AccountId: 011433970860
ContactId: 76681574-dd9a-4bc3-af4b-475c26921829
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423750 ms
Total Talk Time (AGENT): 212640 ms
Total Talk Time (CUSTOMER): 163251 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/76681574-dd9a-4bc3-af4b-475c26921829_20250414T17:53_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, I have, um, I just wanna ask some questions about my claims. I'm not sure if I'm doing it right. I was, uh, diagnosed with cancer, so I, I'm pretty good plans, but I'm not sure.
[CUSTOMER][NEUTRAL] Really, what y'all are supposed to do and what I'm, I'm supposed to do in my role. Someone just told me to sign up for this.
[CUSTOMER][NEUTRAL] When we had open enrollment, so I'm like, why did I sign up for it?
[AGENT][POSITIVE] Well, it would be my pleasure to help you. So, I mean, what is a good callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Thank you. And what is your policy number?
[CUSTOMER][NEUTRAL] Uh, my policy number is, I just had it to hold on one second.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] It's 254, thank you, 2541205.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you mind verifying your name, date of birth, and current mailing address?
[CUSTOMER][NEUTRAL] Um, my name is [PII]. My date of birth is [PII], and then the address I believe it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK, now say your first name again?
[CUSTOMER][NEUTRAL] [PII] or I go by [PII].
[AGENT][POSITIVE] [PII]. That is so beautiful. I just wanna make sure [PII] is gorgeous.
[CUSTOMER][POSITIVE] Yes, no, thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] In my pleasure. So I see you have an active online account and if you ever want to view your policy benefits, you can actually click on the policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it will download your policy. Are you at a computer and we can look at that together?
[CUSTOMER][NEUTRAL] I am at a computer now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me go back one.
[CUSTOMER][POSITIVE] Policy, OK, I love it. How do I get back home? Contact us help? Oh, the house button, of course. I was asking me to sign in again. I'm like, uh.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] OK, I'm at it now.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] And you said, if I click on the claim number.
[AGENT][NEUTRAL] Mhm. And on the policy number.
[CUSTOMER][NEUTRAL] Oh, the policy number?
[CUSTOMER][NEGATIVE] I'm downloading something. So there was an error.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And I do think they are having some issues this morning with the.
[CUSTOMER][NEUTRAL] I did.
[AGENT][NEUTRAL] Um, site.
[CUSTOMER][NEUTRAL] OK, now I clicked on it again, it gave me uh.
[CUSTOMER][NEUTRAL] Uh, 35 pages.
[AGENT][NEUTRAL] That's it. And about halfway through the policy, there's a page called the Schedule of of benefits page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And see if you can locate that real quick.
[CUSTOMER][NEUTRAL] As the inserts.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I see schedule benefits.
[AGENT][NEUTRAL] OK, so that is gonna be what's covered under your policy.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's gonna be the an easy reference way to see what to file for.
[CUSTOMER][NEUTRAL] OK, I see. So what do I do every so when I go to the doctor's office, I get the, uh, you know, the, the bill for this and I just upload it to claims?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Hang on just a quick second, bear with me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm so sorry. I was trying to find my mute button so I didn't sneeze in your ear and it didn't work fast enough. I do apologize.
[CUSTOMER][NEUTRAL] Oh no, you're fine. Oh, you're fine, you're fine.
[AGENT][NEUTRAL] Oh, I was trying to hold it in.
[CUSTOMER][POSITIVE] Yeah, I thought you laughed. I didn't even know it was [PII]. I know, it was fine.
[AGENT][NEUTRAL] Ah, it was funny cause I was trying to hit the mute button and I sneezed and couldn't find any mute button. OK. All right.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so these are what's covered now to submit a claim.
[AGENT][NEUTRAL] Have you completed the claim form for cancer claim form?
[CUSTOMER][NEUTRAL] I think I just did that right now. I think I just uploaded that.
[AGENT][NEUTRAL] OK. So once we have that and on the first page for that cancer claim form our instructions as to what documents you're needing. Now, we have not paid out your first occurrence benefit yet. So with for to pay out the first occurrence benefit, they will need the um pathology report when you were diagnosed with cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So they're gonna need that first and that'll be that'll open up the claims for payment. That's right, and that 1st 1st occurrence benefit will be payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Get things going.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Beyond that, when you go for.
[AGENT][NEUTRAL] Treatment or, or services. We'll need the itemized bill including diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I believe you have, do you have a transportation benefit on here? Do you have to travel more than 50 miles?
[AGENT][NEUTRAL] No, I don't see transportation listed on this one.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No, I don't have this.
[CUSTOMER][NEUTRAL] So I don't know it better.
[AGENT][NEUTRAL] So, we're gonna need the itemized bills with the diagnosis codes and procedure codes for each of your treatments or surgeries.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or diagnostic testing.
[CUSTOMER][NEUTRAL] OK. And I just would upload them?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Diagnosis session, OK.
[CUSTOMER][NEUTRAL] OK, well, I will work on that and that's all like, OK, OK, you answered my questions.
[AGENT][NEUTRAL] Yeah, it's, you're, you're almost there.
[CUSTOMER][POSITIVE] OK, yes. You make it sound so easy.
[AGENT][NEUTRAL] You are almost there.
[AGENT][NEUTRAL] Yeah, so just contact your doctor and see if they can provide you with the the pathology report for you, you were first diagnosed with cancer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm gonna do that right now actually. Well, thank you so much for your help.
[AGENT][POSITIVE] It's been my pleasure. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, there's not.
[AGENT][POSITIVE] Well, it has been a pleasure to assist you and thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Again, thank you.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][POSITIVE] You're welcome bye.