AccountId: 011433970860
ContactId: 28473a37-ff20-4702-b9d9-fd0d86c0ac66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 950099 ms
Total Talk Time (AGENT): 383005 ms
Total Talk Time (CUSTOMER): 407864 ms
Interruptions: 6
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/28473a37-ff20-4702-b9d9-fd0d86c0ac66_20250130T19:48_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I have a question about my policy.
[AGENT][POSITIVE] OK, yeah, I'd love to help look at that with you today. And do you have your policy number handy?
[CUSTOMER][NEUTRAL] Yes, it's 753-860.
[AGENT][NEUTRAL] 860. OK, let me get that pulled up for you real quick.
[AGENT][NEUTRAL] All right, and thank you so much for your patience. Um, would you be able to verify for me please, your, your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect, thank you. And I do just have a couple other things I need to verify with you real quick before I can go into the policy. Would you be able to verify for me, please, the mailing address we have on file?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Perfect thank you and then just the last couple of things are that email on file and that phone number on file if you can.
[CUSTOMER][NEUTRAL] OK, [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you so much and is that a good number to call you back on if we were to get disconnected, ma'am?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][POSITIVE] Perfect. All [PII]. And what questions do you have that I can help answer for you today?
[CUSTOMER][NEUTRAL] Well, on my plan description, it says that the maximum benefit amount for internal cancer is 2500 and the heart stroke is 2500. Is, is that just the maximum for those two types or is that the maximum benefit for my policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, yeah, that is an excellent question. Let me open up that policy document and read through it a little.
[CUSTOMER][NEUTRAL] Hey baby, your words.
[CUSTOMER][NEUTRAL] I'm OK. How are you?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] We're doing OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Oh yeah, we've been getting some money.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I didn't know how.
[CUSTOMER][NEUTRAL] I don't know she was, she, she was telling me about the girlfriend.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] All right, and let me make sure I understand your question right is that benefit for each of them combined or is that for each of them separate? Was that the question?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] No, um, my question is, is that the like the maximum that.
[CUSTOMER][NEUTRAL] Will be paid on my policy like.
[CUSTOMER][NEUTRAL] Or is that just for these two named um
[CUSTOMER][NEUTRAL] illnesses like
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So under those two benefits, the internal cancer maximum has $2500 a calendar year, and the heart and stroke maximum is $2500 per calendar year. And then your critical illness, the reason it doesn't have a number next to it is because each critical illness has a lump sum payout that it pays once per diagnosis.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. So,
[CUSTOMER][NEUTRAL] Where do I find this information in my policy?
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] So I can match it up. OK. I see definitions.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yep, under benefits, it will define every type of benefit you have and what's included in that. But if you scroll all the way down, there's also a schedule of benefits, which will let you know on the maximum benefit amount.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] Yeah, I was looking at that.
[AGENT][NEUTRAL] Um, for each benefit, so like that, um, and let me see if I can tell what page it is on, maybe page 20.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's what I'm seeing, um.
[AGENT][NEUTRAL] And that will let you know like if you have an and oh well let's pick a better one because that's a percentage, um, just the top one hospital confinement benefit so you could be eligible for up to $300 per day for the 1st 30 days and then $600 a day thereafter. um, if you happen to have a.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Ambulatory or ambulance benefit. So if you are in an ambulance on the ground, there's up to a $200 benefit per trip or in the air up to $2000. And so you have kind of all of those benefits available to mix and match up to that $2500 in the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, uh, yes. Got you, got you, got you. Yes. Um.
[AGENT][NEUTRAL] And I do just wanna say, and I should have said this before I started talking about benefits and I'm so sorry I didn't, I do wanna let you know that any benefit information I give you over the phone today, always just a verification of coverage. I can never guarantee payment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah. OK, so.
[CUSTOMER][NEUTRAL] Do I
[CUSTOMER][NEUTRAL] So I, I know this is a named policy, right? So, are these the two.
[CUSTOMER][NEUTRAL] Let's see, 123. Yeah. OK, are these the 3 illnesses that are covered? I mean, I know it says that, but I'm just wondering to kind of covered critical illnesses or, or is that just the rider? Cause see, I have the cancer policy. I see level 3, and then I see critical illness rider.
[AGENT][NEUTRAL] OK, yes. So the critical illnesses cover, and it's a list of particular illnesses. Let me see if I can see where it shows.
[CUSTOMER][NEUTRAL] Mhm. Yeah, I see 3 internal cancer, heart attack, and stroke.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, yeah, I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes. So it is just for those 3.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But my cancer policy, it's for all the other things listed in here, basically, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For instance, if I have breast cancer, that falls under the cancer policy. Mhm.
[AGENT][NEUTRAL] If you have breast cancer, that would fall under the cancer policy as far as like your benefits for radiation or for um surgery, those sort of things. Um, and then we're in that critical illness, it looks like, and I just want to read that a little closer on that writer. um.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. OK.
[AGENT][NEUTRAL] But it looks like that one would be where if you have one of those critical illness diagnosis, um, you could be eligible for just that um it's
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Maximum.
[AGENT][NEUTRAL] Like, uh, yeah, like um uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's not an up to amount. It's like just a lump sum payment sort of style.
[CUSTOMER][NEUTRAL] Oh, I see. OK, OK, I understand. So it's a lump sum and, and that's uh.
[CUSTOMER][NEUTRAL] Maximum. OK, that clarifies things because it doesn't say here just looking at the plan description, it doesn't say.
[CUSTOMER][NEUTRAL] 2500 per
[AGENT][NEUTRAL] So I think I read that wrong. I think that just in that critical illness rider, um, and that heart attack, it's, that would be a lump sum payment, the 2500 for the heart attack or stroke or for the internal cancer. And then for the rest of them, it doesn't look like
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It looks like your benefit amounts are listed in that schedule of benefits instead, um, so the hospital confinement and they're listed there instead of at the top with a with that number limit, they're limited within their own schedule, and I think I misunderstood that when I was reading through it the first time. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] you know you can tell me the time.
[CUSTOMER][NEUTRAL] OK, so where is the
[CUSTOMER][NEUTRAL] Where is the critical illness rider? What page number? Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so I'm seeing that right under, OK, so the schedule of benefits that starts on page 20 goes to 21 and 22, and then the critical illness writer starts on 23.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it will give you the definitions for that one there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You get the.
[CUSTOMER][NEUTRAL] I found it critical illness writer.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, this issues.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] the number of days showing in the post.
[CUSTOMER][NEUTRAL] I'm just looking for where it says um.
[CUSTOMER][NEUTRAL] Dynamic exclusions trip system reinstatement. I'm just looking for where it says it's a lump sum payout.
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] OK, let's read through that.
[AGENT][NEUTRAL] So it says we will pay the specified internal cancer maximum benefit amount.
[CUSTOMER][NEUTRAL] Um, OK, where are you?
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] So if you look right under cancer benefit, it looks like 12, and 3, then it says right after that, we will pay the specified internal cancer maximum benefit amount. And if something is listed in all capitals, it means that it has a definition somewhere, so we can probably find the definition for what that exactly means.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so it says the critical illness waiting period and internal cancer maximum benefit are shown in the policy schedule, which we saw we saw on that first page, and then it says the cancer benefit is payable once for any one covered person. Once the cancer benefit is paid for a covered person, the benefit is no longer available for them.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, it is a good thing, yeah.
[CUSTOMER][NEUTRAL] OK, tell me what page you're on.
[AGENT][NEUTRAL] Oh yeah, so I'm still on, I'm on page, right, you know, at page 23 where it said critical illness writer, I'm on the second page of that. Um, so page 24 total, and I'm at the bottom right under benefits.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, yeah, OK, yeah, that medical illness writers and then benefits. OK, cancer benefit. Got you. All these writers in port.
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] Yep, and so.
[CUSTOMER][NEUTRAL] This on the policy schedule. OK, I see that the uh the cancel benefit is payable once for any one covered person. Once the cancel benefit is paid for a covered person.
[CUSTOMER][NEGATIVE] This benefit is no longer available.
[CUSTOMER][NEUTRAL] For such of a person.
[CUSTOMER][NEUTRAL] The internal counseling. It's just a little confusing because
[CUSTOMER][NEUTRAL] OK, because we're under the critical illness writer, but it's saying cancer.
[AGENT][NEUTRAL] So I think that's for like the lump sum payment of those internal cancers. So if you go up top and it says um the internal cancers, if you're diagnosed with one of those 11 types of cancer, you could be eligible for that lump sum payment that is in that benefit. But if you have one of those cancers, not only could you be eligible for that lump sum payment, but if you're also having
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I see those, yeah.
[CUSTOMER][NEUTRAL] Lump sum, mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, hospital stays or um transportation on an ambulance or radiation or chemo, you're still eligible for the benefits in your, your policy as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's, that's what I needed to clarify. OK, that's exactly. Now you've reassured me. I got it. Yes, that's, that's, that's good.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Oh, absolutely.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you very much. You've answered my question.
[AGENT][POSITIVE] Well, I'm so happy I could answer your questions. Is there anything else you have questions on or we can look through together?
[CUSTOMER][POSITIVE] That's it. Thank you so much.
[AGENT][POSITIVE] Oh well it's my pleasure. Thank you so much for giving us a call and if you need something else just reach out we're always here.
[CUSTOMER][POSITIVE] OK. God bless you.
[AGENT][POSITIVE] Take care. Bye bye.
[CUSTOMER][NEUTRAL] Yeah