AccountId: 011433970860
ContactId: 0ad42c2c-a05a-498c-8030-bf590f00d564
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1402969 ms
Total Talk Time (AGENT): 754027 ms
Total Talk Time (CUSTOMER): 381954 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/0ad42c2c-a05a-498c-8030-bf590f00d564_20250106T18:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi [PII]. I'm hoping you can help me. Um, I'm looking for some help on my mother's, um, claim for her cancer policy.
[AGENT][NEUTRAL] All right. What questions do you have?
[CUSTOMER][NEUTRAL] Well, we got um a $900 check, but, but in addition to that, uh, something saying that you needed more information to process the claim and we just wanna verify what that information is so we can get it to you.
[AGENT][NEUTRAL] OK. Is she available?
[CUSTOMER][NEGATIVE] No, she passed. She, she actually uh died on the [PII].
[AGENT][NEUTRAL] So you're the, so you're the, um, so because you received the check, that means that you are on file as the executive?
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][POSITIVE] My, well, it's, I'm my dad's right here. I'm calling for him. I'm, I'm helping him out.
[AGENT][NEUTRAL] OK, OK. All right.
[AGENT][NEGATIVE] Some missing information that I was like, OK.
[AGENT][NEUTRAL] OK. What is your, that's OK. What, what's your dad's name?
[CUSTOMER][POSITIVE] Sorry, sorry, I, I'm just trying to help out.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] Prayer.
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, can I get a callback number for him, please?
[CUSTOMER][NEUTRAL] Sure, uh, what's your [PII]. Did you hear that?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm barely, uh, did he say [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And um the policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 00.
[CUSTOMER][NEUTRAL] 779-036
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me pull up the policy, let's see.
[AGENT][NEUTRAL] What information do I need to ask you.
[AGENT][NEUTRAL] Alright, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so he's part 2.
[AGENT][NEUTRAL] OK, could you um have, I need him to verify date of birth, address, and email address if you have one, please.
[CUSTOMER][NEUTRAL] Uh, for him or for my mother?
[AGENT][NEUTRAL] Um, he's on the policy, so it would be for him.
[CUSTOMER][NEUTRAL] OK, his, um, his date of birth is [PII].
[AGENT][NEUTRAL] Address and email address if you have one, please.
[CUSTOMER][NEUTRAL] The address is [PII].
[CUSTOMER][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] And the email is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much for verifying the information. So, um, what's your name, ma'am? What was your name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII]. All right, thank you, [PII], for verifying the information. So you're calling about the recent claim for [PII] that was processed and paid at the end of [PII]. You stated that you received a check for $900 and we requested additional information for um the hospitalization and the ambulance and lodging, correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] All right. And you were kind of confused on what information we were needing?
[CUSTOMER][POSITIVE] Yes, yes, we just wanna verify exactly what it is so we can get it to you.
[AGENT][NEUTRAL] OK. All right. So did you receive an explanation of benefits in the mail?
[CUSTOMER][NEUTRAL] Uh, I believe that's what I'm looking at.
[AGENT][NEUTRAL] OK. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, it does say
[AGENT][NEUTRAL] Yes, ma'am. And so if you did receive that, then that does tell you what we're needing. So, um, I'm not sure if it's a, like you can flip it over for page two, but OK, so it says remark code DE 135. It says please provide the hospital admin and discharge summary for hospital confinement, and it gives the dates for further consideration of benefits.
[AGENT][NEUTRAL] Um, and then it says, please provide the itemized bill for the ambulance trip on [PII]. So I'm not sure if um.
[AGENT][NEGATIVE] Those should have been listed on that explanation of benefit. Those were marked codes and what's needed.
[CUSTOMER][NEUTRAL] OK, I actually do see that now. Now is that something we get from the hospital?
[AGENT][NEUTRAL] The itemized billing?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, mhm. All you have to do is call the um
[AGENT][NEUTRAL] Called the um oh slipped my mind, billing department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you will call them and let them know that you're needing an itemized billing um for those dates of service. Um, the ambulance bill is you would get that itemized billing from the ambulance company.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From the ambulance company, OK, oh, give me one second please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh, do I have to have the doctors sign this again to send in or just send this? OK, um, do we need to have the doctors, uh, sign something again or can we just send this information with what we've already sent?
[AGENT][NEUTRAL] You would send the missing information that we've requested.
[CUSTOMER][NEUTRAL] OK, so we don't have to have the doctor's signature again.
[AGENT][NEUTRAL] Uh, no. That, that, uh, I'm not.
[AGENT][NEUTRAL] I'm not sure about what the doctor said. You probably fill out, let me see what you filled out because you might have filled out something that you really didn't have to do in the beginning. So that's, you know, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just send everything I sent.
[AGENT][NEUTRAL] Let me take a look at what was sent the first time.
[CUSTOMER][NEGATIVE] The week another week's work coming before she died.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] We haven't done that yet, right? No, we ain't doing that yet. I'm making sure what what good deal.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, I don't see where a doctor signed anything on this one. I'm not sure. I'm not sure which uh what.
[AGENT][NEUTRAL] I don't see what he was.
[AGENT][NEUTRAL] Referring to, but no. No doctor needs to sign anything. We just need the itemized billing from the hospital and from the ambulance.
[CUSTOMER][NEUTRAL] OK, and what would be our best method to get that to you? Is it like to upload documents online or would we fax them?
[AGENT][NEUTRAL] Um, however, if you're comfortable uploading online, faxing, or mailing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That works. To this address? Um
[CUSTOMER][NEUTRAL] Oh, so if we mailed it, what, what address would it be?
[AGENT][NEUTRAL] It would be the [PII] address.
[CUSTOMER][NEUTRAL] Would it be
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, alright, yeah, we just wanted to make sure because we actually have another week's worth of, uh, medical bills we'll be sending in soon that we haven't.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's not a problem. Um, is there anything else, um,
[AGENT][NEUTRAL] I can, um,
[CUSTOMER][POSITIVE] I think that you've been very helpful.
[AGENT][NEUTRAL] I'm trying to
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] Did y'all send in, and you said she, she, when did she pass away?
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Did you all send in the death certificate?
[CUSTOMER][NEGATIVE] We haven't received it yet. Well, she passed in [PII] and they told us it would be 6 to 8 weeks for it to come in.
[CUSTOMER][NEUTRAL] Do we need a death certificate too?
[CUSTOMER][NEUTRAL] Do will we also need to send that in when it comes in?
[AGENT][NEUTRAL] OK, because we, because you claims are being submitted as if it's her submitting these claims.
[AGENT][NEUTRAL] And not a beneficiary, and so.
[CUSTOMER][NEUTRAL] Well, so
[AGENT][NEUTRAL] It's showing that premium is still being deducted and um we don't have the information on file because once someone passes away, then.
[CUSTOMER][NEUTRAL] The one
[AGENT][NEUTRAL] Things we process them differently.
[CUSTOMER][NEUTRAL] OK, well, the ones that have been submitted so far she did submit herself.
[CUSTOMER][NEUTRAL] Um, because she has been in the hospital off and on for the past 6 months.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so she submitted all of those that have gone. She did that herself. Uh, we haven't actually submitted anything since she passed.
[AGENT][NEUTRAL] Oh, OK. So she submitted the ones that were submitted on [PII].
[CUSTOMER][NEUTRAL] We submitted some on [PII].
[AGENT][NEUTRAL] OK. OK. So just let, so when, once you get that, um,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Then we would need that and just know that these.
[AGENT][NEUTRAL] New claims are gonna be done differently.
[CUSTOMER][NEUTRAL] OK, so when we submit the new claims we will need to submit it with a copy of her death certificate?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and will you accept a copy or will it need to be the original?
[AGENT][NEUTRAL] Oh no, no, it'll copy because even if you fax it, you know, that's a copy to us, so.
[CUSTOMER][NEUTRAL] But we got to sign this next round too then right.
[CUSTOMER][NEUTRAL] OK, and so the and the next round that we send the doctor also needs to decide.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] But I'm just, no, do you, so what claim form are you looking at when we're asking for the doctor to sign?
[CUSTOMER][NEUTRAL] Do you know what on AM on the sheets that we have to send in with it.
[CUSTOMER][NEUTRAL] That place is what the disease was, everything and who the physician is and everything.
[AGENT][NEUTRAL] So are you, so.
[AGENT][NEUTRAL] Let me make sure that you're looking at the correct claim form cause the, let me go online cause I don't think the cancer claim form ask this, but I could be wrong. Let me see. That's page 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3. Yeah, the cancer claim form does not ask for that information. You must be talking about like a critical illness claim form or a short term disability claim form, but the one that says cancer claim form, it does not ask for that information.
[CUSTOMER][NEUTRAL] OK, well
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So I don't need a doctor for the uh cancer part?
[AGENT][NEUTRAL] No, you just need to send the itemized billing.
[CUSTOMER][NEUTRAL] OK, what about the critical illness part?
[AGENT][NEUTRAL] So, are we moving, so you have a critical illness um policy with us?
[CUSTOMER][NEGATIVE] Yeah, we got, we got critical illness and cancer.
[AGENT][NEUTRAL] OK. So we're gonna move to, OK, so I will um do, is that, does this um conclude our cancer um questions?
[AGENT][NEUTRAL] And then I can move on to the critical, OK, just one moment, let me find that particular policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so your critical illness must not be with us because the only thing that you do have with us is a cancer policy.
[CUSTOMER][NEUTRAL] OK, am I sending the right form now?
[CUSTOMER][NEUTRAL] Do, oh yeah, do you know if h[PII] sending the right form?
[CUSTOMER][NEUTRAL] If we submitted everything correctly.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] OK, so she sent it because from what you're stating, she's everything she submitted before. So apparently she's been sending the correct stuff.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so she's been submitting so far the correct stuff. The last thing I stated was we received something on [PII]. This was processed on [PII]. This was paid as if she was still with because we processed this after her passing, and um I'm gonna have to transfer you to customer service because you are gonna have to let them know of her passing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And um so.
[CUSTOMER][NEUTRAL] Is it
[AGENT][NEUTRAL] But um the additional information that is required, um you will submit the itemized billing like we asked along with the claim form, um, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We can do and what were you asking about what were you asking?
[CUSTOMER][NEUTRAL] I'm just the one this is $100,000 and 900 is all we get.
[CUSTOMER][NEUTRAL] Um, so the, it's on the $100,000 medical bill.
[CUSTOMER][NEUTRAL] He received a check for $900. Is that because the claim wasn't processed fully because you still need more information, or is that the final amount? Do you know that answer?
[AGENT][NEUTRAL] So, um, these, we don't pay what you are so like if you receive a bill, you don't send the bill to us and say, OK, this is my bill and uh that's not the benefit, so you have to look at what your policy covers. So while I pull up your policy, this is a verification of your coverage and not a guarantee for payment. So what we paid so far is the intensive care.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, because that's the only payable benefits on what was submitted, um.
[AGENT][NEUTRAL] And let me look and see what your intensive care paid.
[CUSTOMER][NEUTRAL] What about the
[AGENT][NEUTRAL] And so was this um
[AGENT][NEUTRAL] OK, so we paid chemo last last year.
[AGENT][NEUTRAL] OK, so what was submitted was itemized billing. The only thing that was on there, like I stated, was intensive care. Let me look and see how much intensive care paid per day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you look at the cancer claim form, the cancer claim form on page one tells you what is required um when you filing a claim. Um, a lot of times people send a bill and
[AGENT][NEUTRAL] And they really don't know their benefits, um, they don't send everything that is required to process a claim.
[CUSTOMER][NEUTRAL] OK. Yeah, I said everything the hospital sent me.
[AGENT][NEUTRAL] Alright, so that's $600.
[AGENT][NEUTRAL] 36
[AGENT][NEUTRAL] Let's see the power is 36 OK 36.
[AGENT][NEUTRAL] All right. So that's $300 per day for intensive care.
[AGENT][NEUTRAL] And was supposed to be 600, but after a certain age.
[AGENT][NEUTRAL] It's cut in half. So that's the reason why it's $300 for $300 a day. So, the documents that she submitted to us.
[AGENT][NEUTRAL] Let me go back to it.
[AGENT][NEUTRAL] So the bill that she submitted, um, she submitted the claim form.
[AGENT][NEUTRAL] And she submitted to us.
[AGENT][NEUTRAL] A bill from University of Mississippi, where she was admitted from [PII]. There was room and board charges um of 11 days, intensive care was 3 days.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that's it. OK, so.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The thing about this bill is.
[AGENT][NEUTRAL] Why was she there?
[AGENT][NEUTRAL] Um, there's no diagnosis codes, there's no, nothing indicating why she, why she was admitted. That is the reason why we're asking for the additional information.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So there's no indication on this bill because somebody could have been in there for another reason besides cancer, and this is a cancer policy.
[CUSTOMER][POSITIVE] I got you.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so we, we need to get the, the medical codes that show the diagnosis.
[AGENT][NEUTRAL] Yes, the itemized billing for that. That's correct. So the only thing that was payable on what she sent to us was her intensive care, and that is what we paid and then the other things we asked for.
[AGENT][NEUTRAL] Uh my billing.
[CUSTOMER][NEUTRAL] OK, we
[CUSTOMER][NEUTRAL] OK, well, yeah, OK, we can get we can get that information to you.
[AGENT][NEUTRAL] Alright, so is there any other questions concerning the claim before I get you over to customer service?
[CUSTOMER][NEUTRAL] Do you have any other questions? Is this critical or mechanical, do we have a critic?
[CUSTOMER][NEUTRAL] Oh, she said we don't have a critical policy with them. We just have a cancer policy. I know.
[AGENT][NEUTRAL] There's a critical illness rider on the policy, but I'm not understanding.
[AGENT][NEUTRAL] Like what is he trying to, I'm not understanding his question about the critical like.
[CUSTOMER][NEUTRAL] Oh, well, I think he, he may have thought that it was two separate policies, the cancer policy and a critical care policy.
[AGENT][NEUTRAL] Mm, oh no. The cancer, it's only a cancer policy. There is a critical illness router like um for some, um, and let me look and see. She could have been like if you're first diagnosed with cancer, you get um like a lump sum payment, um.
[AGENT][NEUTRAL] I'm not sure if that was on this policy or not.
[AGENT][POSITIVE] Yeah. So the critical illness is if you're diagnosed with cancer, heart attack, or stroke, you get $2500 and that benefit has already been paid out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, when I get the rest of these bills, I don't have to go to Doctor [PII]. I just send them to y'all.
[AGENT][NEUTRAL] That's correct. Um, make sure you pay attention to the page one of the claim form and make sure you're sending in all the information that is like a little cheat sheet to tell you what is required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because there was about another week's worth that she's been in the hospital day by day.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so you would just need to make sure you submit the itemized billing.
[CUSTOMER][NEUTRAL] And I can send that but she's not here I mean.
[AGENT][NEUTRAL] Well, because she's no longer here, now we have to go through the next of kin, look for any beneficiary information, and things are gonna be processed differently. Um.
[CUSTOMER][NEUTRAL] Well, that is like I am the beneficiary.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that she's gonna she's gonna transfer us to customer service and and do all that.
[AGENT][NEUTRAL] All right. Do you have any other claims questions I can assist you with today?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] I think that's it. I think you've been very helpful.
[AGENT][POSITIVE] All right, not a problem at all. One moment and I'm gonna get you to customer service. Thank you. You have a great day.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Good Afternoon, thank you for calling APL. This is [PII] in the customer service department. How may I help you?
[AGENT][NEUTRAL] OK, [PII], this April in the cancer queue, I have
[AGENT][NEUTRAL] Um, the, well, I think.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] On policy 779-036. He's on the line along with his daughter. Her name is [PII].
[AGENT][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You said 4 OK [PII], what was the last name?
[AGENT][NEUTRAL] 15
[CUSTOMER][NEUTRAL] 15. OK.
[CUSTOMER][NEUTRAL] And you said [PII] on the phone?
[AGENT][NEUTRAL] All right, so
[AGENT][NEUTRAL] Part two.
[CUSTOMER][NEUTRAL] Uh-huh, and the daughter. OK.
[AGENT][NEUTRAL] I guess that's right. And [PII] is the daughter that's helping him. OK, so they were calling me about um claim information and so in talking with them, they said that she passed away, but we paid a claim.
[AGENT][NEUTRAL] To part one, you get what I'm saying? And so I was like, well, I'm gonna get you over to customer service so you can let them know about her passing, what is required. And so um like they're submitting claims like she's still here.
[AGENT][NEUTRAL] They stated that she.
[AGENT][NEGATIVE] The last claim we received on [PII], she submitted, she died on [PII].
[AGENT][NEUTRAL] That's what they say. Anyways.
[AGENT][NEUTRAL] I'm just, you know, sending them over so you can let them know what is required.
[CUSTOMER][POSITIVE] How remover, yeah, that's fine. I got it, girl. We can go from here. Thank you.
[AGENT][POSITIVE] OK. Thank you. OK, bye.
[CUSTOMER][NEUTRAL] Bye.