AccountId: 011433970860
ContactId: 1e09f725-86c7-4722-a06a-85694ea124b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 713739 ms
Total Talk Time (AGENT): 326187 ms
Total Talk Time (CUSTOMER): 342709 ms
Interruptions: 6
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/1e09f725-86c7-4722-a06a-85694ea124b0_20250203T17:16_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Um, yes, hello. I, uh, I had a, uh, recent hospital visit, and I wanted to understand if it was possible that I, I'm not really sure what all counts. I have coverage for, um, critical illness, uh, and I'm not entirely sure what all counts as that or, or if I, if I can have something.
[CUSTOMER][NEUTRAL] Be set up as a claim or I, I'm afraid I'm not super experienced with all this so I don't, I don't exactly know uh what my options are.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, what is your name sir?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, [PII], what is um your date of birth?
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] Thank you sir and what is your callback number in case our call is disconnected?
[CUSTOMER][NEUTRAL] That would be area code [PII].
[AGENT][NEUTRAL] OK, thank you, sir. And then what is your policy number?
[CUSTOMER][NEUTRAL] Um, I don't know my policy number, but I do have my employee ID number.
[AGENT][NEUTRAL] OK, um, can you give me the employee ID number?
[CUSTOMER][NEUTRAL] Certainly that'll be D43732246.
[AGENT][NEUTRAL] OK, thank you. I think you just got off the phone with me [PII] and I transferred you over to IMA. Were they able to help you with your benefits?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEGATIVE] It doesn't, no, it doesn't seem that way. And well, they mentioned, they said that I had a critical illness. I didn't realize it was gonna be going right back to the same, uh same place. Um.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] But, uh, so I guess.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Is, is, is there any way to know whether what I was in for would count as critical illness or I don't really know how that, how that works or how it's like categorized.
[AGENT][NEUTRAL] OK, I'll have to pull in your policy. Um, the number that you gave me is an IMA number. Can you give me your social security number and I could pull in all of your policies that way?
[CUSTOMER][NEUTRAL] Sure. Yeah, that's fine. I can give you that. That's uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, sir. Thank you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], did you say?
[CUSTOMER][POSITIVE] Correct. Yes.
[AGENT][NEUTRAL] [PII]. OK, let me look you up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, I've got all your policies pulled up. Now I'll need you to verify some information for me for security reasons. Can you give me your date of birth, sir?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your address, phone number, and email address that we have on the policies for you?
[CUSTOMER][NEUTRAL] My address is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh my phone number is [PII].
[CUSTOMER][NEUTRAL] And my email address should be [PII].
[AGENT][NEUTRAL] OK, thank you. I appreciate you verifying that information for me, [PII]. Let me look at your policies. So you said that you were in the hospital and you're just wondering what kind of benefits you have that would help you with your hospital bill, is that correct?
[CUSTOMER][NEUTRAL] Basically, so uh where you had transferred me, they mentioned that it was only going to be like preventative only type, uh, type of thing that would be, would qualify, I guess, but since I do have um critical illness, uh, coverage, uh, through, through, um through the life insurance policy, I didn't know if
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like there was a way to claim it as critical illness. I mean, uh, you know, basically my, my heart, uh, started kind of freaking out and had a regular beat uh for eight hours, which was, um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] The terrifying ordeal, um, but, uh, you know, I got
[AGENT][NEUTRAL] Mhm. Yes, sir.
[CUSTOMER][MIXED] I got treatment for it, and, you know, that's, that's nice and all, but I'm trying to understand what assistance I could possibly get for paying for all that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right, let's see.
[AGENT][NEUTRAL] I'm gonna pull your policy and your actual policy and read it to see if there's anything in there that can help you with the critical illness part of it. Critical illness is um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It is life-threatening. That's correct. It is life-threatening and it is like a um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, it has different meanings for it. Uh, let me see real quick.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] That's what I was trying to understand is like that could, that could mean a number of things.
[AGENT][NEUTRAL] As far as your benefits go.
[AGENT][NEUTRAL] Right. Very, it's very broad. Yes, sir. As far as your benefits go, we would have to have you talk to the number that I that I transferred you to earlier.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And if you can just explain to them, hey, look, I was in the hospital, I had an irregular heartbeat.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, for 8 hours. Did they put you in intensive care?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Did they do that? Did they put you in intensive care? No.
[CUSTOMER][NEUTRAL] No, well, I was, I was in, I was in a, no, I was in an ICU section, yeah, so I, I guess I, I don't, I didn't, I didn't, I didn't hear them say that until my wife was trying to come see me, and I was like, where, where am I? Because they moved me from one room to another. So I went from the emergency room to
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] To a different, to a different section. And I believe it was, it was an ICU section. Um, I, I, I wasn't entirely sure. They were just kind of like, OK, we're gonna take you to the next room, and, you know, it was they were just kind of doing various things to get my heart to settle down.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Yes, yes, I understand. OK. Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So, so it would, it would still be through them, but they, they kept saying it was preventative and they, they, they made it sound like a hospital visit doesn't count as preventative. cause like, I guess I had an issue and then I went to hospital, even though, to be honest, I tried to.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do something years ago, I tried to do something preventative for this. This is an issue that has come up here and there, uh, where this irregular heartbeat thing pops up. It's usually very brief. It doesn't last for eight hours usually. Um, and the thing is, I can't trigger it, right? So like, when I would go to a doctor and try to prevent it,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] They didn't really have anything to give me. They're just sort of like, I don't know, maybe it's stress, hard to say because we can't observe it happening, so we don't know what it is. Um, and so then, until it actually like flares up for long enough for me to actually see a doctor about it. And then it lasted so long that I, you know, it was late at night and so I went, went to the emergency room. So like, I don't, I don't know if I need to like word it in a way that sounds more preventative, but it really was like, it started happening and then I went to go to the hospital to try and
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Right, yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Finally deal with this thing that I've kind of seen on and off, you know, uh, but yeah, it was, it was really, every, everything kind of hurt and it was like it was very difficult to move. Um, and I guess it's because of like the way the blood is pumping less effectively. Anyway, I don't need to tell you the whole story. I just, I'm just kind of starting to feel like I'm losing confidence, thinking that it's probably not gonna go anywhere with them cause they're gonna be like, well, that's not preventative, so, well,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. So I've got, I pulled up our critical illness, um,
[AGENT][NEUTRAL] Claim for
[AGENT][NEUTRAL] I'm gonna um refer you to our website. It is um [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on the critical illness and you have the critical illness insurance. So if you were to file a claim, you would have to use the critical illness claim form.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And on that critical illness claim form, it that very first page, um, after you go to [PII], you're gonna click on claims and forms.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you're gonna scroll down to where you see the critical illness claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm thinking, I mean, since they were very brief with their benefits for you and you're still left confused, I want to make sure that you have a clear understanding and this instruction sheet for the critical illness claim form gives you step by step what you need to send in when you file a claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, it says on their hospitalization due to infectious disease.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if you have infectious disease, um, genetic testing, um, medical records for the critical illness, um, a diagnosis, additional diagnosis, uh, of course, you didn't have accidental death, but it gives you, um, exactly what you need to file a claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I guess that'll give me a starting point.
[AGENT][NEUTRAL] The question is, yes, it will. And the question is, is it true critical illness or is it not? So that would be determined by your item my statement with diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And you may even be able to call the um hospital that you were at and just ask them, is this hospitalization considered critical illness? Because I have critical illness insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, and see. Sure.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] And just see if they can help you. Otherwise, I can transfer you back over to IMA and let you talk to them and see if you can get a little more detail about your benefits with them.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I appreciate that.
[CUSTOMER][NEUTRAL] Sure, I can, I can always call them back if I, if I run into a dead end, yeah, I, I, I got the number and I know which option to select, so.
[AGENT][NEUTRAL] If you wanted me to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir. Yes, sir. OK.
[CUSTOMER][POSITIVE] Yeah, I think, I think I'll be OK in that regard. All right, well I appreciate the information. I'll see what I can do online and contacting the hospital and all that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, sir. OK, I'm trying to pull up straws here trying to help you the best I can because they were so brief with you with giving you your benefits.
[CUSTOMER][NEUTRAL] No, I, I, I understand. Yeah.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] OK. Well, [PII], is there anything else I can help you with?
[CUSTOMER][POSITIVE] Yeah, I get it. OK, all right, I appreciate that.
[CUSTOMER][POSITIVE] No, I think that's all for now. Thank you.
[AGENT][POSITIVE] OK, you have a blessed day, sir, and thanks for calling APL.
[CUSTOMER][POSITIVE] All right, certainly. Take care.
[AGENT][NEUTRAL] Bye bye.