AccountId: 011433970860
ContactId: 33e6dfc8-a9a7-4ba9-95a2-13953426b7b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 815530 ms
Total Talk Time (AGENT): 313291 ms
Total Talk Time (CUSTOMER): 379712 ms
Interruptions: 8
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/33e6dfc8-a9a7-4ba9-95a2-13953426b7b5_20250102T22:57_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I have a question uh.
[CUSTOMER][NEUTRAL] I have uh that cancer, heart and stroke uh insurance with you all, and I just wanted to know uh I didn't have anything like that. does it uh I had some uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The spine problems. I don't think that I had some really serious back surgery, and I was just trying to find out if uh
[CUSTOMER][NEUTRAL] That didn't go into any of those policies, did they?
[AGENT][NEUTRAL] Um, it doesn't sound like it, but I can check your policies. May I have your policy number?
[CUSTOMER][NEUTRAL] I don't know what my policy number is. What I have to give you my social.
[AGENT][NEUTRAL] Um, yeah, give me just a second. Let me pull another system where I can put in the social, OK?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, may I have the mailing address on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and I need um your date of birth and the email address and a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] Uh, [PII] and uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said that it was a spine problems, but you did not have a surgery, correct?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, I had surgery. Yes, ma'am. I had 4. I had 4, I had I had 4.
[AGENT][NEUTRAL] You do have surgery.
[AGENT][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Just now.
[CUSTOMER][NEUTRAL] I don't think I have anything like this.
[AGENT][NEUTRAL] Let me look into your benefits. Let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you mind holding for me? I'm gonna just go ahead and go over the benefits and see if there's anything like that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding and being patient for Ms. [PII]. Um, was this due to a, uh, like another sickness or was it just problems in your back?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] I had spine surgery. Yeah, honey, I'll be, I'll be paying all this insurance that I'm grabbing grasping the straw trying trying to see what I can find, yeah, yeah, but no, I.
[AGENT][NEUTRAL] Mm yeah.
[AGENT][NEUTRAL] So, but uh what, what's the reason of that surgery? Um, was it another sickness or was it just um an accident or um
[CUSTOMER][NEUTRAL] Um, just, just had it, you know, I guess just over period of time, you know, just, you know, just over a period of time I had to have it because my back was in bad shape, that's all I can say. I mean, you know, yeah, I had 4 of them. I had 4 I had 4 surgeries, so I was just trying to see if I could and uh pile on that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I was trying to see if it, it had to do with any of the sickness, but um no, based on what I'm looking at, um, it doesn't look like it will qualify. Um, the ones that I have here listed are Alzheimer's, Parkinson's, brain tumor, coma.
[AGENT][NEUTRAL] Loss of sight, loss of speech, loss of hearing, artery disease, um, like bypass surgeries or arteries, um, end stage renal failure, heart attacks, intensive invasive cancer, major organ failure, multiple sclerosis.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What is that, what, what's that stenosis? What that mean?
[AGENT][NEUTRAL] Sclerosis is um it's a sickness of the
[AGENT][NEUTRAL] Let me look for it. I know it's like it's the two bones, but yeah, but um.
[CUSTOMER][NEUTRAL] That sounds like that's something like I.
[AGENT][NEUTRAL] Not sure if that's why I was asking if it was related to something else. Let me go ahead and get the definition of that, one moment.
[AGENT][NEUTRAL] Mm yeah.
[CUSTOMER][NEUTRAL] That makes me.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It's um a disease that um affects the nervous system, including brain, spinal cords and optic nerves.
[CUSTOMER][NEUTRAL] OK. It says uh.
[CUSTOMER][NEUTRAL] Well, this might be, it might, it's this laminect to be factomectomy, a formerectomy, you know, unilateral bilateral depression of spinal cord.
[CUSTOMER][NEUTRAL] Cardi equal and the nerve roots, laminectomy, factomectomy, some kind of unilateral bilateral decom decompression of spinal cord and or nerve roots.
[AGENT][NEUTRAL] Mhm yes I know.
[AGENT][NEUTRAL] Yeah, it doesn't sound like it's the same thing.
[AGENT][NEUTRAL] It will say sclerosis in it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How do you spell what you're talking about?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Sclerosis, it's S C L E.
[CUSTOMER][NEUTRAL] Hey, how do you spell that?
[CUSTOMER][NEUTRAL] Yes, see, uh-huh.
[AGENT][NEUTRAL] R O S I S.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] S C E L E R.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I don't know, I say.
[CUSTOMER][NEUTRAL] Find that cause it says spinal cord and or nerve roots.
[AGENT][NEUTRAL] Mm. The only thing I can tell you to do if, if you have a doubt, um, you can always send in a claim. Let us look into it and see if it's something that is covered, um, because what we're gonna be looking at is the coding, the procedure codes and the diagnosis code, and from there we will know if it's something that is covered or not under the policy. Um, so I, I will say the best thing is to just go ahead and send us a claim.
[CUSTOMER][NEUTRAL] Decompression the spinal cord.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Well, do you have a uh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I don't have any claim forms I guess. Let me look and see if I have any claim forms. I may have some claims.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] See if I can see, uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, they, uh, I could, I could send in, it may, it may, it may fly cause I mean I got the codes and all that. I have all the information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Just send it in, let us look into it and see if it's something that will be covered or not. It, it will be easier to determine if it's covered or not if we receive the claim and look into the coding and see exactly how they quote it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, mhm. OK, well, can you uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Send to my email the uh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Claim form, yeah, I can send you the claim form, mhm, yes, and you can also get it through our website at [PII].
[CUSTOMER][NEUTRAL] Claim, claim form.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, and if you have not registered, you can also register and send the electronic if you want to do that.
[CUSTOMER][NEUTRAL] Well, see, I want to send, send me the claim form because I may have some claim forms here already that may be the same thing and then I may have, yeah, that's what I'm saying. If you can go ahead and just send me the claim forms of my, my uh email and then I'll uh.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then what I'll do, I'll look and see if I got the same claim. I got some many claim forms. I I'll be carrying out so many insurance from the job, you know, you don't use it, and I've had this serious surgery and I was just trying to find out what, what if, if this was something that I could claim. I had, I had been saying I'm just feeling better, baby. I've been going through some stuff.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I understand.
[CUSTOMER][NEUTRAL] And I said when I feel better I was gonna, I was gonna pull up to see what all this could cover, and I was gonna be grasping the straw cause honey, this year I have been going through, you hear me? Oh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Mhm. It's gonna get better, um, and we started a new year, so hopefully this year is better.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][POSITIVE] Yeah I hope so, but um, yeah, I'll go ahead just send, send them to my email and then when I do, I'll look and see if I have uh those forms because I have a lot of forms and I'm gonna see if that if those are the ones that I need to send with it and I have all my documentation and everything so uh that wouldn't be no problem and I got plenty of documentation.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And I don't know, uh, does the doctor have to sign off of this to, to that too? Or do I just have to send it in?
[AGENT][NEUTRAL] No, mm mm, no, you just need to send in the claim form and fill out as better as as your knowledge and just go ahead and send the documents that you have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. Now, and also question, do I have to put in uh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What you know what they, what they pay, you know, the uh, what do you call it uh.
[AGENT][NEUTRAL] No, no, we don't need the explanation of benefits.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm, and now, you know what, what sometimes people ask for, you know, what they, what they pay are paid.
[AGENT][NEUTRAL] The receipt or the explanation of benefit is not required on this one.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Yeah, uh, not a problem. OK, not a problem. OK, just send that to my email and then I'll, I'll go ahead on and uh now, yeah, then I'll look.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah, I'm working on it.
[AGENT][NEUTRAL] Yeah, I'm working on it right now so let me go ahead and send them before I let you go, OK?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, all, all of that stuff you, you're talking about, it, it kinda sounds the same, but it may not be the same, you know what I'm saying?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, I understand. All right, so here we go and.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And you did, uh, let me, let me go over your email just to make sure that was um [PII]
[CUSTOMER][NEUTRAL] When they said.
[CUSTOMER][NEUTRAL] [PII] [PII], you spell it out, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And there's no dots in between your names.
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] All together, [PII].
[CUSTOMER][NEUTRAL] Just uh lower case.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I said I was gonna call and see.
[AGENT][NEUTRAL] OK, let's try that.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] And the way he was, he was, I had some degenerative stuff in my, in there, yeah, I did. And it sounds like something like a degenerative type deal.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that's what, that's why I had to have the surgery.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] I'm trying to, I pay, I don't pay on this.
[AGENT][NEUTRAL] OK. Do you want to check and see if you got it?
[CUSTOMER][NEUTRAL] Ma'am, oh, let me see. Let me put you on my.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yes ma'am, I got it.
[AGENT][NEUTRAL] OK, perfect. OK, so just fill it out and send in the documents and, and that's all you need to do. Either you can send it by mail, by fax, or you can register online to send the claim in, OK?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, not a problem. I appreciate you so much. I just, nothing. I just, um, we'll, we'll see, we'll see how it goes, OK.
[AGENT][NEUTRAL] OK. Is there anything else?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, sure, no problem. You have a good day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Yeah [PII]. Bye-bye.