AccountId: 011433970860
ContactId: c97c21de-be5a-414c-8edd-553c4a20e94e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1431680 ms
Total Talk Time (AGENT): 565417 ms
Total Talk Time (CUSTOMER): 331654 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/c97c21de-be5a-414c-8edd-553c4a20e94e_20250424T14:06_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, good morning. My name is [PII]. Um, I had a heart attack and I need to, uh, do whatever I need to do to get my insurance.
[AGENT][NEUTRAL] OK, well
[CUSTOMER][NEUTRAL] Handled
[AGENT][NEUTRAL] Well, I can help you with filing a claim and um [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Thank you. And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, the number I was given is 023.
[CUSTOMER][NEUTRAL] 94,730
[AGENT][NEUTRAL] OK, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing, and email address on file.
[CUSTOMER][NEUTRAL] OK, my uh date of birth is [PII].
[CUSTOMER][NEUTRAL] Uh, what else was it? The mailing address [PII], and email would be [PII].
[AGENT][NEUTRAL] Email.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alrighty, and thank you so much for verifying your information. All the information provided is a verification of benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you do have the um heart attack and stroke first occurrence rider in which the lump sum will pay up to $2500.01 time per lifetime if you have any um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Eligible dependents, they would be paid $3750. So all you'll need to file this is your
[AGENT][NEUTRAL] Um, pathology report from the doctor, just, you know, showing that, that was the diagnosis. And then the itemized bill, um, if you went to a hospital, you'll be asking them for a universal bill. It's called UBO4.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, that form will have the diagnosis code.
[AGENT][NEUTRAL] The procedure code?
[CUSTOMER][NEGATIVE] Mhm, so you can't get all this.
[CUSTOMER][NEUTRAL] OK, so I went to my cardiologist yesterday and they said, uh, they gave me a card and they're like, because I was telling them I was like they're gonna want all this stuff and she's like we have our fax number on this card if they'll let us know we can send everything.
[CUSTOMER][NEUTRAL] Is that possible or do I have to go gather from all these people?
[AGENT][NEUTRAL] No, you don't have to do, well, well.
[AGENT][NEUTRAL] So here's the thing, this is why I kind of stopped because you now like for your services that you received and everything, I would just give them this policy number and have them bill it. But for the lump sum benefit, I personally
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can't advise you, but if it was me, I would, I would file it myself because that comes, that's like a lump sum benefit for you. If you decide to pay your bills with it, that's up to you, but you know what I mean. So I for that part, I would say to file it that part on your own and just let the facility handle all the, you know, treatments and everything else that, you know, that day.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so I need a pathology.
[CUSTOMER][NEUTRAL] And an itemized bill and you said that's the UBO4.
[AGENT][NEUTRAL] Yes, ma'am, and they might try to send you your patient copy, let them know I don't want my patient copy. I need the hospital's version and it needs to have the ICD 10 codes, which is the diagnosis code.
[AGENT][NEGATIVE] It needs to have the procedure codes and all the charges.
[CUSTOMER][NEGATIVE] Hold on, I'm running out of paper. Hang on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Let me make sure I'm writing everything down.
[CUSTOMER][NEUTRAL] OK, so I need the pathology.
[CUSTOMER][NEGATIVE] I'm gonna start over here so I don't get.
[CUSTOMER][NEUTRAL] Pathology report.
[CUSTOMER][POSITIVE] Amas bill.
[CUSTOMER][NEUTRAL] OK, hospital ICD code.
[CUSTOMER][NEUTRAL] OK, let's see, a UBO4. So if I say this, they're gonna know what I'm talking about.
[AGENT][NEUTRAL] You say if you say that, well they know, oh yeah, they'll know, that's the only billing hospitals.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You the only difference.
[CUSTOMER][NEUTRAL] OK, UB 04.
[AGENT][NEUTRAL] Yes, if you have any doctors, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] You know, that you're filing for.
[AGENT][NEUTRAL] The UBO4 and the itemized bill, it's the same thing. It's just the hospitals use UB and then the doctor's office say itemized bill, but whichever term they use is the same thing.
[CUSTOMER][NEUTRAL] OK. So would I have to call the hospital directly to get all this?
[CUSTOMER][NEUTRAL] Or who would I call to make sure I get everything correct?
[AGENT][NEUTRAL] Did you
[AGENT][NEUTRAL] So, so you went to the hospital or like you went to the doctors and they took you or they made you go to the hospital, like how did it?
[CUSTOMER][NEUTRAL] Um, well, first, I had the ambulance come to my house and they did the EKG and all that, and I declined for them to take me because my stuff was showing normal on the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, all my vitals were like showing normal.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, but they did suggest that I go to the hospital and get my troponin checked.
[CUSTOMER][NEUTRAL] And my troponin was through the roof like my doctor told me yesterday uh I had a 2800 and something.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] troponin level and uh normal is like 0 to 14.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So then yes, it would just be the um now if you receive a bill.
[CUSTOMER][NEUTRAL] Anyway, um,
[AGENT][NEUTRAL] If you receive a bill from, well, no, no, no, you said you declined the ambulance, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, but I did have to be transported from the emergency room locally to uh a hospital by ambulance like 30 minutes away.
[AGENT][NEUTRAL] OK, so you think.
[AGENT][NEUTRAL] OK, so if you do receive
[CUSTOMER][NEUTRAL] After that, like once I got in.
[AGENT][NEUTRAL] If you receive a bill from the ambulance, then I would let them know, hey, I have this cancer policy, blah blah blah, and see if, you know, have them file it through us, but for that lump sum, yeah, I would, anything outside of the lump sum, I would make the provider do it so you don't have to do all the work.
[CUSTOMER][NEUTRAL] OK, and what do you mean by my dependents have a, what was that like?
[AGENT][NEUTRAL] Because you have a, um, let me go back to that. Hold on one second.
[CUSTOMER][NEUTRAL] I don't have any paperwork that tells me what this is. I know I bought like a cancer policy but I didn't.
[AGENT][NEUTRAL] Oh, I can
[CUSTOMER][NEUTRAL] I don't have any paperwork on it.
[AGENT][NEUTRAL] I can send this to you. I can email this to you. It's just like a breakdown of your, that's what you're looking for, like a breakdown of your benefits, what pays what. OK. Yeah, I can email this to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm I just vaguely remember the guy said something about a heart attack and I was like I have something but I don't know what it is.
[AGENT][NEUTRAL] Let me, uh, I'm trying to get to the fine print so I can see, and I literally was just reading it and switched when we started talking about the the bills. Hold on one second, let me find. No, we're fine, you're fine, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Let's try, let's start there.
[AGENT][NEUTRAL] its.
[AGENT][NEUTRAL] And I mean, it just had.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold? I'm just trying to find where I just was in your policy. I was just reading about the dependent. OK, hold on one moment.
[CUSTOMER][NEUTRAL] That's fine. Sure.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I literally was just reading it.
[AGENT][NEGATIVE] Benefits decrease no, that's not what I.
[AGENT][NEUTRAL] Was was I looking at dependent uh let me see.
[AGENT][NEUTRAL] Where was I?
[AGENT][NEUTRAL] And I was just reading that disease.
[AGENT][NEUTRAL] Oh man.
[AGENT][NEUTRAL] Well, I know it's here because I was just reading that disability.
[AGENT][NEUTRAL] Jet disease eligible dependent here we go.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Unless specifically named as excluded in any part of this contract means does anybody else covered any child outline a number.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So I did find it, so the dependent, um, it's for, um,
[AGENT][NEUTRAL] Spouse, natural child, adopted child, stepchild, um, who is under [PII] of age, um, that basically that you're responsible for, we would just need, um, let me see what it's asking for.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They have to be a dependent, um, they have to be dependent on your support and maintenance, um, coverage will continue, trying to see what what it's asking for.
[CUSTOMER][NEGATIVE] So like I had my [PII] with me and my husband was in [PII] and I'm in [PII] so that's why I declined the ambulance because I didn't have anybody here to.
[AGENT][NEUTRAL] For the baby.
[CUSTOMER][NEUTRAL] When my, yeah, so I'd had to like take her to daycare and then go to the hospital.
[AGENT][NEUTRAL] Well, then, yeah, any child under the age of [PII] who is under your child care control and has been placed in your home.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, that's talking about adoption, but any child under [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, that you
[AGENT][NEUTRAL] That you support and maintain. That sounds bad.
[AGENT][NEUTRAL] I would file for you and your child. I mean, the worst that we can say is no, it doesn't.
[AGENT][NEUTRAL] Apply, but if it does.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's an extra.
[CUSTOMER][NEUTRAL] Well, at this point I can't work. I'm off work, uh, pretty much I work for the school district, so I'm pretty much out of work till the end of the year and I'm docked.
[CUSTOMER][NEGATIVE] Uh, I'm gonna deducted all my pay.
[CUSTOMER][NEUTRAL] You know, that's kind of how they space your paycheck out through the whole entire year so I'm out of.
[AGENT][NEUTRAL] Mhm. So you can have it for the summer.
[CUSTOMER][NEUTRAL] Yeah, so I'm gonna be kind of.
[CUSTOMER][NEGATIVE] Uh, in trouble.
[AGENT][NEUTRAL] OK, so your child is $3750.
[CUSTOMER][NEUTRAL] So how much will
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then yours is 2500. Mhm.
[CUSTOMER][NEUTRAL] My child gets more than I do.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's weird. All right, so what do I need to do with her just like birth certificate or?
[AGENT][NEUTRAL] Let me see if it asks, it doesn't ask for anything specific, but let me
[AGENT][NEUTRAL] Just to be on the safe side.
[CUSTOMER][NEUTRAL] I mean she's on my tax return and.
[CUSTOMER][NEUTRAL] I actually do not have a birth certificate with me. My, well, my husband may have a separate copy. We just sent it off a while back to go get her a passport, so they keep your birth certificate.
[AGENT][NEUTRAL] Right, OK, because I'm sorry, I know this is off. I promise because when I did my my
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I, my mama argued me down and I'm like, mama, I promise they didn't send me my birth certificate back, and she was like, why would they keep it? I knew they didn't send that back to me.
[CUSTOMER][NEGATIVE] It takes a long time.
[CUSTOMER][NEUTRAL] Yeah, I, I just got mine done back in like November and I had to send my marriage license and my birth certificate and it took forever. I finally got it back but I just had hers done because we were planning a trip for summer and so we got her passport done and so hers, my, I think my husband got two copies of it though when he went and had it done, so one for both of us.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So anyway, that's kind of beside the point. Anyway, I was like, how am I gonna prove she's done if they have a birth certificate?
[AGENT][POSITIVE] I knew it. I'm just glad you confirmed that for me though.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I'm just reading through this while we're, um, just trying to see if it asks for anything specific, but
[AGENT][NEUTRAL] Um, it doesn't coverage will then continue as long as your insurance stays in for, well, OK.
[AGENT][NEUTRAL] Additional proof maybe. It just says additional additional proof may be required, but it doesn't.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] It doesn't like
[AGENT][NEUTRAL] I'm trying to see if it has like something that we definitely have that no it doesn't have anything like that on there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So I would just put on, I'm sorry.
[CUSTOMER][NEUTRAL] Well, I mean, I
[CUSTOMER][NEUTRAL] Go ahead, [PII]. Let's see.
[AGENT][NEUTRAL] So on your because you're you're gonna have to fill out a cancer claim form, I can send that to you also, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on there, I would, I'm pulling it up now so I can see what sections, but I would, I would just put your daughter and her age, um, hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you wanna do?
[AGENT][NEUTRAL] With the cancer. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] No, I'm not doing anything. You can do whatever you need to do.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Or would it be?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] All right. I'll ask the question cause I'm not really sure.
[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] Yeah
[AGENT][NEUTRAL] Mhm mhm mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. I just wanted to check back with you. I'm speaking with my um team lead. So what I'm doing, I've looked on the cancer claim form, but there's nowhere to, there's nowhere to specify that it's for a heart attack.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] So, you know, so they know what benefits you're trying to file for and then also I don't see anywhere where you can put, you know, like your baby's information. So I'm trying to see if you're supposed to write it on there or if there's another form, because I, I looked at the other forms like the wellness, where that list like different testing you can select, but I didn't see heart attack on there either. So I'm just trying to get some direction so I know how to lead you. Are you OK with holding or you want me to call you back?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it, it's such, it doesn't really matter. Um, so you're saying there's a possibility that there's not heart attack coverage or you just can't find it?
[AGENT][NEUTRAL] If
[AGENT][NEUTRAL] Oh, neither, neither. You have the coverage. I'm just trying to locate which form to, to, to send to you so you can send it with your stuff.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK, you can, you can call me back if you need to, uh, if it's.
[AGENT][NEUTRAL] You sure it's whatever you prefer as long as you're OK. I just want to make sure you're OK.
[CUSTOMER][POSITIVE] Yeah, yeah, I'm fine. You can, you can give me a call back.
[AGENT][NEUTRAL] OK, um, so after [PII] gives me the, um, direction, I will, or one of my leaders, [PII] is my supervisor. I will um give you a call back. It'll be today, hopefully it'll be in a few minutes, but um I'll give you a call back to let you know which form to use and then um there was something else that I was sending to you, or was that it? Just the claim form?
[CUSTOMER][NEUTRAL] If you got
[CUSTOMER][NEUTRAL] U[PII]-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, I know your policy certificate, your breakdown.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh yes, OK.
[AGENT][POSITIVE] OK, so I will be giving you a call back shortly and I'm [PII]. I'm the only [PII] here. um, so if you do call back, it won't be hard to get to me, but I'll definitely be giving you a call back.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, [PII]. You're welcome and thanks for calling APL. I'll talk to you shortly.
[CUSTOMER][POSITIVE] Alright, thank you so much.
[CUSTOMER][POSITIVE] OK, thank you, ma'am.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Alright bye bye.