AccountId: 011433970860
ContactId: cdcf2ff9-afdb-4b91-b085-94466eb3d686
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 642359 ms
Total Talk Time (AGENT): 311199 ms
Total Talk Time (CUSTOMER): 239453 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/cdcf2ff9-afdb-4b91-b085-94466eb3d686_20250115T22:01_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] [PII], um, I have some questions about filing a claim.
[AGENT][POSITIVE] OK, yeah, I can definitely help you with filing a claim today and do you mind if I get your name and a good policy number?
[CUSTOMER][NEUTRAL] Yeah, so my name is uh [PII].
[AGENT][NEUTRAL] OK, and do you have your policy number handy, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] But yeah, I'm sorry.
[CUSTOMER][NEUTRAL] OK, I'm trying to get back into that screen so I can see it. Let's do this. OK, so the
[CUSTOMER][NEUTRAL] Policy number is 236-5280.
[AGENT][NEUTRAL] Alright, give me a moment to get that pulled on up. While I'm pulling up that policy, do you mind if I go ahead and grab a quick callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And can you verify for me, please, your date of birth, sir?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect, thank you, thank you.
[AGENT][NEUTRAL] All right. And then,
[AGENT][NEUTRAL] I just need to verify with you your mailing address.
[CUSTOMER][NEUTRAL] [PII]. The last year.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And just uh two more things or no I'm sorry, one more thing is that email address on file if you can.
[CUSTOMER][NEUTRAL] Uh, should be [PII]. So you need to find out.
[AGENT][POSITIVE] Perfect, thank you. And I have that phone number matching the one you just gave me, so we're perfect there. So, as far as submitting a claim goes for your critical illness policy, um, we do have a couple options. I think the most convenient one is going to be using our online service center to
[CUSTOMER][NEUTRAL] Yeah, I'm on, I'm on the, uh, the, the, the, the website right now. I need to find out if I just need.
[CUSTOMER][NEUTRAL] So last year,
[CUSTOMER][NEUTRAL] We have for my wife, uh, a critical illness that was done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, looks like [PII], so, so you had another one later in the year, right?
[CUSTOMER][NEUTRAL] I don't know what that was.
[CUSTOMER][NEUTRAL] Oh, OK. Can, so she's for last year. OK, so, um, she had a breast, uh, bilateral done in October and a CT lung screening in December.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] And a mammogram done in in February.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so can you, can you check those against what we put claims on for her already?
[AGENT][NEUTRAL] Yeah, so I am seeing the mammogram claim came through and it looks like I had a benefit payable of $200 under that wellness, um, and diagnostic benefit. Um, unfortunately that wellness and diagnostic benefit is only available once per calendar year, and it looks like it had been.
[AGENT][NEGATIVE] Met for that calendar year, so it wasn't able to be paid out again.
[CUSTOMER][NEUTRAL] OK, so the 200 that was done in, uh, the beginning of the year, did, did we ever get a money check for that, [PII]? Yeah, it's a calendar year, I guess, yeah, you said it was a calendar year.
[AGENT][POSITIVE] Yes, a calendar year benefit.
[CUSTOMER][NEUTRAL] January to December.
[AGENT][NEUTRAL] [PII], yes.
[CUSTOMER][NEUTRAL] OK. All right. So what about the CT lung screening?
[AGENT][NEGATIVE] So the CT is not a covered, um, it says not covered, so it's just not a covered.
[AGENT][POSITIVE] Um, benefits.
[CUSTOMER][NEUTRAL] OK, what about the mammogram?
[AGENT][NEUTRAL] The mammogram paid the $200.
[CUSTOMER][NEUTRAL] Oh, that was 200. OK. And the ultrasound?
[AGENT][NEUTRAL] The ultrasound, um, it didn't pay out because you'd already used that screening benefit with the mammogram.
[CUSTOMER][NEUTRAL] Right, OK, that's right. You can only use one. OK, so I had surgery done in December and they had uh uh MRI done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So how do I go about filing that for me?
[AGENT][NEUTRAL] OK, yeah, as far as the wellness thing goes, um, did you say you had that online service center you were in there?
[CUSTOMER][NEUTRAL] I mean it right now so you're finding a came for who for me and then continue.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Perfect. So there is for that wellness one, you can just hit file a wellness claim and you, it's just gonna ask you like 4 questions like where you went, when you went, their phone number, um, and I think maybe the location.
[CUSTOMER][NEUTRAL] Alright, so, so the MRI I can have, uh, the MRI I can have covered for me then, right?
[AGENT][NEUTRAL] So let me pull it up. um, every policy is a little different, so let me pull up your policy benefits and see if the MRI is listed as a covered benefit under your wellness.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] What kind of shows my group accident is lapsed.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] But my critical is active.
[CUSTOMER][NEUTRAL] I just saw that on here. It says group accident, which is 236-52229 says it's lapsed.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] On that one, I am showing.
[AGENT][NEUTRAL] That we got a laps date on it. It looks like it was added electronically.
[CUSTOMER][NEUTRAL] But I pay, I pay, I pay monthly for both. I, but that was my understanding that how, how much I paid was for both of them. Why would I, why would one lapse and not the and not the other?
[CUSTOMER][NEUTRAL] It's, it's automatically paid.
[AGENT][NEUTRAL] You might check with your employer that they are still um like on their end what they have.
[CUSTOMER][NEUTRAL] No, no, I'm retired. I'm retired. I'm retired.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I've been retired for a year.
[CUSTOMER][NEUTRAL] And I don't, I don't go through my employer. I pay it myself and I had it set up before I left, um, like probably 3 months before I left, um.
[CUSTOMER][NEGATIVE] And it's been set up on auto payment ever since, so I don't understand why, why it would have lapsed.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] Yeah, I'm so sorry. I have this accident policy. It still looks like it was set to pay from your employer, is like what it has on this side, um, but let me just look into it further.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] If that's all we can do, I mean, I don't know.
[CUSTOMER][NEUTRAL] If something bad happened, I guess it would be good, but otherwise getting that $200 doesn't cover what we spend on paying.
[AGENT][NEUTRAL] OK, I'm not sure about that accident policy, but what I'm gonna do is I'm gonna follow up on that. Let me try to help work on this wellness benefit for you real fast. So, I'm looking at your schedule of benefits on your policy document. It looks like that mammogram, gramma fee um covers the $200. Um, there's also a health benefit a health screening benefit um that can pay up to $50.
[CUSTOMER][NEUTRAL] Let me try to
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and so I'm trying to find out what that health screening benefit covers. It just shows an outpatient basis rendered by a physician, a wellness test, a routine physical exam, or any generally medically accepted screening test received as an outpatient and used to evaluate the risk or promote prevention of a covered condition.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it doesn't have a list of particular tests that are covered um and so as far as you said you had a CT scan?
[CUSTOMER][NEUTRAL] Well, for my wife, there was a breast, um, bilateral ultrasound done in October. OK, so for me I had an MRI done because I had a shoulder surgery.
[AGENT][NEUTRAL] OK, so it looks like it needs to be done on a preventative basis, but I'd still say submit a claim. I think it's always smarter to submit a claim and have it end up not going through than to not submit a claim that could be um.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] You know what I mean, that could be paid out, but it, it looks like, um, so.
[CUSTOMER][NEUTRAL] No, yeah, I know. I mean, yeah, send it through and if, and if, uh, they, if they could take it great if they don't, and then OK.
[AGENT][NEUTRAL] Yeah, it happens. You know what, but you know if they don't take it that the next time you have a wellness visit, you still have that benefit available too. And so I would say, um, we're on the online service center, you don't even need a claim form, um, for that wellness benefit. You just enter in where you went, the date you went. I think it's their phone number and their address and it's like just those four questions and you hit submit and they'll call and double check, um, the information and then they'll move on from there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, so I had to put in the.
[CUSTOMER][NEUTRAL] OK, so I put in the service date. I put in uh the doctor's name, uh his contact number, and it says select the wellness screening test, so I just put in there what it was. OK, I can do that.
[AGENT][POSITIVE] Perfect, yeah, and then it's pretty quick and easy and then I did want to update you because I did give you the wrong information, but that mammography is only available as a benefit every 2 years instead of every calendar year. That one resets every 2 calendar years.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] Yeah, you know what, now that you mentioned that, I, I think that's right, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, if you can look into the other, the other plan that is why it's slapsed and then call me back that'd be great.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] You bet you I'm actually gonna send a request um for one of our customer service teams um that works with uh like lapsing the policies to look into it and to provide some feedback for us and either one of them will give you a call back or I'll give you a call back OK?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Hey, it's my pleasure. Thank you so much, Mr. [PII], and you have a wonderful day.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.
[AGENT][NEUTRAL] Bye bye.