AccountId: 011433970860
ContactId: 4c42940b-12af-4200-b321-801588e45a54
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1222569 ms
Total Talk Time (AGENT): 432004 ms
Total Talk Time (CUSTOMER): 561527 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/4c42940b-12af-4200-b321-801588e45a54_20250512T21:03_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling regarding a policy that my brother had. He passed away on [PII], and your um
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Thank you. Uh, your, um, customer care, uh, sent me a claim form today, and they're asking me to obtain medical records. So, um, I think the only place he went to was a local clinic there in [PII]. And so is there some kind of documentation that I need to give them to access those records? Because I wasn't like his medical power of attorney or anything that I'm aware of.
[AGENT][NEUTRAL] OK, uh, what is the policy number?
[CUSTOMER][NEUTRAL] So I don't know what the policy number is. Let me see if they sent it to me. Hold on. Um, it's under [PII], and let's see, I have a social and his date of birth. Let me look at the email, just a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] It says for your request I attached a claim form to this message. Yeah, it doesn't tell me the, the claim information like I don't know what the policy number is. Um, let's see here, hold on.
[AGENT][NEUTRAL] And what did you say his name was?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, I did just send me there.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] A cancer claim for him, but he had a heart attack, so, um, so I don't know. Yeah, I mean, he had a a heart attack and stroke rider on his cancer policy, so that's what I'm claiming is a heart attack.
[CUSTOMER][NEUTRAL] And I have his birthday and his uh social.
[AGENT][NEUTRAL] Uh, what state is he from? or was from?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Taxis.
[AGENT][NEUTRAL] And what was his date of birth?
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] And what is your last name?
[CUSTOMER][NEUTRAL] [PII], and my first name is [PII].
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And we're currently working with um.
[CUSTOMER][NEUTRAL] An attorney in the [PII] area where [PII] had his residence address listed um on his uh documents um so just to let you know that it's gonna take a while to get letters of administration if those are needed um to go through probate court, uh, so I don't know if those will be needed, but for right now I just at least wanted to get the ball rolling on this claim so, um, that I could find out what y'all need.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, looks like you sent the death certificate. It says today. Um,
[CUSTOMER][NEUTRAL] Yes, ma'am. I think I did that this morning.
[AGENT][NEUTRAL] And you said he had a heart attack?
[CUSTOMER][NEUTRAL] Yes, ma'am, it shows right on the death certificate. If you look at the death, it's, it says myocardial infarction.
[AGENT][NEUTRAL] OK, yes, ma'am.
[CUSTOMER][NEGATIVE] Which is a harder time.
[AGENT][NEUTRAL] Um, along with that claim form, we would need the, any medical records, uh, showing that he was diag or, well, we would need medical records.
[AGENT][NEUTRAL] Like she said the claim form and medical records, um.
[AGENT][NEUTRAL] I'm sorry to ask, but did he pass in the hospital?
[CUSTOMER][NEUTRAL] So I, it's like.
[CUSTOMER][NEUTRAL] No, he died at his residence right on that death certificate says he died at his residence.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the [PII]'s home in [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm not
[CUSTOMER][NEUTRAL] It's on [PII].
[AGENT][NEUTRAL] Sure. Let me, um, I may have to transfer you to an examiner. Hold on one moment for me, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey Ms. [PII], it's [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Doing well, [PII], thank you. How are you?
[AGENT][NEUTRAL] I feel like I need a nap, but
[CUSTOMER][NEUTRAL] Yep, Monday.
[AGENT][NEUTRAL] It is, um, but I have an insured sister on the phone. Apparently, she had sent an email today. Um, and looks like [PII] put a note in the system. Her brother had passed away in April from a heart attack. And [PII] sent her, or she was sent the claim form along with, um, tell her we need medical records. But she is stating that he died at home from the heart attack and
[AGENT][NEUTRAL] As far as records she can see for him, uh, it's only for
[AGENT][NEUTRAL] A clinic, so she didn't, she wasn't, she said she wasn't sure what information we would need to file a claim for heart attack.
[AGENT][NEUTRAL] Even though and it states, she said it's.
[CUSTOMER][NEUTRAL] OK, so that's like a critical illness policy, right? You're saying?
[AGENT][NEUTRAL] Um, well, he has a cancer policy, but, um, let me see. She said he had a heart attack rider, but let me double check.
[CUSTOMER][NEUTRAL] What's up
[AGENT][NEUTRAL] And, well, he does have a critical illness rider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number 21583887.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so she's questioning whether what she can send or?
[AGENT][NEUTRAL] Right, she's wanting to know what information she can send, but she said that she, um, well, no it looks like [PII] put that the death certificate was received and she sent the customer service, um.
[AGENT][NEUTRAL] And it's, and I was wondering because it states on the death certificate he died of a heart attack, what other information would we need?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Let me pull up that claim form, just bear with me for just a moment.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] So it's a critical illness and not uh.
[CUSTOMER][NEUTRAL] Because even though it's a rider, it's still gonna require that critical illness claim form.
[AGENT][NEUTRAL] So he
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So if she can't get the medical records, then I would assume that we would need a completed attending physician statement and since he was, he passed away at home that would then fall to I believe the medical examiner or she would have to get maybe his primary care doctor or somebody to provide us that information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] But was she would need the, the cancer claim form. She would need to clear the Lord words or critical illness form, correct?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right, because even though it's a cancer policy, if she's wanting to file that claim under the critical illness writer, it would then fall to the critical illness because the cancer claim form is gonna be specific to that cancer, you know, information, whereas the critical illness is, is the benefit that we're needing. So then it does, it does state on the critical illness benefit that needing to provide medical records and the completed attending physician statement.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Exactly, right.
[CUSTOMER][NEUTRAL] Um, and the critical illness benefit may include the first time diagnosis additional or reoccurrence, um.
[CUSTOMER][NEUTRAL] So yeah, like I said, if he passed away at home, then she would either need to get with the medical examiner's office to complete that or like I said, uh, um,
[AGENT][NEUTRAL] Lieutenant physician.
[CUSTOMER][NEUTRAL] Maybe possibly a PCP.
[CUSTOMER][NEUTRAL] Yeah, that attending physician form, uh huh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Awesome. Well, I can definitely tell her that and send her the correct form. I'm assuming at least you just send her a cancer claim form. It's from the way it sounds, but, OK.
[CUSTOMER][NEUTRAL] Yeah, you can just kind of double check with her and see what form she received but yeah I would think that um we would definitely need that critical illness claim form if that's the benefit that we are looking at.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Awesome sauce. Thank you, madam. I appreciate you.
[CUSTOMER][NEUTRAL] You're welcome. Did you have any other questions?
[AGENT][NEUTRAL] No, that's it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Thank you. Have a great day.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK. You too, not too much longer, right?
[AGENT][NEUTRAL] Not too much longer and I was supposed to go to the gym tonight, but I think I might just take a uh take a nap.
[AGENT][NEUTRAL] Really don't, he don't need to go to bed anytime soon. Uh, they're almost out of school, so it's not like he has homework or anything, you know.
[CUSTOMER][NEUTRAL] I hear that.
[CUSTOMER][POSITIVE] Yeah, yeah. Get to be that time of year.
[AGENT][POSITIVE] Yeah, and I got to finish registering uh him for next year. Yeah, it's gonna be fine.
[AGENT][POSITIVE] Can't wait for middle school.
[CUSTOMER][POSITIVE] Yeah good luck with that, hon.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I know.
[AGENT][POSITIVE] I appreciate you. Have a great one.
[CUSTOMER][POSITIVE] You too thank you [PII].
[AGENT][POSITIVE] Bye. You're welcome.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, Ms. [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, thank you so much for holding. I just need to verify something with you. The form you received, was it for a cancer claim form?
[CUSTOMER][NEUTRAL] Yes ma'am, it says a cancer claim form. Yes ma'am, that's exactly what it says on there.
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] So I was kind of confused cause I was like, he doesn't have cancer.
[AGENT][NEUTRAL] Right. And I just talked with an examiner.
[CUSTOMER][NEUTRAL] Did they send me the wrong form?
[AGENT][NEUTRAL] Well, since it is a critical illness writer that he has a heart attack and stroke, that's the form we would need, um,
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] OK. Well, then I can fill that out. That's not a problem. It's just obtaining medical records. I'm not sure how to do that because he's deceased, so I don't know how to get that going unless, see, I'm going through probate, OK, but the attorney has to go through the probate process, which is probably gonna take about 90 days.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, uh, so what I'm looking at is, do I have to have the letters of administration to obtain medical records? Is that what I'm probably gonna need? Can you give me that information? Can you tell me if that's what I'm gonna need?
[AGENT][NEUTRAL] Uh, that's something you may, well, and from what the examiner explained to me if, if you know if he has an attending physician, because on a critical illness claim form, there's a big section for attending physician to fill out and complete as far as any history or diagnosis. And
[CUSTOMER][NEUTRAL] Whenever I
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] She was saying that that if he has um
[AGENT][NEUTRAL] Attending or not attending physician, if he has um a physician that he was saying, then they can complete that form or um.
[CUSTOMER][NEUTRAL] Yeah, he had a clinic, um, that he was seeing a doctor at in the [PII] area, and so I can definitely send the claim form and then then they would probably be able to release the medical records that would be needed for that. Um, could they send them directly to y'all if needed because they may not want to release them to me personally.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They can, yes, ma'am. Um, give me one moment. Let see if you have an email address on here.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] What's the, what's your email address and I can send that to you.
[CUSTOMER][NEUTRAL] OK. My email is my first middle initial and last name. So, first name is [PII].
[CUSTOMER][NEUTRAL] And middle initial is [PII] and my last name is [PII].
[CUSTOMER][NEUTRAL] [PII], so it's [PII].
[AGENT][NEUTRAL] OK, uh, I will send over, I'm gonna send the correct form to you in a few moments, um.
[AGENT][NEUTRAL] And like I said, it does have.
[AGENT][NEUTRAL] The first portion is for, it's typically for the insured, but um fortunately, since he is no longer with us, then it does ask for beneficiary or
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] The sign, date, we have a phone number.
[CUSTOMER][NEUTRAL] So when
[CUSTOMER][NEUTRAL] Because it was like on the page too, it says [PII] claim form, and they sent me the form this morning and it is about the insured. It says like name, date of birth, address, phone number, um, and then about the patient, and me, [PII] and his birthday. And then, um, I'm, I'm just gonna go ahead and sign it, you know, that it's me that's signing it, his sister, I'll put underneath there his sister. And then I don't know the policy number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I'm just gonna put the patient's name as my brother, and then the date of birth and then the signature or personal representative, and I'm gonna put my relationship with sister, um, I'm deceased, um, [PII]. Is that OK?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh yes, ma'am.
[AGENT][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK. And then I do not see anything about um something from a doctor. So you're gonna send me that?
[AGENT][NEUTRAL] Yes, ma'am. I'm seeing in a critical uh illness claim form. It will have the attendant physician's portion that needs to be completed. Um, it's a separate form from the.
[CUSTOMER][NEUTRAL] Like a doctor thing?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, tell me she just sent the the cancer form was sent because it's cancer policy, but there's nothing on that cancer form that kinda says anything as far as if you're filling out for critical illness like a writer under the plan, so.
[AGENT][NEGATIVE] That is no good, so I'm saying the correct one.
[CUSTOMER][NEUTRAL] So I need to do both ones or just one?
[AGENT][NEUTRAL] Just one.
[AGENT][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] Which one? Not this one?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, ma'am, the one I'm about to send to you.
[AGENT][NEUTRAL] I
[CUSTOMER][POSITIVE] Awesome. OK, thank you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm gonna go and check my email that way I'll know when I get it.
[AGENT][NEUTRAL] 9 OK.
[AGENT][NEUTRAL] Let me catch.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I just sent that over.
[CUSTOMER][POSITIVE] Excellent. Let me just see here if I got it.
[AGENT][NEUTRAL] It may take a minute.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am and um once I have that information is completed, it can't be emailed but it can definitely be mailed or faxed to our office.
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] OK. And is there
[CUSTOMER][NEUTRAL] OK, I got it. All right, so go ahead.
[AGENT][POSITIVE] Good deal.
[CUSTOMER][NEUTRAL] We just make sure.
[CUSTOMER][NEUTRAL] I just want to look at it real quick.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It's opening to second critical illness claim form. All right, so the statement of insured, then if it's claimed under the
[CUSTOMER][NEUTRAL] So, let's see.
[CUSTOMER][NEGATIVE] It doesn't make sense. It says benefits claim select the condition for which claim is being filed.
[CUSTOMER][NEGATIVE] It's not even under there.
[AGENT][NEUTRAL] Say what? Say that again.
[CUSTOMER][NEUTRAL] It doesn't, it says benefits claimed, select the condition for which claim is being filed, and none of these apply.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Critical illness benefit or what does that mean?
[CUSTOMER][NEUTRAL] Is that what I'm supposed to check?
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Uh, yes, ma'am. Cause critical illness, uh, would include like heart attack, stroke, um,
[AGENT][NEUTRAL] Any of our critical illness policies, they all have to fill this out as far as this form and it could be for
[AGENT][NEUTRAL] Anything that's listed as a critical illness, but for his policy, that writer is only for heart attack or stroke. So you can just mark critical illness benefit and just put in his name and everything, they'll be able to locate and see that he has a cancer policy with a rider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. That's what I need to know.
[CUSTOMER][POSITIVE] Perfect, because I don't know the claim number or anything like that so alright sounds good because it's asking for the APO policy number. Can I get that from you?
[AGENT][NEUTRAL] Uh, yes, ma'am. It is 215-838-887.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, so that is 215-838-7 APL policy number and then let's see, the only thing I'm gonna fill out is the the section A, B, C, and D, but not E, and then I sign at the bottom, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, then I go to page 4 of 9, and if it's the policy number, printed name of patient, the date of birth and I sign, um, and then the relationship, and then the next part is the physician part, right? The 5.
[AGENT][NEUTRAL] Mm yeah.
[AGENT][NEUTRAL] Yes, ma'am. And it's a pretty long, you see, those are different critical illnesses um that could be covered on a certain policies like,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Burns, cancer.
[CUSTOMER][NEUTRAL] So she only has to answer the part and the heart attack, is that right?
[AGENT][NEUTRAL] Uh, right.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Alright, because he doesn't have a lot of stuff, so.
[CUSTOMER][NEUTRAL] All right. And then the physician would do the age [PII] and fine. OK, got it. All right. I will go ahead and reach out to them and we'll get that ball rolling. And then um um I'll, I'll include my um
[CUSTOMER][NEUTRAL] What do you call it my contact information on the phone as well so.
[AGENT][POSITIVE] OK, good deal. Yes, ma'am.
[CUSTOMER][POSITIVE] OK. Well, thank you for your time. I appreciate your help.
[AGENT][POSITIVE] All right, you are welcome, Ms. [PII], and I thank you for calling [PII]. Have a great day.
[CUSTOMER][POSITIVE] Thanks. Bye-bye.
[AGENT][NEUTRAL] Bye.