AccountId: 011433970860
ContactId: 17841087-9084-4283-8487-8dc3104bc86f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 660000 ms
Total Talk Time (AGENT): 305951 ms
Total Talk Time (CUSTOMER): 303560 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/17841087-9084-4283-8487-8dc3104bc86f_20250203T21:45_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. My name is [PII], and I've had an ongoing claim for critical illness for my husband. And we sent all our paperwork in, and I'm trying to find the status of it because I know our doctor sent in that he had had a brain hemorrhage and a stroke. And I have not received anything, and I'd like to know what the status of this claim is, cause this has been 3 months now.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes ma'am, I can
[CUSTOMER][NEGATIVE] This is getting ridiculous.
[AGENT][NEUTRAL] Yes, I can um look at the status of the claim for you Ms. [PII]. Can I please get um your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you ma'am and then what is the policy number?
[CUSTOMER][NEUTRAL] 261-22
[AGENT][NEUTRAL] OK, that sounds like a group number.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It says policy number on the thing that I've got here.
[CUSTOMER][NEUTRAL] Uh, we were with Gulf Crane Services. We got new insurance as of the beginning of the year. So, um, we had Cigna.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, like I said, to Gulf Crane services in [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] And on this paper, I got this group critical illness policy, policyholder Golf Crane Services.
[CUSTOMER][NEUTRAL] Policy number 26122.
[AGENT][NEUTRAL] 0, 2261-22. OK. Um, can I get the um.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I just tried to pull it up with that number. Can I get the social security number and I can pull in the policy that way?
[CUSTOMER][NEUTRAL] OK, his number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me see if I can't find him like this.
[CUSTOMER][NEUTRAL] And you, y'all keep asking for more information. And Miss [PII], I have been sending it over and over, and I know y'all got letters from the doctors. I know it says stroke, and I know in this policy, it says if somebody has a stroke, they qualify for benefits.
[CUSTOMER][NEGATIVE] And we really need the money.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, I understand.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] You're calling about the critical illness policy. Yes, ma'am. Can you please um
[CUSTOMER][NEUTRAL] Critical
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And it's for [PII], you said?
[CUSTOMER][NEUTRAL] [PII] May, it's my husband. He had a brain injury, yes.
[AGENT][NEUTRAL] OK. All right. Let me look at something real quick.
[CUSTOMER][NEUTRAL] Plus as well, when he fell on [PII], he also dislocated his shoulder, and he's been in physical therapy since then, and he cannot go to work, and the doctors have said they don't know when and if he's gonna be able to go back to work. And if that's not critical care, I don't know what it is. Yeah.
[AGENT][NEUTRAL] As far as
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm trying to pull the policy and um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Is he available for me to be able to get the verbal consent to discuss the policy with you? I know you're his spouse, but it's only in his name.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] K
[CUSTOMER][NEUTRAL] Come talk to her.
[CUSTOMER][NEUTRAL] Yes, I get it. Hold on one second.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Here? Hello.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. I'm with APL. Can you please verify a little information for me? Um, can you give me your date of birth, sir?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. So [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your address, phone number and email address that we have on the policy for you, sir?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK. And can you verify your email address for me, sir?
[CUSTOMER][NEUTRAL] Yes, uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Looks like I've got your Gulf Crane services email address.
[CUSTOMER][NEUTRAL] Uh yes ma'am, I don't use that one, no more. I, I got blocked out on the computer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Oh well, you poor thing. OK, um, and is it OK for me to speak with Ms [PII] about your policy and your claims?
[CUSTOMER][POSITIVE] Yes ma'am, please.
[AGENT][POSITIVE] OK, thank you. I appreciate your verification, taking the time to do that with me.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. OK, let's see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right. He hasn't been able to go back to work, and like I said, they don't know when or if. And I sent the records, and I sent, they got all the letters y'all asked and filled out the forms, and I sent them in, and
[CUSTOMER][NEGATIVE] I mean, we're in trouble and we really need this and we've paid so much for our benefits every month. It's not right that we're not getting our money.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, I understand. OK, so have you um received anything in the online service center? That's where you filed the claim at. I'm showing the last reported date was [PII], is that correct?
[CUSTOMER][NEUTRAL] I honestly, I know it was right before [PII] that we pushed through to get the last of the, the, um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The things that you had asked and had the doctors fill out the form you needed.
[CUSTOMER][NEGATIVE] And the letters stating what's going on, and he couldn't work, and then he'd had a stroke, and you had said y'all needed that. So I've sent it in and I don't understand what the delay is.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, let me look here real quick.
[AGENT][NEUTRAL] OK, I am looking and I'm not in the claims department but I'm looking at the claim I believe is the correct one. it was reported on [PII].
[AGENT][NEUTRAL] And it has a remark on it which was sent to you through the online service center and it says, and I can just read you the remark and then if we have more questions we can go to the claims department but it says this condition is not covered under this plan based on the policy's definition of critical illness.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, please refer.
[CUSTOMER][NEUTRAL] That was the one before I got my letters. That's the one that when I called, they had said that it does not need it. And I said, well, what else do y'all need? And then they told me about these forms. And you'll send them to us, and we ran them off, and I took them to the doctors, and they sent them straight to y'all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, looking at you.
[CUSTOMER][NEUTRAL] And that's the last
[AGENT][NEUTRAL] OK. Looking at his policy, I don't see anything that has been reported since [PII] through the online service center.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Y'all should have gotten some love. They sent them from uh Doctor [PII]'s office.
[CUSTOMER][NEUTRAL] Uh, do we scan it or fax them to him to
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do you remember?
[CUSTOMER][NEUTRAL] We sent them in. The doctors called me and said, we, we sent them in the numbers. I had called you and asked the number to send it in.
[CUSTOMER][NEUTRAL] And we sent them in, and if I need to have these doctors again, but that's
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think we kept the letters online, didn't we, Tim?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah, he was supposed to either fax it or, yeah, Doctor [PII] was gonna fax it over to y'all. I took the forms into him.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And instead of me picking them up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I had called you and got y'all's information and they sent it in.
[AGENT][NEUTRAL] Mhm. OK, so what we're gonna do next is we're going to go ahead and go to the claims department. We're gonna see if they've received anything from the doctor's office, OK? I'm gonna let you speak to somebody over there and see if they've received the, the paperwork back from the doctor, OK? All right. It's gonna be a brief hold while I transfer you on over, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're so welcome.
[AGENT][NEUTRAL] I'm just trying to find the person that might be available. It's gonna be just a sec.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Thank you for calling ATL, this is [PII]. With whom am I speaking? How may I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII]. I've got an insured on the phone and she has called several times about um this claim. Let me give you the policy number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 224-44360.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's on part one [PII], and I do have his permission to speak to Ms. [PII] with his wife. He did verify the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 354-436-3.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the remarks state that it's non-covered service under the patient's plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But she said that she spoke to somebody already that said all they had to do was send in information from the doctor's office and she's calling. I don't see anything has been reported since [PII], but she's calling because she said the doctor did tell her he sent something in.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Who?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so, um, OK, so this is a critical illness policy, first of all, and we're so, no, no, you're fine. No, no, no, no, you don't. No, you don't. You got the right cue. No, you have the right cue. I'm just trying to, I have to know what kind of policy I'm dealing with. So this is critical illness and we, so it was denied stating that this condition is not covered under this policy based on the policy definition of critical illness.
[AGENT][NEUTRAL] Oh, goodness gracious. I got the wrong darn you.
[AGENT][NEUTRAL] Oh, OK, OK.
[AGENT][NEUTRAL] Yes. Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, which is what I told her. Yes, ma'am.
[CUSTOMER][NEUTRAL] So you can send her over, but she's gonna, yeah, she's just gonna have to appeal it and, and I mean that's, that's the, that's the decision that was made, so she can appeal it, but I can let her know that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Thank you, Ms. [PII]. I appreciate it. I think it, it would help her to be able to talk to somebody besides me just so she can get it from somebody else. OK. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Mhm, OK, you're welcome.
[CUSTOMER][POSITIVE] OK, no worries, no problem. OK, thank you. Uh huh have a good one.