AccountId: 011433970860
ContactId: 0f5ca6c8-007b-4715-8430-75c38be1ef20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1539069 ms
Total Talk Time (AGENT): 483861 ms
Total Talk Time (CUSTOMER): 250582 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/0f5ca6c8-007b-4715-8430-75c38be1ef20_20250411T21:26_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. My name is [PII].
[CUSTOMER][NEUTRAL] I have a cancer policy through y'all. I work for a school district in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And they turned me down on, on, uh, some prostate cancer. I was kind of wondering why they put some kind of.
[CUSTOMER][NEGATIVE] BS explanation, I don't understand. I don't have a copy of my policy.
[AGENT][NEUTRAL] OK, so there was a claim that was submitted and it was denied, it sounds like?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] That's happening? OK. Well, I can definitely look into it for you and see what's going on. Um, Mr. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and um I can look, do you have the policy number? If not, I can look it up with your social.
[CUSTOMER][NEUTRAL] Uh, no, ma'am, I don't. I've got this letter, but I don't have, it's not don't have the policy number on it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Does it have a reference number on it?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK, um, I can look it up with your social if you'd like.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Let's see, let me tell you if I can remember it.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment. Just waiting for everything to come up here.
[AGENT][NEUTRAL] OK, it just popped up here. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And your mailing address and the email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Alright thank you so much.
[CUSTOMER][NEUTRAL] And my email is
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Do you need my email?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and Mr. [PII], do you mind if I place you on just a brief hold? I'm just gonna look at the claim and the denial and see what's what's going on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Wait a minute. And there's nothing else to reference, just data entry.
[AGENT][NEUTRAL] I ain't saying nothing.
[AGENT][NEUTRAL] Uh, this is um
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] That's what we gonna do.
[AGENT][NEGATIVE] We're gonna go to claims because I already didn't brought it up. Nobody wanna honor it. Cool.
[AGENT][NEGATIVE] Policy hire date, customer hire date, salary amount, nothing referencing why this was. Is there an EOB?
[AGENT][NEUTRAL] He said it gave uh.
[AGENT][NEUTRAL] Uh nope. Um.
[AGENT][NEUTRAL] You know what, wait a minute, what's the date of service on here?
[AGENT][NEGATIVE] Wait, first of all, this wasn't even active.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, so it has to be under the old ones to go there.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] C 237.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] DC 237.
[AGENT][NEUTRAL] Alright, so the first occurrence has already been used.
[AGENT][NEUTRAL] What's the other one say?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That on DC. I just don't know.
[AGENT][NEUTRAL] I supervised.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So I was just taking a look at the claim and the denial reasons. Um, OK, so one of the denial reasons is for the first occurrence, which is we pay out one per lifetime. So, have you ever used the first occurrence benefit before?
[CUSTOMER][NEUTRAL] Yeah, on my, on, uh, one of my kidneys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The reason I'm asking, well, there's another policy here too.
[AGENT][NEUTRAL] Was it cancer on the kidneys?
[CUSTOMER][NEUTRAL] I mean my point is.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Was it cancer on the kidneys?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so, OK, I just want to make sure because that's why it's given that denial because we only pay that.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Well, I mean, you know, what, what.
[CUSTOMER][NEUTRAL] He had kidney cancer on the kidney about 2 years ago and he filed a claim.
[CUSTOMER][NEUTRAL] The current cancer is on his prostate. And I filed another claim and they turned it down.
[AGENT][NEUTRAL] Right, I understand it's not per diagnosis, it's just one payout per lifetime, so whichever one came first.
[CUSTOMER][NEGATIVE] Well then why, why am I paying, why am I paying this premium then?
[AGENT][NEUTRAL] For all of the other benefits, um, like the, the
[CUSTOMER][NEUTRAL] What good are you?
[CUSTOMER][NEUTRAL] What, what are the benefits?
[AGENT][NEUTRAL] Hold on one moment, let me pull up your benefits.
[CUSTOMER][NEGATIVE] I mean, I hadn't got any benefits out of this deal.
[CUSTOMER][NEUTRAL] I'm looking at hospital bills. I'm trying to get paid and.
[CUSTOMER][NEUTRAL] I expected y'all to help me, but I guess I'll remember that come renewal time.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Waiting for your benefits to populate.
[AGENT][NEUTRAL] OK, so the first occurrence benefit um was the 7500, uh, maximum of 1 per lifetime. The policy also covers radiation.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, I had to give 2000. I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] The policy also covers radiation therapy, chemotherapy, immunotherapy. Uh, if that is ever needed, it will pay up to $15,000 per year towards those treatments.
[AGENT][NEUTRAL] Um, there's also hormone therapy, experimental therapy, um, screenings.
[AGENT][NEUTRAL] But in terms of the first occurrence benefit, that's, that's all the cancer policies. It's just a maximum of one per person per lifetime.
[CUSTOMER][NEUTRAL] OK, I'm sorry, this is his wife, [PII]. So, OK, my question is, he had radiation therapy, that's what.
[AGENT][NEUTRAL] Hey, how you doing?
[CUSTOMER][NEUTRAL] That's what he had. I mean, they implanted radioactive seeds in his prostate.
[AGENT][NEUTRAL] Is that what
[CUSTOMER][NEUTRAL] So would that not be covered?
[AGENT][NEUTRAL] Let me see what was submitted. Hold on one second. Let me pull up the documents.
[CUSTOMER][NEUTRAL] The doctor's office sent out a bunch of paperwork.
[CUSTOMER][NEUTRAL] Maybe we, maybe we filed on the wrong claim.
[AGENT][NEUTRAL] So if the doctors, if the
[AGENT][NEUTRAL] So what I'm looking at is only one claim and it was submitted for by you all. Um, I don't see anything from like a provider or anything if they were to file a claim, but I could double check too.
[CUSTOMER][NEUTRAL] Now, well, the
[CUSTOMER][NEUTRAL] Yeah, the, the claim form that we filled out included several pages from the doctor.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, on the, I guess the diagnosis and, and the treatment.
[AGENT][NEUTRAL] Here we go. It's about 150 pages, hold on, they're coming up now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It does page by page. I'm sorry. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEGATIVE] I think you get tired of grumpy old man calls you every day.
[AGENT][POSITIVE] I'm sorry
[CUSTOMER][NEUTRAL] That's why I took the phone, honey.
[AGENT][NEUTRAL] I was not expecting you to say that.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEGATIVE] He, he has no patience.
[AGENT][NEUTRAL] No, I mean.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] My allergy messing up. Sorry.
[CUSTOMER][NEUTRAL] No, you're fine there.
[AGENT][POSITIVE] That was hilarious. I was not expecting that.
[CUSTOMER][NEUTRAL] That that.
[AGENT][NEUTRAL] No, I understand. It's it's, I don't take it personal. Insurance is hard and we've got bills to pay. I don't, I understand.
[CUSTOMER][POSITIVE] Yes it is, yes ma'am.
[AGENT][NEUTRAL] So, um, I just want to look at these documents because if I need to get someone from claims on the line, I definitely can, um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just want to get you your answers, so it's OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And I don't know, are there different claim forms or is it just one claim form because.
[CUSTOMER][NEGATIVE] His benefits lady, his yeah, his benefits lady is not very helpful.
[AGENT][NEUTRAL] So, it's one claim form.
[AGENT][NEUTRAL] Um, the form that y'all sent in is correct. I just
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this is what I'm, I'm going back and forth on.
[AGENT][NEUTRAL] So the date of service on these claims is [PII]. It's right in between.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Your old policy ended on [PII]. The new one started on [PII]. So I was going between the two trying to see which one it was filed under and um so it was filed under the second one, but ah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] This is what I'm gonna do. I think this is the best thing to do. I'm going to get a claims examiner on the line with you. The reason is I see the documents here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I see, you know, I mean, I can I see the, you know, I can read what they're saying in terms of treatment and things, but that doesn't help me in terms of what the examiner is looking for when they're given these benefits. So let me get an examiner on the line with you so they can talk about the documents and let you know why this was processed the way it was and what we can do if, you know, so that we can get this turned around or, you know, just a update and a plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sorry for her.
[AGENT][POSITIVE] Oh my goodness, you're fine.
[CUSTOMER][NEGATIVE] No, no.
[AGENT][NEUTRAL] Alright, Mr. [PII], and Mrs. [PII], um, before I get the claims representative on the other line, was there or on the line with us. Is there anything else I can help you out with today?
[CUSTOMER][NEUTRAL] No, ma'am, no ma'am, you're fine.
[AGENT][NEUTRAL] All right. Well, hold on one moment. I'm gonna stay on the line and then connect you to once I get a rep.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Hello Mr. and Mrs. [PII].
[CUSTOMER][NEUTRAL] I, I don't know I have that.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Um, I was on hold with claims on the other line. No one ever came to the line. Um, I don't.
[CUSTOMER][NEGATIVE] I hope I didn't play that music y'all playing to us to quit.
[AGENT][NEUTRAL] Probably so.
[AGENT][NEGATIVE] Oh my gosh. Uh, now look, I can't catch my breath. My nose is all stuffy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] change that everybody.
[AGENT][NEUTRAL] So this is what I can do, um, because I don't, I'm assuming they're gone because I was, that was like 7 minutes and nobody answered. So I can send a message over to them urgent, um, which the supervisors will see today, but they'll probably give you a call on Monday um to go over everything with you.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that OK?
[CUSTOMER][NEUTRAL] Can you ask them is there any way that they can call me instead of him? What I'm saying.
[CUSTOMER][NEUTRAL] Not work out but
[AGENT][NEUTRAL] Yes, ma'am. Uh, what's a good, what's the whatever callback number I put is uh where they'll call, so that's fine.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And Mrs. [PII], what's your first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm sending an urgent request over to claims to discuss um these claims with you. I put the claim number. Did you need the claim number?
[CUSTOMER][POSITIVE] Yes, that would be helpful.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So it's claim number.
[CUSTOMER][NEUTRAL] Or you could go ahead and cut a check for about 50 and we'll call it a day. That's quit.
[AGENT][NEUTRAL] I wish I could, I would have it in the mail to you tonight.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I wish you could too.
[AGENT][NEUTRAL] Um, so it's claim number 356.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] 656-2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm giving and I um put phone number [PII] for them to call back.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so I'm sending this over to them now, um, again, the supervisors will get it tonight, but you'll probably receive a call back, um, Monday.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that will be great.
[AGENT][NEUTRAL] Alright, Mr. and Mrs. [PII], was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, ma'am, that's it. You quit. Thank you, dear, and thank you for being patient.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL. You're welcome. Have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.