AccountId: 011433970860
ContactId: 64562f11-d4b4-4178-8b87-b2a97100e639
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485299 ms
Total Talk Time (AGENT): 339595 ms
Total Talk Time (CUSTOMER): 112789 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/64562f11-d4b4-4178-8b87-b2a97100e639_20250109T17:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII], it's memory and customer service. How are you?
[AGENT][NEUTRAL] All right, how are you doing?
[CUSTOMER][NEUTRAL] I'm good. I have an insured on the line. She is wanting to talk to somebody about her benefits on her, uh GCP 24 policy, um, the policy number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment, let me get over to that side because I know I have to pull it up. Give me the policy number now.
[CUSTOMER][NEUTRAL] OK. It is 255-837-0.
[AGENT][NEUTRAL] And the patient name?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] All right, you can put it through.
[CUSTOMER][POSITIVE] All right, thank you so much. Here she comes.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Ms. [PII].
[CUSTOMER][POSITIVE] Yes, good morning.
[AGENT][NEUTRAL] My good morning. My name is [PII] and I'm in the claims department and you're calling about your policy you have with our company and you have questions about it?
[CUSTOMER][NEUTRAL] Uh, yes, [PII], just a summary, um, not that I'm submitting anything, it's just that, you know, I'm looking through my policy and I know I called last week and I canceled and I just reinstated and I just wanted to know, um, a little bit more about my policy.
[CUSTOMER][NEUTRAL] Because I had some other people come, uh, from Washington National and uh pretty much they were telling me nothing is good about my policy. But anyway, it's not that I'm paying too much for a month, but you know, it's a security that I have at least something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] So I just wanted, yeah, just briefly, you know, what, what I have that's gonna help me if I.
[AGENT][NEUTRAL] OK, now the policy that, OK, the policy that I pulled up is a
[AGENT][NEUTRAL] A cancer policy, your effective date was [PII] on this particular policy. Uh, this is a policy that pays medical expenses related to cancer. For example, if you've been diagnosed with cancer and it's internal cancer.
[AGENT][NEUTRAL] It has a one-time benefit that'll pay for a lifetime of $5000 for just being diagnosed with cancer and it's internal cancer. Internal cancer means that it don't spread it. So that's what the internal that benefit and we, once we get the pathology report, if you're diagnosed with cancer, once you submit your claim with the patch.
[AGENT][NEUTRAL] report. That's how we determine if you qualify for the $5000 benefit that's payable one time in your lifetime on this policy. You do have surgery benefits if you're diagnosed with cancer, you have to have surgery related to your cancer. You also have radiation, chemo chemotherapy benefit. If you're diagnosed with cancer, you have to have any those medical treatment. You will be paid radiation, uh.
[AGENT][NEUTRAL] A chemotherapy benefits, but it is a cancer policy that pays medical expenses related to cancer.
[CUSTOMER][NEUTRAL] Mhm. Does it say a percentage of what it pays on radiation, or?
[CUSTOMER][NEUTRAL] Chemo
[AGENT][NEUTRAL] Let me see, let me see, can I pull up one of your policies you had before because this is just a policy that you switched over and let me see what your chemo was on that policy. Hold on one moment.
[AGENT][NEUTRAL] And it'll be the same. This is just the same policy. Just changed the name. It's a takeover, you know, it's a same policy G A R C I A H I L D A. Let me see your policy you had before.
[AGENT][NEUTRAL] OK, 273 27.
[AGENT][NEUTRAL] OK, give me one second, I'm looking it up.
[CUSTOMER][NEUTRAL] So you tell me that it.
[CUSTOMER][NEUTRAL] Did it change names, the APL change the names or?
[AGENT][NEUTRAL] It, no, this policy just changed the name to GCP 24, but it's still almost the same policy. So I'm trying, they, they don't have that policy out here for me to review, but I can tell you what your chemo benefit is on this previous policy and it stayed the same. They just got to get your new policy where they changed the name out on on base for me to be able to see. So give me one second to pull up what you had before.
[AGENT][NEUTRAL] 02372531.
[AGENT][NEUTRAL] Make sure that your address [PII] OK that's [PII].
[AGENT][NEUTRAL] What is, what was your previous address? Was it ever, what was your, did you?
[CUSTOMER][NEUTRAL] It's [PII] fine.
[AGENT][NEUTRAL] OK. Uh-huh.
[AGENT][NEUTRAL] Let me see, I'm trying to see something.
[AGENT][NEUTRAL] [PII], let me go. Yeah, did you have a previous address? Did you have a previous address before you changed it to [PII]?
[CUSTOMER][NEUTRAL] Right now I'm at [PII].
[AGENT][NEUTRAL] Uh this always been your address. What was your previous address?
[CUSTOMER][NEUTRAL] Yes, I did.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Um, maybe you have the one in [PII], um.
[AGENT][NEUTRAL] Did you ever live in her hotel?
[CUSTOMER][NEUTRAL] What was it in important as well?
[CUSTOMER][NEGATIVE] No, no.
[AGENT][POSITIVE] OK, it is not you. OK, let's do it this way. Let me have your social and pull up what's gonna come up on you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. OK, here we go.
[AGENT][NEUTRAL] OK, here it is right here. Let's see what it was.
[AGENT][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] Alright, let's see what your chemo radiation benefit is. Give me one second. It's coming up the policy.
[AGENT][NEUTRAL] And it's just a quote of your coverage. There's no guarantee to pay over the phone. This is just a quote of your coverage. But if you're diagnosed with cancer and you had to have chemo, chemotherapy, radiation, medical treatment, this policy is based on actual charges and it'll pay a benefit up to $20,000 in a 12 month period. And the example would be if you had chemo today and your provider charge.
[AGENT][NEUTRAL] You $10,000 then you send in your primary explanation of benefit because we have to have extra charges and just give you an example, say it was Blue Cross Blue Shield so your provider paid $10,000. Your primary insured pay $5000 towards that medical treatment for that data service for chemo, radiation, chemotherapy. We would only pay $5000 for that data service. Then you send another claim in here two.
[AGENT][NEUTRAL] Later you had chemo and you send in your bill. Your bill was say $15,000 and your Blue Cross Blue Shield paid $12,000 then we'll pay the $12,000 that you have $2000 left. Then the next two weeks you send in another bill. The bill was $5000 by the provider. Your insurance paid $3000. You ain't got but $2000 left for the 12 month period we'll pay 2.
[AGENT][NEUTRAL] $1000 you'd be on max that $20,000 out for that 12 month period and it would start over to the next 12 month period for paying radiation and chemo chemotherapy even if you had some that next week you'll get a, uh, when you send your claim in, we'll let you know that that particular benefit been maxed for that 12 weeks period. So that's how that policy works with chemo radiation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yeah, that's what I wanna do.
[AGENT][NEUTRAL] And then, all right.
[AGENT][NEUTRAL] OK, anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, ma'am. That would be all.
[AGENT][POSITIVE] All right, thank you for calling American Public Life, Ms. [PII], and you have a wonderful day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Yeah