AccountId: 011433970860
ContactId: cb00f0db-5346-47cf-8f57-13d52ff91a25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 999859 ms
Total Talk Time (AGENT): 477207 ms
Total Talk Time (CUSTOMER): 456064 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/cb00f0db-5346-47cf-8f57-13d52ff91a25_20250114T21:20_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am, Miss [PII], my name is [PII].
[CUSTOMER][NEUTRAL] I am um new to this process, so I do need some help.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I'm from Grapeland Independent School District.
[CUSTOMER][NEUTRAL] I do have a policy, um, with disability, cancer, heart, and, uh.
[CUSTOMER][NEUTRAL] Critical
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Like critical illness?
[CUSTOMER][NEUTRAL] Yes ma'am, our critical um.
[CUSTOMER][NEUTRAL] I think they want like with hospital stay.
[AGENT][NEUTRAL] Oh, like hostel indemnity?
[CUSTOMER][NEUTRAL] Chris
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm not sure, but I can look it up for you. What's what's going on with the
[CUSTOMER][POSITIVE] Yeah, if you don't mind I'd appreciate it.
[AGENT][NEUTRAL] I don't mind.
[AGENT][NEUTRAL] Sure. Um, and [PII], may I have a good contact number in case we're disconnected and then the policy number, um, for whichever policy you like to work with?
[CUSTOMER][NEUTRAL] OK, I don't have that in front of me. If I said I need to look up first and then call you, that's fine if it's where you can get it. I'd appreciate it whichever way.
[AGENT][NEUTRAL] What, the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK. Well, if you don't have it, I can look it up with, um, I can look your policy up with your social, um, your first and last name.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Yes, OK, so my phone number is [PII].
[CUSTOMER][NEUTRAL] [PII] that's a land base line.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] But my cell phone number is [PII] and that's probably the best number even though I've used the landline.
[AGENT][NEUTRAL] OK, and then um I can look at your policy up um with your social if you'd like.
[CUSTOMER][NEUTRAL] OK, uh, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then were you trying to file a claim or?
[CUSTOMER][POSITIVE] Yes ma'am, I'm trying to start one yes ma'am.
[AGENT][NEUTRAL] OK. For your disability or one of your other policies?
[CUSTOMER][NEUTRAL] Well, that's what I'm saying. What happened was [PII], um, I had a situation where I had to go to the emergency room. When I got to the emergency room, they discovered that I pretty much had uterine cancer. And so then that started a series of events that leads me to [PII], which was when I had my surgery, and then since then, I've been off work and I've been home.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that's kind of what's taking place in a short amount of time but very fast.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, well, I can definitely assist you. I have the policy here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Alright, [PII].
[CUSTOMER][NEUTRAL] Um, what my address [PII].
[AGENT][NEUTRAL] And then your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty, and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. So, um, let me go to all your policies. OK, so the only policy that you have with us is the cancer policy. Now, um, you said you've never filed a claim before, right?
[CUSTOMER][NEUTRAL] Well, not, not with y'all and not with uh this type of situation, no, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, if you like, I can send you a copy of like your breakdown, but you have several benefits depending on what services you received. Um, there is, for an example, like the first occurrence benefit, um,
[AGENT][NEUTRAL] Which would pay the, the first, OK. So the policy um could pay up to $5000 to you as a lump sum benefit um for a positive diagnosis of um cancer, and we would just need the pathology report.
[CUSTOMER][NEUTRAL] That's what this is.
[CUSTOMER][NEUTRAL] OK, I will be going to see my surgeon on Friday.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Those are things I need to ask them to give me for that or how, how does this work? I guess it's the best way to ask.
[AGENT][NEUTRAL] Well, there's two ways. So like if you're wanting to outside of the first occurrence, I would
[AGENT][NEUTRAL] Uh, have your provider file the claims, and the only reason I'm saying that is because first occurrence comes to you. Um, if it's something to wear like a surgery or treatment, then I would have the provider file that because it's just paperwork that that you don't have to try to get together. Um, but if you'd like, you do have the option to file all the claims on your own. Um, I would just give the provider, you would just give them this policy number.
[AGENT][POSITIVE] And our phone number and they'll call us to verify the benefits, just let them know you have a secondary or you have an additional cancer policy and they'll begin to bill us so that you don't have to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so alright, so my policy number is what?
[AGENT][NEUTRAL] It is 252.
[CUSTOMER][NEUTRAL] 252
[AGENT][NEUTRAL] 5083.
[CUSTOMER][NEUTRAL] 50.
[CUSTOMER][NEUTRAL] 83.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and this is strictly the cancer policy.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Now, along with it, you also have, um, hold on, I'm trying to get back to the top. Hold on one second.
[AGENT][NEUTRAL] Um, you also have the first occurrence, like we mentioned, um, you had the heart attack and stroke coverage. Um,
[AGENT][NEUTRAL] On, on this within this policy.
[CUSTOMER][NEUTRAL] OK, so here's, here's kind of my story. It's been a very strange story.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yes I did have so.
[CUSTOMER][NEUTRAL] Um, like I said, they immediately, when I went into the, um, ergency room, they did CAT scans and all that stuff. That's when they discovered that I need to go ahead and move on to see a, you know, gynecologist. And she did a biopsy which confirmed that there was the cancer and then she sent me to a, uh, oncologist, OK? Meanwhile, uh, my primary started doing all the things so that they could do the surgery.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And discovered my blood sugar was too high, they discovered that I had possibly even had a heart attack. And I called them back and I said, what are you talking about?
[CUSTOMER][NEUTRAL] I mean, I was like, what in the world? And they told me, they said, you, they had me do an EK EKG. Then they followed it up with an echo, and then they had me go and see a, uh, cardiologist cause all this was trying to get me approved so I could have the surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so anyway, I did go see the cardiologist and he told me he says we're gonna put you on medication and he says we will see you next year unless there's something and meanwhile, everything's been doing good so that with the heart policy, is there something there that I should be doing as well?
[AGENT][NEUTRAL] Mm, let's see, intensive care.
[CUSTOMER][NEUTRAL] Since you mentioned that, that's why I thought, well,
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] OK. Hold on one moment. I'm just going through the
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] This is.
[AGENT][NEUTRAL] No, um, so this is just in the event that there is, um,
[AGENT][NEUTRAL] That there was a heart attack if there's, if they have um
[AGENT][NEUTRAL] Not really a pathology report for that, but just the the document showing that there was a heart attack, then you could take advantage of that um benefit as well. Um, I'm trying to see if it's a different.
[CUSTOMER][NEUTRAL] Well they're showing that there was one.
[CUSTOMER][NEUTRAL] But that's my primary versus my oncologist.
[AGENT][NEUTRAL] Oh, well, no, it doesn't, um.
[AGENT][NEUTRAL] It doesn't matter who who the doctor was, it's just if a heart attack or stroke does occur, um, the lump sum benefit for this policy is $2500. Um, so I would, I would do a few things. First, um,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] I would decide if you want to file the claims for yourself or if you want the provider to file it. If you want, um,
[AGENT][NEUTRAL] Outside of the
[CUSTOMER][POSITIVE] I think it makes more sense for the provider to do it right.
[AGENT][NEUTRAL] Right. Outside of the um internal cancer and the heart attack, I would just go ahead and let the provider file the rest because you have benefits, you have surgical benefits, you have diagnostic testing benefits, imaging, um, so that's just my suggestion. And then for the two that come to you, have, you know, go ahead and file that and have those, uh, unless you want it to go.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[CUSTOMER][NEUTRAL] OK, so this seat I have here is APL claim department, which is who I'm talking to, this is over the cancer.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, we have your cancer policy. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so then down here where it says like the disability part of it.
[CUSTOMER][NEUTRAL] Is that y'all too?
[AGENT][NEUTRAL] Let me see what um er sorry, what policies you have with us. So with APL you only have the cancer policy. So, um, for the benefit, um sorry, benefit for the um
[AGENT][NEUTRAL] My mind just went blank. For the disability benefit, I will reach out to the benefits department to see who
[AGENT][NEUTRAL] Services you offer for disability.
[CUSTOMER][NEUTRAL] Alright, so I need to go back to my school for that?
[AGENT][NEUTRAL] I don't know if you need to go up to the school, just call like your whoever your HR.
[CUSTOMER][NEUTRAL] So that's what I'm saying. I need to contact our school, our human resources.
[AGENT][NEUTRAL] Oh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][POSITIVE] Because they'll be able to tell you, you know, how you choose from your benefits from enrollment, they'll be able to tell you who serves you all for the um other products.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][POSITIVE] Got you. OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Well, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] OK, so your name is [PII]. My cancer policy is 252-508-3. I want to talk to my provider and let her file the claim, which would be my doctor [PII], which is the cancer doctor.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I would do
[CUSTOMER][NEUTRAL] Or her department.
[AGENT][NEUTRAL] You can do cancer and then for the primary care with the heart attack, they would still need this um policy number because the benefit is on the cancer p[PII].
[CUSTOMER][NEUTRAL] OK, and then primary care to address the heart attack.
[CUSTOMER][NEUTRAL] OK, um, question.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That first occurrence you don't do that if the provider is taking care of everything.
[CUSTOMER][NEUTRAL] That first occurrence 5000.
[AGENT][NEUTRAL] Mhm. You don't do that if the provider is taking care of everything. What do you mean? You don't file for it?
[CUSTOMER][NEUTRAL] Like I don't do that right? Or do I do that and the provider does it but if I let the provider do it I don't have to do the first occurrence.
[AGENT][NEUTRAL] No, no, no, no, I'm
[AGENT][NEUTRAL] I don't know that I would, for the first occurrence and the heart attack, I will handle those two and let your provider handle everything else.
[CUSTOMER][NEUTRAL] OK, so alright, but
[AGENT][NEUTRAL] Because those two are coming to you.
[CUSTOMER][NEUTRAL] OK, so the first occurrence I should let my primary care take care of that and then the provider.
[CUSTOMER][NEUTRAL] OK, I think this is where I got confused. You told me there were two options the provider could fill out the claim or I could fill out the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, if I don't fill out the claim I'm just handing this over to the provider to take care of it.
[AGENT][NEUTRAL] Right, if you don't have, if you're not filing the claim, you're giving the provider this policy number and our phone number and then they'll begin to bill us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, I got you and then what I'm entitled to is.
[CUSTOMER][NEUTRAL] That first occurrence plus whatever due to all of the things that's taking place, right?
[AGENT][NEUTRAL] Mhm. You have an internal cancer first occurrence and then you have the heart attack and stroke first occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I got you, OK, alright, and then I give my primary care this for them to address the heart attack part of it.
[AGENT][NEUTRAL] You can, but I kind of feel the same way. now this is to your discretion. I'm just giving, OK, so for me, I would, I would, for the heart attack and the cancer first occurrence, I would just file those on my own.
[CUSTOMER][NEUTRAL] I understand, yes ma'am.
[AGENT][NEUTRAL] Just those two.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And I say that because that's what, 7500, yeah, $5000 and then $2000 yeah. So between the two, that's like $7500 that would be coming to you. So I would just, just because there was a positive diagnosis, so I would go, I would file those myself and then for the treatments and the testing and all of that, I would just give that to the doctor and have them do it.
[CUSTOMER][NEUTRAL] OK, and so all of this is still under the policy number of the cancer policy?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, all right, and uh.
[CUSTOMER][NEUTRAL] So this claim form that I have right here.
[CUSTOMER][NEUTRAL] It just wants name, Social Security policy, street name, all of that business. It says, is this claim to an accident? No, uh, describe the illness.
[CUSTOMER][NEUTRAL] This is like, OK, the pathology report is claim is due to cancer and that I'm gonna fill out is that's something I'm gonna give y'all as well if I do it myself.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, that claimant form you'll send in, so you'll always need the claim form, um, and then like if you're proven a diagnosis, the pathology report, and then the billing.
[CUSTOMER][NEUTRAL] OK, and then like I was hospitalized short time but hospitalized, and with that, um, is there a, maybe that's what I meant was a critical illness?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Critical illness.
[CUSTOMER][NEUTRAL] If you're looking at my stuff.
[AGENT][NEUTRAL] Not really critical illness. There's a hospital intensive care.
[CUSTOMER][NEUTRAL] Oh, OK, OK, so that was only if you were in [PII]?
[AGENT][NEUTRAL] Yes, ma'am, for that one, because that pays like per day if you're in an intensive care unit and then like if you go to an acute care, step down, it'll decrease.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK alright and then.
[CUSTOMER][NEUTRAL] Name of the attending physicians and then um here it says for disability claims only date you stopped working due to disability and date you'll return to work.
[CUSTOMER][NEUTRAL] So I just say like, I came home and I, they went back to school on
[CUSTOMER][NEUTRAL] [PII] and so then I have not returned yet. I'll see her on Friday and find out at that point in time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, so then yes, I would just put um.
[AGENT][NEUTRAL] The day that you
[AGENT][NEUTRAL] The, the, the last day worked.
[AGENT][NEUTRAL] And then for the anticipated return to work, that I would just put to be determined or, you know, because you're not sure yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and so my disability policy, do you see that?
[CUSTOMER][NEUTRAL] Or you don't see that.
[AGENT][NEUTRAL] Um, no, I don't see the disability policy, only the cancer.
[CUSTOMER][POSITIVE] OK, well, [PII], I really appreciate it thank you so much for your help.
[AGENT][POSITIVE] Well, you're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Not right now, but I appreciate it. I may be calling back, OK.
[AGENT][NEUTRAL] Well, if you need anything, definitely let us know, and again, all the information provided was a verification of benefits, not a guarantee of payment. And [PII], was there anything else I can help with?
[CUSTOMER][POSITIVE] I think I'm OK, thank you.
[AGENT][POSITIVE] All right. You're welcome. Thanks for calling [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Bye bye.