AccountId: 011433970860
ContactId: 6ed59edf-20d9-4cae-943d-b7f9305bfab1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472040 ms
Total Talk Time (AGENT): 135060 ms
Total Talk Time (CUSTOMER): 170349 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/6ed59edf-20d9-4cae-943d-b7f9305bfab1_20250324T20:47_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII]. My name is [PII], and I was calling to see if maybe you can tell me what I need to do. I sent in claims for my husband and I for the wellness, um, checkups because I didn't know if we had that, so I went back.
[CUSTOMER][NEUTRAL] A few years and sent um and submitted them. They was paid on that and that's fine. Um and I also thought I submitted, I tried to submit a cancer claim.
[CUSTOMER][NEUTRAL] Because he was diagnosed with cancer. But that claim is, is.
[CUSTOMER][NEGATIVE] They didn't pay it and I, I didn't get no there's no explanation showing why or what I needed to do. So my question is, if you can tell me how to file that claim so I can refile it cause I must have didn't do it the right way.
[AGENT][NEUTRAL] OK, um, I can help you with looking at that claim. Do you have a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And do you have the policy number for that, uh, account?
[CUSTOMER][NEUTRAL] Um, let's see. Um, he have, it's
[CUSTOMER][NEUTRAL] A critical illness one is 1415882.
[CUSTOMER][NEUTRAL] And he the uh the cancer claim is a rider on that policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see, OK.
[AGENT][NEUTRAL] I'm pulling this up, just bear with me please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what date of service was denied on that claim or do you have the claim number?
[CUSTOMER][NEUTRAL] Um, let me give you the claim number, and it, I never got a denial or any because like I said I filed several claims under the same thing, but it was under claim number um 3677033.
[AGENT][NEUTRAL] And do you have your um husband's date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And then what is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um, let's see, yeah, OK, 35 or [PII].
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm just reading through what I've got here, see what, figure out what's going on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like section 10 of the claim form must be completed by you and your physician and returned.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So it looks like that section where we were missing. Let me pull up that claim and see.
[AGENT][NEUTRAL] What's
[CUSTOMER][NEUTRAL] Yeah, well, see, I didn't, when I did it online, it didn't, it didn't, um.
[CUSTOMER][NEUTRAL] I didn't see a section 10, you know, nothing like that. I just filled out, it just asked for his name and what type of policy and I uploaded the.
[CUSTOMER][NEUTRAL] Um, pathology report, so.
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] I didn't know that there was a section 10.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so you do have access to our online portal, is that correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see exactly what we got and.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Sorry, just bear with me here.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What do I pay?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What about?
[CUSTOMER][NEUTRAL] I see the picture.
[CUSTOMER][NEUTRAL] So I'll be the owner.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, so it looks like this form's pretty long and there is a section on here, um, that has to be completed um so it it refers to that section 10 if you do go online there the claim if you keep scrolling down on page 6.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Have that completed by your physician and then we can resume, you know, through the processing of the claim.
[CUSTOMER][NEUTRAL] OK. OK. OK. So.
[AGENT][NEUTRAL] Because they have to yeah they have to um um sign that so.
[CUSTOMER][NEUTRAL] OK, so it's a a form I need to print out and take to the doctor.
[AGENT][NEUTRAL] Yes, it's the critical illness form and basically like I said, page 6 and then the the the physician will sign on the last page 9 as well. So take that to them, have them complete that, resubmit that, and then we can go from there on potentially processing that claim, so.
[CUSTOMER][NEUTRAL] OK, so when I
[CUSTOMER][NEUTRAL] Or resubmit it, do I just upload it to the system or do I have to just do it all over again?
[AGENT][NEUTRAL] Yes, you
[AGENT][NEUTRAL] No, no, you can just upload it to the system just reference that claim number, um, that was denied and then they'll know that that's the piece of information that would corresponds with it.
[CUSTOMER][NEUTRAL] OK. So, do I just go to that claim? do I like?
[CUSTOMER][NEUTRAL] So, uh, click on that claim and then upload documents or something.
[AGENT][NEUTRAL] Yes, there should be a function to upload documents.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Alright then thank you.
[AGENT][NEUTRAL] OK, is there anything else I can help with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well thank you so much for calling APL and you have a terrific afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye.
[CUSTOMER][NEUTRAL] Mm