AccountId: 011433970860
ContactId: 252ba9ef-5799-4aaf-b233-9facf0023c8e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592539 ms
Total Talk Time (AGENT): 246679 ms
Total Talk Time (CUSTOMER): 263224 ms
Interruptions: 5
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/252ba9ef-5799-4aaf-b233-9facf0023c8e_20250430T18:22_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. I'm not transferring a call to you, but I do need for you to please help me with the policy before I give these people an amount.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] 784-039. The last name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So he has been diagnosed with cancer. And looking at this policy certificate, I don't like these old policies.
[CUSTOMER][NEUTRAL] OK, when I'm looking at PIBFT, it says the base benefit package on CPA 22. OK, it's 15,000.
[CUSTOMER][NEUTRAL] And critical illness is 7500. I'm looking at the policy certificate.
[CUSTOMER][NEUTRAL] And it doesn't say 15,000 anywhere that I've been able to locate anyway.
[AGENT][NEUTRAL] OK, so you're looking, cause it's, so for the critical illness rider is um 7500 and there's an additional 7500. That's where the 15 is probably what you're saying. Let me see here. Let me pull up the policy.
[CUSTOMER][NEUTRAL] So I don't wanna tell her what.
[CUSTOMER][NEUTRAL] I look at PI BST, so that's that's confusing.
[CUSTOMER][NEUTRAL] Because it shows $150,000 as the base benefit and then a $7500 critical illness rider.
[AGENT][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] And this policy says internal cancer benefit amount 7500.
[AGENT][NEUTRAL] Yes, so I see the internal, yes, and then the 15, let me take a look here.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] And then it didn't even give me the critical illness benefit amount in the policy certificate.
[CUSTOMER][NEUTRAL] Or not that I can find.
[AGENT][NEUTRAL] Which that's the 7500.
[AGENT][NEUTRAL] The 7500 is the um critical illness benefit.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] So it's it, so the PIBFT where it says 15,000, that's actually not the cancer benefit.
[AGENT][NEUTRAL] Um, I'm looking at the.
[AGENT][NEUTRAL] Cause it looks like he, the coverage that he has breaks down into different benefits here.
[AGENT][NEUTRAL] Hold on here.
[CUSTOMER][NEUTRAL] I just don't wanna tell them wrong. I, I mean, on these cancer policies, especially these old ones.
[CUSTOMER][NEGATIVE] That are when PIBFT is useless in relation to the policy certificate.
[CUSTOMER][NEUTRAL] The last thing I want to do is to tell people, you know,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Wrong benefit information they've got enough on their plate.
[AGENT][NEGATIVE] It should give the dollar amount though, but it is not for.
[CUSTOMER][NEUTRAL] On page 6 of 40 I'm looking on page 6 of 49 on this old.
[AGENT][NEUTRAL] Yeah, that only tells, it tells that they have the level 2.
[AGENT][NEUTRAL] And then it has a critical illness.
[CUSTOMER][NEUTRAL] And then right below that, mhm, and then it says internal cancer benefit max 7, yeah, that does not.
[AGENT][NEUTRAL] It's a 7500.
[AGENT][NEUTRAL] Let me see something real quick.
[CUSTOMER][NEUTRAL] That doesn't, that's confusing. That doesn't say that that's the critical illness benefit amount. That says that's the internal cancer maximum benefit amount.
[CUSTOMER][NEUTRAL] Uh uh.
[AGENT][NEUTRAL] Do you know if their condition is for cancer?
[CUSTOMER][NEUTRAL] Yes, it is. He's been recently diagnosed, about to be going under surgery, radiation. Yeah. So I don't.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So then that would be the benefit of the 7500.
[AGENT][NEGATIVE] Being diagnosed with cancer.
[AGENT][NEUTRAL] Looks like it seem like it's a page that might be missing in it. Let's see.
[AGENT][NEUTRAL] That's why I'm scrolling here.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] At the certificate.
[CUSTOMER][NEUTRAL] And policies.
[AGENT][NEUTRAL] Cause they normally give additional benefits amounts, and I'm not seeing that this one is. It's only given at 7500 which that will be the initial benefit for being diagnosed with cancer.
[CUSTOMER][NEUTRAL] I can
[AGENT][NEUTRAL] Do you mind if I put you, 00, no, here it is. No, I see it. Here's the schedule page back here, page 23.
[AGENT][NEUTRAL] Page 23, there is a bit of.
[CUSTOMER][POSITIVE] Yeah, there's a lot of benefits.
[AGENT][NEUTRAL] Yes, so the, so him being initially diagnosed with cancer is the 7500. Then on page 23 of the pilot certificate, it breaks down what the benefits pays as far as other cancer treatment for hospital, hospital confinement, drugs, and things of that nature.
[CUSTOMER][NEUTRAL] Oh, hold on.
[CUSTOMER][NEUTRAL] OK. So, how do they get the critical ill where's the critical illness benefit?
[CUSTOMER][NEGATIVE] Because that's very misleading on PIBST.
[AGENT][NEUTRAL] That is in the back of the rider.
[AGENT][NEUTRAL] Um, of the policy, which it pays that one-time benefit.
[CUSTOMER][NEUTRAL] So does he
[CUSTOMER][NEUTRAL] I mean, I found the schedule.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so he's gonna get 7500 before being diagnosed with cancer and another 7500 under the for a total of 15,000, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] Mm. So, no, no. So for being diagnosed again, no.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] For being diagnosed with cancer, he's getting the 7500 and then the policy breaks down into the other benefits being if he has other treatments. But just being diagnosed with cancer is the 7500.
[CUSTOMER][NEUTRAL] OK, well then PR BFT is wrong.
[CUSTOMER][NEGATIVE] That's not correct information.
[AGENT][NEUTRAL] So, yeah, so it'd be, I, I think it's showing the, the 1500 as far as cause if it's another condition, like if he had a heart attack or something like that, then it'll pay the 7500. And then if it's cancer, it'll pay the 7575.
[CUSTOMER][NEUTRAL] Well, this is critical illness. OK, it's still being.
[AGENT][NEUTRAL] So he won't get 2 7500. So it'd be one benefit for 7500.
[AGENT][NEUTRAL] And then it covers whatever other treatment that he's received and then those, the policy outlines those how much it pays up to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so this, OK, so I'm gonna tell them it's the 70. OK, I'm not even gonna get it. OK, any deeper than that.
[CUSTOMER][NEUTRAL] OK, because I'm still confused on that the way PIBST is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] That is, that makes no sense because it shows RCA 15,000.
[CUSTOMER][NEUTRAL] And then a rider under that for cancer of 7500.
[AGENT][NEUTRAL] Mhm. Yup.
[CUSTOMER][NEGATIVE] That's misleading as all can be.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean, is that not confusing to you? Do I mean
[AGENT][NEUTRAL] So the, so, well, it, so what is it, I guess let me explain it like this where it's confusing. OK, so as far as the RCA, um, the RCA.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That actually refers to
[AGENT][NEUTRAL] The radiation and chemo.
[CUSTOMER][NEUTRAL] The base.
[AGENT][NEUTRAL] The radi radiation and chemo pay up to 15,000.
[CUSTOMER][NEUTRAL] Uh, yeah, I saw that because I've already given her that. OK.
[AGENT][NEUTRAL] And then the critical illness and that comes into play as the 7500, but it'd be for either or either for a cancer diagnosis or a critical illness diagnosis. Yeah.
[CUSTOMER][NEUTRAL] That comes into place as the diagnosis.
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] So, the critical illnesses for cancer that they have, so it only would pay 7500 for their initial, initially being diagnosed with cancer. And then the 15,000 is in regards to their max that the policy pays out as far as radiation and chemo. Does that make sense now?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yes, but so this policy is different in other, the other cancer policies and the fact that hypothetically, so he's diagnosed with cancer, that's a $7500 benefit this time. But then if he were to have some other type of critical illness.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, such as like a, yes, such as a heart attack or things of that nature which is outlined back it breaks down which other critical illnesses would fall within that category.
[CUSTOMER][NEUTRAL] Other than cancer, would he be eligible for that?
[AGENT][NEUTRAL] A heart attack or stroke or things like that.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK, alright, so let, OK, let me just provide her this and then I'm gonna order this policy to be made viewable in the OSC because she can't see this information right now anyway, but I'm, and I'm gonna do that. OK, [PII], well thank you for looking at that for me and helping me understand that a little better.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] OK, alright, thanks as always.
[AGENT][POSITIVE] Mm. You're welcome.
[CUSTOMER][NEUTRAL] All right, [PII]. bye.
[AGENT][NEUTRAL] Mm bye.