AccountId: 011433970860
ContactId: 138cf850-16e3-4376-ad72-57c3be6a210e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1650140 ms
Total Talk Time (AGENT): 371293 ms
Total Talk Time (CUSTOMER): 408652 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/138cf850-16e3-4376-ad72-57c3be6a210e_20250103T20:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling CPL. This is [PII]. May I assist you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, this is [PII]. How are you?
[AGENT][POSITIVE] I'm good. How about you, Miss [PII]?
[CUSTOMER][POSITIVE] I'm good, thank you for asking. I just had a couple of questions about um my policy.
[AGENT][NEUTRAL] OK, may I have the policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. It is.
[CUSTOMER][NEUTRAL] 02552188
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have a callback number just in case we get disconnected this time?
[CUSTOMER][NEUTRAL] Of course [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and I need your date of birth for security, the mailing address and email address.
[CUSTOMER][NEUTRAL] [PII] and it's [PII]. The email is [PII] [PII].
[AGENT][NEUTRAL] OK, and what questions do you have on your policy?
[CUSTOMER][NEUTRAL] Um, OK, what I never received an actual copy of the policy, so I wasn't sure if they were like preexisting condition limitations with like, you know, kind of like 312 exclusion or if um.
[CUSTOMER][NEUTRAL] You know, if a person, like if, like, I have Medicare as well, does that like make the policy like null and void? Um, so I just had some questions about that.
[AGENT][NEUTRAL] Well, this one was not a major medical. This is not a major medical. This was a limited hospital indemnity plan. So it's not related to any other insurance. This is um separate from any other insurance you have.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I just didn't know because I do have right, OK, so it's not major models. OK and then what about like pre-existing conditions?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see if it says anything about preexisting condition for anything in particular or just everything?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just and yeah just in general any preexisting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me go over the documents. Um, do you mind holding for me?
[CUSTOMER][NEUTRAL] No, that's fine thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for this card. OK, yeah, there, there was a pre-existing condition up to 12 months.
[CUSTOMER][NEUTRAL] Yes I am.
[CUSTOMER][NEUTRAL] There was a pre-existing up to 12 months.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, alright, that's all I wanted to check. Can you mail me a copy of the policy please?
[AGENT][NEUTRAL] Um, the policy is now terminated. Um, let me see.
[AGENT][NEUTRAL] Let's see if he will let me. Mhm. Yeah.
[CUSTOMER][NEUTRAL] Yeah, I know we have like a different provider for the policy now.
[AGENT][NEUTRAL] I can ask and see if that's possible because it's terminated usually when the policy is terminated, we don't send that information over, um.
[AGENT][NEUTRAL] Let me ask, I'm gonna put you on hold again, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for me. Ms. [PII], I checked and it looks like we we're not gonna be able to send that out because the policy is lapsed.
[CUSTOMER][NEUTRAL] OK, can you read the preexisting condition clause to me?
[AGENT][NEUTRAL] OK, I will have to find the document um.
[AGENT][NEUTRAL] See if I can find the master. One moment.
[AGENT][NEUTRAL] Bear with me, I'm trying to find the master document that has those limitations in it, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Gonna be a minute because since this turn I cannot even see that document. I can see some information but not the whole document.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Um let me see if they can tell me where to find the master document.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK that's.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Let me call her. I don't see it. Uh, let me call them this person hold on.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding. I do apologize for that long wait. OK, I found it. Um, so there is pre-existing conditions and then there's a preexisting conditions limitation. So I'm gonna start with the preexisting conditions and then I'm gonna jump to the limitations, OK?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, you're welcome. So the preexisting condition means that specified disease, heart attack, stroke, internal cancer.
[AGENT][NEUTRAL] Um, so that will be the preexisting condition period which is um the preexisting condition is 3, this one is for 3 months.
[CUSTOMER][NEUTRAL] For 12 months?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then the limitation is for 12 months. So let me go down to the limitation.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, so the limitation.
[AGENT][NEUTRAL] OK, exclusion. All right, so let's see.
[AGENT][NEUTRAL] OK, uh, no benefits are payable for any loss incurred during the pre-existing condition exclusion period following the coverage of person affected days. um.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It doesn't really say much.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if I have more information because it's just saying that it's following the other one.
[AGENT][POSITIVE] an effective day or such an increase.
[AGENT][NEUTRAL] Charges to coverage in section 10.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, where it says is that no benefits are payable for any loss incurred during the pre-existing condition, and exclusion period following the covered person effective date, which is the 12 months. Um, now this one doesn't specify which ones are the ones under the condition.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, let me ask this real quick before we move on to anything else. Now, it said it internal cancer, heart attack or stroke, is that all the pre-existing conditions they have or like for instance, is like diabetes considered a pre-existing condition as well?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's not listed. The only ones that are listed there are the ones that I just mentioned, um, let me go back to that page.
[AGENT][NEUTRAL] And if, if you find a document anyhow, um, you can find this information on page 12 and 15, but.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I just don't think I was ever given one because I mean I started like in September and then I never got any the only documents I've ever gotten are like from the actual like Blue Cross from my insurance.
[AGENT][NEUTRAL] OK. OK. So, um, yeah, this one just says that it is uh for a specified disease, heart attacks, stroke, internal cancer. So those are the ones that are under the preexisting condition clause.
[CUSTOMER][NEUTRAL] Yeah, on that.
[CUSTOMER][NEUTRAL] So when it says specified disease, is that like is what comes after? Is it listed like a comma or a colon when it listed in the sentence?
[AGENT][NEUTRAL] Let me see if it has anything on there specified disease. means cancer or skin cancer?
[CUSTOMER][NEUTRAL] OK. So you don't know if that includes diabetes?
[AGENT][NEUTRAL] It doesn't say that it includes diabetes.
[CUSTOMER][NEUTRAL] OK, and then that's a 3 month exclusion on that one you said 90 days?
[AGENT][NEUTRAL] It says that it's a 3 month, um, and let me just read it how it shows. So, let me go back to it.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so this one is 12 months. It is 12 months altogether. So they went for the 12 months on everything.
[AGENT][NEUTRAL] So it's 12 months for all of it.
[CUSTOMER][NEUTRAL] OK, alright, and then who I guess I need to talk to somebody in claims so I can ask them a question because I did submit a claim, but I wanted to ask them about the turnaround time and I can further ask them about, you know, the condition.
[AGENT][NEUTRAL] OK, well, I can give you the turnaround time which the turnaround time is 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is the other question?
[CUSTOMER][NEUTRAL] Well I wanna ask them about the specific diseases and preexisting conditions since you don't have all the information on that.
[AGENT][POSITIVE] OK, let me try to get somebody in that department. Yes, right, OK, you're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII]. I have a member on the line. She's asking for a claims specialist.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] Um, her policy number is 2552188.
[CUSTOMER][NEUTRAL] OK, what's the callback number?
[AGENT][NEUTRAL] Um, it is, uh, back [PII].
[CUSTOMER][NEUTRAL] And her name?
[AGENT][NEUTRAL] Her name is Miss [PII].
[CUSTOMER][NEUTRAL] Who?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] OK, let's see here. Let me get it pulled up. Give me just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, is there a question about a claim or?
[AGENT][NEUTRAL] Yeah, well, she submitted a claim. I already told her that it's 7 to 10 business days. Um, we went over the documents of the policy and over the exclusion on the limitations of the policy and, um, the preexisting, and she, um, I guess she has questions still about the preexisting even though I went over it and I read everything that is under the preexisting. Um, she keeps asking me if diabetes is a preexisting condition which is not listed and that's what I told her, but she's still.
[AGENT][NEUTRAL] Wants to ask that to a specialist.
[CUSTOMER][NEUTRAL] OK, you can uh send her through.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, here she comes.
[CUSTOMER][NEUTRAL] Uh, oh, [PII].
[AGENT][POSITIVE] Thank you for holding. Yes.
[CUSTOMER][NEUTRAL] OK, never mind, go ahead.
[AGENT][POSITIVE] Thank you for holding, Miss [PII]. I can place you on the line and she's gonna assist you from here. She's in the claims department.
[CUSTOMER][POSITIVE] I appreciate your help thank you.
[AGENT][POSITIVE] You're welcome. You're welcome.
[CUSTOMER][NEUTRAL] Hey so this is uh hey [PII], sorry, this is [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good [PII] how are you? Good. I understand you have questions.
[CUSTOMER][NEUTRAL] Yes, about the preexisting, she didn't have all the information, um, and I never received a policy, and she told me she couldn't send it because it was like a terminated policy. My, my employer had switched carriers for this typical pro this, uh, product, so I just needed to get some information, um, from you. I did submit a claim, but I'm trying to figure out like what exactly the pre pre-existing conditions are since I never got like a physical paper. I can't see how it's worded or anything, um, and the limitation on them I guess.
[CUSTOMER][NEUTRAL] OK, um, she said that so this will let me just say that this will be a verification of benefits and not a guarantee of payment so she said that you were wondering about the diabetes, is that correct?
[CUSTOMER][NEUTRAL] Yeah, that's considered a preexisting because the way she read it to me it was like specified disease, cancer, heart attack, or like um a stroke.
[CUSTOMER][NEUTRAL] OK, what now, could you please repeat that? I'm so sorry, the phone cut out. Yeah, she had specified it as to where it was like specified disease or cancer, heart attack or a stroke, like internal cancer, and something about that being like a ninety-day exclusion. Um, and then there was a pre-existing condition limitation, which I didn't really understand what that meant. And like I said, I don't have a copy of the policy to like put eyes on it myself to interpret it.
[CUSTOMER][NEUTRAL] OK. Now, the diabetes would not be considered as a preexisting.
[CUSTOMER][NEUTRAL] OK. Yes ma'am.
[CUSTOMER][NEUTRAL] OK, that's what, that's what I was wondering that's basically like what my hospitalization stemmed from like diabetic ketoacidosis, and I just didn't know like if that's what it was, you know, um, because like I said, I never got a copy of the policy and then I understand you guys can't send them because it's laps now.
[CUSTOMER][NEUTRAL] Yes ma'am, um, so whenever we process claim that would not be considered as a preexisting condition.
[CUSTOMER][NEUTRAL] OK, OK, that's what I wanted to check, and I think she said the turnaround is like 7 to 10 days, so I sent the itemized bills and I, I just wanna confirm maybe that you guys got the claim. I had my mom send it to you guys through fax, so I just wanna confirm that you guys did at least receive it.
[CUSTOMER][POSITIVE] Uh, let's see here, yes, ma'am, we received it actually today, so the turnaround is 7 to 10 business days, so hopefully, you know, by the end of next week we should get this claim processed for you.
[CUSTOMER][NEUTRAL] And do y'all reach out to me to like to let me know the findings? Should I be like expecting a phone call or an email or do y'all just process everything like internally if you have all the documents?
[CUSTOMER][NEUTRAL] Um, no, ma'am, we don't reach out by email or um phone call. You should receive something in the mail if benefits are payable, then let's see here.
[CUSTOMER][NEUTRAL] Um, you don't have anything set up for direct deposit, so if the benefits are payable, you will receive a check in the mail or if benefits are not payable, you'll receive the denial of the EOB in the mail. Now can I set up something for direct deposit? Yes ma'am, um, you would get the direct deposit form from your bank.
[CUSTOMER][NEUTRAL] And you would just you could fax that in.
[CUSTOMER][NEUTRAL] OK, yeah, that's not a problem I'll go ahead, um, the same way you done your same number I sent it to, yes ma'am, yes ma'am. OK, OK, well then yeah I'll take care of that. I'm assuming that's probably a little bit quicker than having to rely on the postal mail. Uh, yeah, because what we say is unfortunately we say to allow at least 30 days for everything to be received because of the way the postal service is nowadays because once we send it out it's honestly out of our control.
[CUSTOMER][POSITIVE] OK, no problem, but y'all usually send it out within 7 to 10 days. Yes ma'am, that is correct. OK, well then yeah I'll go ahead and get that taken care of today. I'll send it in. Thank you so much for your help I appreciate it. Yes I am, is there anything else I can help you with today? No, that's it you have a nice weekend. OK well thanks for calling APL and I hope you do the same bye bye.
[CUSTOMER][NEUTRAL] Right.