AccountId: 011433970860
ContactId: 99c57912-036c-442c-901e-833c6d320bef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 664909 ms
Total Talk Time (AGENT): 318933 ms
Total Talk Time (CUSTOMER): 139418 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/99c57912-036c-442c-901e-833c6d320bef_20250605T15:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Um, am I able to file a claim with you, um, for annual blood work?
[AGENT][NEUTRAL] OK, so you're the insured carrying and you're trying to find out about filing a claim for yourself or wanting to know if something is covered under your policy, is that correct?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] Yes, ma'am. I can try and help you with that. Um, what is your last name, [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And what is your
[CUSTOMER][NEUTRAL] Well, it's [PII].
[AGENT][NEUTRAL] I'm sorry, what's the last name?
[CUSTOMER][NEUTRAL] Well, I was recently married, so I don't believe you guys have that information, but it's [PII].
[AGENT][POSITIVE] OK, miss. OK, thank you. All right, and [PII], what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] 01203311
[AGENT][NEUTRAL] OK, thank you. One moment while I get your information pulled up.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so first off, um, if there's any information that I provide for you today will be a verification of benefits and not a guarantee of payment, and again I will need to verify your information for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one that you provided for me, so that is your best contact number still that we should have, is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] Thank you and lastly your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, OK, thank you. So while I'm getting your benefit information loaded and you said this is for lab work, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] It's just taking a moment to load some of the policy information for me, Miss um [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So I do not see benefits for laboratory testing on this policy.
[CUSTOMER][NEUTRAL] OK, what is it for just um regular wellness like.
[CUSTOMER][NEUTRAL] Mammogram and PA.
[AGENT][NEUTRAL] Is this, are you, are you asking for the preventative care benefits?
[CUSTOMER][NEUTRAL] Oh, that's the only thing that's on it? OK, preventative, OK.
[AGENT][NEUTRAL] Oh, no, ma'am. Well, no, this policy provides, I mean, this is,
[AGENT][NEUTRAL] The policy itself.
[AGENT][NEUTRAL] is a cancer policy.
[AGENT][NEUTRAL] So are you needing
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I mean, uh, what are, what are you asking as far as your benefits? Because there's a lot of benefits on a cancer policy.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Well, I know when you do certain proceed certain testing per year, you can call in to file a claim.
[AGENT][NEUTRAL] So that's, you're asking about your pre preventative wellness type screening benefits?
[CUSTOMER][NEUTRAL] Like certain wellness.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, so let me look at those to see what's on here.
[AGENT][NEUTRAL] OK, so on your, the diag I mean the description under your preventative care benefits states each calendar year, we will pay the amount shown in the schedule of benefits for each covered person to have one or more of the following screening tests performed mammogram, a PSA for man, flexible sigmoidoscopy, colonoscopy, ovarian cancer blood test.
[AGENT][NEUTRAL] A Pap smear, chest X-ray, or hemacult stool specimen.
[AGENT][NEUTRAL] Benefits do not include charge, if any, for the office visit associated with the test or tests performed. Benefits will only be paid for tests performed after the thirty-day period following the person's covered effective date of coverage, and this benefit is available without a diagnosis of cancer.
[AGENT][NEUTRAL] So those are the those are the things that can be reviewed under.
[AGENT][NEUTRAL] The benefit for your preventative care.
[CUSTOMER][NEUTRAL] OK, so it sounds like it says one or more, so it's not just one.
[CUSTOMER][NEUTRAL] Am I right? So.
[AGENT][NEUTRAL] I believe, well, let me look. I have to look in multiple places. Bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it is actual charges up to $60 per calendar year, so it would be 1.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] All right. And another question I have, um, I know it's like years later, but I did a hysterectomy.
[CUSTOMER][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] Does the policy cover anything for hysterectomy?
[AGENT][NEUTRAL] This policy would not unless it was related to a diagnosis of cancer.
[AGENT][NEUTRAL] This is a, a cancer, this is a cancer and dreaded disease policy and then you do have your preventative care benefit, that $60 benefit per calendar year.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] The like, what do you call it?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The, the reason for the hysterectomy was due to um
[CUSTOMER][NEUTRAL] What's the word?
[CUSTOMER][NEUTRAL] Oh, gosh, I can't think of it, um.
[CUSTOMER][NEUTRAL] Like they found some, I can't, I can't think of the word.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Again, this would be for a positive diagnosis of cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, on this particular policy.
[CUSTOMER][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] Well, you're welcome and then I do see Ms. [PII], I was going to tell you that I can see that you have your profile set up in our online service center portal where you can log in.
[AGENT][NEUTRAL] To file claims and and see your information there was an upgrade made to our portal over this last weekend, so the next time that you go to sign in right be right under where it says log in you're gonna see where it says to create OSC account you will need to reset up your profile because you will not be able to log in any longer like you did before.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you will just select create your OSC account.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Create what?
[AGENT][NEUTRAL] Your OSC account.
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's still at um [PII], right?
[AGENT][NEUTRAL] Well, [PII].
[AGENT][NEUTRAL] For the portal.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, [PII] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm, yes ma'am and so when that page pulls up, it's gonna say welcome to the online service center and you'll see like a a blue button that says log in and just below that it's gonna say create your OSC account so you will need to just select that and set up a new profile.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Mhm. And if you have any issues or difficulties with that, obviously, please call us back and we will be very happy to help you with it.
[CUSTOMER][NEUTRAL] OK, I'll go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, is there anything else, Miss [PII] that I can help you with?
[CUSTOMER][NEUTRAL] All right, will do.
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, thank you so much then for calling APL and I do hope you have a very nice day.
[CUSTOMER][POSITIVE] You too thanks.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.