AccountId: 011433970860
ContactId: b4179c06-4f29-4294-a990-f7e079a69701
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 808760 ms
Total Talk Time (AGENT): 256837 ms
Total Talk Time (CUSTOMER): 339848 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/b4179c06-4f29-4294-a990-f7e079a69701_20250307T20:23_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, [PII], it's [PII]. Happy Friday. I
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] I need to transfer a call um I've got.
[CUSTOMER][NEUTRAL] Policy number 135797.
[CUSTOMER][NEUTRAL] This is a heart attack and stroke policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I have [PII] on the line. She's um, power of attorney and she's executor as well at the wheel um.
[CUSTOMER][NEUTRAL] Ms. [PII] passed away on [PII] from a heart attack.
[CUSTOMER][NEGATIVE] Kind of went downhill.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I'm looking at the back file. I see some.
[CUSTOMER][NEUTRAL] I'm not really sure if there's intensive care on here.
[CUSTOMER][NEUTRAL] I saw some notes about intensive care since the policy sir it's not here.
[CUSTOMER][NEUTRAL] But I'm, I'm not sure. She needs to know what benefits we've already talked about the claim form needed and the death certificate, she's aware of all that. Can you help her a little further?
[AGENT][NEUTRAL] OK, so she just needs um help on filing a claim?
[CUSTOMER][NEUTRAL] Yeah, and um the benefits, and I, we, we did discuss it was a first occurrence benefit for the heart attack and stroke.
[CUSTOMER][NEUTRAL] But I've got the back file pulled up and I was there intensive care benefits or?
[AGENT][NEUTRAL] Um, normally I guess if there's not a policy certificate we would request one through customer service to be uploaded, but then they're, they're also all on SharePoint as well, um, copies of the policies.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Can you help her?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, it's [PII] and I do have her callback number.
[CUSTOMER][NEUTRAL] It's [PII] and I'll go ahead and put that hub request in um 271.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and I have [PII] on the line.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] And I'll take care of the hub request for the policy, sir. Thank you, [PII]. Hope you have a great weekend, one moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Alright, Ms. [PII], I do have [PII] on the line and she's going to assist you further with those benefits, OK? OK, thank you so much. My pleasure and thank you for calling APL bye bye. Bye bye.
[AGENT][POSITIVE] Thank you for holding, Ms. [PII]. Uh, this is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] OK, um, well, I'm sure [PII] explained that my mother-in-law had passed away and she had a policy with you guys, um, heart attack and stroke policy, um, so I, I, I don't really know anything about it other than she had it, um.
[CUSTOMER][NEUTRAL] I, I don't know what the benefits are. I know that [PII] had explained for me to um go on your website and um fill out a miscellaneous treatments claim perhaps.
[CUSTOMER][NEUTRAL] Um, so could you just tell me a little bit about what she had?
[AGENT][POSITIVE] Oh sure I can help you with that. Um, did she, I'm so sorry to hear about your loss.
[AGENT][NEUTRAL] Uh, did she pass away from a heart attack or a stroke?
[CUSTOMER][NEGATIVE] Well, she had a stroke [PII], which basically led to her demise and her death in January. She never came home. She never got over the stroke.
[AGENT][POSITIVE] OK. I'm so sorry to hear that.
[AGENT][NEUTRAL] Um, yes, so this policy, um, it does cover benefits, um, as a, as a direct result of a heart disease, heart attack, or stroke.
[AGENT][NEUTRAL] Um, and there are benefits that would include, um, like a daily hospital benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if she had to receive any blood plasma or platelets.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it also has benefits for an inpatient physician's expenses.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, any surgeries, uh, I'm sorry?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, she did have to have um.
[CUSTOMER][NEUTRAL] Oh gosh, it just, when she had the stroke, she had a blank a a blood clot in her brain and had to go through a thrombectomy, uh thrombectomy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Early on, right, right when she had the stroke, but like I, I guess what I'm asking is, you know, she, she has Medicare and she had a supplementary insurance that is taking care of, you know, a lot or most of the medical bills. So what is this policy, what does this policy do for her family?
[CUSTOMER][NEUTRAL] As far as does it pay towards the medical bills? I mean.
[AGENT][NEUTRAL] Yes, so it will pay towards the um to the insured directly. So, uh, the insured will most likely they would file a claim with us directly where they would submit, you know, the claim form along with the itemized bills, um, from the facility for the treatment that they received.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And they would also include um medical records that basically confirms their diagnosis of whether it was a heart disease, heart attack, or a stroke.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we receive those documents, we will process that and then we would um reimburse, you know, it's it's a reimbursement policy. We will work whatever, you know, according to the policy, like if there's hospital confined or surgeries, that would be reimbursed directly to the insured. Um, so if the insured in this case has passed away, then it would go to either the beneficiary on the policy, um, or if there was an estate set up, um, we would also process those benefits to their estate.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, well, uh, do, can you tell me if she had a beneficiary set up through this policy?
[AGENT][NEUTRAL] Um, I can have a quick look here and see if we have that on file. Bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So I'm not seeing it on the policy here. Um, let me just look one other place.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I don't see a beneficiary listed, so once you send in the documentation for review, if you can also send in just like a written piece of paper that has her next of kin verified.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that would of course be, you know, a spouse, um, children.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, well, I, I did send in a copy of her will that stated that everything went to her two sons, um.
[CUSTOMER][NEUTRAL] So, would that suffice or I just need to state her next of kin as in her son's?
[AGENT][NEUTRAL] Um, so you can send that as well. So this will go to our legal department and they would review the documents. Um, you can send a copy of that as well. Um, I would also list out her next of kin, um, just so that we have the information if they need it, it will help prevent any delays in the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, like I said, that would include, um,
[AGENT][NEUTRAL] Like I said spouse, brothers or sisters, and children.
[CUSTOMER][NEUTRAL] OK, well, there it's just children.
[AGENT][NEUTRAL] Um, and then if there was also.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and if there was any an estate that was set up, if you have any the testamentary documents, um, you can send that as well.
[CUSTOMER][NEUTRAL] OK, so, um, these forms that I, I, I'm assuming I'm the one that needs to be filling out and gathering all this documentation, um, to send them.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Um, I, I believe so, yes, I believe [PII] said that you were the, the power of attorney.
[CUSTOMER][NEUTRAL] Yes, yes, power of attorney and then the executor of the will, um, so I'm looking on your website and I'm seeing all of these different forms so obviously we don't need an accident claim form, um, do I need a, a uh critical illness form um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hospital inde indemnity form. Um, I mean, what forms is it that I need to be?
[CUSTOMER][NEUTRAL] Loss of life claim form? What what is it that I need to be?
[CUSTOMER][NEUTRAL] Doing
[AGENT][NEUTRAL] Yeah sure, uh, so let's see here.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] OK, so I'm, I'm kind of clicking through here, um, the miscellaneous treatment and services claim form.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, that's what I was looking at too. I believe that's one that that [PII] said for you to complete.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that's fine, that, that can, that can be completed as well and just verify the um, the policy number on the form as well, um, and then we should be able to go ahead and review that, um, on that policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so do, is that the only form that I need to do at this time is the miscellaneous treatment form?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] I just wanna try to get everything filled out. I mean, I'm sure that there'll be other things that you guys need I would just like to be able to.
[CUSTOMER][NEUTRAL] Get everything sent on the front end if possible, um, you know.
[AGENT][NEUTRAL] Yeah, sure. Yes, I would for sure fill out the form, um, along with all the medical records and that they had discussed just verifying the um diagnosis and along with the medical bills.
[CUSTOMER][NEUTRAL] This is a lot.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so, um, now when I get all of this together is this something that I mail or I can fax or what?
[AGENT][NEUTRAL] Uh yes, ma'am. You can either mail it or fax it.
[CUSTOMER][NEUTRAL] OK, is your fax [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And do I put it as attention to anyone or?
[AGENT][NEUTRAL] Um, you can just put attention to the claims department and then I'll just make sure that the policy number is somewhere visible on that cover page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, well, I guess that's all the questions that I have for right now, um.
[CUSTOMER][NEUTRAL] Until I kind of get everything gathered up and sent to you guys.
[AGENT][NEUTRAL] Uh, sure, Ms. [PII], was there anything else I could do to help you today?
[CUSTOMER][POSITIVE] I guess that'll do it. I sure appreciate it, [PII].
[AGENT][POSITIVE] Uh, sure, thanks for calling AP. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thanks bye bye.