AccountId: 011433970860
ContactId: b495b0bf-f21e-40c5-ae93-7473c3447f0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 722400 ms
Total Talk Time (AGENT): 291438 ms
Total Talk Time (CUSTOMER): 271899 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/b495b0bf-f21e-40c5-ae93-7473c3447f0d_20250310T16:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII]. My name is [PII], and I was calling in reference to um my husband's policy that he have um for the critical care, and I was trying to see. I spoke with someone maybe two weeks ago, and I wrote everything down in the website, but I cannot find that paper. But I needed to see about filing a claim, a cancer claim for him.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, let's definitely take a look. Do you by chance have his policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't, I don't, um, have it. I have like a blue APL card.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] But I don't, that has a group number and a group affiliate, but every time I call I get transferred so much, so I'm not even sure if this is the right department or not.
[AGENT][NEUTRAL] OK, let's take a look. What's the group number that you see?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, it's APL 2 uh 20,000 I guess 20,000.
[CUSTOMER][NEUTRAL] You said the group number or the affiliate?
[AGENT][NEUTRAL] The group number, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, yeah, that's what it says on this card, APL 20,000.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Let, let me try and find out by his name. OK, what's his, what's the last name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And then what's his first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right. And then let me just verify either your date of birth or his, please.
[CUSTOMER][NEUTRAL] Uh, my date of birth is [PII]. I can give you his too if you need it.
[AGENT][NEUTRAL] I got you here and then let me just verify the address we should have on file.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then the [PII], that's still a good email?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so if you want, what I can do [PII] is just basically send you an email with the cancer claim form um I'm sure when you spoke to the representative last time, you know, claims can be filed online or you can do it in the mail or fax it and so have you guys ever set up any log in online for the portal?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think I did, but like I, I can't, what's the email I mean the website for the portal.
[AGENT][NEUTRAL] So the, the website is [PII]. So that's [PII], the word [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, [PII], OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when you get to the
[CUSTOMER][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] To the site, you'll see, that's OK, you'll see an option there in the far right to click that says sign in.
[CUSTOMER][NEUTRAL] Mhm, I'm sorry, go ahead. Mhm.
[CUSTOMER][NEUTRAL] OK, it says what?
[AGENT][NEUTRAL] It should say sign in.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Sign in, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Alright, I'll, um, if you can just email me the claim form just in case I can't.
[CUSTOMER][NEUTRAL] Get it in, get signed in.
[AGENT][NEUTRAL] Yeah, absolutely. So I'll send you the claim form and then page one is essentially just instructions on what you're gonna need to submit with your claim. So it's pretty detailed as far as telling you what exactly you may need, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And um
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, do you know what the policy amount is?
[AGENT][NEUTRAL] I can pull that up. Let's take a look.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Uh, let's see.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So it looks like the maximum benefit on the plan is up to 250,000 per covered person.
[AGENT][NEUTRAL] Um, it says on the schedule of benefits that if it's any sort of like invasive cancer, it shows that the benefit amount is 100%.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And you said it's, it's how much? Up to what?
[AGENT][NEUTRAL] Um, it looks like the maximum benefit is 250,000 per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And, OK. So, do he have like a first diagnose type um benefit also, or not? I, I don't know what he got.
[AGENT][NEUTRAL] That's, yeah, that's what I was looking to see if there was any sort of first occurrence benefits.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And um, if I'm not mistaken, I think, yeah, I, I get it confused cause I have it on my job for him also. So I don't, I don't know if it was my job that told me stuff or I, I don't know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I wanna say, somebody told me maybe 7000 or something.
[AGENT][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] But um
[AGENT][NEUTRAL] First.
[AGENT][NEUTRAL] Current, uh, let's see.
[AGENT][NEUTRAL] This one has a recurrent diagnosis benefit and for like heart attack.
[AGENT][NEUTRAL] Um, and stroke, but I'm not seeing anything for first occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 50%.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] I know that it, I think it's something I just don't know which one is which because both companies, my job and his company gave me.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Something that I don't know.
[AGENT][NEUTRAL] Yeah, I don't see it on this one, so maybe check your other one because I just see in the policy something about a reoccurrence.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that applies to just heart attack and stroke.
[CUSTOMER][NEUTRAL] Mhm. OK. I think I, I just.
[CUSTOMER][NEUTRAL] I just pulled it up. I see where it says critical illness benefit amount. It's 10,000 for the insured and 5000 for the spouse.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, I would think
[CUSTOMER][NEUTRAL] That would be, I don't know, all I could do is file a claim and see I guess.
[AGENT][NEUTRAL] Yeah, because the on the schedule, usually like if there's a first occurrence benefit, it'll state it on the scheduled benefits page.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And all I see on there is that like additional critical illness like benefit writers, and there's a reoccurrent recurrent diagnosis. It says maximum one recurrent benefit per covered person, heart attack, stroke, major organ failure.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So where it says critical illness with cancer benefit policy, the, and that's what they, you think they're talking about as far as the cancer part is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Reoccurrence.
[AGENT][NEUTRAL] Mhm. Yeah, I just don't see cause it usually will state pretty um in black and white first occurrence benefit and then it states the amount and I just, I don't see it on the scheduled benefits page so I don't think it's part of this one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, well I'll just um.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have to send in the claim and just see what it says. So what, what I mean like what would it cover if it's first occurrence you're saying it don't cover anything?
[AGENT][NEUTRAL] No, no, no. First occurrence is usually like a lump sum benefit. So like if you're diagnosed with cancer, then it just pays you a lump sum benefit. Yeah, no, it'll still cover any sort of treatment, diagnosis, anything like that.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, up to, up to that amount, it's just this particular policy doesn't have that lump sum payout for being diagnosed.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And I'll I'll email you the claim forms and it looks like you have logged in before online so if you need me to give you yeah the username I have that here, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I just, I just got logged in just now. I figured it out, yeah, so.
[AGENT][POSITIVE] OK, great. All right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. Well, I am.
[CUSTOMER][POSITIVE] OK. Well, thank you so much.
[AGENT][POSITIVE] Yeah, you're welcome. I'm sending you those forms now.
[CUSTOMER][POSITIVE] OK thank you mhm bye bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.