AccountId: 011433970860
ContactId: d43852aa-db73-4b30-8bfa-d6bf8d9bd9b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 908869 ms
Total Talk Time (AGENT): 374741 ms
Total Talk Time (CUSTOMER): 407790 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/d43852aa-db73-4b30-8bfa-d6bf8d9bd9b1_20250519T15:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Actually, this is [PII] and um
[CUSTOMER][NEUTRAL] I, uh, have a, uh, APL cancer policy with uh.
[CUSTOMER][NEUTRAL] My school that I work for, and someone told me that I was eligible if I had had a colonoscopy that I could get credit for it and the same thing with my wife, she's had a mammogram and stuff, and I wasn't sure how to do that. Uh, can you help me with questions on this?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Sure, I can help you with uh with all of your benefits. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and I'm [PII].
[AGENT][NEUTRAL] And what's your policy number?
[CUSTOMER][NEUTRAL] Um, policy number is 02532534.
[AGENT][NEUTRAL] Alright, let me look that up for you.
[CUSTOMER][POSITIVE] And the policyholders prosper ISD.
[AGENT][NEUTRAL] OK, can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] I'm old. [PII].
[AGENT][POSITIVE] Thank you so much and your mailing address and phone number.
[CUSTOMER][NEUTRAL] [PII], and my cell is [PII] and that's what I'm calling you on now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you wanted to check and see if mammograms and colonoscopies were covered? Is, am I correct?
[CUSTOMER][NEUTRAL] Yeah, she said that, well, I have my information. I don't quite have everything on my wife's yet. Um but like I've had a, a colonoscopy [PII], and I have, I was under Humana, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, I have, uh, Medicare under Advantage plan. Human and I had like a summary on it and it has the er the date that I had it and uh the code and stuff, and is that all I need to turn in.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] So you on your claim form, it'll tell you everything you need um and I can go over that with you in just a second. Um, I'm pulling up the benefits right now and then I can help you with that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think she said it was something like 50 bucks that I'd get back for for having it.
[AGENT][NEUTRAL] So you
[AGENT][NEUTRAL] OK, let me check so mammograms and colonoscopies are covered under this policy, um, let me look and see.
[AGENT][NEUTRAL] About dollar amount and this is a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, both of those are parts that are covered on here um let me double check and see.
[AGENT][NEUTRAL] So that was correct. Um, the diagnostic testing.
[AGENT][NEUTRAL] Is a maximum of 1 test per covered person per calendar year, uh, which means for each of you, you each have a maximum of 1 test per calendar year and the benefit amount uh they were correct, it's up to $50.
[CUSTOMER][NEUTRAL] The calendar year, um, I've had this policy with my school for I think at least 2 years, um.
[CUSTOMER][NEUTRAL] And um I had this colonoscopy on [PII]. When is there, is there a problem with the date on that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] of last year.
[CUSTOMER][NEUTRAL] Of [PII] correct.
[AGENT][NEUTRAL] Right, um.
[AGENT][NEUTRAL] Yeah, because I'm seeing that your policy was active.
[AGENT][NEUTRAL] Starting with an effective date of [PII], give me just one second, um.
[CUSTOMER][NEUTRAL] But I also had it in [PII].
[AGENT][NEUTRAL] OK, so it looks.
[CUSTOMER][NEUTRAL] It just it just renews every year.
[AGENT][NEUTRAL] Right, and so with that one, because it was a different policy number and I am showing that you were.
[AGENT][NEUTRAL] Covered on that one. Give me just a second so I can pull that one up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so because that was a different policy, uh, let me double check and make sure that the policy benefit that I, I stated earlier is still correct, um, because if anything changes within a policy you're given a different policy number um so the important thing is that we file it under the correct policy number um because of the effective date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and I'm just gonna double check and make sure that everything I told you from the policy you currently have.
[AGENT][NEUTRAL] It's still in play.
[AGENT][NEUTRAL] So give me a moment while I look that up because if it is covered under this new policy and I can give you that policy number in just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you will file it under that policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I have to use an appropriate claim form or something.
[AGENT][NEUTRAL] Right, and I can give you that claim form um it is on our website if you would like I can email that to you as well. Would you prefer me to email you?
[CUSTOMER][NEUTRAL] Um, I have you.
[CUSTOMER][NEUTRAL] I have your website here um and this is uh supplemental insurance APL Public life I can hit on it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claims and forms.
[CUSTOMER][NEUTRAL] I need to sign in, I guess, sign in.
[AGENT][NEUTRAL] Do you have, do you know if you set up an online portal with us?
[CUSTOMER][NEUTRAL] I do. I, I'm, I'm on it right now. The online service center coming soon don't show again, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My ID cards sample. I don't know that I have one.
[AGENT][NEUTRAL] So you might not have an ID card with this one.
[CUSTOMER][NEUTRAL] And shows group cancer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it shows, uh, [PII] for both my wife and I, it says lapsed. [PII] it says lapsed and [PII] it says active.
[AGENT][NEUTRAL] Right. And it looked.
[CUSTOMER][NEUTRAL] And the policy numbers do look like they may have changed.
[AGENT][NEUTRAL] Right, so for this one, so for your colonoscopy, the everything that I stated earlier, um, the benefit amount of $50 per calendar year for mammograms and colonoscopies, uh, one.
[AGENT][NEUTRAL] One test max per calendar year per person, um, and it's still that $50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I can give you the, for your colonoscopy, I can give you the policy number for that.
[CUSTOMER][NEUTRAL] OK, so I need
[CUSTOMER][NEUTRAL] Is it 24
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 241-0368
[AGENT][NEUTRAL] Yes, sir. So you will want to file it under that, that policy.
[AGENT][NEUTRAL] And then you should be covered for that up to $50. Again, that is just the verification of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on that claim form it should have everything that you need so we'll need um any explanation of benefits you have an itemized bill uh you might need procedure codes on those.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Well how do you manage it.
[CUSTOMER][NEUTRAL] My Medicare Advantage plan was through Humana, and Humana gave me a, uh, every month they gave me a readout of where I, where I stand in terms of procedures and prescriptions and everything, and it, it shows my doctor and what he billed and it shows the procedure. I think it says preventative.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] This is colorectal cancer screening, colonoscopy on individual at high risk, I guess because of my age.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it has a a service date and a claim number, and it has a, a code, it has reason code 16/.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] Yeah, you'll want to send that one in.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] And in addition to the claim form that I'm gonna fill out that you're gonna help me find.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then was her
[CUSTOMER][NEUTRAL] So what do I do? I hit on.
[AGENT][NEUTRAL] Oh, yes.
[CUSTOMER][NEUTRAL] Well, I don't have my wife's information yet. I'm still waiting on to get, I get that from the doctor, um, but I do have mine. So what do I do to find the claim I hit on this 241-0368 policy number and it should, should, uh, take me to the appropriate claim forms, or does it go do I go somewhere different?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm online right now.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] You will want to download the claim form from the [PII] because I don't believe the claim forms are in your portal.
[CUSTOMER][NEUTRAL] On your portal.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so X out all this.
[AGENT][NEUTRAL] And you will need to sign it.
[CUSTOMER][NEUTRAL] OK, so not, don't go there in public life. I go to what? Tell me that designation again.
[AGENT][NEUTRAL] Yes, you, you will go to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, that's where I just was to sign in again, OK.
[AGENT][NEUTRAL] OK, no, you don't need to sign in uh right in that same area where it says claims and forms.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] It's right at
[CUSTOMER][NEUTRAL] Have claim forms.
[AGENT][NEUTRAL] Claims and forms right on the.
[CUSTOMER][NEUTRAL] In top left.
[CUSTOMER][NEUTRAL] Or claims and forms.
[AGENT][NEUTRAL] Yes, and then it should give you a list of all the creams. Mhm.
[CUSTOMER][NEUTRAL] We got it file a claiming.
[CUSTOMER][NEUTRAL] Well, it's a general thing. A claim author cancer claim form is that the one I want the details? No, no, it wouldn't be cancer, I guess it would be cancer claim form, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] Right, because it's a it's your cancer policy.
[CUSTOMER][NEGATIVE] OK, oops, messed up.
[CUSTOMER][NEUTRAL] Yes they're quite high detailed cancer.
[CUSTOMER][NEUTRAL] Where's the change request forms I guess I hit on that, right?
[CUSTOMER][NEGATIVE] No, it won't let me do that download the form.
[AGENT][NEUTRAL] No, it's right above it.
[AGENT][NEUTRAL] Cancer claim form.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it should only be.
[CUSTOMER][NEUTRAL] Download the form to the right, to the right, looks like download, let me see what it tells me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] An claim form. File claims using the online service center for faster payments, claim status updates, direct deposits, and more sign up or log in now.
[CUSTOMER][NEUTRAL] That's not it probably is it?
[AGENT][NEUTRAL] Right and then it'll show you the instructions for the claim form.
[CUSTOMER][NEUTRAL] Maybe it's a 2nd
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think I see the form. It doesn't have a number on it or anything. It says, uh, CL form cancer 1222.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, page 1, page 23, page 4.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I just need to download. Well, looks like there's also page 4 something to fill out.
[AGENT][NEUTRAL] Right, and page 4, is where you will give your policy number and you will eventually need to sign it and um
[AGENT][NEUTRAL] You want to make sure that you get that signed when you turn it in because we can't, we will deny the claim if it's not signed and then if we deny the claim because it's not signed, all that means is that we'll need you to send it in with a signature um and then we'll reprocess it but it's important to to.
[CUSTOMER][NEUTRAL] Can I just sign it? Can I, can I download the form, print it and then sign it and then scan it again and and email it back?
[CUSTOMER][NEUTRAL] Is that possible or do I have to mail it?
[AGENT][POSITIVE] Yes, you should
[AGENT][NEUTRAL] Uh, you should be able to upload it. So if you scan it in, you should be able to upload it through your, um, your online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But yeah, you will need to print it out because you do need to sign it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, a lot of trouble for $50.
[CUSTOMER][NEUTRAL] Palpitations on local transportation begin data travel, none of that really applies to it doesn't.
[AGENT][NEUTRAL] Right. You, you shouldn't need to fill out C. Um, you'll just fill out uh section A.
[AGENT][NEUTRAL] And B, um, and you'll need a separate one for your wife as well, depending on when hers was, but for yours, you'll fill out section A and B. It says section D, but all that is is asking you to read um the the fraud statements, but there's nothing to actually fill out. And then the very bottom at in section E is where you will print it and sign it.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now do I need to submit all 4 pages back again, or can I just submit the appropriate page which is page 4 and.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Page 2 and 4.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, you can just send them page 2 and 4, right. And then uh everything that you, you stated earlier talking about um
[CUSTOMER][NEUTRAL] Is that all right, just those two pages.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The itemized bill or invoice, or I'm sorry, the item uh bill, and then you the um major medical that you had, um, that explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah I'll just go ahead and uh send it as an attachment. I'll just send all three pages to.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and just be, just be sure to put the appropriate 241-0368 policy number.
[AGENT][NEUTRAL] Right for that for for your colonoscopy, yes.
[CUSTOMER][NEUTRAL] Right, OK, and if I have questions when I can get my wife's mammogram and stuff, I'll, I'll call back and make sure I've used it that should be, uh, this calendar here.
[CUSTOMER][NEUTRAL] So I need the policy that I currently have. OK, thank you, [PII], right?
[AGENT][NEUTRAL] Yes, sir. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, I just wanted to say thank you very much for trying for helping me and uh navigating me where to find the form and and what to do so I appreciate that a whole lot. thank you.
[AGENT][POSITIVE] Anytime, anytime. Thank you so much for calling ATL and I hope you have a great day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yes you too thank you now right bye.
[AGENT][NEUTRAL] Alright bye.