AccountId: 011433970860
ContactId: 5506cca6-6147-42cc-a61a-41f56ddf5402
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 832270 ms
Total Talk Time (AGENT): 432899 ms
Total Talk Time (CUSTOMER): 329355 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/5506cca6-6147-42cc-a61a-41f56ddf5402_20250214T20:15_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], I was calling to see um if I could file um a claim on my husband. He, he's on my.
[CUSTOMER][NEUTRAL] I mean we have the family plan, but he in December had a um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm not pronouncing it, um, correctly, a squamous cell carcinoma removed on his left arm and I was just wondering if I could send in like the report from the dermatopathology and all that we pay, would that be sufficient enough to turn into y'all?
[AGENT][NEUTRAL] OK, so you're wanting to find out how to file a claim on your policy for your husband, is that correct?
[CUSTOMER][NEUTRAL] Well, I have the I have the sheet like where it says um you know I, I fill out the information and then I turn in like I have the reports and all can I just send those in to y'all? I mean.
[CUSTOMER][NEGATIVE] And y'all will pay so much on it, I guess that's what I'm asking. We will any of this.
[AGENT][NEUTRAL] OK, so you
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][POSITIVE] I don't know what I'm trying to ask. I'm sorry.
[AGENT][NEUTRAL] OK. Now, you're fine. So it sounds, it sounds to me like your husband had a procedure and you're wanting to find out about filing a claim.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] On your policy you have with us.
[CUSTOMER][NEUTRAL] Yes, if I can just send.
[CUSTOMER][NEUTRAL] Right, if I can just send in.
[AGENT][NEUTRAL] OK, sir.
[CUSTOMER][NEUTRAL] I have, you know, like the pathology report and you know what we paid if I can just send that all in, I have the sheet where um you know like the statement insured and I fill out like his name and all and then send this in is that all I really.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so what I need, yes, sir, but actually what I need to do first to verify that you have the correct form because for different types of policies, we do have different claim forms. So you, we need to make sure you have the correct forms. So who I can help you with all of this. So who am I speaking with, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I am [PII]
[AGENT][POSITIVE] OK, thank you and Ms. [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have your policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Oh heck, uh, who, uh, let me see I know I do I know I do um.
[AGENT][NEUTRAL] If you, uh, maybe, are you the, you said that you were the primary policy holder, Ms. [PII], is that correct?
[CUSTOMER][NEUTRAL] I am, um, yes.
[AGENT][NEUTRAL] Now, I may look it up with your social if that's easier for you.
[CUSTOMER][NEUTRAL] OK, um, let me see I've got.
[CUSTOMER][NEUTRAL] Oh, let's see here's I even think about either. OK, let's try my social.
[AGENT][POSITIVE] OK. All right. Well, I'm ready when you are.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, so thank you very much Ms. [PII]. Give me just a moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] OK, Ms. [PII], so I have located your information. I will need to verify several things with you go first for security purposes, and any information that I did provide for you would be a verification of benefits and not a guarantee of payment. So first off, Miss [PII], if you would please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Also the home mailing address for you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Reston.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and your zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. The phone number that we have on file for you is different than the one you gave me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's is it [PII]?
[AGENT][NEUTRAL] Yes, ma'am. Um, is that number?
[CUSTOMER][NEUTRAL] We that are um.
[CUSTOMER][NEUTRAL] And we don't have a landline anymore, no, ma'am.
[AGENT][NEUTRAL] OK, so your only phone number that we should have is the [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you. And lastly, um, your email address, please.
[CUSTOMER][NEUTRAL] OK, that's probably changed too, um, it's all lower case.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so what was another email that you would have had?
[CUSTOMER][NEUTRAL] Uh, let's see, it would have been [PII].
[AGENT][NEUTRAL] OK, so what does it need to be now? That is the one that we had, so if you could give me your other email again so I can update it.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, we moved last August, so a lot changed, so.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] I have it my name [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I just found my policy number.
[AGENT][NEUTRAL] That's OK. I have it now. Now, let me ask you, I can see that we have on file, uh, direct deposit information for you, Ms. [PII]. Is that from your, a checking account or a savings account?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Checking.
[AGENT][NEUTRAL] OK, alright, for some reason the system when I made the change to your phone number.
[AGENT][NEUTRAL] It removed that piece of information, so I had to add it back in and I, I didn't notice it before. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII]. So the policy number that you should have is 729,960.
[CUSTOMER][NEUTRAL] That's it. Yes, ma'am.
[AGENT][NEUTRAL] OK, all right, so first off, Miss [PII], have you ever set up your profile in the APL online service center where you can log in and have access to your policy information and you can also submit claims to us through that portal from a computer.
[CUSTOMER][NEUTRAL] No, I have not.
[AGENT][POSITIVE] OK, well what I can do for you, I have a user guide that I will be happy to email to you.
[CUSTOMER][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] And this email will give you the instructions on how to set up your profile and then it also explains how to upload your information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Directly into the portal you can also opt in for text alerts so when a claim is processed you will be able to, you know, you'll get a notification or you should receive a notification letting you know that.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Alright, so give me just one second to go ahead and email you this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm also going to, I'm just gonna go ahead and pull up the cancer claim form since this is a cancer policy, Ms. [PII], because the the, the claim that you should have would say cancer claim form at the top.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, this one doesn't.
[AGENT][NEUTRAL] OK, now these forms can also be printed from our portal, I mean, I mean from our website on our main web page at um [PII], but since I'm emailing this user guide to you, I'm just gonna go ahead and include the cancer claim form.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] OK, so give me just one moment to do that.
[AGENT][NEUTRAL] OK, Ms. [PII], so that email that I have sent to you that you should be receiving in just a moment or so is gonna come from care team at [PII]. I did put APL in your subject line as well as online service center portal and cancer claim form so that you can recognize that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK. OK. OK, and
[AGENT][NEUTRAL] And that claim form has all of your instructions on completing the claim form and it also gives you um you know it tells you what other documents you would need to send in so since you already have, you know, documents together you can just use that as a checklist for what you need to submit.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And again the user guy gives you instructions for uploading it because that really is the quickest and most efficient and secure way to get your information to us for a claim review.
[CUSTOMER][POSITIVE] OK wonderful.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][POSITIVE] That's wonderful, absolutely wonderful. OK, I
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, one other question, and you might not can answer this might be in that information. Um, let's see, the [PII], my husband, um, went in and had a PSA test. He's had every year because prostate cancer is very prominent in his family.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And his prostate level was high or the PSA level was high. So he had an MRI and everything came back clear and now he's gonna have a biopsy in 2 weeks. So,
[CUSTOMER][NEUTRAL] If that all comes back, if it's, I guess my question is, if it's all clear, will y'all cover any of that or since his PSA was high, would you cover any of the MRI.
[AGENT][NEUTRAL] This policy, no, ma'am, this policy is for a positive diagnosis of cancer unless it's, you know, if they did this for his screening benefit that you have. Now, you know, you do have your screening benefit and a PSA is on, is one of the tests that you could file a claim for, for screening purposes.
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh, um, because you do have that benefit on here now if you're going to be filing a wellness claim actually once you set your profile up in the portal.
[AGENT][NEUTRAL] The wellness claim filings or your screenings is made very simple now because when you you and again all of this is in that user guide so I'm not I don't wanna overwhelm you but there is a button that says file a wellness claim in the portal. All you have to do is click on that, follow the steps completing that form because you don't have to submit any additional documentation now. You will just complete it mark what test was done.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, you electronically, you know, you sign it online, you provide the provider's information again, all of that's on the claim form, but you just complete that and submit it for your wellness benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh wonderful. OK, that, oh, OK, good, good. OK. I mean, I was thankful that negative but we were out of pocket over 1500 for the MRI and I was like, oh, so anyway, but thank [PII] it was.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][MIXED] It was fine, you know, because it could have been bad, but anyway.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][POSITIVE] OK thank you.
[CUSTOMER][POSITIVE] [PII], you have been just a deer. I appreciate it so much.
[AGENT][POSITIVE] Oh, well, you are certainly so welcome, Miss [PII]. It was my pleasure in helping you today. I, I really enjoyed visiting with you. So is there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK, well.
[CUSTOMER][POSITIVE] I don't think so. I think you have answered my questions and I will get this set up. Thank you so much. I guess.
[AGENT][NEUTRAL] OK. Well, you are certainly welcome. and Ms. [PII], one last thing, I believe I already told you this, but in your portal too, there's a copy of your policy in its entirety in a PDF version that you can download, you know, and review any of your benefit information in there as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Fabulous. OK, thank you so much. I appreciate you more than you know, so thank you.
[AGENT][POSITIVE] Oh, well, it was my pleasure. Yes, ma'am. And thank you for calling APL. I hope you have a very nice [PII] and a great weekend too.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Oh you too thank you dear.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Bye bye.