AccountId: 011433970860
ContactId: 1fce105d-6329-427d-8219-1597471a4cc3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1238790 ms
Total Talk Time (AGENT): 346329 ms
Total Talk Time (CUSTOMER): 444390 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/1fce105d-6329-427d-8219-1597471a4cc3_20250603T18:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Hey, I'm trying to get into my account to look at a claim, and I'm doing the new set up, but every time I put stuff in it comes back and says claim not verified and then print see it says email address.
[CUSTOMER][NEUTRAL] But I went to my email, got the verification code. I put that in and then it still comes back with that error code.
[AGENT][NEUTRAL] Huh, OK, so you're trying to do the verification and it's just not accepting the code?
[CUSTOMER][NEUTRAL] No, it's not.
[CUSTOMER][NEUTRAL] So I'm trying to like reset my account since y'all had the update.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, what is the policy number? Do you have that by chance?
[CUSTOMER][NEUTRAL] I don't, um, I don't have my card with me and I always just get the policy number offline, but I can't get in.
[AGENT][NEUTRAL] OK, I can look you up by name or social, whichever you would prefer.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The social is [PII].
[CUSTOMER][NEUTRAL] So I assume I do this um create your OSC account?
[AGENT][NEUTRAL] Mhm yep, you're gonna have to create a new username and password because your user name go is gonna be the email.
[CUSTOMER][NEUTRAL] And I click [PII].
[AGENT][POSITIVE] Mhm. Insured, correct.
[CUSTOMER][NEUTRAL] And then, mhm.
[CUSTOMER][NEUTRAL] And then I put my last name, which I've done several times.
[CUSTOMER][NEUTRAL] And then does it matter? It says social or member ID so I can use my social, correct?
[AGENT][NEUTRAL] Yeah, put your social, that should work.
[CUSTOMER][NEUTRAL] Cause when I asked, when I was doing this yesterday, um,
[CUSTOMER][NEUTRAL] The lady told me you would sign up by email instead of your social this time, but she'd asked for both, so.
[CUSTOMER][NEUTRAL] OK, so the email that is sending my verification codes to is the one I'm putting in so um apparently have the right email that y'all have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I put my date of birth in incorrectly.
[CUSTOMER][NEUTRAL] And then it says continue.
[CUSTOMER][NEUTRAL] And I put the same email address in.
[CUSTOMER][NEUTRAL] And then I just create any password, right?
[AGENT][NEUTRAL] So once you do that I believe it says um verification code and then you have to verify the email then to create the password.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I've done that.
[CUSTOMER][NEGATIVE] I've already got it to send me like 3 verification codes and I've tried it every time it says.
[CUSTOMER][NEGATIVE] Not valid or whatever right.
[CUSTOMER][NEUTRAL] So I put the verification code in again.
[AGENT][NEUTRAL] And then click, I think it says verify email.
[CUSTOMER][NEUTRAL] A new one.
[CUSTOMER][NEUTRAL] Well, it asked me to go ahead and create a password, but I'll click that.
[CUSTOMER][NEUTRAL] And then that password comes up again.
[CUSTOMER][NEUTRAL] So maybe I was filling out every blank on that screen.
[AGENT][NEUTRAL] Before verifying the email, yeah, yeah, correct.
[CUSTOMER][NEUTRAL] And I should have click verify first, right? because it's all on there together so it it doesn't really specify that you need to do it one at a time.
[AGENT][NEUTRAL] Yeah, because you do the code, click verify email, create the password, then it should create the login, then it should take you back to the login page.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It did. It just has all those blanks together, so I figured before I click continue, I would need to complete them all, but it looks like it's working this time.
[AGENT][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] So that makes sense now, um.
[CUSTOMER][NEUTRAL] Let me check this before.
[CUSTOMER][NEUTRAL] Um, make sure to let me log in.
[CUSTOMER][NEUTRAL] So it happened.
[CUSTOMER][NEUTRAL] Or verification code again let me log in.
[AGENT][NEUTRAL] Yeah, with the, the new.
[CUSTOMER][NEUTRAL] Was it less?
[AGENT][NEUTRAL] Well, with the new service center it's always gonna ask for these verification codes now that was part of the enhancement and so yeah.
[CUSTOMER][NEUTRAL] So it won't remember any device at all. It's gonna need a verification code every time.
[AGENT][NEUTRAL] Yeah, they did that for an added layer of security.
[CUSTOMER][NEGATIVE] And I understand, but it's also a pain in the rear.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It'd be better if they would um um if y'all can make recommendations or not but I wish it would text instead of email.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][POSITIVE] A lot quicker to get to.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] So if I don't want to file a claim, let's see.
[CUSTOMER][NEUTRAL] So what I'm looking for is I got a
[CUSTOMER][NEUTRAL] A text this morning saying that my claim had been verified um had been completed and I wanted to see if it was approved or not before I got off the phone with you and, and I'm trying to get to it, but it's not quite as quick as it used to be. They've changed everything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So how do you see claims now? Oh this is different.
[AGENT][NEUTRAL] Yeah, so it should be under, let me pull up the guide here.
[AGENT][NEUTRAL] Give me just a sec.
[CUSTOMER][NEUTRAL] I thought I could just look at it real quick while I had you on the phone I see claims now.
[AGENT][NEUTRAL] Yeah, I think there's something that says claims and then you should be able to I believe still click on the claim.
[AGENT][NEUTRAL] Uh, to view it.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So I guess the one they completed may have been a wellness claim.
[CUSTOMER][NEUTRAL] 1481.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] I think I have all your info pulled up. If you want to give me your name and date of birth, I can pull it and see what um I see on my side.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah, it looks like on the
[AGENT][NEUTRAL] Cancer policy, there was
[AGENT][NEUTRAL] Radilogy diagnostic for a mammogram that was paid out, that was $100.
[AGENT][NEUTRAL] And then there was another $100 paid out for wellness for a PA.
[AGENT][NEUTRAL] So both of those were paid out under that.
[AGENT][NEUTRAL] And then your other plan is your hospital indemnity.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What, what is this claim number 3606899 and at the bottom it says coverage type limited benefit medical plan.
[AGENT][NEUTRAL] What was the number again that you gave me ends in 99?
[CUSTOMER][NEUTRAL] Mhm. There's a couple.
[CUSTOMER][NEUTRAL] One of them is 689-96892.
[AGENT][NEUTRAL] So you have two different plans with us. You have a limited benefit like hospital indemnity medical plan and then you have a cancer plan with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I knew the hospital in, but I didn't know if that was what it meant by limited benefit medical.
[AGENT][NEUTRAL] Yeah, that's what it means. It's not like a major medical, it's a limited benefit plan.
[AGENT][NEUTRAL] So the two claims that were submitted looks like they were both paid and processed.
[CUSTOMER][NEUTRAL] OK, so there was one submitted um for hospital.
[CUSTOMER][NEUTRAL] On the [PII].
[CUSTOMER][NEGATIVE] And it was processed and denied because they needed more information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I sent more information in.
[CUSTOMER][NEGATIVE] And I don't see where that one is still open.
[AGENT][NEUTRAL] Was that under [PII]?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you upload the additional information last Friday or was had a new claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That was the additional information.
[AGENT][NEUTRAL] OK, so it's still showing pending. It doesn't done anything with it as of yet, but I do show that it's been received.
[CUSTOMER][NEGATIVE] OK, because I can't even see that on here anymore.
[AGENT][NEUTRAL] Yeah, there have been some people reporting that some things are not, I don't know if it's because of the switch over and it was done on Friday, but um I do see it showing reported on our side.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] OK, so do you have any idea when they might possibly look at that new information?
[AGENT][NEUTRAL] Uh, generally, we just ask for 5 to 7 business days for them to be processed and completed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So as far as what was completed.
[CUSTOMER][NEUTRAL] Today
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's showing me 3 claim numbers here, so is that 3 $100 that was approved?
[AGENT][NEUTRAL] I believe so.
[AGENT][NEUTRAL] It looks like.
[CUSTOMER][NEUTRAL] 12.
[CUSTOMER][NEUTRAL] 3, yeah, it looks like.
[AGENT][NEUTRAL] So it was a total of $200 that was paid. Uh, it looks like from what I can see, you may have submitted these originally on the limited benefit plan.
[AGENT][NEUTRAL] And then the claims examiner moved your claims to your cancer plan because that's where the benefits were payable so that's why you may see the additional claim number because the actual paid claim was under the cancer because that's where the benefits were payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I wanted to ask to.
[CUSTOMER][NEUTRAL] About um
[CUSTOMER][NEUTRAL] Things that are payable for the wellness benefits.
[CUSTOMER][NEUTRAL] One of the things it says is CT scan.
[CUSTOMER][NEUTRAL] Does it matter what the CT scan was for? What does it have to be like a cancer screening? Is it just in general?
[CUSTOMER][NEUTRAL] Having a CT scan.
[AGENT][NEUTRAL] Probably
[AGENT][NEUTRAL] Yeah, it probably has to be for a screening of cancer. Let me double check.
[CUSTOMER][NEUTRAL] Also the chest X-ray, that was another.
[CUSTOMER][NEUTRAL] Another thing I was just wondering if it has to be, I mean, because you generally don't just go get a chest X-ray for a.
[CUSTOMER][NEUTRAL] For a screening, and they generally don't do a CT scan just for a screening.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so the screening is for a medically recognized to detect internal cancer, including but not limited to
[AGENT][NEUTRAL] Mammogram, ultrasound, breast ultrasound, um, a PSA test, colonoscopy, a blood test for like ovarian cancer. It does say chest X-ray is listed. Um, it does also list Pap test, um,
[AGENT][NEUTRAL] Those are listed under the test. It does say to generally recognize to detect internal cancer. So if it was just an X-ray for something not a concern cancer related.
[AGENT][NEGATIVE] Probably wouldn't pay any sort of benefit on it and from what I'm reading.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On this um dropdown box, it also lists the hemoglobin A1C.
[CUSTOMER][NEUTRAL] That's not generally something for cancer, but it's on the list. Is it included?
[AGENT][NEUTRAL] I don't see that because the benefits payable.
[CUSTOMER][NEUTRAL] And it, it
[AGENT][NEUTRAL] For like the recent stuff that you had done was under the care policy there was nothing payable on the hospital indemnity.
[AGENT][NEUTRAL] So the, the payable benefits, yeah, would just be for like any sort of test trying to detect internal cancer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Well, I, I actually submitted under the cancer policy. It just, they, I've talked to them before about that because I was like, I didn't submit anything and they said that it just kind of crosses and submits for both, for every policy you have.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] When you submit it.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] You said you only see 2 $100 payments. I was looking at um.
[CUSTOMER][NEUTRAL] The [PII]. I'm sorry, while I'm talking and sitting here spinning, I'm waiting on it to flip back over.
[CUSTOMER][NEGATIVE] Everything's not on the front screen like it used to be.
[CUSTOMER][NEUTRAL] Hope I'm getting used to.
[CUSTOMER][NEUTRAL] I just wanna make sure I was seeing the same thing you were seeing.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, um, I don't know if it's gonna load it again. I don't know.
[CUSTOMER][NEUTRAL] I was seeing 3. That was the only reason I wanted to go back and make sure we were seeing the same thing.
[CUSTOMER][NEGATIVE] But it doesn't like it to want to load it.
[CUSTOMER][NEUTRAL] OK, so I'm seeing one ending in 0181.
[CUSTOMER][NEUTRAL] Ending in 8016.
[CUSTOMER][NEUTRAL] And one ending in 8014.
[CUSTOMER][NEUTRAL] I say completed [PII].
[AGENT][NEUTRAL] OK, yeah, the other one was under [PII]. I didn't check under him. It only brings him up per person though.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] The 3608018 was processed for [PII] same date of [PII]. So that was the third at $100. So there are three, you are correct.
[CUSTOMER][POSITIVE] OK, alright, I will just give them more time on the other one. All right, thank you.
[AGENT][POSITIVE] OK. You're welcome, [PII]. Have a good day.
[CUSTOMER][NEUTRAL] Yeah