AccountId: 011433970860
ContactId: 4ac64089-597a-4fbb-9df1-df303f77fb9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 985919 ms
Total Talk Time (AGENT): 508204 ms
Total Talk Time (CUSTOMER): 312753 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/4ac64089-597a-4fbb-9df1-df303f77fb9d_20250102T23:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I was calling because my husband had.
[CUSTOMER][NEUTRAL] A cardiac event.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And I believe that we have coverage for heart attacks. He had open heart surgery.
[AGENT][NEUTRAL] OK, alright, um, can I please get your name and your callback number so that I can help you with your benefits?
[CUSTOMER][NEUTRAL] Yes, it's um [PII].
[AGENT][NEUTRAL] OK [PII], what is your um callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And then um.
[AGENT][NEUTRAL] What is the policy number?
[CUSTOMER][NEUTRAL] Uh, I'm not, I don't know right now. Uh, let me see here, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me look on.
[CUSTOMER][NEUTRAL] Mm plan information.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] I, I don't, I don't know.
[AGENT][NEUTRAL] OK. OK. Um, what is the Social Security number and I'll be able to pull in the policy that way.
[CUSTOMER][NEUTRAL] It's a group
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, I've got the um social security number and what is your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] Your telephone number?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII] no, no, no, that's my social. I'm so sorry.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Oh, it's been a day. So sorry, my brain is so discombobulated and I'm exhausted and worn out and I just, 00, I'm so sorry. I apologize.
[AGENT][POSITIVE] That's all right
[AGENT][NEUTRAL] That's OK. I understand. No, when you gave it to me the first time.
[CUSTOMER][NEGATIVE] It has been a holiday and I, I'm like on the verge of tears every moment. Um, OK.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Oh, please, um, I'll help you all I can. OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII]. OK, perfect. Thank you so much. I appreciate you giving me that information.
[CUSTOMER][POSITIVE] Oh, I appreciate you.
[AGENT][NEUTRAL] OK, let me pull up the policy.
[CUSTOMER][NEUTRAL] checking
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said your last name is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what is
[CUSTOMER][NEUTRAL] Originally it might have been
[AGENT][NEUTRAL] Yes, ma'am. Go ahead.
[CUSTOMER][NEUTRAL] Beer, but I, I've changed it so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I understand.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] I'm going to need first [PII], OK, I'm going to need for you to verify your date of birth for me please, ma'am.
[CUSTOMER][NEUTRAL] And my husband is [PII].
[CUSTOMER][NEUTRAL] Alright, [PII].
[AGENT][POSITIVE] Thank you so much. And then what is your address and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] OK, address should be [PII].
[CUSTOMER][NEUTRAL] And I don't know if y'all have my school email address or my regular personal email.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's, it's [PII].
[CUSTOMER][NEUTRAL] Oh, OK, so that'd be [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], and then the phone number that you gave me to call you back in case our call is dropped is that um your cell phone number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you, Ms. [PII]. I appreciate you verifying your policy for me.
[AGENT][NEUTRAL] So, let me look at it real quick, um.
[CUSTOMER][NEUTRAL] We priorit
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let's see if you have.
[CUSTOMER][NEUTRAL] Is that
[AGENT][NEGATIVE] Heart attack and stroke on this.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I thought I did. I thought I had the whole.
[AGENT][NEUTRAL] This is a
[CUSTOMER][NEUTRAL] It's a summary of benefits, um, on my little paper here it says that you get.
[AGENT][NEUTRAL] OK, this
[CUSTOMER][NEUTRAL] Uh, let's see, um.
[CUSTOMER][NEUTRAL] There is heart attack, stroke, first occurrence, benefit rider, level 3.
[CUSTOMER][NEUTRAL] Um, and your spouse 750,000.
[CUSTOMER][NEUTRAL] Um, for, uh, yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, that is what I'm looking at on this policy also.
[AGENT][NEUTRAL] And that's just to verify benefits. It's not a guarantee of payment, but I do see that you have um uh 7000.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] $7500 for heart attack and stroke.
[AGENT][NEUTRAL] First occurrence, let me pull the policy in itself, um, so that we can read exactly what it says about that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you signed up in the online service center?
[CUSTOMER][NEUTRAL] I don't know. I, I don't know.
[AGENT][NEUTRAL] That would be really helpful for you um when you're ready, when you, when you have a chance to do it, let me give you the um website that you can go to to sign up for it.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I tried to get on there earlier and it just wasn't, I don't know why, but it's like I put all my stuff and I don't know if the last name was different or.
[AGENT][NEUTRAL] Oh well, I'm showing that on this policy, your last name is [PII] on this policy. Um, let me go in there.
[CUSTOMER][NEUTRAL] But it, it's just.
[CUSTOMER][NEUTRAL] Yeah, I don't know what's going on, not.
[CUSTOMER][NEUTRAL] I put my social security number in I put the zip code, my email.
[AGENT][NEUTRAL] OK, let me look up there.
[CUSTOMER][NEUTRAL] And it just
[AGENT][NEUTRAL] Let me look at something real quick to help you with that.
[CUSTOMER][NEGATIVE] So it first seems to be a problem.
[AGENT][NEUTRAL] OK. Oh no. OK.
[CUSTOMER][NEUTRAL] I'm like,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm looking at it now to see.
[CUSTOMER][NEUTRAL] I don't know if I already have it signed up. Do you think maybe?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Because your last name and
[AGENT][NEUTRAL] You must just, um, the last name on the online service center.
[AGENT][NEUTRAL] Is [PII] [PII] is.
[CUSTOMER][NEUTRAL] [PII]. OK, that's what I thought, yeah.
[AGENT][NEUTRAL] And it should be [PII]. So when you sign up for it, you'll need to put in your last name as [PII], um, and let me give you this policy number too in case you need that. It's.
[CUSTOMER][NEUTRAL] OK, that makes sense.
[AGENT][NEUTRAL] 253.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Let me, let me make a, a giggle a uh.
[CUSTOMER][NEUTRAL] A document to put that on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] Oh my gosh, OK.
[AGENT][NEUTRAL] OK, so your policy number?
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Is 253-1996 for this policy.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] So that's, that's where the, that's where the issue is, is the last name. Um, and then let's go ahead and
[AGENT][NEUTRAL] Look at your policy certificate.
[AGENT][NEUTRAL] To see what it says about the heart attack and stroke.
[AGENT][NEUTRAL] It's gonna be just a second because it's a pretty large policy.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So I can look it up for you.
[CUSTOMER][NEGATIVE] I'm hoping this is gonna provide us some financial relief because this has been a nightmare and my husband cannot work and
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] And we, and he lost his, his uh insurance.
[AGENT][NEGATIVE] I hate that.
[CUSTOMER][NEUTRAL] One,
[CUSTOMER][NEUTRAL] Like 2 weeks that happening and so it's, it's been crazy.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It's a $250 million to get open heart surgery.
[AGENT][NEGATIVE] Oh my gosh. That is ridiculous. I mean, honestly. And everything is so, so high now, everything is.
[CUSTOMER][NEUTRAL] I know, I, um, yeah.
[CUSTOMER][NEUTRAL] And then they did, they did a discount for um.
[CUSTOMER][NEUTRAL] For self pay kind of thing and brought it down to.
[CUSTOMER][NEUTRAL] Uh, what was it? 100 and
[CUSTOMER][NEUTRAL] I got one bill that's $155,000 and I have another bill that's like $20,000.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] That's what the discount.
[CUSTOMER][NEUTRAL] I'm like, OK, and then they're like financial aid, how much would the payments be a month? Oh, it's like um $7000 a month. OK, yeah, sure, no problem. Let me just pull that out of my little teacher back pocket and.
[AGENT][NEUTRAL] Oh no, you're like, oh, the, the disco.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][POSITIVE] Yeah, bless your heart. That's, that's a lot.
[CUSTOMER][NEUTRAL] I'll just get it out of my my student pencil funds.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] I'm just, yeah, it's like I'm done.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So looking at the policy where it says heart attack and stroke first occurrence, it's a lump sum benefit of $7500 a maximum of 1 per covered person per lifetime.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEUTRAL] Yes, so go ahead and send in your claim for that. You're going to need uh
[AGENT][NEUTRAL] Your explanation of benefits, you'll need your um
[AGENT][NEUTRAL] Itemized statement with your procedure codes and your diagnosis codes.
[AGENT][NEUTRAL] Along with the
[CUSTOMER][NEUTRAL] The itemized statement.
[AGENT][NEUTRAL] Yes, along with the yes, but it'll have to have the procedure codes and the diagnosis codes on it. Um, you can get that from the facility, the physician that you guys went to to have the procedures done. You can get that from them. Um, we have a web.
[CUSTOMER][NEUTRAL] Like the bill?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's it called?
[AGENT][NEUTRAL] Itemized statement.
[CUSTOMER][NEUTRAL] Itemize.
[AGENT][NEUTRAL] And it'll
[AGENT][NEUTRAL] Statement, yes.
[CUSTOMER][NEUTRAL] I can I.
[CUSTOMER][NEUTRAL] State where
[AGENT][NEUTRAL] Procedure codes.
[CUSTOMER][NEUTRAL] Procedure.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll go to our website where let me give you the website.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And you'll click on claims and forms.
[AGENT][NEUTRAL] And you'll fill out the cancer claim form. It's on the first page after you click claims and forms, the cancer claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll need to send that in with your itemized statement.
[AGENT][NEUTRAL] And if you have an explanation of benefits from your primary insurance.
[AGENT][NEUTRAL] You can send that in with it also.
[CUSTOMER][NEUTRAL] An estimation of well we have no insurance.
[AGENT][NEUTRAL] Oh, OK, so you won't need that. So you don't have that. OK.
[CUSTOMER][NEUTRAL] For him
[AGENT][NEUTRAL] So that's what you'll need to send in for the claim.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And let me give you
[CUSTOMER][NEUTRAL] Alright, so just the itemized statement with procedure codes and diagnosis codes.
[AGENT][NEUTRAL] Yes, and let me give.
[CUSTOMER][NEUTRAL] And fill out the cancer claim form.
[AGENT][NEUTRAL] Right, cause that's, it's under the cancer under your cancer policy. And then also you'll need um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me give you the fax number if you wanna fax in the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or if you want to mail it in, the address to mail it in is [PII] [PII].
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] 248.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII], [PII].
[AGENT][NEUTRAL] And then the zip code is [PII].
[CUSTOMER][NEUTRAL] What's the best, what's the fastest way to get your um.
[CUSTOMER][NEUTRAL] To get it processed and done.
[AGENT][NEUTRAL] Through the online service center or to fax it in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The online service center if you sign up for that and get your last name on there corrected, you can actually uh get the claims, all the claims informations, upload your documents there and send it that way or if you wanted to fax all your information and you can do that too once we receive the claim information it takes 7 to 10 business days to process it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if there's anything else that they need from you, they'll send you a letter and let you know what they need.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Or you can call in and make sure that everything is going good and the claim is being processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, that's helpful.
[AGENT][POSITIVE] OK. Yes, I'm so, I'm so glad I'm able to help you cause I know this has been a headache for you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Oh, it, it is just, it's overwhelming. It is a lot and my husband is very different now and.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, he's just had a hard time and it's an adjustment and
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then I wouldn't wish this on anyone. I mean, it's, it's just, it's a lot, you know, I mean, he's, he's dealing with the reality that his whole life has changed dramatically and
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, we'll be that way for at least the next 2 years and
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, just trying to.
[CUSTOMER][NEUTRAL] That's just crazy.
[AGENT][POSITIVE] And, and you're trying to be the rock in the family when you need a rock yourself. Yes, I get it. We, we put.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] As women, we put that upon ourselves because we want to be there and be able to fix everything and make everything better and be the support system. And uh, sometimes you need support yourself, you know, when you're going through something like that. Bless your heart. Well, look, if there's anything that we can do or you have any other questions during this time that you're filling all this out and you're trying to get a little relief, just pick up the phone and call us, OK? We'll help you all we can.
[CUSTOMER][NEUTRAL] For real, for real.
[CUSTOMER][NEUTRAL] It's, it's just a lot.
[CUSTOMER][POSITIVE] Alrighty well I appreciate it very much. Thank you for your help today.
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] You're very welcome, [PII]. I'll keep you in my prayers.
[CUSTOMER][POSITIVE] I need it. Thank you for real. We need it.
[AGENT][POSITIVE] Well, I will definitely do it. Yes, ma'am. I will definitely do it. OK. All right. Well, you take care and you have a wonderful rest of your night. All right. You, you're welcome. Bye-bye.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][POSITIVE] You too. Thank you so much. Bye-bye.