AccountId: 011433970860
ContactId: 187bca4f-0913-4b5e-b517-b953b89a8a98
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 911710 ms
Total Talk Time (AGENT): 491348 ms
Total Talk Time (CUSTOMER): 292149 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/187bca4f-0913-4b5e-b517-b953b89a8a98_20250515T18:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in Breer Resources. I have a customer on the line that is needing to know how to file a claim. Her husband's had a stroke. Can you help her with that?
[AGENT][POSITIVE] Sure, I can help her.
[CUSTOMER][NEUTRAL] OK, let me give you the policy number. It is 249-8100.
[AGENT][NEUTRAL] 249-810-0
[CUSTOMER][NEUTRAL] Mhm. Yes, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you verify her already?
[CUSTOMER][NEUTRAL] I verify, I verified her date of birth and the last four of her social. I did forget to verify her address and I've got her callback number is [PII].
[AGENT][NEUTRAL] OK, what's that?
[AGENT][NEUTRAL] And you said [PII], correct?
[CUSTOMER][NEUTRAL] Yes, uh-huh, yes.
[AGENT][NEUTRAL] Alright, let me go ahead and pull it up. My name is [PII]. This is my first week, so you probably never heard of me.
[CUSTOMER][NEUTRAL] I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] [PII] first.
[CUSTOMER][MIXED] Oh no, you're fine, you're fine. And it's always scary at first, but you're, you're doing good.
[AGENT][NEUTRAL] All right, uh, you can go ahead. Did you say you verified her date of birth?
[CUSTOMER][NEUTRAL] Yeah, I got her date of birth or last four of her social, her name, and a callback number, but I did forget to get her address, so I apologize for that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'll, I'll get the rest I'll get the rest that's OK, right, you can send her over.
[CUSTOMER][NEUTRAL] Alright, OK, I'll, I'll pull her on. I'm gonna announce her. OK, just one second.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Hi, Ms. [PII]. Yes.
[CUSTOMER][NEUTRAL] Um, I have [PII] on the phone, and she's gonna help you with the questions on filing a claim under that critical illness policy, OK? OK, thank you. You have a great day. Thanks for calling APL. Bye bye. Bye bye.
[AGENT][NEUTRAL] Am I speaking to [PII]?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] If I could get you to just verify your address for me and your phone number.
[CUSTOMER][NEUTRAL] OK, it's [PII], and my phone number is [PII].
[AGENT][POSITIVE] Thank you so much for verifying that with me.
[AGENT][NEUTRAL] And I see you needed help with submitting a claim on behalf of your husband.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] So there are a few ways you can do this. You do have, let me double check and I will pull up how to.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do that specific claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just one moment while I pull that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Do you have an online account with us by any chance?
[CUSTOMER][NEUTRAL] I don't no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I do not.
[AGENT][NEUTRAL] If you would like, you are able.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To submit claims through an online portal at [PII] you will use the email address. 00 go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you just, I'm sorry.
[CUSTOMER][NEUTRAL] I just grabbed my, I just grabbed a pen, so can you repeat that?
[AGENT][NEUTRAL] OK, so you can start an online account at [PII] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You'll click new user and you'll go to individual with a policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We will need your last name, your social security number, and your zip code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your date of birth and we will need the email that we have you'll use the email that we have on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you know which one that is?
[CUSTOMER][NEUTRAL] OK, is that.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][POSITIVE] Yes ma'am, so you'll go ahead and use that one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can set it up and then whenever you get all of your forms, you can submit it online and that might be easier because that way you can also download any ID cards you need, view your policy documents and you can uh check your claim status as well uh just in case it might be a little helpful for you you can always call us back as well, but let me see which claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I don't, I don't have no problem doing that, but I just wanted, before I go through all that, I have, you know, I was speaking with someone from the open enrollment, and he, I had just, we're just going over my policy and he, um, I had mentioned that my husband had had a stroke in November, and he said, well you have a claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And he didn't really give me any other information other than that except for the call. So I just wanna make sure he, I have one, you know, before I go through all that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so let me check your policy real quick. Yes, ma'am, let me just go ahead and check your policy real quick to see what all is covered.
[CUSTOMER][NEUTRAL] Can you help me?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just a second while I pull it up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] He had also mentioned that he had spent a night in the hospital, and he said that was covered under um an indemnity or hospital indemnity I have. I should know all this, but when you're trying to, when you're trying to, you know, yeah, when you're trying to get this all in school and they got you in a, you know, in a room, you have to get back to classes, you know,
[AGENT][POSITIVE] You're OK.
[AGENT][NEUTRAL] Yeah, and you do have multiple policies with us, so the one that you gave me is critical illness and then you do have a hospital indemnity one as well, as well as a short term disability, uh, so you do have all of those. It just depends on which one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're going to file under and the good thing about the online service as well is when you go to [PII] and find the claim form, it is very detailed in which one you would pick so there is a critical illness form and there is a hospital indemnity form, and they're very good about telling you everything that you need to submit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And my recommendation to you is anything and everything that you think is relevant to this claim or to that claim, send it all in because we review all of it um even if it says that you need this and that if you feel that something else is relevant go ahead and send it because we review everything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So let me check.
[AGENT][NEUTRAL] So under your critical illness plan, it does look that you like you have a spousal benefit of $30,000 up to $30,000 and I'm gonna keep checking for you. And I do want to remind you that this is just a verification of benefits and not necessarily a guarantee of payments.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] But stroke is covered under that policy that you gave me.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] Then I'm checking to see what all other you might have.
[AGENT][NEUTRAL] Related to that.
[AGENT][NEUTRAL] It's taking just a moment because my computer is going a little slow today, so I apologize.
[AGENT][NEUTRAL] And anytime I mention a confinement, so a hospital confinement for that particular benefit, you'll need, it'll be for a period of at least 18 consecutive hours in hospital confinement. And I just want to, uh, clarify that with you in case I end up saying that later on cause I'm still looking for your full benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah it can be very tedious when you have multiple policies with us and you, you never know which one it is, so you can always file everything under both and just hope that one pays one and so.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] I know, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I didn't know if there was any sort of like stipulation, like he did have a stroke. It did not cause him any permanent um damage. So, that's why I didn't think of it back then. I, I don't know what I assumed, but
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] When I explained that to the rep, he said, no, that's not accurate.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Right. Now, for the one that you gave me, the policy that you gave me, I'm sorry, uh, the the benefit amount is up to $30,000. Would you like me to check your hospital indemnity plan as well?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think he told me it was 2000.
[AGENT][NEUTRAL] OK, let me double check just in case.
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][NEUTRAL] Would you happen to know if there were any, like, if there are any stipulations to having a stroke, like if that, and I know this is like such an awkward conversation, but um does it have to be like, go ahead, go ahead, when my dog out, he's afraid of the rain, um.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] He was a pit bull.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][POSITIVE] You know, he had a stroke, but like I said, thank [PII] he didn't have any permanent damage.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, is that still considered coverable?
[AGENT][NEUTRAL] So, let me read what your first policy has.
[CUSTOMER][NEUTRAL] Or is it like you have to have a stroke and
[AGENT][NEUTRAL] So your first policy defines the stroke, the $30,000.01 defines your stroke as confirmed by a clinical diagnosis or neuroimaging study, a result of damage to the brain tissue caused by either thrombosis, hemorrhage, or embolism.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And determined by a physician that neurologic impairment resulted from the cerebrovascular event currently being diagnosed and was not previously present. That is the only thing that it says, and there are um some exceptions to that. So if he had a TIA or transient ischemic attack.
[AGENT][NEUTRAL] Or a brain injury associated with uh anoxia, hypotension, or hypoxia, brain injuries related to trauma, which it's not sounding like it's any of those, an ischemic disorder or a vascular disease. Those are the only stipulations in terms of strokes for that particular policy that you just gave me.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so I might not have heard that, right. So if he had a stroke and it was, did not cause any brain damage, it's not covered, correct? Or neurological damage.
[CUSTOMER][NEUTRAL] Is that, did I hear that correctly?
[AGENT][NEUTRAL] It just says neurologic impairment.
[CUSTOMER][POSITIVE] So it didn't cause any neurological impairment. Thank [PII].
[AGENT][POSITIVE] It didn't, um, that's great, um.
[CUSTOMER][NEGATIVE] Did not, no.
[AGENT][NEUTRAL] I would rather be safe than sorry, and I would just submit it as a claim. And if all else fails, it gets denied and it'll tell you why it was denied. Um, I wouldn't take a chance on something like that just because we read that and I think you and I are kind of defining it about the same, but it might not be 100%, um, just because he didn't get damaged, he still had a stroke. So I would still go ahead and file that claim under the critical illness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, because if all else fails, the worst that happens is it gets denied and you go through your hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right, OK, and do you know how long it takes to receive a um determination?
[AGENT][NEUTRAL] It could take anywhere from a couple of days to maybe a few weeks. Uh, we are coming up on a short week, um, I think next week, so it may take a little bit longer. It usually doesn't take that long. It all depends on the documents that are provided. So if you give us 200 documents to review, it's gonna take a little bit more time. Um, you shouldn't need that many for that.
[CUSTOMER][NEUTRAL] I see. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct, yeah.
[CUSTOMER][NEUTRAL] No, no, no, I don't, I don't think there's much other than just the diagnosis and, I mean, I'm grateful, believe me, but.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Like I said, that's why I didn't even.
[CUSTOMER][NEUTRAL] I mean, you know, he has to take his medicine every day, I think, you know, but, um, he's good, so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, I would go ahead and file the claim anyways um because I mean it, it would still be beneficial and just remember at the bottom of the claim it does need or the claim form, it will need to be signed it can be denied just because a signature wasn't provided so just make sure you go through all of the the all of the paperwork on that form and make sure you sign everything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And then it looks like for your hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You were correct. You do have a hospital admission benefit amount of up to $2000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check and the confinement amount so that anything over 18 hours um is $200.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With a maximum of 15 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so I will go online and I will submit it and see what happens.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right and like I said if you submit it on through the online portal, um, you'll be able to check the status of that if we deny anything and we need, um, we will tell you why it got denied or you can always call us back and then you can just keep um uploading documents into that form or into that uh online portal and it should be all right there so and we don't have timely filing so if something is taking a really long time to get to you we don't have timely filing you can file it whenever you have the ability to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect, good to know alright thank you so much for your help I appreciate it.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're welcome and if there's nothing else I can help you with, [PII] I hope you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.