everything laid out as I had mentioned, um, you'll go to your schedule of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][MIXED] And that will have everything kind of laid out, um, and easy to read kind of plain sight and then it has definitions as well, but your schedule of benefits starts on page 23.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, you were very helpful and then I'll have a better a little better understanding. I'll start the process and uh we'll go from there.
[AGENT][POSITIVE] Alright, well, if there's nothing else, thank you for calling ATL and I hope you have a great week OK?
[CUSTOMER][POSITIVE] All right, thank you, take care.
[AGENT][NEUTRAL] Right, right, bye.
[CUSTOMER][NEUTRAL] Bye.