AccountId: 011433970860
ContactId: 043d1207-e57a-41f5-8cce-6b1a26b64b85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 668880 ms
Total Talk Time (AGENT): 238551 ms
Total Talk Time (CUSTOMER): 208116 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/043d1207-e57a-41f5-8cce-6b1a26b64b85_20250311T18:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII]. How are you doing?
[AGENT][POSITIVE] Hi [PII]. I'm good, my [PII].
[CUSTOMER][POSITIVE] Good. Good. I was in the middle of coffee when I got this call, bless him. I hope he can understand me. Sorry honey, I have policy number 781-949.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] He just needs claims assistance or whatever.
[AGENT][NEUTRAL] OK. All right, um, who?
[CUSTOMER][NEUTRAL] I verify this information.
[CUSTOMER][NEUTRAL] It's participant number one [PII].
[AGENT][NEUTRAL] And it's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, and his callback number is the same as what we have on file.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can give that to you though if you like.
[AGENT][NEUTRAL] I see it.
[CUSTOMER][POSITIVE] OK, dear. Oh he's very nice.
[AGENT][NEUTRAL] OK, and he's
[AGENT][NEUTRAL] Oh and he just wants claim status is that right?
[CUSTOMER][NEUTRAL] Well, kinds of assistance, really, I think he's uh
[CUSTOMER][NEUTRAL] I think he's trying to file a claim, a preventive claim or something on his policy. Is that something you all help with?
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yeah, I can help him with that.
[CUSTOMER][POSITIVE] Oh, you're awesome. Thank you, [PII].
[AGENT][NEUTRAL] You're welcome, [PII].
[CUSTOMER][POSITIVE] Have a good day, sweetie. Bye dear.
[AGENT][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Hello Mr. [PII], this is [PII] with the care team.
[AGENT][NEUTRAL] So [PII], let me know that you need help filing a claim. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, perhaps got a few questions to make sure I kinda understand this. Uh, I've had this looks like since [PII] and um I have representatives who have told me, uh, about the, the wellness, uh, preventive, uh, all that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, can you kinda tell me more about the, the wellness claim and, you know, the preventive test? Um, what, what, what, what makes it beneficial for me?
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK, let me, I'm gonna pull in your policy real quick and see what it says about.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] How it helps you with that. Um, it's gonna be just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I can pull it in the computer is gonna need to download it and I'm gonna need to look over it real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] While you're looking at, I, I think the word claim kind of.
[CUSTOMER][NEGATIVE] Scares me off a little bit.
[CUSTOMER][NEGATIVE] You know I I I didn't want, you know, I, I didn't want the, you know, the premium to go up or.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Anything like that.
[AGENT][NEGATIVE] Oh no, it won't happen.
[AGENT][NEGATIVE] No, that won't happen.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] No, it doesn't go up just because you filed the claim. You pay your premiums a month so that you can file a claim.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] If you ever need to use it.
[AGENT][POSITIVE] And my computer is being very slow and I apologize for that. It's just taking its sweet time thinking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] These older policies are, um.
[AGENT][NEGATIVE] You have to load one page at a time.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK, so this is what your policy reads. Each calendar year we will pay the indemnity amount shown in the schedule of benefits for each person who receives a screening test that is generally medically recognized to detect internal cancer including but not limited to.
[AGENT][NEUTRAL] A mammogram, breast ultrasound, breast thermography, breast cancer, colon cancer blood test.
[AGENT][NEUTRAL] A specific antigen blood test, flexible synoscopy, colonoscopy, virtual colonoscopy, ovarian cancer blood test, Pap smear, chest X-ray, hemocult, stool specimen.
[AGENT][NEUTRAL] Or a serum pro uh blood test for myeloma and a thin prep Pap test. So, um,
[AGENT][NEUTRAL] Let me look at your policy and see what that benefit amount per calendar year is.
[AGENT][NEUTRAL] And this is just to verify your benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] Let's see I'm applying your schedule benefits.
[AGENT][NEUTRAL] And that's gonna be on page.
[AGENT][NEUTRAL] This is a very large policy. It has a lot of pages in it, sir.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And keep on going, trying to get that dollar amount, it doesn't seem to be in order, so let me keep looking.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I wanna say the representative has told me $50. I don't know if that's just.
[CUSTOMER][NEUTRAL] Uh, I don't, I don't know the details of it. I don't know if it's per test or all together.
[CUSTOMER][NEUTRAL] For one year I, I don't know.
[AGENT][NEUTRAL] It's um
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me look, let's see, I've got it right here.
[AGENT][NEUTRAL] OK, it's $50 per calendar year for wellness, so the test that you do pays $50 per calendar year. It's not per test.
[CUSTOMER][NEUTRAL] All right, so it's $50 per calendar year and it doesn't matter how many tests that are done in that time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Now, uh,
[CUSTOMER][NEUTRAL] My wife went last year, well, she's been the last couple of years and had, you know, mammogram, a few other tests done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, she took, she, I was given this form from the representative it's a printed form, and she gave it to doctor's office and she said they acted like they didn't, they never seen this before and they, they didn't know why she had it and uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Uh, all I have, yeah, all I have on the form is just what what test was done and the date.
[CUSTOMER][NEUTRAL] Um, I don't have any other information besides that.
[CUSTOMER][NEUTRAL] Um, and there's various dates she had tests done. Go ahead.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Um, definitely file a claim with it.
[AGENT][NEUTRAL] And um ask the facility that you guys went to for an itemized statement.
[CUSTOMER][NEUTRAL] I my statement.
[AGENT][NEUTRAL] And send that in with the client.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Out of my, I guess just fax it or what?
[AGENT][NEUTRAL] You can fax the claim in or if you wanted to sign up for the online service center you guys can do it electronically.
[AGENT][POSITIVE] You can fax send it electronically or even mail it whichever you prefer.
[CUSTOMER][NEUTRAL] OK. Ama, OK.
[CUSTOMER][NEUTRAL] Alright, and like I said, it's $50 per calendar year, OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] All right. All right, well, that, that, that helps, so I appreciate it.
[AGENT][POSITIVE] OK. You're so very welcome, Mr. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Mm, no, ma'am, that's it.
[AGENT][POSITIVE] OK, well we appreciate you being an APL customer and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You too. Thank you so much.
[AGENT][POSITIVE] You're welcome, sir. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.