AccountId: 011433970860
ContactId: 28fe9f19-af3c-4560-b12c-a3b0941deb4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1274020 ms
Total Talk Time (AGENT): 366174 ms
Total Talk Time (CUSTOMER): 562347 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/28fe9f19-af3c-4560-b12c-a3b0941deb4b_20250603T19:34_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I had a question. I had a really difficult time logged on to the online service center with the new system, um, and I was the reason I was logging on was to check on claim status, so I don't know if you can help me so that I don't have to bother anyone via telephone so I can get in and check on that and just get an update.
[AGENT][NEUTRAL] OK, is it for your your individual policy?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] OK, do you have your policy number?
[CUSTOMER][NEUTRAL] Let me get into my email because.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me go back here.
[CUSTOMER][NEUTRAL] I'm so sorry, normally I just look it up through email. I'm having to go back a few weeks.
[AGENT][NEUTRAL] Oh, you're fine.
[AGENT][NEUTRAL] Or I can look up by your last name or social.
[CUSTOMER][NEUTRAL] My social is [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, can I get your first and last name?
[CUSTOMER][NEUTRAL] My first name is [PII]. Last name is [PII].
[AGENT][POSITIVE] Thank you, [PII] and let me get this pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then [PII], could you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And then what is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then what is your email address?
[CUSTOMER][NEUTRAL] Hey [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so are you on the site?
[CUSTOMER][NEUTRAL] Um, I can be, uh, let me click on that tab. Yeah, now I'm there.
[AGENT][NEUTRAL] OK, so we click on insured.
[AGENT][NEUTRAL] And then next.
[CUSTOMER][NEUTRAL] OK, I'm already at online service center log in.
[CUSTOMER][NEUTRAL] Do I need to go back?
[AGENT][POSITIVE] Oh, yeah, so you'll do create a new account. Sorry about that. Yeah, that's what I meant to tell you.
[CUSTOMER][NEUTRAL] Yeah, that's what I tried to do. It says your account has successfully, has been successfully created. And so I did that because I knew I was gonna have to do that way back when when all those messages were coming up that they were updating everything. And so then when I try to log in.
[CUSTOMER][NEUTRAL] Which is what I tried to do. I get the verification code and so reduce that and I'm going back to my inbox inbox.
[CUSTOMER][NEUTRAL] OK, I just got the little verification code email. OK, I'm gonna copy it.
[CUSTOMER][NEUTRAL] And see if I have better luck while you're on the phone with me than I have had all morning here.
[CUSTOMER][NEGATIVE] Fuck up.
[CUSTOMER][NEUTRAL] Pop in the code in.
[CUSTOMER][NEUTRAL] OK, I'm hitting verify code.
[CUSTOMER][NEUTRAL] OK, everything just disappeared.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, now I'm getting start a claim.
[CUSTOMER][NEUTRAL] All right, so it looks like I'm, it's in.
[CUSTOMER][NEUTRAL] Alright, now it says hello [PII], you can receive claim status updates via text message, so should I put my phone number in there?
[AGENT][NEUTRAL] Uh, yes, if you'd like that, yeah.
[CUSTOMER][NEUTRAL] OK, yeah, that's fine.
[CUSTOMER][NEUTRAL] Verify
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so, um, I don't need policy details and I don't need access to my ID card.
[CUSTOMER][NEUTRAL] So where would I look to see like under my policy or where would I look now to check on those claims?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Yeah, I've got several.
[CUSTOMER][NEUTRAL] When I go to dashboard?
[AGENT][NEUTRAL] Yeah, we've got several in here that just loaded, um, so.
[CUSTOMER][NEUTRAL] No, that's where I just was.
[AGENT][NEUTRAL] It usually takes from the time that they finalize it typically takes about 4 to 8 hours to go into the dashboard, so those just finalized end of yesterday.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so if you can give it just a few more days, you'll, you should see all of those on there, um, and I can, I can give you any kind of status right now. I can see them.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yeah, that would be great if you could just kind of tell me what I'm looking at.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like, let's see.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Looks like we're requesting more medical records. Let me see what we received.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so it looks like we've got
[AGENT][NEUTRAL] OK, submitted the claim form. I think it came through on several different.
[AGENT][NEUTRAL] Give me just a moment. I'm gonna look through these.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so you did send in, you sent in your list of medical providers.
[AGENT][NEUTRAL] Um, we got that we received.
[CUSTOMER][NEUTRAL] Yeah, I sent in like every appointment. I've had like a, cause I know there's like a writer or disclaimer or something like if you've had cancer in the year previous to establishing the plan, and I haven't, and I sent in all that. And so, and then I sent in the diagnosis. I mean, if there's any other like if they need the MRI or the oncologist, anything like that. I mean, I'm, I'm, I've got all that now too.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, so yeah it looks like we received the list of providers and what the standard process then is to send questionnaires to them confirming that they have not seen you for this condition so that's that's where it's at right now um so that process is taking place looks like we sent all of those requests yesterday um to the providers that you had listed so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, once they respond back, then we, then it, you know, we can review the information and then determine from there, um, you know, the next, the next process. So now did you prevent or did you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have any idea like
[AGENT][NEUTRAL] Yeah, so that.
[CUSTOMER][NEUTRAL] Do you have any idea about how long that takes?
[AGENT][NEUTRAL] Um, it just depends on how fast your doctors respond. Yeah, um.
[CUSTOMER][NEUTRAL] Generally,
[CUSTOMER][NEUTRAL] Well, I'm gonna call them and tell them to please hurry.
[AGENT][NEUTRAL] Yeah, I understand. Uh, so, I'm, I'm looking at everything else we received too. Did you submit your pathology report?
[CUSTOMER][NEUTRAL] I believe that I did, yes, um, but I'll, if I need to submit that again, I will.
[AGENT][NEUTRAL] Trying to find the ice because we received, we received um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Making sure. I don't want, I don't wanna want you to resubmit it if we don't have it, so let me make sure, um.
[AGENT][NEUTRAL] Cause like what I've looked at so far is the forms that we've received. Um, let me make sure though.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][MIXED] I mean, what I'm paying the hospital right now is manageable, but once you start putting the surgeries on there, and the oncologist and the geneticist and all the other things I've already been seen for, [PII]'s gonna get high really quick.
[AGENT][NEUTRAL] Yeah, I understand. Yeah.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] that
[AGENT][NEUTRAL] You can sure
[AGENT][NEUTRAL] OK, yes, we've got the, we've got the pathology report. OK, so yes, so that's, that's where the process is at this current moment is us sending out the medical records to the doctors that you listed, confirming that there's no preexisting condition so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And then just depending on when those all come back, is that a snail mail thing? They went out in the paper mail?
[AGENT][NEUTRAL] They did one out through paper mill. That is correct. So I, yeah, I mean, I would give your doctor.
[CUSTOMER][NEUTRAL] All right, well I'm gonna call those offices and tell them to get.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] To keep an eye out for it for me.
[AGENT][POSITIVE] OK, yeah, I'd do that and then hopefully they'll respond pretty fast.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Well, I'll call all of them and say, please, if this comes across your desk, please, please, please get it back in as quickly as possible. And then the other question that I had for you, I also submitted, I have coverage for like, uh, I believe I submitted a claim form for a breast MRI, a diagnostic breast MRI. I believe that was covered on my plan and I submitted that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do you see that in there? Is there something else I have to do for that?
[AGENT][NEUTRAL] Uh, looks like we sent out.
[CUSTOMER][NEUTRAL] Cause I just got the results back from that.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] We did send out a payment. Did you get the $50 payment for preventative?
[CUSTOMER][NEUTRAL] Yeah, that was for the first ultrasound, or not that, the first mammogram, like the normal, do all the things you're supposed to do mammogram. I sent that one in a ways back. And then I uploaded another claim because I saw that I could upload like breast MRI's for diagnostic purposes, stuff like that. Is that attached to the approval of the cancer claim, or?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Cause I think that was like, that was a little bit more money.
[AGENT][NEUTRAL] Um, let me see what we got.
[CUSTOMER][NEUTRAL] That would be the last claim form that I submitted.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I think I did that like a week or so ago.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I make sure I'm not missing it. Um.
[AGENT][NEUTRAL] This is for the first.
[AGENT][NEUTRAL] OK, and you said that was like a week ago. Um.
[CUSTOMER][NEGATIVE] It might be longer, like I am on this like stink on the skunk the minute that some the minute that I get.
[CUSTOMER][NEUTRAL] You know, I try to get things.
[CUSTOMER][POSITIVE] Turned in as quickly as possible and I do it all online.
[CUSTOMER][POSITIVE] You know, I don't wanna miss something that, you know, could help either.
[AGENT][POSITIVE] Absolutely, yeah, definitely.
[AGENT][NEUTRAL] OK, I have the pathology report. Let me see if that was maybe with that.
[CUSTOMER][NEUTRAL] Cause I, I turned in a whole new claim form.
[AGENT][NEUTRAL] Oh, you turn in a whole new claim, OK.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yeah, I did. I, I said I turned that and because I didn't know if that was separate or if it's part of like, it's not super clear if the diagnostic MRI is included once you get.
[CUSTOMER][NEUTRAL] The cancer plan approved or if you file it separately. So,
[CUSTOMER][POSITIVE] I just turned that in on top because it looked like that was an additional benefit.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEGATIVE] Sorry, system's running just a bit slow.
[CUSTOMER][POSITIVE] No, it's OK. I appreciate you taking the time to check for me.
[AGENT][NEUTRAL] Yeah, I've got that one. Now let me see if I can, OK, here we go.
[CUSTOMER][NEUTRAL] I'm trying to see if I can get to my claims on the.
[AGENT][NEUTRAL] Yeah, the ones from [PII] should be on there.
[AGENT][NEUTRAL] I see this for, OK, there's that one.
[AGENT][NEUTRAL] Travel. I see that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I think I might have surfed my way through it. I wait.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And to find out which one
[AGENT][NEUTRAL] There's a list of doctors.
[AGENT][NEUTRAL] Well, I'm not finding the MRI. Let me make sure.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, because I'm looking on this new and it was I knew where I was looking before but now I don't know where I'm looking to find my claim updates and.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I am not. I see the wellness claim form. OK.
[AGENT][NEUTRAL] That was for breast ultrasound.
[AGENT][NEUTRAL] I see that.
[AGENT][NEUTRAL] And then we've got the biopsy. I got that.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] I'm not seeing an MRI, uh, let me see.
[CUSTOMER][NEUTRAL] Or a breast ultrasound with biopsy, I might have turned that in. You know, I do have like the results of the MRI. I would just, like I said, I'm pretty sure I went ahead and turned that in because it looked like that was an additional benefit on my policy. Aside from the first incidence of cancer, which is like the 7500 for the first like diagnosis. And then there, there's, there's this other items that are
[CUSTOMER][NEUTRAL] You know, on the, the list of things that are covered and I don't know if that's.
[CUSTOMER][NEUTRAL] A separate claim or part of this one, that's where
[CUSTOMER][NEGATIVE] You know, I'm just scrambling.
[AGENT][NEUTRAL] Yeah, I don't, I see the ultrasound and that's what or the uh.
[AGENT][NEUTRAL] The mammogram, that's what we had reimbursed on.
[CUSTOMER][NEUTRAL] Yeah and you guys already funded that you funded way back like in May and I'm just looking at the new, you know, the new stuff that's coming down the pike right now.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] In maths.
[AGENT][NEUTRAL] Let me make for sure.
[AGENT][NEUTRAL] I'm not, I, yeah, because I've looked through every document that we have and I'm not seeing anything else besides the pathology report, which, which that's, that will be, we received and then that's based on the information we received from the doctors you listed.
[AGENT][NEUTRAL] Um, and then,
[CUSTOMER][NEUTRAL] Right and like right now in the online service center I don't even know like before well maybe if I click on claims maybe that's where I used to find stuff.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I see 36028 [PII].
[AGENT][NEUTRAL] OK, yes, that was for the mammogram.
[CUSTOMER][NEUTRAL] Right, and then I turned in.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This was, uh, this is, uh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And that was received on [PII] and that must be the initial.
[CUSTOMER][NEUTRAL] Yeah, that's part that so maybe I didn't upload that other like I should have.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't see, I don't see anything for an MRI and so there is a medical imaging benefit under the policy that specifically is for MRI.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, so yes, if you can put that reloaded.
[CUSTOMER][NEUTRAL] So, that would that be a new claim?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Or how would I do that? Like,
[AGENT][NEUTRAL] Yeah, you actually, if you're uploading on our website, um, through the portal, you, you don't have to submit the claim form if it's for one of those benefits. So you can, you can just submit, just be sure you submit, you know, that, that the information submitted shows your diagnosis, shows what was performed, um, meaning the MRI and then obviously where the facility was and the service and charges.
[CUSTOMER][NEUTRAL] Alright, let me see.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right, I'm looking, I keep, I keep a digital folder and I keep a.
[CUSTOMER][NEUTRAL] Hard copies of everything that I do. All right, well, I'm gonna send then, I'm just gonna go ahead and send.
[AGENT][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] Um, that, uh, that MRI that's the results from the MRI and then I'll just upload, I'll upload that.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK alright cool I mean I've done so much that I'm.
[CUSTOMER][MIXED] Doing well to keep, keep track of appointments. All right, what's this? All right. I'm digging through, yeah, it's, it's super sucks. I went from ya, I'm about to be able to afford to retire to, maybe not.
[AGENT][NEGATIVE] I understand, yeah, it's overwhelming, really overwhelming.
[CUSTOMER][NEUTRAL] Oh well, OK, well I'm gonna go ahead then and um and just submit that on and upload that and if that's all there then that that is that like 500? I can't remember. I know it was a beefier amount than 50.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It was. It's 500 for medical imaging. Yes.
[CUSTOMER][NEUTRAL] I don't remember what
[CUSTOMER][POSITIVE] Sweet. Oh, that would be great. OK, um, I'm gonna go ahead and knock that out real quick and I appreciate you taking so much time to dig through all this with me and being patient with me while I try to figure out the new website updates and um I'm gonna go ahead and.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Oh, no problem at all. We're, we're here for you.
[CUSTOMER][NEUTRAL] Thank you. I'm gonna go ahead and call all those doctor's offices and tell them to just keep an eye out for that paperwork that it went in the mail yesterday, is that correct?
[AGENT][POSITIVE] Yes, that's correct. Uh-huh.
[CUSTOMER][NEUTRAL] All right, OK, so it should be showing up before too long, hopefully at some point this week and I'll just have uh the front office just keep an eye out for those at at my doctor's offices.
[AGENT][POSITIVE] OK, that sounds good.
[CUSTOMER][POSITIVE] Alright thank you I appreciate you so much you have a great rest of your day.
[AGENT][POSITIVE] OK, thank you, [PII]. You as well. Thank you for calling APL.
[CUSTOMER][POSITIVE] Thanks, thanks. Mhm. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.