AccountId: 011433970860
ContactId: 899785ac-208c-4453-bc49-9f84ecf4eee4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 920809 ms
Total Talk Time (AGENT): 459246 ms
Total Talk Time (CUSTOMER): 388602 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/899785ac-208c-4453-bc49-9f84ecf4eee4_20250129T19:39_UTC.wav
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[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, I have one question.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have an insurance with your company?
[CUSTOMER][NEUTRAL] OK, maybe I can give you the name the group.
[AGENT][NEUTRAL] OK, I'm sorry, we were just saying if you had a policy with us.
[CUSTOMER][NEUTRAL] Yes, and I have the number number group.
[AGENT][NEUTRAL] OK, I could take that.
[CUSTOMER][NEUTRAL] OK. Uh, the number is 16768.
[AGENT][NEUTRAL] OK, and what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] What was your last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you spell that for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright thank you and then uh if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. OK, we just need to verify to see uh whether or not you have a policy under this group, correct?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that right?
[CUSTOMER][NEUTRAL] Yes, but I have some question, but first, uh, I want really, I want to know this is poli policy is it includes um in the person of money.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Life, uh, death.
[CUSTOMER][NEUTRAL] Does the policy include
[AGENT][NEUTRAL] OK, if it's a
[AGENT][NEUTRAL] Oh, like a a life policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we can definitely take a look. Um, I do not see you listed under this policy or anyone with that last name rather, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Not under the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, that my
[AGENT][NEUTRAL] What I can do
[AGENT][NEUTRAL] I'm sorry, can you hear me?
[CUSTOMER][NEUTRAL] What, what do you say you don't know my last name?
[AGENT][NEUTRAL] Yeah, I don't see anyone with your last name under this particular group, um.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] Oh, or maybe then my then my husband, the name is [PII].
[AGENT][NEUTRAL] Was it the same last name?
[CUSTOMER][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], let's see.
[AGENT][NEUTRAL] [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do believe I found it. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, I'm just gonna verify some of your information really quick, [PII]. Can I get your, uh, date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] It's [PII]. Oh, the address is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. OK.
[AGENT][POSITIVE] Thank you. All right, I appreciate y'all verifying that information. OK, so this policy, let me see, you are covered. I do see [PII] is the primary, so thank you for that.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So you, [PII], and then there's 3 dependents.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Now this policy that I found is a secondary medical policy. So it is designed to help with uh co-pay, deductible and co-insurance after major medical pays. So this is, does not provide any life benefits.
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So in the case of death, this policy does not cover any of that?
[AGENT][NEUTRAL] That's right. So if there was a death for one of the uh covered members, um, we would simply just have them removed from the policy. This policy is more supplemental for medical.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Maybe, but the same can you send for email that policy please.
[AGENT][NEUTRAL] Yeah, I can send you a copy of the policy. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and we do not have an email address on file for you um what was a good email to send that to?
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, the same is [PII]. Oh, it's [PII], the same last name my husband.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, this is yeah.
[CUSTOMER][NEUTRAL] Why, why?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh and my last name, [PII]
[AGENT][NEUTRAL] OK, so that was [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what was the
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]. Got it. All right.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, I, I'll just repeat the email just in case. It's [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, got it. OK, did you want me to go ahead and add that email uh to this account? or did you just want me to? OK, alrighty, let me go ahead and get that policy sent to you um, did y'all also need copies of ID cards or just the policy?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, both, please.
[AGENT][NEUTRAL] Both, OK, yep, I can get both of those emailed to you. It will be two separate emails. Um, did you have any other questions for me at the moment?
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Yes, I, I have some bill, uh, from the last year, I think it was in October, uh, I had been in some place and I do scanner.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, so one isha?
[CUSTOMER][NEGATIVE] And, and maybe the, the sign that they covered something, but another, they say you need to cover. But don't cover because I received the bill for close to $300.
[AGENT][NEUTRAL] Uh huh OK was this claim was this for you or was this for someone else under the policy? It was OK let me verify and make sure that we did receive that. Bear with me just a moment. Do you, uh, happen to remember kind of sort of when uh this was?
[CUSTOMER][NEUTRAL] Uh, I don't know.
[CUSTOMER][NEUTRAL] For me, for me.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh my God, I think it was in October.
[AGENT][NEUTRAL] October, OK.
[CUSTOMER][NEUTRAL] [PII], and, and, and the name of the company is the vision.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] OK, sorry, I just sent that email with your policy um OK let me take a look here.
[AGENT][NEUTRAL] That's from September.
[AGENT][NEUTRAL] OK, so I did find a policy I'm sorry, a claim for you. The date of service was [PII]. 0, that was [PII]. 0 my goodness, was this just last [PII], right?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][NEUTRAL] OK, OK, in that case we did not receive that claim, so that was the last claim that we received for you was in [PII]. So what I would recommend doing is reaching out to that provider wherever you went for treatment, make sure that they have this information if they have any questions or if they are seeming like they're giving you any kind of push back or anything like that, they are more than welcome to give us a call we talk to providers all the time.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So we can't explain the policy um if there's any sort of confusion.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So she has to send it to the what what does she have to send to the company?
[AGENT][NEUTRAL] Um, honestly, it's just mainly for ease if you reach out to that provider, um, that's billing you and give them this information, this policy number that um I can give you that policy number too, um, let me know when you're ready.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh hold on please.
[CUSTOMER][NEUTRAL] OK, I think.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Where are we?
[AGENT][NEUTRAL] OK, the policy number is 02.
[CUSTOMER][NEGATIVE] Oh sorry.
[AGENT][NEUTRAL] 06
[CUSTOMER][NEUTRAL] 022.
[AGENT][NEUTRAL] 19
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 59.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you wanna read that back to me?
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] 021959
[AGENT][NEUTRAL] No, OK, so that's 02061959.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] OK. 0206.
[CUSTOMER][NEUTRAL] 1959.
[AGENT][POSITIVE] Correct, yes, that's right.
[AGENT][NEUTRAL] So you can give them that policy number. I will also of course be emailing you um ID cards as well that will have that information on there.
[AGENT][NEUTRAL] Um, now if they just seem like they will not budge, uh, they're not going to help or file a claim, you can file the claims yourself. It's just a bit more roundabout so I always try to see if the provider can do it for you just so you can avoid a headache um, I would try that first if not and you need assistance on how to get those claims filed just give us a call right back and we'll help you with that.
[CUSTOMER][NEUTRAL] OK, understood. OK.
[AGENT][POSITIVE] I would definitely try to see if they would do it for you first though.
[CUSTOMER][NEUTRAL] Yes, OK, OK, yes.
[CUSTOMER][NEUTRAL] Oh yes, OK, another question, lady. I have the um
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I have, um, in the last month in December, I have some seriously uh surgery for my husband and my daughter, but in another country.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You cover this?
[AGENT][NEUTRAL] What, what was the treatment they received? I'm sorry.
[CUSTOMER][NEUTRAL] A phone uh the i was the.
[CUSTOMER][NEUTRAL] No, well,
[CUSTOMER][NEUTRAL] In um on a in a city here in that.
[CUSTOMER][NEUTRAL] Uh, they got the uh wisdom tooth taken out.
[AGENT][NEUTRAL] Wisdom teeth. OK, let me see, that's a good question. um, bear with me just a moment. I will get, I'm getting your ID card sent to you.
[AGENT][NEUTRAL] Um, and then I will check that. Give me just a moment.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Because what had been in some hospital, not in the clinic was in the hospital that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. Give me just a moment, let me get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did your, OK, this is probably a good question to ask first, um, who did you say your primary was? I'm sorry, is it Cigna?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Who is, who is the native for money the company or or the or the native my house?
[AGENT][NEUTRAL] Your, um, your primary insurance, was that Cigna, did you say? Yes. OK. So did Cigna help with that, uh, surgery?
[CUSTOMER][NEUTRAL] Singer. Yes, singer.
[CUSTOMER][NEUTRAL] No, we, we need to ask.
[AGENT][NEUTRAL] They didn't. OK. So, OK, OK. Well, I will say this policy is very dependent on your primary. If they will not pay, this policy cannot.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] When you say primary, uh sorry, what are you refer or who are you referring to?
[AGENT][NEUTRAL] Your primary medical, so that would be Cigna, for example, that's Cigna.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's uh your primary and then this is your secondary.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. So, so you said that this, the secondary policy is very dependent on the primary signal one.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes, absolutely. If Cigna does not pay for anything or if it's something that they won't cover, then this policy absolutely can't. But if Cigna can and they have, then this policy can help.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is it now and, and, and another question if I have some some yeah some surgery from 1.1 from 2 years ago, but see that document I can send for you that document.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, you can absolutely there is no timely filing limit. This policy has been active since [PII], so anything from that point up until now, um, you can file those any time.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh oh, great. And what is your email? The same day you send me that.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, yes, it's [PII].
[CUSTOMER][NEUTRAL] Can you repeat that? [PII].
[AGENT][NEUTRAL] Yes, so [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] And then the word [PII].
[CUSTOMER][NEUTRAL] So she can submit the claim, but if Cigna didn't accept it, will you be able to cover that as well?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No, no. If Cigna does not pay anything, then this policy cannot.
[CUSTOMER][NEUTRAL] Uh, but maybe if they don't cover for the time.
[CUSTOMER][NEUTRAL] I will ask this.
[CUSTOMER][NEUTRAL] Uh, because that was 2 years ago. What is the
[CUSTOMER][NEGATIVE] They don't cover because it expired like it was too long ago. Would you guys still cover it?
[AGENT][NEUTRAL] What do you mean? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, because, uh, it was 2 years ago, so what if Cigna doesn't cover because it was too, too long ago, so it's, it's, uh, outside of the time frame. Will you guys still be able to cover it?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh, so Cigna has not, they, they weren't presented with the claim at all, is that right?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK, I understand. Sorry, I just wanted to make sure we're on the same page um if they don't they then we can't, that's just that's how this plan works so if they will, uh, then we can, but if they don't then this plan can't.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] OK, so you know, good. OK, I will ask again for Sina. OK, ladies, thank you so much for your information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're very welcome. I know this is very confusing um if you needed help filing the claims, I will say that the quickest and generally the easiest way to do that is through our online portal um I did include links to that website in uh those emails I sent you and it would just be all of the information that we verified at the beginning, including that email that you gave me uh that's what you would use to create an account.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, so uh OK, thank you so much.
[AGENT][POSITIVE] OK, yes, if y'all have any other questions don't hesitate to give us a call back OK?
[CUSTOMER][POSITIVE] OK, thank you. Thank you.
[AGENT][POSITIVE] All right thank you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][POSITIVE] Thanks bye bye.