AccountId: 011433970860
ContactId: ccbb9c91-a048-4271-9f5e-af4e1971f3a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 793159 ms
Total Talk Time (AGENT): 375542 ms
Total Talk Time (CUSTOMER): 191697 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/ccbb9c91-a048-4271-9f5e-af4e1971f3a3_20250527T21:20_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I was calling to check the status of, uh, a recent claim.
[AGENT][NEUTRAL] OK. Are you the insured?
[CUSTOMER][NEUTRAL] I, yes, I'm the patient.
[AGENT][NEUTRAL] OK, and you're wanting
[AGENT][NEUTRAL] OK, and you're wanting to check claim status on a claim for yourself, is that correct?
[CUSTOMER][NEUTRAL] Yes, I, I received a letter that they, I think they said it was complete or may have been a text message.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, so I can help you and who am I speaking with?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, Mr. [PII]. What is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 406-88
[AGENT][NEUTRAL] OK, Mr. [PII], thank you. Give me a moment to get your information pulled up please.
[AGENT][NEUTRAL] And I will have to verify several things with you first, Mr. [PII] for security and any information that I provide for you will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me, so again that is the best contact number that we should have on file for you, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then lastly your email address and this does appear to be your work email email Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do see that there was a claim, um, Mr. [PII] that was processed on [PII].
[AGENT][NEUTRAL] For you
[AGENT][NEUTRAL] And that claim, the benefit amount paid is $5000 even.
[CUSTOMER][NEUTRAL] OK, can I ask you a question?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm, I'm currently taking chemotherapy. And so, um,
[CUSTOMER][NEUTRAL] Do I need to submit that all the way through?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir. You would need to file claims for those services separate from this because this was just your first occurrence benefit claim.
[AGENT][NEGATIVE] That this was paid, the $5000. That's not for any of your treatment. That's just the first occurrence benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Um, so I need to.
[CUSTOMER][NEUTRAL] File a new claim for all my chemotherapy.
[AGENT][NEUTRAL] Yes, sir, you would, uh-huh.
[AGENT][NEUTRAL] And do you still
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] To have the claim form.
[CUSTOMER][POSITIVE] Um, yeah, yes, I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I have
[CUSTOMER][NEUTRAL] I have several of those, I think.
[CUSTOMER][NEUTRAL] I I see a blank one here.
[CUSTOMER][NEUTRAL] Um, so I can just make copies of that and then
[CUSTOMER][NEUTRAL] Um, I'm assuming so.
[CUSTOMER][NEUTRAL] I have an ostomy where it's for the small intestine comes out.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so that's gonna be another surgery.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And so I assume I could file a claim for that also.
[AGENT][NEUTRAL] Yes, sir. Now, on this policy, your benefits for surgery is a $25.
[AGENT][NEUTRAL] Benefit
[AGENT][NEUTRAL] On this, this policy, but yes, sir, for, for each thing you have done and for your chemo and your radiation, yes sir, you would need to file the claims and so and the on the claim form that you have, Mr. [PII] on page one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It should be
[AGENT][NEUTRAL] An ins basically an entire page of instructions.
[AGENT][NEUTRAL] Is that what you're, does it say cancer claim form at the top?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] No, can you resend that to me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So give me just a moment then. Let me um.
[AGENT][NEUTRAL] And I know that you're already set up on the online service center, Mr. [PII], but did you ever receive the user guide?
[CUSTOMER][NEUTRAL] I think so. I just have trouble logging in. I, I can't remember what my login and password are, so that's why I call plus I like to talk to someone.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh well that's perfectly fine now um.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I just wanted to make sure that you and we can provide you your user name if you don't remember that but as far as the password you would just have to reset your password because we do not have access to that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yeah, if you could do that, that would be great.
[AGENT][POSITIVE] OK, I can provide you that in just a moment. I'm gonna send you this.
[AGENT][NEUTRAL] I'm gonna email you the claim form.
[AGENT][NEUTRAL] So give me just a second to do that.
[AGENT][NEUTRAL] And I'm just gonna go ahead and attach that user guide again now I do wanna let you know Mr. [PII], that they, um, we're having some changes to the portal that are being made so when you get ready to log in, I believe those are gonna be rolled out tomorrow it's gonna prompt you to have to do some things again so you would just follow the steps all of that would be.
[AGENT][NEUTRAL] There.
[AGENT][NEUTRAL] And should be self-explanatory. Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the email that I'm sending to you will come from [PII] team at [PII] and I did put APL and cancer claim form.
[AGENT][NEUTRAL] In the subject line for you. Oh, you're welcome, but it will have those two attachments instead of just the cancer claim form.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, and then give me just a moment and I'll be happy to get you your username for the portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the username that's currently assigned, Mr. [PII] is [PII].
[AGENT][NEUTRAL] 837.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir. The only capital letter is that first [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have another question. I don't know if you can answer this.
[CUSTOMER][NEUTRAL] Of the benefits of the $5000 that they're sending me, what, what, um, what does that fall under?
[CUSTOMER][NEUTRAL] What category on my insurance benefits?
[AGENT][NEUTRAL] That's the $5000 as your first occurrence benefit.
[CUSTOMER][NEUTRAL] Does it yeah.
[AGENT][NEUTRAL] And then you have separate benefits for your chemo for other things. For example, your, your radiation, chemotherapy and immunotherapy benefit, that's a maximum per covered person per 12-month period of $15,000.
[CUSTOMER][NEUTRAL] Yes, I see that.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Um, so the, the 5000 is not a part of the 15,000, is it?
[AGENT][NEUTRAL] No, sir. That's, no, sir. That's, if you come on down in your policy certificate where it has first occurrence benefits, that's the one lump sum benefit that's payable once per lifetime.
[AGENT][NEUTRAL] That's what the 5000 was for.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Does it say first.
[CUSTOMER][NEGATIVE] Uh, I'm having trouble finding it.
[AGENT][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] It starts with first.
[AGENT][NEUTRAL] Are you in
[AGENT][NEUTRAL] If you're in your policy certificate, you would go to your schedule of benefits.
[AGENT][NEUTRAL] And it does, it is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So on the first page where it has schedule of benefits, it's gonna list the radiation, the chemotherapy benefit, that's the first one.
[AGENT][NEUTRAL] And if you come on and come on down just a little bit and then all bold capital letters it says first occurrence benefits.
[CUSTOMER][NEUTRAL] I see that.
[AGENT][NEUTRAL] Internal cancer first occurrence.
[CUSTOMER][NEUTRAL] Ok and
[AGENT][NEUTRAL] Lump sum benefit, 5000 maximum 1 per covered person per lifetime.
[CUSTOMER][NEUTRAL] OK, and, uh, I just have an old.
[CUSTOMER][POSITIVE] Um, it's not on there, so I, I'll look at it on, on, online. I appreciate your help.
[AGENT][NEUTRAL] Yes, if you
[AGENT][POSITIVE] Oh, well, you're very welcome. So is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] Um, you're just, you're gonna send me a, a tax form for all the money you've sent me, yes.
[CUSTOMER][NEUTRAL] For tax purposes?
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] That's what the last lady.
[AGENT][NEUTRAL] At the you for at the end of the tax year, let's see um OK let me know, sir, we don't send.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Tax forms, let's say for
[AGENT][NEUTRAL] Let me look on your policy.
[AGENT][POSITIVE] OK, so for the lump sum benefits, yes, you will.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they would be issued the same as any other tax document by the [PII] for the prior year.
[CUSTOMER][POSITIVE] All right. Thank you very much.
[AGENT][POSITIVE] That's not something. Yes, sir. Well, you're very welcome. So again, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. I appreciate your help.
[AGENT][POSITIVE] All right, well, you're very welcome and thank you for calling APL Mr. [PII]. I hope you have a nice evening.
[CUSTOMER][NEUTRAL] All right, you too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.