AccountId: 011433970860
ContactId: e5cdc856-8c2c-4299-a9c2-2cf04f34df50
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 713049 ms
Total Talk Time (AGENT): 274550 ms
Total Talk Time (CUSTOMER): 399876 ms
Interruptions: 8
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/e5cdc856-8c2c-4299-a9c2-2cf04f34df50_20250319T21:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII], and I was calling, um, I had did a claim for myself and my husband, um, for, uh, wellness checks, and I also sent in a claim for my husband for um the diagnosis cancer. um, he was diagnosed with cancer. So I, I see where like the well all the wellness claims that I sent in.
[CUSTOMER][NEUTRAL] Um, were, were paid, but I don't see anything about the cancer policy one.
[AGENT][NEUTRAL] OK, I can help you with your claim. Can you please give me the policy number?
[CUSTOMER][NEUTRAL] OK, uh, uh, it's 2, let's see 1415882, I think it is.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Ms. [PII], is [PII] available for me to be able to discuss his claims with you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah, I thought you could cause I was on there with him, but hold on one second, yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, it's the insurance company, they need to talk to you to be able to discuss the stuff with me.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Here, here we go, ma'am.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, hello?
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] with APL. Um, I just need you to verify some information for me. Can you verify your policy for me by giving me your date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's [PII], and I think she might have [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then one last verification, can you give me the phone number that is on the policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. And is it OK if I discuss your claims with your wife, Mr. uh, [PII]? OK, thank you very much. I, I appreciate that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, yeah, French here. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. OK, so on this policy number that you gave me, that's the critical illness policy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That's the one that you filed on?
[CUSTOMER][NEUTRAL] Um, well, it's, it's critical illness with the cancer rider, I think or something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, so let's see, do you have the claim number of the one that you're in question about for him?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I like, I sent in a lot of claims because I didn't realize we could do the wellness. So she, the lady told me to go back to day one.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um file all of those, so I did, but I don't, I like, I just sent them in one at a, you know, but let me see if I can.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][NEUTRAL] I'm not sure which one it actually fell up under.
[AGENT][NEUTRAL] And um actually because I'm looking at this policy that you gave me the policy number and everything that you have sent in is showing paid.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, well I sent in, I did a claim for the cancer and I sent in um his pathology report because that's what it said it needed um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, uh, can you try?
[CUSTOMER][NEUTRAL] Uh, claim num you want a claim number or policy number?
[AGENT][POSITIVE] If you can give me the claim number that you're in question about that would be awesome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not sure if it's like I said because I got like three different claim numbers so I don't know which one it fell up under, but here's 1 3576571.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look at that one.
[CUSTOMER][POSITIVE] And I think that's just, I think that's just a wellness one as I try to pull up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's all bragging.
[AGENT][NEUTRAL] OK, let's look.
[CUSTOMER][NEUTRAL] Like when I look now like I don't even see see before when I pulled it up, it showed like where it had the oh I see it it's up on claim number 3577033.
[AGENT][NEUTRAL] 357-703-3. OK, let me pull that.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, I'm showing that that was paid $300. Let me see if there's any remarks on it.
[AGENT][NEUTRAL] OK, so let me read you what the remarks say of the part that was, um, there's just two remarks on this claim. The first one is the health screening test benefit rider provides benefits for one health screening test per covered person per calendar year. According to this information on file, benefits have already been paid for this calendar year. Therefore, additional benefits are not payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] How about.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I, I didn't know if he was leaving.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] That can happen if you accidentally send it in 2 times.
[CUSTOMER][NEUTRAL] Right, and I think I did on one of them, yeah, uh-huh.
[AGENT][NEUTRAL] You said you said a bunch at one time, yeah, OK.
[AGENT][NEUTRAL] All right. And then, um, the enclosed claim form must be completed by you and your physician.
[AGENT][NEUTRAL] And return to our office. The claim form will be used as proof of loss for your critical illness diagnosis, if you should have any questions.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, cause they didn't like I don't, I didn't see a claim form that had for the physician to fill out.
[CUSTOMER][NEUTRAL] I just went online and filed the claim, so where do I get that form from?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, it looks like the.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Uh, claim form section 10.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] It looks like they may have sent that to you.
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] And that section 10 on the claim form needed to be filled out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] So, OK, so it's not a
[AGENT][NEUTRAL] And that was sent yesterday, so you just probably haven't received it yet.
[CUSTOMER][NEUTRAL] Yeah, OK, OK, so that's not a form that you can print they have to send it to you.
[CUSTOMER][NEUTRAL] Is that what you're saying?
[AGENT][NEUTRAL] It's the critical illness claim form. Let me see, let me see if there's a section 10 on the one on our website.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] gonna be just a second while I scroll through and look.
[CUSTOMER][NEUTRAL] I see, I.
[CUSTOMER][NEUTRAL] I do see something say cancer form.
[CUSTOMER][NEUTRAL] Statement of insured.
[CUSTOMER][NEUTRAL] But that's this phone that I pulled up looks just like the same one maybe.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Let me see what the physician fills it out.
[CUSTOMER][NEUTRAL] It's the same form I filled out online.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It it appears to me that they have mailed it to you and that you just haven't received it yet. But when you do get, make sure that you get the physician to fill out section 10.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Is it OK.
[CUSTOMER][NEUTRAL] Are you good?
[CUSTOMER][NEUTRAL] OK, OK, yeah, so that must be a, a different form because it's not the same one that I filled out online.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, cause I'm looking at the one online and it actually doesn't have a section 10. It has an E, it's by alphabet. Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I just pulled up another one and I see it now, um, it's, it's another critical illness form and it says about the attending physician statement.
[AGENT][NEUTRAL] Section.
[AGENT][POSITIVE] OK, good.
[AGENT][POSITIVE] Yes, that's what you need.
[CUSTOMER][NEUTRAL] Yeah, I see it. That's the form. OK, yeah, OK, well, I wish they would have told me that the first time. I could have got that done, uh.
[AGENT][NEUTRAL] Oh, yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so then when I, when I get that filled out, um, do I just, uh, do I fax it back or mail it back or do I, or do I have to do a whole another claim?
[AGENT][NEUTRAL] Or if you wanted, you can.
[AGENT][NEUTRAL] You can send that
[CUSTOMER][NEUTRAL] Do I have to fill out a whole another claim?
[AGENT][NEUTRAL] Just go ahead and fill out that portion or have the physician fill out that portion. You can upload it and send it through the online service center like you've been doing, but reference the claim number, the claim 35,770.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 33.
[CUSTOMER][NEUTRAL] OK, and I'm looking on here. I was trying to make sure this one has about cancer. I so far I maybe I'm overlooking it, but.
[CUSTOMER][NEUTRAL] I'll look, I'll print it out and look at it and if not, then I'll just wait on the one that they sent me, mhm, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well thank you. Oh, and one other thing, can you verify um or I don't know if you're able to tell me like what the benefit amount is for um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah. Well, what, what cancer your dad had prostate cancer. Do, is there like a clause for it or anything, do you know? I mean, by looking at it.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It doesn't say on the information that I have, um, it will have to just be sent in and let the claims examiner examine the right and see the diagnosis codes and procedure codes and all of that to know for sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claims, OK.
[CUSTOMER][POSITIVE] OK. OK. All right. Well, thank you so much. You've been very helpful.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I'm glad I was able to help you. I hope you guys have a good rest of your night. Do you have any more questions for me, Ms. [PII]?
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] OK. You have a blessed night and thanks for calling APL. Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Mm. All right. You too. Uh-huh, bye-bye. Mhm.