AccountId: 011433970860
ContactId: 880fc2c8-d3ed-4884-ab9b-69cc8dbe64c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1418839 ms
Total Talk Time (AGENT): 455535 ms
Total Talk Time (CUSTOMER): 711654 ms
Interruptions: 7
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/880fc2c8-d3ed-4884-ab9b-69cc8dbe64c2_20250616T20:12_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling again regarding my uh benefit that has been terminated by some sort of like a error by my employer, I think, or I don't know where that error began, but um.
[CUSTOMER][NEGATIVE] That's why I'm calling. I was told by one of your uh agents to contact my benefit department, which I did and uh I don't know what they're doing so far they have like they transferred me 3 times already to different departments over there in that area.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So they're very inefficient.
[AGENT][NEUTRAL] OK, and what is your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], is the number you're calling from a good number to call you in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you have your policy number with you and I can look it up?
[CUSTOMER][NEUTRAL] One second, let me see if I have written down here.
[CUSTOMER][NEUTRAL] No, ma'am, I don't have it.
[AGENT][NEUTRAL] OK, that's OK.
[CUSTOMER][NEUTRAL] I can give you something else.
[AGENT][NEUTRAL] Uh, can I look it up by your social?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Give me just a moment to look that up.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Alright, and can you verify your date of birth for me please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the address that we have on file?
[CUSTOMER][NEUTRAL] Uh, so I think you have the [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right, let me see.
[AGENT][NEUTRAL] It looks like you have a cancer policy with us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I said, is it back on or it's conseminated?
[AGENT][NEUTRAL] OK, I'm
[AGENT][NEUTRAL] I'm currently showing it as active.
[CUSTOMER][NEUTRAL] OK, so it's back on active because I called like about 3 weeks ago.
[CUSTOMER][NEUTRAL] Uh, you know, requesting, um, how do I upload my, um, wellness benefits.
[CUSTOMER][NEGATIVE] And at that moment I was told that my policy actually was terminated.
[CUSTOMER][NEUTRAL] Which I didn't know.
[CUSTOMER][NEGATIVE] And I called my employer benefits department and left a message and everything, and they never reply, which I called again today and they still transferred me back and forth with 3 other people. So that's why I decided to call you to see if they already fixed some problems.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Which seems like they already did.
[AGENT][NEUTRAL] Yes, it looks like we fixed, it looks like your policy became active again as of [PII].
[CUSTOMER][NEUTRAL] OK, [PII], not too long ago, OK.
[AGENT][NEUTRAL] Right, and so your policy is currently active.
[CUSTOMER][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] So now I need to like uh um uh re-register again to go check on my portal and upload documents.
[AGENT][NEUTRAL] Um, have you been on, have you been in the portal in the past, uh, week or two?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEGATIVE] Right, I tried to get into my portal and I couldn't.
[AGENT][NEUTRAL] You can
[CUSTOMER][NEGATIVE] I couldn't because it was terminated.
[AGENT][NEUTRAL] OK, let me see here real quick.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So whenever you tried, so what I would do is I would go in, let me see here let me do this before I.
[AGENT][NEUTRAL] Uh, give you the wrong information. Let's see what we can do.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like you should be able to log in or create the account.
[AGENT][NEUTRAL] Um, even if you had a portal previously, um, what you'll want to do is go to that [PII].
[AGENT][NEUTRAL] And create a new account.
[AGENT][NEUTRAL] Um, only fill out the boxes that are required, which is just your last name, email, and date of birth, and everything from your old account will transfer over.
[AGENT][NEGATIVE] It should have transferred over. Mhm.
[CUSTOMER][NEUTRAL] OK, I think.
[CUSTOMER][NEUTRAL] Well, I still have to see that but I'm not, I'm not doing it right now, now I'm gonna do that from the computer.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, well, hopefully it won't.
[CUSTOMER][NEUTRAL] Deny me, OK. Um.
[AGENT][POSITIVE] And if you have any other questions or if you get that denial again just go ahead and give us a call back and we can walk we can walk through it with you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK, perfect. So besides that, uh, so since the, the, the, the, the period from [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That gap, how is it gonna be treated?
[AGENT][NEUTRAL] Uh, your policy is shown as active, so it should be, it's not, it's showing your effective date is [PII]. So because they got it back on, it looks like, yeah, it looks like the policy number and everything has stayed the same, um, it ends in 1211, yeah, it looks like it, it just got reactivated, so it shouldn't have any damage to anything that you had pending or anything like that.
[CUSTOMER][NEUTRAL] Oh [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it's not showing that it was off and back on again, so you should be OK just filling up the claims as needed.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, got you. OK, I'll do the claims now, um, uh, the dental, the dental care is preventable and that counts also as a, as a eligible.
[CUSTOMER][NEUTRAL] Uh, wellness, uh.
[CUSTOMER][NEUTRAL] You are, right?
[AGENT][NEUTRAL] Are you asking if yours covers wellness visits?
[CUSTOMER][NEUTRAL] Yeah, the wellness visit. Yes, the dentist.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Let me check real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like you are a lot of diagnostic testing such as a mammogram or um ultrasound, uh certain blood tests to check for cancer. Uh, those diagnostic testing that is covered.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Hormone therapy.
[CUSTOMER][NEUTRAL] What else? What about the dentist?
[CUSTOMER][NEUTRAL] Because the thing is how they did the mammo and the uh wellness, uh, you know, the physical.
[CUSTOMER][NEUTRAL] The physical exam, but I did it before.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Before the probation period or whatever they told me.
[CUSTOMER][NEUTRAL] You know, before the, um, there's a period like within the 30 days after you get the, the insurance, you, you, there's nothing counts if you do it right away. So you wait until 30 days later and then you go do it.
[AGENT][NEUTRAL] Right, if that's what it says on your account which um let me see.
[CUSTOMER][NEUTRAL] Well, my doctor appointments and lab and all that was right there on September. So when I, uh, you know, bought the benefit, it started in September, but
[CUSTOMER][NEUTRAL] And the letter said that nothing would be covered if you did it during the September month. It would start on October.
[AGENT][NEUTRAL] Right, for the diagnostic testing benefit, it was a 30-day waiting period um for the diagnostic testing. Um, so that one was not able to be paid because it was before the 30 days. However, um, since, yeah, so, so starting in, let me see what it would be.
[CUSTOMER][NEUTRAL] Which after October.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So starting in [PII], you should have been able to um.
[AGENT][NEUTRAL] To get that testing done.
[CUSTOMER][NEUTRAL] Well, you know, you don't go and just, just about at the random time to go you're testing, you only do it like when the doctor request that.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But I'm gonna see if uh if I still have some labs that I can use for claim, but other than that I have the dentist.
[CUSTOMER][NEUTRAL] Isn't that the dentist in the list?
[AGENT][NEUTRAL] What you
[AGENT][NEUTRAL] Let me see what else you've got um if you have dental coverage, it's not through us, I'm not showing that you did that one you will need to contact your employer on to see who you have coverage through um the dental is not through us though.
[CUSTOMER][NEUTRAL] No, no, I do.
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, I know my dental coverage.
[CUSTOMER][NEUTRAL] My dental coverage is not with um, with APL or, you know, it's a different provider. That's the same way with my medical provider. My medical is not covered, it's not, you know, APL. I am, I have a Blue Cross Blue Shield.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what's the difference?
[AGENT][NEUTRAL] Uh, it looks like this is just, your APL is just your supplemental. We're not major medical, uh, we're just supplemental insurance.
[CUSTOMER][NEUTRAL] Yes, yes, I know, but, so, but do you, you do, you do pay out uh claims when they do a wellness.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Uh, check, you know, wellness test against cancer screening and all that kind of stuff. If we do that, there is a, a, a claim that we can um present. That's the one I'm talking about.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Correct, so whenever you get into your OSC you will file a wellness claim. It'll say, do you want to file a wellness claim or a traditional claim? You will file a wellness claim.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, wellness claim, yes, so and my wellness claim, can I use my dental?
[CUSTOMER][NEGATIVE] Scared to do that.
[CUSTOMER][NEUTRAL] My dental provider is another company.
[AGENT][NEUTRAL] Um, not, oh, go ahead.
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Yeah, because, you know, I mean, I'm gonna use any other, whatever company I like to, to check my health, and but you as my
[CUSTOMER][NEUTRAL] APL cancer insurance and if you're telling me, well, if you go do your mammogram.
[CUSTOMER][NEUTRAL] And within this period of, you know, time, when you cover it, will, will give you a rewards. So, but it doesn't say, but you have to be insured with us, you have to be all that, no.
[CUSTOMER][NEUTRAL] So it really doesn't matter who does my mammogram. As long as I tell you the date and and I have proof for that, I can claim, right?
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Right, so the same thing with the dentist. The dentist, whether it's Delta or Blue Cross Blue Shield or DHMO and all that, what matters is that I did the, I, I, you know, I did my annual dental exam, in which I would like to use that to claim my benefits with APL. Is that OK?
[AGENT][NEUTRAL] Uh, no, this one doesn't cover dental benefits or dental wellness claims. This is just for the diagnostic.
[CUSTOMER][NEUTRAL] OK, so this is just for the, the, the medical part, the body part, even though the dental is also part of the system, but they separate that. Is that what it is? Nothing, nothing in dental, nothing vision exam, nothing, none of that. Just the medical, your main organs, that's it.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, so why is it in the paper on the APL form to wellness claim? There's also in the list the dental part.
[AGENT][NEUTRAL] Well, if you have dental insurance through us.
[CUSTOMER][NEUTRAL] Dental exam and says for a date.
[CUSTOMER][NEGATIVE] Um, OK, I'm not getting it.
[AGENT][NEUTRAL] If you have dental insurance, if you have dental insurance through us, you can file a claim for dental, but your specific policy lists which which ones you can test for in your policy if you go to your policy certificate and go to page 24. Page 24 has a list of everything that you can that you can get covered.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But it's one, it's one claim form, but it's for for all different policies, so we don't have a different claim form for every little thing. It's just one claim form and it's based off of what you have through us.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Ah, OK. So you
[AGENT][NEUTRAL] Does that, does that help?
[CUSTOMER][NEUTRAL] OK, so you also provide the dental care insurance? Wow.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, yes, we do have dental insurance, but it depends on the, uh, the employers on if they want it through us or not.
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh, yeah, yeah.
[CUSTOMER][NEUTRAL] Oh, OK, so that's how it is. Um.
[CUSTOMER][NEUTRAL] Well, in that case, well, I just have to check the dates when I did my um lab work for, you know, diagnostic purposes or whatever. And um
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So going to the specialist, does it count also as a
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] I saw um
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEGATIVE] Well, I only go like twice to the doctor. So the first one is my uh PCP for annual exam, and she ordered mammogram, Pap smear, and some more basic blood tests. But I did all that, you know, way too soon on, on, on September. So I'm not gonna get recognized for that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I'm not gonna claim that because it was rejected.
[AGENT][NEUTRAL] Right, and I, I do see that one.
[CUSTOMER][NEUTRAL] And besides that,
[CUSTOMER][NEUTRAL] Right, besides that, I went to see the specialist.
[CUSTOMER][NEUTRAL] And uh I did a blood test and um um ultrasound, no, no ultrasound, no, uh um.
[CUSTOMER][NEUTRAL] Oh, there's another one, MRI, MRI images.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It was ordered by the doctor, so I did that, so will that count for me to do a wellness claim?
[AGENT][NEUTRAL] Uh, those
[AGENT][NEUTRAL] Those should count um as long as it was, uh, after that 30 days like your policy stated on that 30 days as of September, so 30 days from [PII], yes.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah, yeah, it was after September, um, but I did the MRI test and I did some other blood tests and all that, so I can use only one, right? Only one claim per year.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Uh, for the wellness, yes.
[CUSTOMER][NEUTRAL] Oh OK, OK, so I can just pick anyone. Um, how much does he pay?
[CUSTOMER][NEUTRAL] Is is it
[AGENT][NEUTRAL] Let me see here.
[CUSTOMER][NEUTRAL] Is it the same amount for any test or has a different rate for?
[AGENT][NEUTRAL] So for the diagnostic testing.
[AGENT][NEUTRAL] It is a maximum of 1 test per year and that is a $50 benefit amount from that testing if you need to have a follow up diagnostic testing done, it will, uh, it allows you, um, one extra follow up diagnostic testing, so 1 per calendar year, and that's a $100 benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then if you get a medical imaging test done, um, you get up to $500 but that is following the diagnosis of a cancer.
[AGENT][NEUTRAL] For the medical imaging.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Right, um, and that is for this cancer. Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] The medical imaging, OK.
[CUSTOMER][NEUTRAL] Oh, OK, but the MRI isn't that a medic, uh, diagnostic imaging?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Your, uh, your
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Your Pap smear will count towards uh the diagnostic testing, but for medical imaging such as an MRI um for this specific policy because it's a cancer policy, um, you can count it, but you only get the benefit amount um if it's following the diagnosis of cancer.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so that's the only way would be $500 otherwise it will be what, $50?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] You will get like, so you said you did your Pap smear after uh September depending on uh when it was and if you had any other testing done, you will get $50 for that and that's covered uh per calendar year.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] But I can use my uh MRI as a claim.
[AGENT][NEUTRAL] Yes, if you were diagnosed with cancer, um.
[AGENT][NEUTRAL] And you got an MRI afterwards you can oh.
[CUSTOMER][NEUTRAL] I mean, no, it wasn't, it wasn't it, it was not diagnosed as cancer, but it's to, to look at it, the organs and, you know, as a prevented it to see.
[CUSTOMER][NEUTRAL] I don't know, I, I, it's getting a little confusing, I think.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] Right, so, no, not as a preventative. This is after you had a diagnosis only for the only for the MRI or the medical imaging. It has to have a diagnosis of cancer.
[AGENT][NEUTRAL] But not for the diagnostic. Mhm.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So just to test you.
[CUSTOMER][NEUTRAL] I, whether you have a cancer or not, that test order.
[CUSTOMER][NEUTRAL] Which, you know, the doctor chooses, it could be a CT scan, MRI scan, ultrasound, or whatever. So that order, just to see whether there is anything bad or nothing bad, just to see that, that doesn't count then. You're saying that doesn't count as a claim?
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Uh, not for this policy.
[CUSTOMER][NEGATIVE] For, for the wellness, only for the wellness claim, not for the whole payout, you know, oh, I have cancer now, you pay me my 20,000, no, no, no, not that one. I'm just talking about the wellness.
[AGENT][NEUTRAL] Right. The, the MRI.
[CUSTOMER][NEUTRAL] Reward because I used to have that with uh Metlife.
[AGENT][NEGATIVE] Right, the MRI PT scans, PET scans, anything like that, um, for this policy, uh, won't be for a wellness, it will be for, uh, a cancer.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, so this, this is not been.
[AGENT][NEUTRAL] So it won't be included in the wellness.
[CUSTOMER][NEUTRAL] OK, so it's not considered wellness, OK.
[CUSTOMER][NEGATIVE] So there's no reward at all on this one.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No, not even the blood test, anything?
[AGENT][NEUTRAL] Uh, blood test will be considered as a diagnostic test, and so that would be covered under the diagnostic testing.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I'm gonna try to claim that to see what happens. Other than that, I did everything right on September, right before the 30 day waiting period, and I didn't know, I didn't know that there was a waiting period. Last, my appointments were already back to back, you know, in September, so I just go ahead and done it, but.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, you know, I cannot claim those.
[CUSTOMER][NEUTRAL] So I don't have, but only one left to do the claiming that's still, we still have to see.
[CUSTOMER][NEUTRAL] If APL is gonna agree.
[CUSTOMER][NEUTRAL] Well, you, you guys do the same thing that Aflac and MetLife do, OK?
[CUSTOMER][NEUTRAL] But I used to have those, but my company changed and um now they're dealing with APL instead of MetLife.
[CUSTOMER][NEUTRAL] Midlife used to send me a check, like a 33 checks, well, 11 for each year, you know, when I did my claim about wellness, about mammogram, blood test, uh, all that stuff, which I guess I did it right after the waiting period or whatever that's why I was not questioning at all.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, well,
[CUSTOMER][NEUTRAL] Other than that, that's pretty much it.
[AGENT][NEUTRAL] OK. Is there anything else I can, I can help you with?
[CUSTOMER][NEUTRAL] I'm just gonna fill it out the form.
[CUSTOMER][POSITIVE] Mm, no, ma'am, that's all for me. Thank you so much for listening.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. You have a great week as well, right?
[CUSTOMER][POSITIVE] Have a, have a good afternoon.
[CUSTOMER][NEUTRAL] Alright bye bye. You too, you too, bye.