AccountId: 011433970860
ContactId: d9c94929-b808-4cfe-a56a-5782fe5ee789
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 973840 ms
Total Talk Time (AGENT): 349766 ms
Total Talk Time (CUSTOMER): 662708 ms
Interruptions: 10
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/d9c94929-b808-4cfe-a56a-5782fe5ee789_20250319T15:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning. This is [PII], and we recently got a copy of our policy book. Uh, let me go ahead and give you our policy number, uh, if that's OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] 0040
[CUSTOMER][NEUTRAL] 8307
[CUSTOMER][NEUTRAL] And we, we think we found out that we have more coverage on things than we.
[CUSTOMER][NEUTRAL] We, we were not even aware of some things. So here, here's my first question. On page 9 of the policy book, it lists specified diseases, means one of the following is definitely diagnosed and treated by a physician. So we were scanning through that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And my husband actually has had tuberculosis. So, on that page are those specified diseases, something that American public life covers when you get those.
[AGENT][NEUTRAL] Mhm. That's right. So for the specified diseases, did you receive a policy certificate?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, ma'am, that I, I had, uh, was sending in my mammogram, uh, things for several years. Um, I don't think we've had, unless I'm mistaken and we got one at some time, our house burned at one time and then we, we've moved several times. So I, I didn't have a policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] Uh, thing that I could, you know, look at. So the like, I called and they sent me one and got my, I got my policy number and everything because I didn't even have that. So what, what my question is, um, what is the time frame? Because it was like, um, we think 3 years ago when he got that diagnosis. So does he still fall in the category of being able to address that?
[AGENT][NEUTRAL] He certainly does. There's no time frame.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] To submit a claim.
[CUSTOMER][NEUTRAL] Alright, so where would I.
[CUSTOMER][NEUTRAL] Start. OK, let me back up a little bit. He had had prior to his diagnosis, several chest X-rays. Then he began to have fluid on his lungs, so he was admitted to um a hospital in [PII]. And after being there for 4 or 5 days, they finally diagnosed him with um tuberculosis, which is very rare in these days.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But anyway, he, he went through a series month long, months and months and months, 8 months of treatment for tuberculosis. So do you get just a one-time payment for the diagnosis of that? Um, or, or, or, I don't know where to start with, with getting the stuff together, so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let me pull up your, I'm gonna pull up your policy certificate and let's take a look and see now um excuse me, I apologize. Now on your, we do have a website if you ever want to create a login and password, you can actually.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yeah, I know. I just, I, I know. I, I, I hate doing that. I rather talk to a.
[AGENT][NEUTRAL] I'm not either.
[AGENT][NEUTRAL] I get you. See, I already did when you said that.
[CUSTOMER][NEUTRAL] I rather talk to a live body.
[AGENT][POSITIVE] I am so like you, Miss [PII]. I promise you. Um, I'm telling you after work when I get off this computer, if I have any business to do, it's on the phone.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah, I understand.
[AGENT][NEUTRAL] And, and I just feel like there's just so much you, you just need.
[AGENT][NEUTRAL] Explanation zone.
[CUSTOMER][NEGATIVE] needs help, yes, yeah, yeah. Probably I wouldn't have got what I needed on the computer with this my questions anyway. I still had to have called.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So let me, what I'm doing is I'm pulling up your exact policy certificate and I can request that they mail you a copy of your policy, a paper copy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I've got, I got it. That's why I said I they sent me one.
[AGENT][NEUTRAL] Is it a booklet or is it the policy certificate?
[CUSTOMER][NEUTRAL] I it's not a certificate. It is a booklet. It's, I don't know how many pages it is, but it's quite a few pages. I thought that was the policy. It says this is a limited benefit policy. That's on the first page. And then when you turn it, you've got page after page after page of, yes, ma'am. So I would, I would assume that is the policy.
[AGENT][POSITIVE] A benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then it's got American Life, um, like a the policy number, the effective date, the type of, uh, a sheet in there, um.
[CUSTOMER][NEUTRAL] You know, that's kind of the cover letter.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then, as you go through, it, it just benefits schedule. You know, I think that's the policy.
[AGENT][NEUTRAL] OK. Yeah, that sounds like it. I just, I wanted to make sure. But I do see tuberculosis is listed as a specified disease.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, it's number 28, 28 on.
[AGENT][POSITIVE] Yeah, you got it
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Yeah. OK. So what we'll need, there is a claim form. You don't have to sign in, but on our website at AMPublic, there is a cancer claim form.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] And you and it works for.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] For this, for this type of claim, yes, ma'am.
[CUSTOMER][NEUTRAL] OK. I would like to request that several be mailed to me because our printer does not always cooperate with our computer, if that is allowable, that you can mail me some.
[AGENT][POSITIVE] Absolutely, absolutely. We'll be happy to do that.
[CUSTOMER][NEUTRAL] Yes. And I'm gonna need several because when I also turned the page, I found that uh uh uh colonoscope, is that the same as when you have a colonoscopy?
[CUSTOMER][NEUTRAL] On page 10,
[AGENT][NEUTRAL] Now, colonoscopy is gonna be a little different.
[CUSTOMER][NEUTRAL] OK, so it may not be one that's covered because I have had a um
[CUSTOMER][NEUTRAL] Um, colonoscopy. I thought they used a colonoscope, you know, they, I don't know, I'm just asking. So, uh,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have had that. And he has had, I, I could just kick him because he has PSA tests all the time and never turns them in. In fact, he had one, this week. So because he's had prostate cancer. Um, so he might get a few of those together, but getting all this together is, is not easy because you've got to go back and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Find somebody that will give you the documents.
[AGENT][NEUTRAL] Now, now you know for the wellness, all he, all you have to do is complete a claim form.
[CUSTOMER][NEUTRAL] OK, and put what you have and it pays us, it pays a certain amount. Yes, that's what I did. That's what I did with my mammogram, OK.
[AGENT][POSITIVE] That's right.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] So we don't have to have the um any receipts or documentation for the PSA.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's, that's the
[CUSTOMER][NEUTRAL] But we have, but we have to, we have to show proof that he got it, so you have to get records from the doctor.
[AGENT][NEUTRAL] But before
[AGENT][NEUTRAL] No, ma'am, you just complete that form and it'll give the doctor's name and um
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] That's all you, there's no form that's the only thing we need for a wellness claim it's just that form completed.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So that makes it easier when he forgets.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, he, he just, we just don't, you know, we hadn't even looked at this book and I can't tell you when. So when I got it out to look through it, I'm thinking, [PII], uh,
[CUSTOMER][NEUTRAL] Tuberculosis is on this thing. So, OK, just, on it, go ahead.
[AGENT][NEUTRAL] Mhm. So what we'll need.
[AGENT][NEUTRAL] For the tuber I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] What I was gonna ask is what is covered if you have tuberculosis?
[AGENT][POSITIVE] I'm gonna get that benefit for you. Now, what we will need will be the pathology report or the, where they diagnosed him with tuberculosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I can prob maybe get that from the hospital that they did the pathology.
[CUSTOMER][NEUTRAL] And uh they had to send it off to one of the, I think Lady of the lake or one of the hospitals in [PII]. So, uh, but I'm sure [PII], where he was, um, staying, got the pathology report. So I can I can call records at [PII] and see if they can help me get some of this. So, OK, I got the pathology report. So what else will you need for that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I did my spill from the hospital when he was there.
[CUSTOMER][NEUTRAL] OK. Say that again. The what?
[AGENT][NEUTRAL] So, for the specified disease benefits, you're gonna have a hospital benefit per day. So we'll need the hospital charges, an itemized list of the hospital charges. When he was diagnosed with tuberculosis. You also have a benefit for the attending physician in the hospital.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And they have hospitalists. So,
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Uh, they would need, I would need something to show what their charges were. What about travel to the [PII]. OK, she's explaining to me what all you're getting, so. Yeah, I know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, the uh, the only other thing that's covered under the specified disease benefit is for a private duty nurse in hospital or ambulance charges. That's under your, yeah, that's under your specified.
[CUSTOMER][NEUTRAL] And go ahead.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] We did not
[CUSTOMER][NEUTRAL] We did not have that.
[AGENT][NEUTRAL] Benefits
[AGENT][NEUTRAL] And if you look, I don't know if you look in the beginning of your policy under the benefit schedule, that's gonna be your benefits that we would pay and the list of services that are covered.
[CUSTOMER][NEUTRAL] OK, OK, let me look.
[CUSTOMER][NEUTRAL] OK, let me turn.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so, mileage to and from the, I'm looking at one, it says transportation expenses, actual charge for insured and one adult family member by common carry like and he's driving back and forth to, he had to go to the health unit every so often and back to the doctor every so often. Uh, is that gonna be covered at that 50 cents per mile rate?
[AGENT][NEUTRAL] Yes, ma'am. We'll need the, well, it is for cancer treatment or surgery. Now, um, for this for tuberculosis.
[CUSTOMER][NEUTRAL] OK, but I'm, I'm just looking at the uh.
[CUSTOMER][NEUTRAL] OK. I'm just looking at the overall benefits thing. It's all together, so I don't know whether there's, I don't have, have a, I don't think there's a benefit schedule in here for specified diseases. There may be, I just may not have seen it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] See, that's what I'm wondering if you have the policy certificate or if you have like a benefit booklet. So that's why I was wondering if maybe we should send you a copy of your policy.
[CUSTOMER][NEUTRAL] Yes, ma'am. Because would it be a separate, now, here it is. Schedule of benefits for specified diseases. You got a hospital expense benefit, attending just what you went over with me, private duty nurse, ambulance expense. So that's what's covered. OK.
[AGENT][NEUTRAL] There you go.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So I will start the ball.
[CUSTOMER][NEUTRAL] Rolling with um.
[CUSTOMER][NEUTRAL] Trying to get [PII] to get us copies of all of this.
[CUSTOMER][NEUTRAL] You still there? Oh yeah, oh yeah, oh, OK.
[AGENT][POSITIVE] And then yeah, I'm, I'm here. I was looking I apologize. Yes, ma'am.
[CUSTOMER][NEUTRAL] I'm on page 18, and that's what it was telling me. So, um,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's right. And then, um.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We're going to send you that claim form. Now, if you don't.
[CUSTOMER][NEUTRAL] I think I
[AGENT][NEUTRAL] Or, or you can go online to [PII] under claims [PII] and get the cancer claim form.
[CUSTOMER][NEUTRAL] OK, I want, I want some in the mail.
[AGENT][NEUTRAL] I'm gonna put in that request for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] hit you over there. I'm gonna hit you over the head for not taking care of this.
[AGENT][NEUTRAL] I didn't hear a word. I didn't hear a word.
[CUSTOMER][NEUTRAL] We didn't know it. I, you, you didn't hear a word. Yeah, I didn't talk softly enough. I just happened to be looking through here and I'm like, wha, wham, wham.
[AGENT][POSITIVE] Well, you know, the good thing is, is that there's no time frame, so to submit it, so you're good. You don't have to hit him too hard.
[CUSTOMER][POSITIVE] That's wonderful.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I won't. He was sick, so I, I'll give him a little leeway.
[AGENT][NEUTRAL] There you go.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And that was, when was that diagnosed, a couple of years ago?
[CUSTOMER][NEUTRAL] He's not so sure. We, it was several years ago. I think it was in the spring day because I was supposed to go. I got through October. He got through in October, so 8 months back from October. I can't get the bus backwards up, but uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can't either.
[CUSTOMER][NEUTRAL] Yeah, he's, yeah, [PII] will have all the dates.
[AGENT][NEUTRAL] Yeah, so that's what we'll need and let them review to see if it's payable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And anytime that you are wondering, you know, you, you think something could be covered, if you can send us the itemized bills with the diagnosis codes, um, and procedure codes, our adjusters will be happy to review it to see if those benefits are payable.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I might, you know, procedure and diagnosis codes, OK. Cause I wanna talk to the lady. I'm gonna, I'm gonna tell her and make sure that it has procedure and diagnostic or d
[AGENT][NEUTRAL] Mhm. We just need itemized bills.
[CUSTOMER][NEUTRAL] Um, that's just, uh, code on them.
[CUSTOMER][NEUTRAL] All right, well, this, that won't be, it's not as difficult as I thought it was because we can get most everything from one hospital's records, so. No, she says you just need something uh to let the pathology report that the pathology report was.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEGATIVE] I came to. Yeah, that's not covered. You're gonna get so much for being in the hospital. No, not on the specified diseases, OK, yeah.
[CUSTOMER][NEUTRAL] OK, I was getting him straight about something, so.
[AGENT][NEUTRAL] Yeah, you're fine.
[CUSTOMER][NEUTRAL] Oh, OK, do you, do you have my mailing address there with my information?
[AGENT][NEUTRAL] Let's go ahead and re-verify that mailing address. What is that mailing address?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][NEUTRAL] Yes ma'am, I've got that on here and then what is a good callback number for you? We don't have a phone number listed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, Ms. [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] No, ma'am, you've been very good. So all I have to do is just make a few more calls after I talk to you.
[AGENT][POSITIVE] It's been my pleasure.
[AGENT][POSITIVE] All right. Well, we'll be happy to assist you any way we can if you need any further assistance at any time.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yeah, y'all are so good. I used to go by the office in [PII] and just take my stuff. There was one lady who worked at the front. She got to where she knew who I was becaus[PII] I would, I had breast cancer, so I would, uh, just bring all my stuff straight to the office.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Now, you didn't come from [PII] to bring it to our office.
[CUSTOMER][NEUTRAL] I would, I wouldn't make a special trip to do that. I would be on my way to somewhere where I passed through [PII]. Yes, but it's only about an hour and a half over there, so it's not bad.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's true. It's just, just across the river, aren't you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, yup. Now we're always, she was so nice. It was an older lady that was working and she was always so nice.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Her name was [PII].
[CUSTOMER][NEUTRAL] You know who I'm talking about. Yeah.
[AGENT][NEUTRAL] Miss [PII], yes, ma'am.
[CUSTOMER][POSITIVE] Yes, ma'am. And she was so sweet. OK, well, thank, thank you so, so much and I'm gonna get to work on this.
[AGENT][NEUTRAL] it.
[AGENT][NEUTRAL] She is.
[AGENT][POSITIVE] My pleasure, Ms. [PII]. Thank you for calling EPL. Y'all have a wonderful afternoon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Yeah