AccountId: 011433970860
ContactId: 3759f084-f930-40f9-87e1-e0b9f8e71393
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1775599 ms
Total Talk Time (AGENT): 495647 ms
Total Talk Time (CUSTOMER): 630529 ms
Interruptions: 18
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/3759f084-f930-40f9-87e1-e0b9f8e71393_20250521T18:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon
[CUSTOMER][NEUTRAL] We're experiencing technical.
[AGENT][NEUTRAL] Yeah, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] And I have a question. I am working on making a cancer policy claim, and I keep running into technical glitches trying to upload forms. And I have regularly I'm getting an error that says, oops, there has been an error. Um, and it says for me to call customer service options for, and all I'm trying to do is get like my medical use of my medical information release form uploaded and the correct cancer claim uploaded.
[AGENT][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] And I'm getting explanation of benefits that are saying I'm not, I'm not gonna be covered, so I, I, I wanna kind of know what's going on.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with your claim. So, I don't know if you saw the pop-up when you um signed on to the online service center. I would wait um because they're, they're doing work on the online service center, they're getting ready to launch a whole new system, I believe on the [PII]. So there are some technical difficulties because they're trying to do that launch right now. So,
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you can still fax it to us or mail it in if you'd like, but that's probably why you're receiving that message, um, because they are working on, it's a whole new site, so they are working on it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Right, um, well, one uploaded just a moment ago without any difficulty, and I, and I saved the screenshot that said that I uploaded, but I believe that I needed to send in an additional form so I was just going back in and trying to upload another and make sure that I had gotten what was needed into um my digital file. Is there any way that you can look at that claim for me and see what's actually showing up there?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. May I have your name?
[CUSTOMER][NEUTRAL] Sure, [PII]. The last name is [PII]
[AGENT][NEUTRAL] And [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Do you need my last name as well?
[AGENT][NEUTRAL] No, it's OK. Um, may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure thing.
[CUSTOMER][NEUTRAL] Sure, um, my, uh, phone number is [PII].
[CUSTOMER][NEUTRAL] Are you ready for policy number?
[AGENT][POSITIVE] Mhm, I'm ready.
[CUSTOMER][NEUTRAL] OK, 253.
[CUSTOMER][NEUTRAL] 9460.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII]. My mailing address is [PII].
[CUSTOMER][NEUTRAL] And my email address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification benefits, not a guarantee of payment. So I do see the statement of insured came over. Um, so what was the second part that you're trying to send over?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] Well, when I sent uh the initial uh additional claim form, they said I needed to send one specific to my cancer claim and so I was working on, I had filled that out, scanned it and um I was working on getting those sent uh over to you all with the like the medical documentation form because I had a hard time or the a permission to use the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, my medical information, I had, um, trouble uploading those the other night, so.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I was trying working on those too.
[AGENT][NEUTRAL] OK, so we got that.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] See.
[AGENT][NEUTRAL] OK, so you're talking about the, the, um, OK, the
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, pre-existing condition form. OK, so that's the one that's not uploading. So if you like, um, because that's not really, let me think this through. Hold on one second. I'm going to give you an email, but I'm just trying to technically we're not supposed to receive claims documents through email, but
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] Is that considered, do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] She sends in the list of
[AGENT][NEUTRAL] It's still claims documents, so I'm not gonna do that.
[AGENT][NEUTRAL] She said the OSC is giving her issues, which
[AGENT][NEUTRAL] It could be.
[AGENT][NEUTRAL] Right, but it's the preexisting.
[AGENT][NEGATIVE] That's not that claim form though. Who told her that, cause that's not even what we asked for.
[AGENT][NEUTRAL] All we needed was the, oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Male dogs are on.
[AGENT][NEUTRAL] Wait, so we already have it?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] This is from us to her, right?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's where she got it from.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So she, so we still, she sent the.
[AGENT][NEUTRAL] Claim form.
[AGENT][NEUTRAL] It's the same day.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] So she can't responding to you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, thank you so much for holding. I apologize for that wait. Um, so I just want to get a clear answer for you. So, um,
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] We have the claim, the cancer claim form. I, I had to go through the emails again. So I see where they told you to send that, so we have it. In terms of the form with the doctors and all of that for the pre-existing.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you, if you're wanting to upload it.
[CUSTOMER][NEUTRAL] Oh, I haven't seen that yet.
[CUSTOMER][NEUTRAL] Well, what I have uploaded, I just got it the other one to finally upload. I uploaded the cancer claim form. I uploaded a release of medical information form, and then I uploaded um the cancer diagnosis. Is there another one that I need to fill out that I'm missing?
[AGENT][NEUTRAL] From this claim that's been denied, what's being asked is a list of doctors for the pre-existing conditions. Are you saying that you've already done that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] That does not sound familiar to me.
[CUSTOMER][NEUTRAL] What is that? Where would I find that one on on claim forms?
[AGENT][NEUTRAL] Well, no, so this one was sent to you, um, but it looks like
[AGENT][NEUTRAL] [PII] sent it again on the [PII], the pre-existing farm and the
[AGENT][NEUTRAL] Um, HIPA form.
[AGENT][NEUTRAL] This is being mailed to you, so you haven't received this yet. Did you call in on the [PII]? Let me see, I'm trying to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] I've been trying to call because it's much faster digitally. I mean, treatments for me have already started, and I'm already starting to rack up a bill. And, you know, I was hoping that I could have some kind of an idea that I could tell the hospital system when I might be able to like.
[CUSTOMER][NEGATIVE] I mean, I have a huge deductible and my insurance is crappy. So I'm just trying to get a grip on, do I need to take out a credit card and start getting charged interest or how long is it going to be and exactly how much am I gonna be able to count on from this company?
[CUSTOMER][POSITIVE] You know, so that I have a better idea of what I'm facing financially.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like a budget. Mhm. OK. I mean, if you, because there's so many reasons that there's technical difficulties right now, you can continue to try if you like, but
[AGENT][NEUTRAL] Uh, you do have the
[CUSTOMER][NEUTRAL] Well, I got those 3 to upload.
[CUSTOMER][NEUTRAL] So if there's any way um that that um you said it was on the [PII] that there was a document sent to me because I got something from uh a.
[AGENT][NEUTRAL] But it's being mailed to you.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, boy, that takes a lot longer. Um, is there a way that that could be um emailed to me in a syllable form like some of these others or no? is that something that has to be signed by the doctors or?
[AGENT][NEUTRAL] Yes, these have to be um signed by the doctors. Let me see if I can reach out to somebody in claims, because that, that um the pre-existing form comes only from claims, like I don't even have a way to access it. Let me see if there's a way that they can maybe email it to you, um.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because then I could take those to the hospital, like, I'm gonna be at the hospital the day after tomorrow. So,
[AGENT][NEUTRAL] OK, let me see if I can reach [PII] because that's who sent it. Hold on one second.
[CUSTOMER][NEUTRAL] You know, I might be and in the hospital I'm being treated out as an hour and a half away from my house.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, this is [PII]. OK, hold on one second.
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] You know what, this is what I'll do so that, well, it's up to you so that you don't have to hold. Do you want me to, if you don't mind holding, that's fine. Um, but if you like, I can send over an urgent request for claims to get these forms and let and give you a call back to let you know what the options are, um, but it's up to you if you want to hold, that's fine.
[CUSTOMER][POSITIVE] That would be great if they could send me the, you know, you can that way you don't have to worry about me just sitting here on hold um if that if they can send those digitally fantastic if not I'll just keep an eye out in the mail and get those filled out as soon as I get the information.
[CUSTOMER][NEUTRAL] Just so that um I just wanted to make sure that that was the only thing that I'm missing right now then is a preexisting conditions form is that correct? Everything else that you see that I'm supposed to have I most likely have in place or do I need to call claims and check with them?
[AGENT][NEUTRAL] Yes, you know what?
[AGENT][NEUTRAL] Hold on, because actually, 3 things literally just popped up. Hold on 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, because I just scanned them in.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, well, let me see, um, but yeah, I did go through all the denied, well, there's only one denied claim to see what was asked for and all that was asked was the um pre-existing condition form and then in the email I saw they asked about the claim, the cancer claim form, so that was just those two,
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] There's yeah.
[CUSTOMER][POSITIVE] Right, so I filled, I filled that one out and got it sent in right away and then the HIPAA form I got filled out and sent in right away. And if there's one other, then if it can be done digitally, fantastic if it can't.
[CUSTOMER][NEUTRAL] Then I'll just watch it for it in the mail and get it in.
[AGENT][NEUTRAL] OK, before I reach out to claims, let me look at, oh wait, is this the same thing?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, I think I duplicated one of them because I wasn't sure if it went through because I got that pop up window that said there was an error.
[AGENT][NEUTRAL] So it might be whatever, um.
[CUSTOMER][NEUTRAL] There's probably a duplicate in there.
[AGENT][NEUTRAL] Mhm. OK, so this is the claim form and then
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Is there anything else that, so, so we received it twice.
[CUSTOMER][NEUTRAL] The next one was permission to use my medical records.
[AGENT][NEUTRAL] Right, I'm saying from what just popped up, it was a duplicate, it was the claim form.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] Yes, yeah, absolutely, so throw that one in the trash.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I, I'll let them know that, no, it's fine. I'll let them know that this one was duplicated. I almost want to wait and see.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] What the other two were. It looks like whatever said oops just popped up, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold? I'm just trying to see what these other two.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][POSITIVE] No, that's not a problem.
[AGENT][NEUTRAL] OK, um, hold on one moment.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Nope.
[AGENT][NEUTRAL] Talk to you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, thanks for holding. So they all came through. So,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I did see the authorization form, so we have the claim form and the authorization form. We received the claim form 3 times and then um the authorization form is on here. So I'm gonna send um the message over to claims. I'm gonna make it urgent and see if they um just, I don't know what their process is in terms of getting the form because only they have it. So um I'll just have them reach out to you to let to let you know and then y'all can go from there so we can get that one back too.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Sure thing. Hey, do you by chance see um the electronic funds transfer form? I, I submitted a wellness claim for the initial mammogram that found all this cancer and um I thought I downloaded uh one of those with another claim.
[CUSTOMER][NEUTRAL] Would that, would I need to do a separate one for this one?
[AGENT][NEUTRAL] No, um, but you said the direct deposit? Yeah, I, I don't see it, but I do know that you sent it in because it shows that your, um, direct deposit is active.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK great all right and then I had another question before I let you go. OK, fantastic um I remember that when I originally talked to the group that sold our school district all of these um policies that the lady on the other end said she could not tell exactly what level of coverage that I selected.
[AGENT][NEUTRAL] So they did receive it.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And um I'm curious if you can tell me exactly kind of like if this is all approved what I might expect I realized that depends upon you know me filling out all the forms correctly and then processing everything but can you see what my benefits are officially so I kind of have an idea.
[AGENT][NEUTRAL] Mhm. Um, hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As long as it's, um, it should be up here. Hold on one moment.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] It's not uploaded. OK, so this is what I'll do. When I send claims, um, because I see like your first occurrence benefit pays out 7500, but like all the little specifics, I'll have to pull up your
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, like a digital.
[CUSTOMER][POSITIVE] Well, that's the biggest thing. It's like, am I gonna have it, if it's $7500 that's just, that's fantastic. Like right now, I'd take $100 just because it's gonna be so expensive. But knowing that that's gonna help me meet my deductible and handle some of these bills that we've had that like front money for right now, is that, that's huge. That's, that's huge. And as long as that, that's really all I needed to know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm still gonna uh
[AGENT][NEUTRAL] OK. So yes, the first occurrence if there um once it's, you know, everything is approved, yes, that's the, um, that's the amount, it will be 7500, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still gonna, when I send this over to claims, I'm still gonna have them um upload, they'll have to create a digital, a digital copy of your policy, so you'll just so you'll know what's covered, what what will pay out, what, you know, so you can kind of have that reference.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, I see it, but I didn't know exactly what coverage I picked. I don't know, like, do I get, I was looking through there and it's like, OK, every time you have a test they're gonna give you $50 you know, I saw that stuff and I don't know.
[CUSTOMER][POSITIVE] If that matter, you know, that would, you know, if I'm getting a $50 here and there every time they run a test, that helps, you know, me pay the bill as, you know, the hospital bills us. So like I said, I'm happy for anything right now, because, you know, you go from being perfectly healthy and about to retire, and then you get slapped with, you're gonna have $300,000 in medical bills. So it's a little bit of a mental shift.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] Well, all you can do is take it a day at a time and you're getting everything together. So I hope you're giving yourself some grace. I know it's like day and night, one day it's this and the next day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] It's like, oh my gosh, this sucks.
[AGENT][POSITIVE] Just don't forget to breathe and you're gonna be just fine.
[CUSTOMER][POSITIVE] Oh, but it's all right. I've, I've been trying.
[CUSTOMER][POSITIVE] Thank you for your help. I appreciate you taking the time to dig through all of that, and it sounds like the website's pretty clunky, so I hope whatever they're updating you with run smoother for you.
[AGENT][NEUTRAL] Yes, um, it's gonna be a whole new website, um, for our portal, a whole new portal. Um, so I hope you all like that. Um, I'm gonna go ahead and send um [PII] the request for the pre-existing, and I'll put the request for the digital version of your policy just in case you want to reference it, it'll be on your portal, you know, it'll be available to you. And was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK fantastic.
[CUSTOMER][POSITIVE] No, you really cleared some things up for me and you helped me make sure that I got everything in there that needed to be so I appreciate your time thank you so much.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL and I hope you have a good day.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] Thank you you too bye bye now.
[AGENT][POSITIVE] You're welcome. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.