AccountId: 011433970860
ContactId: 3ee8cba5-6843-4ca6-9388-678feafca7d4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 608130 ms
Total Talk Time (AGENT): 308024 ms
Total Talk Time (CUSTOMER): 238596 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/3ee8cba5-6843-4ca6-9388-678feafca7d4_20250501T19:07_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, um,
[CUSTOMER][NEUTRAL] I need a little assistance, um.
[CUSTOMER][NEUTRAL] I, I downloaded um.
[CUSTOMER][NEUTRAL] Uh, one, I have two forms and I downloaded one. It has codes on it that y'all need for my claim. Do you want my claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me have your name, a callback number, and the policy number, please.
[CUSTOMER][NEUTRAL] OK, [PII] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And are you still there? I
[AGENT][NEUTRAL] Yes, I'm here. Mhm.
[CUSTOMER][NEUTRAL] The uh um the policy number or the policy number is um 005956559.
[AGENT][NEUTRAL] OK. Thank you, Mr. [PII]. For security, may I have your date of birth, mailing address and email address for verification security.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][POSITIVE] Oh perfect, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So I see that you uploaded 2 documents today.
[CUSTOMER][NEUTRAL] Yes, and one of them says received, but the other one just says uploaded and then I thought well maybe I did something wrong.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK. Yeah, it looks like they're both here. Um, so, um, they are in line to be processed, so they go to a line where they are sent to an examiner. The examiner will review the information and process the claim. If she needs any additional information, once she process, she'll let you know if she needs anything else, but it's 7 to 10 business days to process the claim.
[CUSTOMER][NEUTRAL] OK, so I, I guess I uploaded the 2, correctly.
[AGENT][NEUTRAL] Mhm. Yeah, it looks like you uploaded two of them, yes, mhm, yes.
[CUSTOMER][NEUTRAL] You said you got, OK.
[CUSTOMER][POSITIVE] OK, good. I just wanna make sure.
[CUSTOMER][NEUTRAL] And um
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, my other question is um I don't know if it's for you or for somebody else would be um.
[CUSTOMER][NEUTRAL] Um, on my policy, do I have a, what kind of wellness claim do I have? Um, I have a cancer policy with y'all.
[AGENT][NEUTRAL] You want to know what kind of wellness benefit you have?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. All right. Let me go.
[CUSTOMER][NEUTRAL] Because I
[CUSTOMER][NEUTRAL] Because I had breast cancer.
[CUSTOMER][NEGATIVE] But I've been treated for it and everything. I don't think I even filed a claim with y'all at all. I could have and I think I forgot I even had the policy. It was made way back in [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] But I do, I do go for a wellness mammogram every year to [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] So I, I guess I didn't know I had a wellness part.
[AGENT][NEUTRAL] OK, let me check and see how much we pay for that wellness. One moment, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me go over your benefits. Let's see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so wellness dispense is $75 per year. So yes, you do have that benefit and um all you need to do is fill out a claim and send it to us. It's just a claim form that you need to fill out. You don't have to send any documentation. You just fill that out and send it to us. Um, we don't have timely filing on those, so you can submit uh the years that you have not submitted before.
[CUSTOMER][NEUTRAL] You, you don't have what? I missed that.
[AGENT][NEUTRAL] You don't have to send any paperwork. You just need to have the dates and the information of the doctor that you want to visit. So all you need to do is send us a claim form.
[AGENT][NEUTRAL] Um, and we'll go ahead and process the claim, and I see you have deposit since [PII]. Uh, you can go as far back as [PII]. We don't have timely filing limits.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] That's a lot of years.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I, I would have to do a claim, a claim form for each year.
[AGENT][NEUTRAL] No, um, you just list the dates that you had the test of which test you had, the date of service, and the doctor that took, um, or did the test for you.
[CUSTOMER][NEUTRAL] Oh gosh, I don't even know when all that was dates of service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, if you are seeing the same, um, yeah, if you're seeing the same doctor for a while, for years, they probably have a history that they can give you and you can just go ahead and go by that.
[CUSTOMER][NEUTRAL] I'm gonna have to get that.
[CUSTOMER][NEUTRAL] That's what I probably need to ask for, the history.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And it would just need the dates of service?
[AGENT][NEUTRAL] Mhm. Yes, the days of each test and um the name of the provider that did the test. That's all you need in the claim form. Um, the claim form, uh-huh, you can find it on our website on [PII] or you can do it electronically, just the, the, you know, the one you just did right now. You can do it electronically by just clicking wellness claim form.
[CUSTOMER][NEUTRAL] Provider
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, and you fill it out actually on the computer?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You go, um, you go to your account and it's gonna ask you if you want to submit a wellness claim form or a wellness claim and you click on that and you just fill that out.
[CUSTOMER][NEUTRAL] 00.
[CUSTOMER][NEUTRAL] Oh wow and they'll pay me for all those back years.
[AGENT][NEUTRAL] Yes, unless you have the dates and we can go ahead and call and confirm the dates with the doctor. We can go ahead and pay as far back as [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][POSITIVE] Wow, and now I, I did have um
[CUSTOMER][NEUTRAL] OK, this claim that I'm working on today is because I have a form of leukemia and I take a chemo pill every day. That's this one I'm working on, but the wellness one.
[CUSTOMER][NEGATIVE] I can't go back and claim.
[CUSTOMER][NEUTRAL] When I had
[CUSTOMER][NEUTRAL] Uh, radiation, can I? Probably not.
[AGENT][NEUTRAL] For what year?
[CUSTOMER][NEUTRAL] On the breast
[CUSTOMER][NEUTRAL] It wasn't
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, your policy was active during the time of service. Anything that happened, um, that is positive for cancer or wellness from [PII], you can still claim it.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm not sure if I even remember the
[CUSTOMER][NEUTRAL] The doctors that I went to.
[CUSTOMER][NEUTRAL] Well, I had a surgeon and all that. What I have to have more.
[CUSTOMER][NEUTRAL] Uh, I would probably have.
[AGENT][NEUTRAL] Yeah, for what, yeah, yeah, whenever it's like radiation, surgery, um, any type of um procedures that is not wellness, you need documentation. So for any type of cancer benefits, you're gonna need the claim form.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But you also need uh itemized bills. So you are gonna need the itemized bills for that. And if you had like um surgery or anything like that, and this is the first time that you're trying to submit claims for that one, we're gonna need the pathology report of the findings as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I probably have all that. I probably have it all somewhere, but I went to, I had it in [PII] and my surgeon was in [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] And I had Methodist Hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I don't know how I get all that. They have to have probably cla uh codes put on them too, or no?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it has to be a fully itemized deal with with diagnosis codes and procedure codes and all that information. So, um, yeah, you can just take your time and see what you can gather and whatever you gathered, you can send it to us and let us look into it and see if it's enough to uh to process or not. If it's not, we'll let you know what else we need.
[CUSTOMER][NEUTRAL] OK. Well, might as well.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah, just take your time. There's no timely filing limit.
[CUSTOMER][NEUTRAL] All right. Uh, well, I really
[AGENT][POSITIVE] So you don't have to rush. Yeah.
[CUSTOMER][POSITIVE] Wow, that's great that is great.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] I thought I just missed the boat on all that one day I thought, oh my gosh, I had that cancer policy I didn't even use.
[AGENT][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, no, no, it's not timely. Yeah, mhm. You're on time.
[CUSTOMER][NEUTRAL] OK, well, I'm.
[CUSTOMER][NEUTRAL] I will work on all that and uh try to get you what I can and then just go from there I guess.
[AGENT][POSITIVE] All right, sure, no problem. But yeah, if you have any questions, any doubts, or you, you run into any kind of problem and you have doubts about it, just give us a call back, OK?
[CUSTOMER][POSITIVE] OK, sounds great. Thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I'm gonna help you with today? Any other questions or concerns today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Um, no, I think that's all so far. I really appreciate it.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon, Miss. [PII].
[CUSTOMER][NEUTRAL] Uh-huh. You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.