AccountId: 011433970860
ContactId: 5ee97101-c648-4b5a-abdb-67eebda959e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 522109 ms
Total Talk Time (AGENT): 199578 ms
Total Talk Time (CUSTOMER): 252557 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/5ee97101-c648-4b5a-abdb-67eebda959e9_20250113T17:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, I have a question.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 00 I'm sorry. OK, I have a cancer insurance.
[CUSTOMER][NEUTRAL] And I typically do the wellness claim.
[CUSTOMER][NEUTRAL] Um, but this time I was reading over it and it mentioned something about a
[CUSTOMER][NEUTRAL] Uh, screening, um, claim that I could possibly.
[CUSTOMER][NEUTRAL] Submit
[CUSTOMER][NEUTRAL] Um, would you know one thing about that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can assist you with your benefits. Can I have your name, please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII], can I have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] May I have your policy number, please?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, I don't have that on me.
[AGENT][NEUTRAL] One moment please, let me get to the screen. I'm gonna ask you for your social and I can look you up. One moment.
[AGENT][NEUTRAL] May I have that number, please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Can you please verify your date of birth, address, and email address, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Your mailing address, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. So thank you so much, Miss uh [PII] for verifying the information. So you was calling about the screening benefit while I pull up your policy, this is a verification of your coverage and not a guarantee for payment.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Screening, screening, screening. I don't see a screening benefit under your policy. You have a diagnostic testing, um, you have the follow-up diagnostic testing and the imaging.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, that, that, that follow up.
[CUSTOMER][NEUTRAL] What is that about? Because typically I know about the wellness claim where it's the $50 and you um you know.
[AGENT][NEUTRAL] The follow up is if you um
[CUSTOMER][NEGATIVE] Cause I.
[AGENT][NEUTRAL] was diagnosed with, if you had a biopsy done, not a biopsy, if you had a mammogram done and then they turn around and say they found something or something's going on and then they do a biopsy where they cut you and then it comes back negative, then you can submit information for that follow-up diagnostic.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so that did something like that, but let me ask you, so I did a.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, screening for.
[CUSTOMER][NEUTRAL] Um, let me see. It was a follow up. So I did my, I, I went in, you know, some pain, so they, they did a sonogram screening, I guess, um, of, uh, you know, sonogram and they saw, um, something about my endometrius or uterine, uterine was
[CUSTOMER][NEUTRAL] Look, had some issues, you know, the sticker or whatever it was. And so they did a biopsy.
[CUSTOMER][NEGATIVE] But it came back negative.
[CUSTOMER][NEUTRAL] So does that
[AGENT][NEUTRAL] You will have to submit the um information where you had the first um.
[CUSTOMER][NEUTRAL] Co
[AGENT][NEUTRAL] The first um diagnostic testing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then you will submit the um documents from where you had the biopsy done and the results from that biopsy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and so.
[CUSTOMER][NEUTRAL] Which claim would that be? Would that be?
[CUSTOMER][NEUTRAL] Because there are 2 different claim forms here that I see.
[CUSTOMER][NEUTRAL] So what it let me see.
[AGENT][NEUTRAL] It wouldn't be the cancer claim form because that's not a positive diagnosis of cancer. You would, you can uh fill out the wellness form, select, you can select that form and you can put um what you had done, but you also need to make sure that you have the supporting documentation. Like I said, the diagnostic testing screening where you had the screening done, um.
[CUSTOMER][NEUTRAL] Oh, so the way this phone.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And then the um.
[CUSTOMER][NEUTRAL] Yes, the.
[AGENT][NEUTRAL] The biopsy done and then the results from, yeah, that, that information.
[CUSTOMER][NEUTRAL] And the thing is when I did the.
[CUSTOMER][NEGATIVE] When I did the first claim for the wellness, I did it online and it didn't prompt me to upload anything.
[AGENT][NEUTRAL] But wellness?
[CUSTOMER][NEUTRAL] And I guess they would get, yeah, I guess I was like, OK, I had all my paperwork, but it didn't do a prompt to upload, but then they sent the 50 but I think.
[CUSTOMER][NEUTRAL] I don't know if they
[AGENT][NEUTRAL] You don't have to send documentations with the wellness anymore.
[CUSTOMER][NEUTRAL] OK, yeah, because I think you're used to or something, but OK, but this particular one you want to get because I didn't know if they just call the doctor or get the information from them, but this particular.
[AGENT][NEUTRAL] No, you have to submit the supporting documentations because this one is um where you it has to be an incision, an incision. It has to be a decision made and then it has to come back negative for this benefit to pay.
[CUSTOMER][NEUTRAL] For this one.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I will put that in. You said go ahead and do the wellness claim though.
[AGENT][POSITIVE] Yeah, you can do it and I think you can, it has a screening um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or other, you can put screening, follow up, um, you can make a notation, follow up, um, diagnostic testing. That way it'll prompt the reviewer to know that's the benefit you're claiming.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so I'm looking at that um the wellness one.
[CUSTOMER][NEUTRAL] Wait a minute, wait a minute, which one am I looking at? I'm looking at there's one that says welder claim form and then there's another one that says.
[CUSTOMER][NEUTRAL] Claim form. I don't know if they're the same ones or what.
[CUSTOMER][NEUTRAL] Cancer claim form, it wouldn't be that one, right?
[AGENT][NEUTRAL] No, this is not a positive diagnosis of cancer.
[CUSTOMER][NEUTRAL] OK, so it'll be this wellness. OK, so I'm gonna print that out. OK, I will get those things, but so, uh, that's what I was looking for. It has 5610.
[CUSTOMER][NEGATIVE] It looks like it can only go on other cancel screen test.
[CUSTOMER][NEUTRAL] For the
[AGENT][NEUTRAL] I couldn't hear you.
[CUSTOMER][NEUTRAL] Oh, it looks like it can only go on uh where it says cancer screening test.
[CUSTOMER][NEUTRAL] It looks like it can go. I I'll have to check under.
[AGENT][NEUTRAL] Yeah, that's why I told you to make sure you make a notation that it's a follow up diagnostic testing that way.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it'll prompt the reviewer to know that that's the benefit that you're claiming for.
[CUSTOMER][POSITIVE] OK, alright, well that's what I'll do and I can.
[CUSTOMER][NEUTRAL] Submit. What kind of way can I submit? Let me see, because the other one was able to upload, but.
[CUSTOMER][NEUTRAL] Do you know how I would submit this?
[CUSTOMER][NEGATIVE] Because like I said, when I did the other wellness it just submitted and didn't allow me to upload anything.
[CUSTOMER][NEUTRAL] So would I fax it in?
[AGENT][NEUTRAL] So when you went to, when you went to Wellness and did it online, it just, you just completed the form. It didn't tell you that it didn't prompt you to file a claim. It didn't say file a claim and then.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] The first one, it didn't, even though I had all that stuff, but I, I'll look at it again. I could have missed something. I'll relook at it.
[CUSTOMER][NEUTRAL] But OK, alright.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] That's it, that's it, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. Thank you for calling APO. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too bye.