AccountId: 011433970860
ContactId: 933e756b-7219-4bb1-a7c3-208156c3326d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 526049 ms
Total Talk Time (AGENT): 358508 ms
Total Talk Time (CUSTOMER): 97447 ms
Interruptions: 1
Overall Sentiment: AGENT=2.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/933e756b-7219-4bb1-a7c3-208156c3326d_20250109T17:50_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes ma'am. My name is [PII], and I have a cancer insurance policy with y'all through the company I work for.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, and how can I help you with that today?
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] I just had a colon surgery. I had colon cancer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it, uh, I just had surgery and had it removed. I was wondering how I just have to go about filing a claim.
[AGENT][POSITIVE] OK, yeah, absolutely. I can help you with that today and then do you have your policy number handy, sir?
[CUSTOMER][NEUTRAL] Uh, I put it out what she gave me.
[CUSTOMER][NEUTRAL] I don't think I do.
[AGENT][NEUTRAL] That's OK if you don't. I can search with your social if you'd like.
[CUSTOMER][NEUTRAL] No, I just have a.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Alright, and I'm ready for that when you are.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, give me one second to search that.
[AGENT][NEUTRAL] And [PII], could you verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful, thank you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Do you mind if I get a good call back number from you real quick as well just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful. Thank you so much, [PII], and
[AGENT][NEUTRAL] All right, so we have a couple options for the, for filing a claim for you.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the first thing is.
[AGENT][NEUTRAL] I'm gonna try to get you a claim form. Our claim forms are available online. Um, alternatively, I could email you a copy of the claim form.
[AGENT][NEUTRAL] And or um if you don't mind the delay, I could also mail um the claim form out to your address um in a paper copy. um how best would you like to receive that?
[CUSTOMER][NEUTRAL] I mean, uh, if you, if you could, I could give you my email address and you can send it to it.
[AGENT][POSITIVE] OK, perfect. I think that would be wonderful. Would you be able to um help me out with a great email address today, [PII]?
[CUSTOMER][POSITIVE] Yeah, I can give you my email address today.
[AGENT][POSITIVE] OK, and I'm ready for that when you are.
[CUSTOMER][NEUTRAL] OK, it's [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. [PII] and your last name for it [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Perfect let me get that started for you real quick and start putting together an email so then there we do also have a couple options for how you can remit the claims to us. So if you want you can fill out this um form on your computer and you can.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, like save it as a PDF and upload it through our online portal.
[AGENT][POSITIVE] And you can submit all your claims online. I if you feel comfortable with the computer, I think that is the best option because you get your confirmation number instantly that your claim was received. You can track your claims in real time you can get notifications when a claim has been processed or if it's pending more information, but instead of waiting for those letters to come out to you, you can be notified in real time and so I think that it is.
[AGENT][NEUTRAL] The best option um and I can send you an enrollment guide on how to set that up and it will go through it'll have like how to submit claims, how to view your claim information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I can include that in the email with the claim for you so you can track your claims and do it all online alternatively, you don't have to do that um you can also send your information through fax or through mail, um, as far as those claims go. I do recommend though, um, if you're gonna send anything through mail to never send originals to make copies, um, but then those are the other two methods for us to take claims as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, if you could set it up online, I'll just have to uh go in and put a password and all that and to be able to do it online.
[AGENT][NEUTRAL] Yeah absolutely so I'll ask you it will actually ask you for your last name, your social, your phone number, and your.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Maybe not even your phone number, uh, your zip code, um.
[AGENT][POSITIVE] And so what I'll do is I'll make sure your email is also in the system so you have no trouble logging in.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] You said that phone number was [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] All right, and so I'm gonna get all of this together and then.
[AGENT][NEUTRAL] I know this is a lot of information. I'm not trying to dump like all this information on you, um, so.
[AGENT][NEUTRAL] As far as the claim goes for the cancer claims, um, and you're gonna see this in the cancer claim when you open it up. So don't feel like you have to hold all of this in your brain. Um,
[AGENT][NEUTRAL] It's gonna that first page is just instructions for you on the documents we're gonna need so it's gonna tell you to complete sections A through D, um, and then you don't have to complete section E. however it is it helps if you want to, and I think that is just for um.
[AGENT][NEUTRAL] That is authorization for us to get um any medical records we might need. Um, and if you don't choose to elect it anytime we need particular medical records, we'll have to mail you out a form, have you sign it, send it in to us, um, and then we can request those medical records or you can just fill out option E and not worry about it. So it's your choice. Um, and then because this is your first time submitting a claim with us for cancer, we will need your pathology report.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That has your diagnosis, um, and then when you file the claim, we'll need your itemized medical bill from your providers and then the explanation of benefits from your primary insurance. Um, and then anything else required, um, would just be.
[AGENT][NEUTRAL] If the the examiner needs a little more, but typically it is your claim.
[AGENT][NEUTRAL] Um, the first time you file your pathology report and then it's your medical bill and your explanation of benefits, um, and then those are the items you need to make a claim. And again, don't worry about remembering all of that. It is listed out as step by step instructions on the front page of that form, OK?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Do you have any questions so far? I know I've covered a lot of things.
[CUSTOMER][NEUTRAL] Uh, send me what you got and I'm trying to figure it out. If not, I can call y'all back I guess. I don't.
[AGENT][POSITIVE] You are always welcome to call us back and we will help you through anything you need.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because I already got my print out of my while I was in the hospital and everything, it shows what it was and all that other stuff and.
[AGENT][POSITIVE] Perfect. That will save you so much.
[CUSTOMER][NEUTRAL] I spent 5 days in the hospital. It has all my medicines that they gave me, everything on it, so.
[AGENT][POSITIVE] Perfect and so what I do is I'm having that email I'm hitting send on it right now for you so you should get it pretty quick and then.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] Otherwise, if there's anything else you need, just feel free to reach on out. I know I covered a lot of information uh if you have questions, don't hesitate to let us know, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][POSITIVE] All right, [PII], well, I'm so glad I was able to help you today and please call us if you need anything else, and I wish you the best of luck with your recovery.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[AGENT][POSITIVE] Hey, it's my pleasure. Thank you. You take care.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks. Bye bye.