AccountId: 011433970860
ContactId: 1f44d041-d1c0-4d17-bdf7-6d52374bad23
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1235290 ms
Total Talk Time (AGENT): 488524 ms
Total Talk Time (CUSTOMER): 448421 ms
Interruptions: 8
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/1f44d041-d1c0-4d17-bdf7-6d52374bad23_20250616T14:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, uh huh, um, I wanted to, I needed to know, um, let's see, uh, I have an explanation of benefits that I received, um, do you need, uh, I need to know what it means, um, it's a cancer policy, uh, do you need the policy number? Uh huh, it's uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yes, ma'am. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's uh 025413.
[CUSTOMER][NEUTRAL] 95
[AGENT][NEUTRAL] And who am I speaking with?
[CUSTOMER][NEUTRAL] Yes, uh, [PII].
[CUSTOMER][NEUTRAL] And this is uh for uh my husband [PII].
[AGENT][NEUTRAL] And can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. Uh-huh. It's [PII].
[AGENT][NEUTRAL] OK. And you said this is in regards to your husband, [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII], uh huh.
[AGENT][NEUTRAL] OK OK give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And is he with you currently?
[CUSTOMER][NEUTRAL] Uh, yes, uh-huh, yeah, [PII], uh-huh, yeah.
[AGENT][NEUTRAL] Is it all right if I go ahead and get a one-time authorization over the phone so that I can speak with you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, uh-huh, [PII].
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] [PII], OK, she needs, um, we're talking about your cancer policy. This is [PII].
[AGENT][NEUTRAL] Uh, is it all right if I talk to, uh, [PII] on behalf of you for your cancer policy?
[CUSTOMER][POSITIVE] Yeah, yes, yes, of course.
[AGENT][NEUTRAL] Uh, what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you so much, um.
[AGENT][NEUTRAL] Now that is just a one time authorization if you'd like for her to speak on your behalf, um, without having to go through this every time, you can fill out a third party authorization form found on our website and that way you won't have to do this every time, um, but if you're OK with me speaking with her, you can go ahead and give her the phone back and I'll help her out as best as I can, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK, and, uh, give her the information about that third party thing again so she can start on it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I can help with that.
[CUSTOMER][POSITIVE] OK thanks. OK. I can help you out. Thank you. Uh huh. Yes.
[AGENT][NEUTRAL] Alright, [PII], what is the um address that we have on file for you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh, it's [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and as I was talking to him earlier, um, if you go to [PII].
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And go to claims and forms. There will be like a third party authorization form you can fill out, um, that way, uh, once you fill it out and return it and all of the return information will be on that form, um, we'll be able to speak to with you on his behalf every time um I won't need to do that that one time authorization over the phone every time.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that's up to you if you guys would like to continue that, yeah, um otherwise every time you call um about him we'll just need to get him to uh.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To uh allow us that one time authorization, but if you'd like to do it without having to do that, um, you can fill out that form and let us know that we can speak to you on his behalf.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. OK, and where is that format again? I'm sorry.
[AGENT][NEUTRAL] So you'll go to [PII].
[CUSTOMER][NEUTRAL] The the form?
[CUSTOMER][NEUTRAL] Am [PII]. OK.
[AGENT][NEUTRAL] Right and then you'll see something that says claims and forms.
[CUSTOMER][NEUTRAL] A in [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you want a third party authorization form.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then it'll say uh what kind of forms are they? I'm sorry, what kind of forms?
[AGENT][NEUTRAL] Let me see what the exact name is and I can tell you.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK, so once you get on [PII] on the top right corner, you'll see claims and forms. You'll scroll down. Oh, and it's that very second one authorization to disclose information.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, to disclose information. OK, and I can just send that to you or can I fax it to you or uh let's see or or email it?
[AGENT][POSITIVE] Yes, you can
[AGENT][NEUTRAL] Uh, you can fax it. Our fax number is where to send this is on the bottom as well as the mailing address.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, OK. OK, that's fine, that's fine. OK. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's, it's on the bottom of the first page.
[CUSTOMER][POSITIVE] OK, OK, got you. OK, thank you.
[AGENT][NEUTRAL] All right, and on his claim.
[CUSTOMER][NEUTRAL] And then, OK.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is it the most recent claim that you're talking about?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yeah, yeah, the, the most recent one where, where it says the condition you're following.
[AGENT][NEUTRAL] Ending in 8247.
[CUSTOMER][NEUTRAL] 8247, yes, uh-huh. Yeah. Uh.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah, I didn't know what uh which which claim that was.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It just says no benefits are payable for any loss incurred during the pre-existing condition exclusion period following the covered persons, uh, effective date.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It said the preexisting conditioning exclusion period is shown on the certificate schedule.
[CUSTOMER][NEUTRAL] So it just says to contact our office with any questions, so.
[AGENT][NEUTRAL] OK. Yeah, it looks like you had a preexisting condition, and let me go ahead and look up your policy um details.
[CUSTOMER][NEUTRAL] Mhm. OK. OK.
[AGENT][NEUTRAL] Um, I, and then I, as I pull that up, I am showing that you have an email address on file with us. So if you would like um to ever view these policy documents, um, you can always go to [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you'll go to create.
[CUSTOMER][NEUTRAL] 1
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, wait, uh, [PII]?
[AGENT][NEUTRAL] Uh, [PII]. [PII]. So you'll put a period in between secured and AM as well.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And then um from there once you fill out an account it will be under it looks like your email um.
[CUSTOMER][POSITIVE] Secured.
[AGENT][NEUTRAL] And then you'll fill that out or once you create an account, you'll be able to see any of your policy documents, ID you can print ID cards and then you can even see the uh status of your claims and you can file claims online as well. um, but let me see.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] About your preexisting conditions. Clause. Give me just a moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure, uh huh, OK.
[CUSTOMER][NEUTRAL] I have a preexisting conditions.
[CUSTOMER][NEUTRAL] Mhm. Mhm. I know.
[AGENT][NEUTRAL] OK. Looks like you do have a pre-existing condition period of 12 months. This policy became active [PII]. So starting um after that [PII], uh, so it looks like you've got about, what are we in, 3 to 4 months before that 12 month waiting period is ending.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so any pre-existing conditions, it shows 12 months from, uh, 12 months from [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's why they, they've been denied. Mhm. Your policy became active [PII] and the pre-existing condition exclusion period is 12 months.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, and so the date was, uh, when we filed was uh was it [PII]?
[CUSTOMER][NEUTRAL] You said 12, I'm, I'm sorry, you gave me a December, December date.
[AGENT][NEUTRAL] It's
[CUSTOMER][NEUTRAL] I think you gave me like a was it December was it on on the front here? 0 122, right?
[AGENT][NEUTRAL] So the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the policy became active?
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And of, of last year. And so you have a pre-existing condition or period of 12 months. So after [PII] of this year, um, those benefits for that pre-existing condition.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] will be covered.
[CUSTOMER][NEUTRAL] Oh, OK. Oh, OK, would be, uh, yeah, in September of this year, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Is that, uh-huh, it would be covered, it would, it would have been covered only after, only after, uh, after 12 months. Oh, I see. That's why they denied it, right?
[AGENT][NEUTRAL] After 12 months.
[AGENT][NEGATIVE] Right, that is why it was denied.
[CUSTOMER][NEUTRAL] The the claim
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. And, and the claim was for the, I guess like um um for I guess like if you find out that you have cancer, uh, it would be, it would be uh.
[CUSTOMER][NEUTRAL] They usually give like um since I'm on the low policy, right, I think I had filled out the claim for to get the, the fee, the, the money, right? For 5000 for each occurrence or something like that for cancer.
[AGENT][NEUTRAL] Uh, let me look at what you've got.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And are you asking about the one you just um
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, the one that I just OK.
[AGENT][NEUTRAL] Submitted for? OK, let me pull that up.
[CUSTOMER][NEUTRAL] I just wanna make sure it was it for that.
[AGENT][NEUTRAL] OK give me just a moment, it's pulling up.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] Alright, it is taking a second. Let me try again.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Here we go.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] And we're gonna feed them?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I am I able to read that. Looks like the fax didn't come in.
[AGENT][NEUTRAL] Let's try this one. The fax, the way it was faxed in, it looks a little blurry, so give me a moment. Let me see if I can.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Find it.
[AGENT][POSITIVE] An easier version to read.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause you were trying to file a wellness claim, correct?
[CUSTOMER][NEUTRAL] Yeah, wellness, uh-huh, uh, it was, um, well, uh, I was trying to file a claim, uh, you know, because it says if you have cancer, you're entitled to, you know, some money.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, and, and that's what I was wondering if it was for that, you know.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] What what would be a wellness claim?
[AGENT][NEUTRAL] A wellness claim would be something such as like a diagnostic test, um, like, for example, for you, if you were to get a mammogram, it would cover that kind of test.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, I see. OK.
[AGENT][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Yeah, because if, if he's like, if he has cancer, it would be um
[CUSTOMER][NEUTRAL] They would pay out, you know, some money, he would get a payout of $5000 so that's, that's what I'm thinking that this claim was, was for.
[AGENT][NEUTRAL] OK. This one shows that it was for a wellness exam, um, with an elevated PSA it looks like. I'm not seeing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Anything further for that. Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, that I was the, the one that um.
[AGENT][POSITIVE] Yeah, it looks like you filled out a form and a wellness form.
[CUSTOMER][NEUTRAL] Yeah, so it was like.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, what, what is the, the K form also put this in there. So which one was it?
[AGENT][NEUTRAL] Yeah, you send in a wellness form and a cancer form. Let me see.
[CUSTOMER][NEUTRAL] A tax reform, yeah. Yeah.
[AGENT][NEUTRAL] Mhm, yes, ma'am.
[CUSTOMER][NEUTRAL] So it, it would be for both of those?
[AGENT][NEUTRAL] Uh, depending on what you're filing for, if you're filing for the cancer one, yes, but you will need to wait on that one, depending on what his pre-existing condition is and if it's been met. Uh, if you would like, I can send you to someone from claim support and they can go into this a little bit more further with you. Um, I was unable to read the document. Um, it was, it was a little blurry, so they might be able to have it. So give me just one moment and let me see if I can transfer you, OK?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. OK, thank you. OK, thank you.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] from the care team. I have an Emma Patino on the line for her husband [PII] for a claim. Um, the policy number is 2541395.
[AGENT][NEUTRAL] Um, I tried looking at her documents and what she was trying to, uh, I think they were wanting more information on exactly, I told them about the pre-existing condition waiting period, but I was unable to read some of those documents.
[AGENT][NEUTRAL] Um, because it was a little blurry from the facts, and I was wondering if you could go over, um, more about what, what they're trying to file for. I, I couldn't read it. I couldn't understand her completely, but it looks like she filed a wellness claim form and a cancer claim form, and they both got denied because of the waiting period. Um.
[AGENT][NEUTRAL] And I, I don't know, I don't understand the waiting period part for
[AGENT][NEGATIVE] The claim, I couldn't read the documents well enough.
[CUSTOMER][NEUTRAL] OK, give me just a second. I'll take a look here.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I went ahead and got a one-time authorization to speak to her from [PII].
[CUSTOMER][NEUTRAL] OK, but she the policy holder?
[AGENT][NEUTRAL] Uh, she is the policyholder.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's that last claim ending in 8247, and there's a bunch of them, so I'm
[AGENT][NEGATIVE] I'm confused on how to go about that, with that many being submitted.
[CUSTOMER][NEUTRAL] OK, yeah, I'm just pulling her information up here just, uh, just give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you have a callback number for her?
[AGENT][NEUTRAL] Yes, ma'am, I do. It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Uh, I'm ready for it.
[AGENT][NEUTRAL] Oh, OK, give me just one moment and I'll introduce you.
[AGENT][NEUTRAL] [PII], are you on the line?
[CUSTOMER][NEUTRAL] Yes, yes, I am.
[AGENT][NEUTRAL] I, I, I have [PII] from claim support. She'll be able to talk me through that claim, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Uh huh uh huh you're welcome.
[CUSTOMER][NEUTRAL] Yes, good morning, Ms. [PII]. Uh, how can I help you today? Yes, uh-huh, um, I had filled out a, a claim form for my husband, um, because we just found out that he had, uh, uh, cancer, um.
[CUSTOMER][NEUTRAL] Oh, let's see, what was it? I think I wanna say it was.
[CUSTOMER][NEUTRAL] Uh, sometime last year, but I don't know what what the month was, um, but I was gonna see if, uh, if it was denied or, um, or considered preexisting or, uh, because I don't know if it was, uh, September, you know, because I already got the insurance in in September on [PII] it went into effect, so I just don't remember what day.
[CUSTOMER][NEUTRAL] He found out, you know, then he said he had cancer. So I was just wondering what, um, you know, what, what the status is on, on the cancer uh form that I had filled out.
[CUSTOMER][POSITIVE] Oh sure, I can just look at that for you.