AccountId: 011433970860
ContactId: 06860cbc-5ba5-4ff5-8dbf-49d1b43d481f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 605299 ms
Total Talk Time (AGENT): 176617 ms
Total Talk Time (CUSTOMER): 265893 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/06860cbc-5ba5-4ff5-8dbf-49d1b43d481f_20250404T16:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], uh, this is [PII] from the care team. I've got a, a spouse on the line, um, asking about, uh, how this claim will pay out.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is 1415882.
[CUSTOMER][NEUTRAL] And I've got Francia on the line. I verified all the information.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So she's resubmitted on the portal.
[CUSTOMER][NEUTRAL] Um, let me give you the original claim and then.
[CUSTOMER][NEUTRAL] You can see the one that's not um processed yet that we just received.
[CUSTOMER][NEUTRAL] Basically she's uh submitted the she submitted the pathology report on [PII].
[CUSTOMER][NEUTRAL] And then now we've just received her upload of the physician's statement.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and I was this policy was kind of weird. um, I had to get help on it because I didn't quite understand how it was gonna.
[CUSTOMER][NEUTRAL] Pro or what the benefits were. So her question is, long story short, she's now received or submitted the physician statement. Is it gonna pay the lump sum 10,000 benefit for this new diagnosis of cancer is what her question is.
[AGENT][NEUTRAL] OK, so yeah, it'll have to be reviewed first, but it does only pay a one a one-time benefit, that lump sum benefit, but once it's reviewed to determine if it's, it will be covered, then yeah, the plan will only pay that, that benefit.
[AGENT][NEUTRAL] For the occurrence.
[CUSTOMER][NEUTRAL] OK, so she
[CUSTOMER][NEUTRAL] She doesn't have to submit claims or anything, right? Like from the hospital or anything.
[AGENT][NEUTRAL] No, if she's filled out that claim form and provided that information on that critical illness claim form, then that is sufficient.
[CUSTOMER][NEUTRAL] OK, OK, do you mind just letting her know the process if, if that's OK, can I transfer her through?
[AGENT][NEUTRAL] Sure, that's fine.
[CUSTOMER][POSITIVE] OK, uh thank you so much.
[AGENT][POSITIVE] Thank you. You're welcome.
[AGENT][NEUTRAL] Claims department, this is [PII].
[CUSTOMER][NEUTRAL] Yes, hi, how are you?
[AGENT][NEUTRAL] Fine, how are you?
[CUSTOMER][NEUTRAL] I'm doing fine. Um, I guess she transferred me to you to get some questions answered.
[AGENT][NEUTRAL] Yes, she did. She transferred me to, and she let me know that you had a question regarding the, the coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, like, um, OK, so she was explaining to me that the, um, face amount would be paid, you know, based on the diagnosis, but she was also saying like sending the bills and stuff. So my question is like, uh, do, do they not pay out until they receive all the bills because that could take forever. It's an ongoing thing, so I don't, I don't quite understand that.
[AGENT][NEUTRAL] So this coverage is a critical illness coverage, um, so it covers, uh, it will pay a limited, it will pay a, a, a lump sum benefit for that critical illness.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] If it is a covered critical illness under the policy, then the benefit would cover that. There is a form to complete for critical illness. Um, let me see. I see we got new mail in.
[CUSTOMER][NEUTRAL] OK, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so I did the form. I sent them a pathology report and then they sent me a notice saying they needed um a position statement, so I uploaded that, but I don't know, I, it's not like up under that claim number, so I don't know if they, it'll be tied together or.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it will be tied together.
[CUSTOMER][NEGATIVE] Because I mean I don't want them to send me something saying they need it and I already sent it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I understand that. So yes, it would be tied together it'd be just under a different claim number. So let me take a look and see what we did get in give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] with.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mm yeah.
[CUSTOMER][NEUTRAL] Like I
[CUSTOMER][NEUTRAL] That's I'm following up.
[CUSTOMER][NEUTRAL] Yeah, um, you see it?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, hanging up.
[CUSTOMER][NEUTRAL] Oh, but not the bike and the scooter don't put you at.
[CUSTOMER][NEUTRAL] That's what I say here.
[AGENT][NEUTRAL] OK, yes, this is, this is what we need this form completed, um, in order to consider the benefits, so it looks like we did receive it. It usually takes at least 7 to 10 business days for processing. So we would need any itemized billing um based off this information, the benefit can be considered from the claim form.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] OK, so you need what else do you need now?
[AGENT][NEUTRAL] We don't need any additional information at this time with this claim form being completed by the physician. This is the information that that they will be utilized to determine benefits under the benefits under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so as far as his bills and stuff or whatever, do I, so I still just send I just upload those as I get them?
[CUSTOMER][NEUTRAL] Or I don't understand like what.
[CUSTOMER][NEUTRAL] What does that do?
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Let me see what other.
[CUSTOMER][NEUTRAL] Oh sorry mhm.
[AGENT][NEUTRAL] So this policy only covers that one-time benefit. It doesn't cover any um
[AGENT][NEUTRAL] Additional benefits as far as any any services received due to the cancer. It only will cover that critical illness of cancer, that one-time benefit. So you would need to submit any itemized billing in for his treatments.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you say I don't need to.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm. OK. And um,
[CUSTOMER][NEUTRAL] And is that
[CUSTOMER][NEUTRAL] Uh, is that, um, so you're talking about the face value of the policy, the $10,000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, and is that like, is it like a one and done or if it's another, if he was to have another critical illness, is the policy still in effect or is no good in after this?
[AGENT][NEUTRAL] Let me check on that for you. Give me one moment.
[AGENT][NEUTRAL] Give me one moment, Ms. [PII]. I'm gonna put you on a brief hold I'll check on that for you. Give me one moment.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] Thank you for holding, Ms. [PII]. Under the critical illness benefit, a benefit is payable once per covered person for each critical illness under the policy, it covers a max the maximum critical illness benefit payroll under the policy cannot exceed 250,000 per covered person.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] That makes sense.
[AGENT][NEUTRAL] Is there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] OK, well, thank you so much.
[CUSTOMER][NEUTRAL] No, and you said they will tie in that form I just sent to that claim number.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] That 357-703-3 claim number, OK, because that's where the other stuff is, yeah, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] Uh, you too, bye-bye.
[AGENT][NEUTRAL] Bye.