AccountId: 011433970860
ContactId: 9631a68f-787e-4d44-aee2-16fad79e4e9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342049 ms
Total Talk Time (AGENT): 204393 ms
Total Talk Time (CUSTOMER): 185185 ms
Interruptions: 9
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/9631a68f-787e-4d44-aee2-16fad79e4e9a_20250121T16:40_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking? How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you today?
[AGENT][POSITIVE] I'm good and you?
[CUSTOMER][NEUTRAL] Doing all right, thank you. I've got a bit of a fun question for you, um, so I got an insured on the line, a very old cancer policy, uh, from about [PII], um, and they're calling uh with several questions. Uh, the policy of course is not in Onase, but I do see, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy and the back fall, uh, so I do see some of the descriptions about the coverage dollar amounts and such, um, but I did want some clarification on a couple if you wouldn't mind helping me.
[AGENT][NEUTRAL] What's the policy number? Sure, what's the policy number?
[CUSTOMER][NEUTRAL] Yes, it is 83939.
[AGENT][NEUTRAL] OK, and what's the member's name?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] OK. Let's see here, take a look at it.
[CUSTOMER][NEUTRAL] And I can tell you the specific pages if that helps um I think I know, but just because it's not very clear cut and dry.
[AGENT][NEUTRAL] Let me see what type of policy. OK, so it's a C44 policy and what is it that Mr. uh [PII] is needing to know or need clarification on?
[CUSTOMER][NEUTRAL] OK, yes, so it is in regard to his wife [PII]. She did have breast cancer, um, and he just never filed claims for her, um, so on page 9 of the back file it shows family coverage so it says daily hospital benefit for 1st 60 days, $250 and then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The first day thereafter see extended benefits on page 12 it says daily hospital benefit is $100. So the question he has is if it was within that 60 days that she was hospitalized, would it be $250 per day or would it be that $100?
[AGENT][NEUTRAL] What I'm seeing on his uh on PIBFT with his benefits that are loaded I see for DHB and DHB means inpatient hospital stay I see $100 that's what I see $100 a day, mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so, OK, so what would the $250 be? If, do you think is that for, if they're hospitalized for 60?
[AGENT][NEUTRAL] Ma
[AGENT][NEUTRAL] I don't usually, I don't usually make guesses when it comes to uh a back file because we, um, number one, we need the policy loaded in. I can only go off what I see on the uh PIBFT which is telling me what the benefits are. I don't see a benefit. Let me, let me check, check one other thing. Hold on one second. I know. Hopefully, no, he hasn't had a claim process. I was gonna say if he claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, apparently they were I I'm actually speaking with.
[AGENT][NEUTRAL] Oh, well, she has. Give me one moment. Give me one moment. I can kind of, I can go inside of the claim and I can see the benefits, so.
[CUSTOMER][NEUTRAL] Sure. Uh-huh.
[AGENT][NEUTRAL] And then I'm just gonna suggest to you that you know um of course you probably already done it we need to send a request to have that uploaded OK OK so let's see.
[CUSTOMER][POSITIVE] Yes, absolutely.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And sometimes those back files it lists benefits for other policies and that's why I don't, you know, you can't really go according to that um you have to go to the scheduled page now if he had a scheduled page and that scheduled page is telling you that amount, then that's gonna match what's on the policy but again I went into one of her claims where I could see all her benefits.
[CUSTOMER][NEUTRAL] OK, and that's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it is $100 a day. There is no, there is no benefit for $200. So there, her benefit for being inpatient is $100 a day and that has to be related to the cancer diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. OK. And then my other question, I don't see anywhere because they're asking about it says specified diseases as well, and this might have to be after we get the actual policy, but I'm not seeing a list of specified diseases.
[AGENT][NEUTRAL] Yeah, I will just let them know, unfortunately, they, yeah, they have an older policy and unfortunately, we don't know that off the top of our head. Um, we need to get that loaded and just let them know, you know, they, they can submit the claim, submit a claim for review. Uh that's the best thing to do, you know, and um then we'll go from there. Mhm. But yeah, their, their house for the benefit is $100 a day. And their chemo, their chemo, you're welcome. The chemo and radiation and immunotherapy is $10,000.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, OK, got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Gotcha. All right.
[CUSTOMER][POSITIVE] Alright, I sure appreciate your help with that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and is that, do you know if that resets per calendar year or is that just that essentially a lump sum like once they use it it's done?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] No, that's usually, let me pull, let me pull up that policy and see if I can see a policy, uh, schedule, not the certificate since I know that's not out there.
[CUSTOMER][NEUTRAL] I was trying to see that too but it's just so it seems vague like it just says the dollar amount but
[AGENT][NEUTRAL] Yeah, it's, it's, those are kinda, yeah, they're, they're confusing. Uh, let's take a look. And
[CUSTOMER][POSITIVE] Well, I'm so used to just kind of, especially with cancer policies, I'll just go straight to the policy instead of the PIBFT, um, but I guess with these it's actually better so I appreciate you educating me on that.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh-huh, you're welcome. Oh, that's fine. I'm just trying to see why it won't come up for me. 123 83939. 0, maybe I got 20s. 83939.
[AGENT][NEGATIVE] I can't get, I can't get it to come up for me.
[CUSTOMER][NEUTRAL] I just did the double click on uh M track um and just again there's no policy but I am looking at the back file where it does show some.
[AGENT][NEUTRAL] Oh, but that should come up at 1. OK, I was missing a 0. I had it right the first time. I don't know why. Like something should be coming up at 1 day. OK, so let's take a look at the back file.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I want to take a look at that.
[CUSTOMER][NEUTRAL] OK, no, I found it. I'm sorry, um, $10,000 per calendar year, yep, I see it. Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Per calendar year. So it will be on the scheduled benefit page. OK. Well, all right, [PII]. You have a great one. You're welcome. You're welcome. Bye-bye. Uh-huh.
[CUSTOMER][POSITIVE] Got you. I really appreciate your help. Thank you so much. You too. All right, bye-bye.