AccountId: 011433970860
ContactId: c1decdbc-2093-4e11-9a6f-6275b9a91b29
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1948020 ms
Total Talk Time (AGENT): 475562 ms
Total Talk Time (CUSTOMER): 602196 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/c1decdbc-2093-4e11-9a6f-6275b9a91b29_20250404T15:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. How are you doing?
[AGENT][NEUTRAL] Hey.
[AGENT][POSITIVE] Good how are you?
[CUSTOMER][POSITIVE] I'm doing good. I have an insured on the line uh that's wanting to know the benefits on a critical illness policy.
[CUSTOMER][NEUTRAL] And I've got the certificate pulled up and
[CUSTOMER][NEUTRAL] Uh, to be honest, it, I'm not really sure how to give her these benefits for cancer. Can you help her?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The policy number is 141.
[CUSTOMER][NEUTRAL] 5882 and I have Ms. [PII] on the line.
[CUSTOMER][NEUTRAL] And she does have the portal she said she's pulled up the policy and she wasn't really sure how to.
[CUSTOMER][NEUTRAL] Read it either.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] For [PII] uh the policyholder [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So 100% cars so I'm not real sure.
[CUSTOMER][NEUTRAL] Of the critical illness benefit.
[AGENT][NEUTRAL] OK, I've got the policy certificate up.
[AGENT][NEUTRAL] OK, and what was the question?
[CUSTOMER][NEUTRAL] So for a cancer diagnosis, she just want to know what the benefits or how to read this, you know, how, what the benefits are for.
[CUSTOMER][NEUTRAL] Evidently, she's got a cancer policy that's normally pays out, you know, for the diagnosis and all that, but
[CUSTOMER][NEGATIVE] And I don't even know if it's with us, but she's not sure how to read this policy certificate.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you can help her.
[AGENT][NEUTRAL] I can transfer on through.
[CUSTOMER][NEUTRAL] All right thank you. Her callback number, [PII] is.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] And thank you and I hope you have a great day. One moment.
[AGENT][POSITIVE] Thank you. You too.
[CUSTOMER][POSITIVE] Miss [PII], thank you for your I mean sorry, Miss, Miss [PII], thank you for your patience. I have [PII] on the line that's going to assist you further with this. OK, thank you. You have a great day.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] OK, Ms. [PII], are you there?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh-huh, I'm here. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] I'm doing OK.
[AGENT][NEUTRAL] OK, and what was your specific question? Let's see if we can figure it out.
[CUSTOMER][NEUTRAL] OK, um, well I was just trying to find out like I sent in a claim for my husband's cancer, and I'm not, I was trying to, we were trying to look at the policy, but I don't quite understand like what's the benefits for the cancer policy I don't, we don't understand.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me look and see, so.
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] I'm looking at your policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] a $10,000 amount for critical illness, that's the base. Let me see what it says in regards to cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It looks like we've paid before let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It looks like what?
[AGENT][NEUTRAL] We've got claims on file from the past that we've processed on this policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Those, um, yeah, we, I sent them claims for wellness checks because we didn't know that he had that, um, policy. I didn't realize that we had it. So I sent all those in along with his um cancer um claim, but they sent me a thing saying I had to get a physician statement done, so I did that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] So the payout was for the wellness stuff.
[AGENT][NEUTRAL] OK, I see that.
[CUSTOMER][NEUTRAL] Ah.
[AGENT][NEUTRAL] Give me just a moment. I'm looking through.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Mom, they are.
[CUSTOMER][NEUTRAL] The social the social the stuff yeah the might.
[CUSTOMER][NEUTRAL] That's the way I live with my he's not here. No, I don't know. You check that out, OK, in the truck over there, OK, OK, yeah, I uh, I go to another side. OK, yeah, I do, I do over here.
[AGENT][NEUTRAL] Alright
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can I place you on a brief hold?
[CUSTOMER][NEUTRAL] Uh-huh. Sure, why not. Mhm. You are on hold.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so, so sorry about that. Um, looking at your policy, it looks like, and this is not a guarantee of payment, it's a basic outline of the policy. So what the policy says is that there's a blanket.
[CUSTOMER][NEUTRAL] Uh-huh. That's OK.
[AGENT][NEUTRAL] $250,000 benefit.
[AGENT][NEUTRAL] For critical illness, which includes invasive cancer.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So, have you, if you have a cancer diagnosis, we would need like the pathology reports that show that, and then along with any um bills that have been incurred. Um, so it would need to specifically show what type of treatment was rendered, the diagnosis, um, and then what were the charges.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, so I, OK, so I sent in the pathology report and I sent that the first time. So, and then I sent in a physician's statement.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I sent that in, I think, the beginning of the week.
[CUSTOMER][NEUTRAL] Um, however, all his bills are just starting to come in and his treatment, um, they're still working like his treatment plan. I know he will do radiation, but we don't, that's not gonna start until July. So,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, I, I don't. So what
[CUSTOMER][NEUTRAL] I guess my question is like my policy that I had on from my job with him on it.
[CUSTOMER][NEUTRAL] Um, they did, they paid out like for diagnosis, so I don't know if this policy is like that or and then they continue to pay like.
[CUSTOMER][NEUTRAL] He also, I also have like a $200,000 coverage, um, that they pay, so I don't know if.
[CUSTOMER][NEUTRAL] And we wasn't sure if this one was like that also.
[AGENT][NEUTRAL] So I don't show a lump sum payout benefit. It's just that 200, the maximum critical illness benefit of 250,000 per covered person.
[AGENT][NEUTRAL] And so we would need like again we would I know you sent the pathology report but to pay out on the plan we would need to see what what are the bill charges from the provider etc.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and so what is the 10,000 face amount for? What, what is that for?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I, I don't see.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] not see a 10 I.
[CUSTOMER][NEUTRAL] Cause it's 10,000 for him and 5000 for me.
[AGENT][NEUTRAL] I know it's loaded. Let me see what they've got. I
[AGENT][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] And I guess I'm just confused because any time I call, you know, I always get somebody tell me something different, you know, each time, so I don't know what, what's what just confusing. I mean, insurance is, is confusing.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, I understand.
[AGENT][NEUTRAL] Let me see, um, can I place you on a brief hold again? I'm so sorry. Or do you want me, would it be easier for me to call you back because I can talk to a supervisor about your policy and we can really get some, I don't want to give you the wrong information and um.
[CUSTOMER][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] Ah mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Could I give you a call.
[CUSTOMER][NEUTRAL] Um, I don't.
[CUSTOMER][NEUTRAL] Um, I may not be, I, I can hold if that's OK.
[AGENT][NEUTRAL] Or you wanna just.
[AGENT][NEUTRAL] OK, OK, just give me a moment, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Wow
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey,
[AGENT][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] I can. I was muted. I'm sorry. OK, is the 250 a life benefit?
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Are you with me? Yeah, OK.
[AGENT][NEUTRAL] So what I'm seeing here is.
[AGENT][NEUTRAL] What's this, so I, I guess I'm confused. So what's the 10,000 for?
[AGENT][NEUTRAL] I know this policy is weird and I think [PII] transferred it back to the queue. I swear it was [PII]. I'm like, well, hell, [PII], if you can't figure it out, I don't know.
[AGENT][NEGATIVE] It's just funky because I don't understand what is it.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I don't see, she and she doesn't want to call back, so um it's fine holding just FYI.
[AGENT][NEUTRAL] It's just a weird plan. I don't, I don't understand what's the 10,000 for and then the 250.
[AGENT][NEUTRAL] I assumed it was a blanket benefit like that's the max of the lifetime of the policy that it'll ever pay, but is it like.
[AGENT][NEUTRAL] You get 100 is the max per specific or specific cancer or specific diagnosis code or?
[AGENT][NEUTRAL] Um, uh, so it was kind, so it under.
[AGENT][NEUTRAL] OK, OK, that makes.
[AGENT][NEUTRAL] Benefits and then
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, OK, that makes sense. It was just confusing when I was, yeah.
[AGENT][NEUTRAL] I'm like, I don't understand what are these dollars about? What is happening? OK, OK, that makes sense.
[AGENT][NEUTRAL] You know, I definitely
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, OK, sounds good. OK, thank you so much. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK thank you alright bye.
[AGENT][NEUTRAL] OK, I am so sorry that was such a long hold. OK, so.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] So this is how the policy works, um, so you have a $10,000 so the $10,000 will pay per critical illness of which cancer would be one of the critical illnesses and then the max it will pay over the lifetime of the policy is up to $250,000. So say as an example, say you had um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's say prostate cancer. So prostate cancer would pay a
[CUSTOMER][POSITIVE] And that's exactly what he has.
[AGENT][POSITIVE] Oh, OK. I'm sorry.
[CUSTOMER][POSITIVE] That's it's funny that you said that cause that's exactly what he has. OK.
[AGENT][NEUTRAL] So it was paying back 10,000 for that and, and that specific thing but again keep in mind this is per critical illness, so it's kind of like per diagnosis.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if there was another illness line that was unrelated, um, but under this policy, you still get that 1000 again, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, OK, so and then it would be up to 250,000.
[AGENT][NEUTRAL] I that
[AGENT][NEUTRAL] Right, yeah, so, um, but 10,000 per, you know, per issue, so per se.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Per, OK, for illness.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, so with that being said, then once they get all the information, then he should get the $10,000.
[AGENT][NEUTRAL] Yes, that's correct. So we would just need, once we get those bills rolling in, um, just send in those bills and then we can start processing under this $10,000 payout.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm OK, so now is that 10,000 sent to him or?
[CUSTOMER][NEUTRAL] Uh, to his, um, daughter's.
[AGENT][NEUTRAL] Um, so it would be sent to you if you submit the claims, so be sure and um log in or get those back if it's submitted by you, we're gonna pay you out so.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Right, well, I sent it like I did the same way like they, I guess the same way they paid out our wellness stuff up into our account basically.
[AGENT][POSITIVE] Right, yeah, exactly.
[CUSTOMER][NEUTRAL] And then.
[CUSTOMER][NEUTRAL] Alright, OK, so now if this is just like I mean the bills are gonna keep rolling in because he continuously have thought the visits and things now do they wait? I mean because this could take forever to finish with all of that, so like.
[CUSTOMER][NEUTRAL] Do they have to wait for all his bills to come in before they start paying or is it because there was a diagnosis, they'll pay the face value first and then continue to whatever else as the bills come in.
[AGENT][NEUTRAL] Um, let's see how they'll pay out.
[CUSTOMER][NEUTRAL] Can you, you understand what I'm saying? Like,
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Yeah, I do.
[CUSTOMER][NEUTRAL] Yeah, because it's an ongoing thing, so.
[AGENT][POSITIVE] Right, exactly, yeah.
[AGENT][NEUTRAL] Um, so for the 10.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But I mean like I, I sent them what they asked for because what when I did the claim it asked for a pathology report and I filled out the claim so I sent that in and then they sent a notice saying that they needed a physician statement so I sent that in so they hadn't asked for any bills or anything yet, I guess for that part, for the, the claim, the face value part I guess.
[AGENT][NEUTRAL] Let me see what we received on.
[CUSTOMER][NEUTRAL] Um, but yeah, I can.
[AGENT][NEUTRAL] I don't know that we, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when I first submitted the claim, it went under claim number 3577033.
[AGENT][NEUTRAL] OK, I see that.
[AGENT][NEUTRAL] And when did you submit
[CUSTOMER][NEUTRAL] And that's where the pathology report was sent in, that was back in February on [PII], I mean, so the pathology report is in that and then that's when they asked for the physician statement, so I didn't know how to tie when I sent that in. I didn't know how to tie it to that claim, so you know that's.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] My question is like, are they gonna be able to tie those together because there's one claim. I'm just sending in additional information.
[AGENT][NEUTRAL] Yes, it should, it should, uh, the, the claims department should be able to put those together. When did you send the physician statement?
[CUSTOMER][NEUTRAL] I think that uh the.
[CUSTOMER][NEUTRAL] Uh, yeah, I think it was on Monday. Let me look at the date on the [PII], I think it was, yeah, [PII].
[AGENT][NEUTRAL] Did you fax that over?
[AGENT][NEUTRAL] Or was that an upload?
[CUSTOMER][NEUTRAL] I, I uploaded it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was an upload.
[AGENT][NEUTRAL] OK, so I see.
[AGENT][NEUTRAL] OK, we've got the claim form. Let me make sure we have everything.
[CUSTOMER][NEUTRAL] Because I see online where it says it was received, but it's just not tied to that claim number, it doesn't have a claim number on it, so.
[AGENT][NEUTRAL] OK, I see the physician filled out the form.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Yeah, and then under that claim number is the pathology report.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I just don't want them to send send something saying they need a pathology report because I've already sent it, you know what I mean?
[AGENT][NEUTRAL] I think they'll look at it, but do you mind? I can transfer you to the claims department and they can tell you for sure because they're the ones that actually process.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] So would that be OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll let them know that we what we're talking about, OK? Hold on one moment, OK?
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you. I hope you have a good weekend.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Referring
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] [PII], uh, this is [PII] from the care team. I've got a, a spouse on the line, um, asking about, uh, how this claim will pay out.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Uh, policy number is 1415882.
[AGENT][NEUTRAL] And I've got Francia on the line. I verified all the information.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So she's resubmitted on the portal.
[AGENT][NEUTRAL] Um, let me give you the original claim and then.
[AGENT][NEUTRAL] You can see the one that's not um processed yet that we just received.
[AGENT][NEUTRAL] Basically, she's uh submitted the, she submitted the pathology report on 357-703-3.
[AGENT][NEUTRAL] And then now we've just received her upload of the physician's statement.
[AGENT][NEUTRAL] Um, and I was, this policy was kind of weird. Um, I had to get help on it because I didn't quite understand how it was gonna.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Pro or what the benefits were. So her question is, long story short, she's now received or submitted the physician's statement. Is it gonna pay the lump sum 10,000 benefit for this new diagnosis of cancer is what her question is.
[CUSTOMER][NEUTRAL] OK, so yeah, it'll have to be reviewed first, but it does only pay a one a one time benefit, that lump sum benefit, but once it's reviewed to determine if it's, it will be covered, then yeah, the plan will only pay that, that benefit.
[AGENT][NEUTRAL] OK, so she
[CUSTOMER][NEUTRAL] For the occurrence.
[AGENT][NEUTRAL] She doesn't have to submit claims or anything, right? Like from the hospital or anything.
[CUSTOMER][NEUTRAL] No, if she's filled out that claim form and provided that information on that critical illness claim form, then that is sufficient.
[AGENT][NEUTRAL] OK, OK. Do you mind just letting her know the process if, if that's OK, can I transfer her through?
[CUSTOMER][NEUTRAL] Sure, that's fine.
[AGENT][POSITIVE] OK, um, thank you so much.
[CUSTOMER][POSITIVE] Thank you. You're welcome.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Claims department, this is [PII].