AccountId: 011433970860
ContactId: 39deb973-d71d-4cf7-884b-4b5861d55b31
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 894340 ms
Total Talk Time (AGENT): 261849 ms
Total Talk Time (CUSTOMER): 362897 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/39deb973-d71d-4cf7-884b-4b5861d55b31_20250310T21:43_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII]. My name is [PII], and I was trying to send in a claim form, um, on my husband's behalf for a cancer policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And I was trying to fax it, but I don't know, it keeps saying there's no answer.
[AGENT][NEUTRAL] Hmm. What's the fax number that you have?
[CUSTOMER][NEUTRAL] Um, I was faxing to [PII].
[AGENT][NEUTRAL] OK, yeah, that's right. [PII]. Is it just coming up busy?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Um, it just says no answer like I can hear it like trying to connect or whatever, but then it just, my, on my end it just comes back and say no answer.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Is that the only way? Is that the only way it could be sent?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Aside from doing it like an upload online or putting it in the US mail, yeah, we don't unfortunately we don't accept claims via email or anything like that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, right, OK.
[CUSTOMER][NEUTRAL] Um, so, I don't know.
[CUSTOMER][NEUTRAL] Um, uh.
[AGENT][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] And um could you um verify like um his the policy with me because I got like two different things. When I called last week and talked with a lady, you know, when we suspected something may be brewing and then today when I called earlier, um, I would, I pulled it up online like uh so I'm sending in, I guess, for the diagnosis, the first diagnosis of having cancer.
[CUSTOMER][NEUTRAL] And um like when I look online, I see where like it says the face value of 10,000 and then it tells me what to send in, so I sent in the pathology report that the doctor gave us. Um, but is that, is that the way it go, like they would send him the face value for the diagnosis and then any other.
[CUSTOMER][NEUTRAL] Related, um, medical stuff that he have to have. I send in a claim for that too.
[AGENT][NEUTRAL] Right. So if you're filing for like a first occurrence benefit, then you would submit the pathology with the diagnosis from the provider, the doctor that he's seen with the claim form.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] And then any treatment going forward, you would submit claim forms and then the itemized receipt for whatever treatment, whether it's with the radiation, chemotherapy, whatever.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right, OK, alright, so, um, just, well, we know that so far he's gotta have radiation, but, um, so is the, and y'all don't, you don't call it first diagnosis, what, what do you call it? first occurrence, I guess.
[AGENT][NEUTRAL] Some of our plans, yeah, have a, have a first occurrence benefit where when you're initially diagnosed, the plan would pay out a lump sum.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. Is there any way you could check to see if that's the plan he has to, just to verify it with me because when I read it, it looks like that's what it is. But like, like I said, one person told me that's what it is, and then today, the other lady told me it doesn't say first diagnosis or something, so I, I don't know what we got.
[AGENT][NEUTRAL] All right, yeah. What's the policy number that you have?
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] The policy number, let me look on the form that I filled out. I put it on there, um, just a minute, let me find it.
[CUSTOMER][NEUTRAL] 20,390
[AGENT][NEUTRAL] OK, so it's 20,390.
[CUSTOMER][NEUTRAL] 390, uh-huh.
[AGENT][NEUTRAL] Alright let me try and pull.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Are you sure that's not the group number?
[CUSTOMER][NEUTRAL] Well, when I pulled it up online when I was looking at the policy and I went to the top, it's that's what it said for policy number but I can go back and look again and see.
[CUSTOMER][NEUTRAL] Um, cause I was getting confused like it with the critical care stuff or I, I don't know.
[CUSTOMER][NEUTRAL] Cause he has
[CUSTOMER][NEUTRAL] Alright, let me pull it up. She still got it up on my computer. You should have let me.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Alright, let's see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right. So,
[CUSTOMER][NEUTRAL] So when I look on this particular screen, it has a different like, would it be the one for the critical illness is 1415882.
[CUSTOMER][NEUTRAL] Like this way.
[AGENT][NEUTRAL] If I pull that one up, I should be able to see all the policies. So let me see here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright. What is your first and last name and date of birth?
[CUSTOMER][NEUTRAL] His or mine?
[CUSTOMER][NEUTRAL] His is [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And then if you could just verify the address on file.
[CUSTOMER][NEUTRAL] Oh sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Hard to do with your mama.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Live with your mother.
[CUSTOMER][NEGATIVE] Go get your shoes on and get stuck.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so you're seeing on the section 2 certificate schedule volunta[PII]. You're seeing under the critical illness benefit amount, you see insured 10,000, insured spouse, 5000. That's what you're looking at, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And then [PII]ow that it says maximum critical illness benefit of 250 per covered person, correct?
[CUSTOMER][NEUTRAL] Mm, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I don't, I'll double check on this for you because I don't read that as like a first occurrence benefit because if you scroll down.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The the actual, well, you wouldn't scroll down, it would be pages down. There's an actual scheduled benefits page further on in the policy.
[AGENT][NEUTRAL] And that starts.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The schedule of benefits and then it has policy benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so underneath that.
[AGENT][NEUTRAL] That list the policy benefits and then the benefit amounts.
[AGENT][NEUTRAL] So like critical illness, it says maximum one critical illness benefit payable per critical illness per covered person.
[AGENT][NEUTRAL] So is that just a lump sum?
[AGENT][NEUTRAL] This writers.
[CUSTOMER][NEUTRAL] Bye. Bye-bye. Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And she like the first lady I talked to, that's where I guess she was looking at, and she told me that um depending on the type of cancer, it would be 100% of the face value, lump sum.
[CUSTOMER][NEUTRAL] Or, you know, if it was.
[CUSTOMER][NEUTRAL] Like skin cancer, she said 250 and carcinoma in situ was 25% of it. So, I, I don't know.
[AGENT][NEUTRAL] Right. I do see, I do see that where it says carcinoma, skin cancer, 25%, and then it says invasive cancer 100%.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. 100%, right.
[AGENT][NEUTRAL] And then they probably list down below.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] What they consider.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Invasive.
[CUSTOMER][NEUTRAL] Yeah, and I saw, right, I saw like um where they had it.
[CUSTOMER][NEUTRAL] Somewhere, um.
[CUSTOMER][NEUTRAL] I guess the type of cancers are not limited to or
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me just get some clarification on it because yeah, it doesn't, most of them will just say first occurrence, but I'm gonna check, just double check for you. So do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, that's fine. Mhm.
[AGENT][POSITIVE] Thanks.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you so much for your patience and waiting on that. So, in speaking with a claims examiner, it looks like that the um benefit payment is the 10,000 as long as it, like the previous rep had stated, it has to be considered internal and then they give that list. So if you feel like his situation does fall under that and not the skin cancer or anything like that, then.
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] Um, it's, it's prostate.
[AGENT][NEUTRAL] It looks like that amount of, yeah, that amount then is applicable.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And did you say something about previous? What did you say?
[AGENT][NEUTRAL] Oh, I just said the first rep that you had spoken to, that's all.
[CUSTOMER][NEUTRAL] 000, OK, OK, yes, uh-huh, OK, yeah, OK, well, yeah, so it's, it's not skin, it's, um, prostate.
[AGENT][NEUTRAL] I said just a previous rep, yeah.
[CUSTOMER][NEUTRAL] So it's just, um, OK, well I'll just send in everything.
[AGENT][POSITIVE] Yeah, and I'm sorry about the facts. I would just keep trying it. I haven't heard of any issues with the fax, um, because we've been sending faxes just fine and receiving them, so I would just keep trying on that. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, and, and how, what's the uh the turn of the normal processing time for claims?
[AGENT][NEUTRAL] 5 to 7 business days.
[CUSTOMER][NEUTRAL] If you know everything is OK, OK, alright, well I'll try to keep faxing it and see. Alright, thank you, uh-huh.
[AGENT][POSITIVE] OK, sounds good. Bye-bye.