AccountId: 011433970860
ContactId: ebec4ad1-9639-4e30-8b2f-cb339acf8f73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1401800 ms
Total Talk Time (AGENT): 836207 ms
Total Talk Time (CUSTOMER): 310449 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/ebec4ad1-9639-4e30-8b2f-cb339acf8f73_20250131T23:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] How you doing today?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I was calling in reference with my um insurance.
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What information that you need from me so you can hook up on up.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Sure, um, first, if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, ma'am, um 318.
[CUSTOMER][NEUTRAL] Uh, 547-9291.
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, I don't think so.
[AGENT][NEUTRAL] OK, um, I could start using your social.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, I do believe I found you. Uh, just gonna verify some information really quick. Uh, can I get your date of birth please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. Uh, looks like it is a Yahoo account.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] No, but that's uh it's uh.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] I could just it's fine uh.
[CUSTOMER][NEUTRAL] Like he's like
[AGENT][NEUTRAL] It's [PII]. I have [PII] [PII], is that right?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] That OK, OK, cool, thank you for verifying that. I just wanna make sure what we had was correct. OK, so it looks like you've got a couple policies with us, [PII]. You've got a cancer policy and a hospital indemnity policy. Uh, which one did you have questions about?
[CUSTOMER][NEUTRAL] Both. So with the uh with the hospital, you have to be in the hospital, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not necessarily, no, let me get that pulled up. Essentially what it is is a limited indemnity medical plan. It can act as a major medical policy or it can be secondary. It's very different from traditional major medical though it is, uh, basically just pays a set dollar amount per procedure or office visit, but hence the name it is very limited, but give me just a moment, let me get that pulled up here so I can get better information for you.
[AGENT][NEUTRAL] And I can send this policy to you as well um if you'd like [PII], I can email it to you just so you've got it as a reference.
[CUSTOMER][POSITIVE] Yes, ma'am. Yes, fine. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, no, I'm a very visual person. I have to have something to reference. Somebody could tell me something and I'm, I know I'm gonna forget that's just me. OK, let's see. I'm just gonna get the benefits page pulled up here. It is very easy to read. It's not just a bunch of jargon, I promise, um, and it does go in depth as to what is and is not covered, dollar amounts, frequencies, that kind of thing, OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] So I can kind of give you a brief overview of what is covered, um, so you've got a hospital consignment benefit so daily amount, you know, if you were in the hospital for a daily amount of time they would pay that set dollar amount, uh, intensive care, coronary care, um, let's see, we have emergency accident benefit, a wellness and diagnostic testing benefit, so for a wellness exam or diagnostic test, which is usually like a MRI or CT scan.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] And you've got an outpatient sickness benefit.
[AGENT][NEUTRAL] And then a surgical and anesthesia benefit.
[AGENT][NEUTRAL] That's just extremely brief. um, I can go more in depth as to each benefit if you'd like that information.
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you so much.
[AGENT][NEUTRAL] Yeah, um, which one did you need more clarification on?
[CUSTOMER][NEUTRAL] Well, uh.
[CUSTOMER][NEUTRAL] Well, OK, I have um like uh the records. So I'm trying to see, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Do I like get the like the um like the the claim form?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And can I just like,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] That's fine. OK, you're just wondering how to file claims?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, OK, um, do you have an account on our online portal?
[CUSTOMER][NEUTRAL] Mm, I mean, I don't think so.
[AGENT][NEUTRAL] OK, so in the email I'm going to send you, uh, with your policy I'll include a link to our uh web address. Do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] I have a uh uh.
[CUSTOMER][NEUTRAL] A Chromebook. That's what it is. I have a laptop.
[AGENT][NEUTRAL] Um, yeah, that'll work. That's that's Google Chrome. I think that's pretty much the same thing. It's just the reason I ask our website really doesn't have support for mobile devices like phones or tablets, uh, to upload claim information. So I will send that link to you. You'll just use that same information that we just verified, so that email that I'm sending this to the [PII].
[AGENT][NEUTRAL] Um, and then you can create a username password. There will be a spot where you can upload documents and then you'll have all of the claim forms there as well.
[AGENT][NEUTRAL] Um, I can let you know the necessary documents we need to let me know when you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you'd like to write it down.
[CUSTOMER][NEUTRAL] Well, I have a a wellness claim form in a hospital, uh.
[CUSTOMER][NEUTRAL] Them for.
[AGENT][NEUTRAL] OK, so you do have forms. OK, so what we would typically need for to file claims it's going to be the itemized statement.
[AGENT][NEUTRAL] That shows any diagnosis and procedure codes.
[AGENT][NEUTRAL] And you can get that information from whatever provider you went to for treatment.
[CUSTOMER][NEUTRAL] OK, you say I need.
[AGENT][NEUTRAL] Yes itemized statement.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] That shows diagnosis.
[AGENT][NEUTRAL] And procedure codes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And of my statement you say?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And procedure, procedure. Can you P R E C I S?
[AGENT][NEUTRAL] Yes, diagnosis and
[AGENT][POSITIVE] Let's see. oh my goodness, I just went. I'm such a visual person. I have to spell it out first. I like type it pro, OK it is uh.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said what's the name of its procedure?
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] And diagnosis codes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so that um really gonna be all the information that we need, um, especially for this kind of policy, and then I did send you an email with the policy certificate there will be one page that's going to be, you know, pretty much your best friend.
[AGENT][NEUTRAL] Um, it's the certificate schedule and it's just exactly what I read out to you briefly shows the coverages and the dollar amounts and frequencies. The rest of all of the other pages are going to be more definitions, so what is and is not considered this specific benefit, um, OK, do you have any other questions for this policy?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I can send you your cancer policy too.
[CUSTOMER][NEUTRAL] Yes, ma'am, that's fine.
[CUSTOMER][NEUTRAL] So with the uh the one that you stay in the hospital.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the hospital indemnity? Yes.
[CUSTOMER][NEUTRAL] Listen,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's all I need for this one. This is the wedness claim form?
[AGENT][NEUTRAL] Oh yes, um.
[CUSTOMER][NEUTRAL] At the hospital.
[AGENT][NEUTRAL] OK, so if it's for just a regular wellness, you can use the wellness benefit that's fine, um, because this does have a wellness benefit so you can use that claim form, um, but anything else, so if there was, um, you know, a hospital consignment or somebody got sick, had to go to the doctor, um, or a surgery, that would be more the hospital indemnity claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, and the website really makes it um a lot easier with that too uh typically with the wellness it will find which policy has that benefit.
[CUSTOMER][NEUTRAL] Yeah, my daughter, I mean my daughter was in the hospital, so that's the uh form that I need the hospital there do.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Do I need to, uh, do, do I need to send um documents or can I just write down the days that she went into the hospital? Or you need like.
[AGENT][NEUTRAL] We do have to have yeah as long as we've got that itemized statement with the diagnosis and procedure codes you should be it it really does depend on each provider unfortunately um most of the time though they should be able to send you that information no problem if there are any issues or if there's any confusion they are more than welcome to give us a call just on the same number that you've called us on.
[AGENT][POSITIVE] Uh, we do talk to providers all the time, so you know if they need clarification or anything like that, we'll be more than happy to speak with them.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, say for instance like
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] January to December.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So if you went to the emergency room.
[CUSTOMER][NEUTRAL] Is it like
[CUSTOMER][NEUTRAL] One time or all the time she went into the emergency room.
[AGENT][NEUTRAL] She's in the ER, OK, and she's um.
[AGENT][NEUTRAL] Let's see, you had multiple visits to the emergency room?
[CUSTOMER][NEUTRAL] Yeah, multiple visits it's not like through after, after the year.
[AGENT][NEUTRAL] OK, did she?
[CUSTOMER][NEUTRAL] Do I need to send that verification?
[AGENT][NEUTRAL] Yes, every single visit, absolutely, um, because they would all be separate. What might make it easier, do you know if she went to the same emergency room every time?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I know 2 different times she had a baby.
[AGENT][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] She had to go to the emergency room for it?
[CUSTOMER][NEUTRAL] No, ma'am, just like, you know, just, just saying something in general.
[AGENT][NEUTRAL] Oh, sure, yes, so that would definitely be considered hospital and uh uh consignment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But in like any time she went into the hospital.
[CUSTOMER][NEUTRAL] I need to send that information.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Absolutely, yes, ma'am, so that we can pay that benefit, yes.
[CUSTOMER][NEUTRAL] So how much is the uh the uh the uh the hospital stay?
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, so hospital confinement, um, so the daily indemnity benefit, it's $30 per per day essentially of being confined to the hospital. Um, if it was in regard to an emergency, let's see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Maximum days per calendar year, 2 per covered person with the exception of dependent children, which is limited to a total of 2 for all. OK, so it would still be 2, and that's $100 each, um, and now of course that was not intensive care or coronary care, right?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, um, and then the wellness and diagnostic, so if you know they had to do, uh, like I said, like a CT scan or an MRI or something, that benefit is $250 and then of course for your wellness exam that you were talking about, that is $75.
[CUSTOMER][NEUTRAL] What's the wellness, uh, what is the wellness thing?
[AGENT][NEUTRAL] The wellness exam is $75.
[CUSTOMER][NEUTRAL] And what is that like if you went to the hospital, like the emergency room or something?
[AGENT][NEUTRAL] No, wellness exam is going to be more like um just a standard doctor's visit, you know, like um.
[AGENT][NEUTRAL] We could check up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did she have any surgery?
[AGENT][NEUTRAL] When she was there at all? OK, OK, so then that that wouldn't apply.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Do you know if when she went it was in regards to a sickness or was it an accident that she went to the ER for?
[CUSTOMER][NEUTRAL] Right, uh, some of us with the accident, some and like uh.
[CUSTOMER][NEUTRAL] And she got sick, like a cold or something like that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they true to her in the emergency room.
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] OK, yeah, so that's that would fall under there's an outpatient sickness benefit as well, and that one is let's see.
[AGENT][NEUTRAL] 5 days per calendar year per covered person and that's $50 per day for that benefit.
[CUSTOMER][NEUTRAL] It's like if she going to the emergency room, correct?
[AGENT][NEUTRAL] Similar, yes, but if they were for different things, those are two separate benefits. Does that make sense? So it would pay if they were, it was in regard to both, then it would pay both uh these kinds of policies are a bit confusing.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So for instance I went to my doctor, like, you know,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What like a checkup or just a a a visit, got cold or something like that?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] How much is that?
[AGENT][NEUTRAL] If that's like a cold or something if that was in regard to a sickness that would fall under that outpatient sickness benefit, so that one that's $50 per visit.
[CUSTOMER][NEUTRAL] So they're just like, any time you go to the hospital, you get paid for that visit. Correct.
[AGENT][NEUTRAL] If it was OK, so hospital, there's a hospital consignment, so essentially if you're there for I would say that longer than a day if you were confined to the hospital, um, then that would be that $30 per day and then there's the emergency accident and then outpatient sickness, so those are all going to be separate benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So every time I went to the hospital, or that my kids went to the hospital, I need to send, send that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I absolutely would, yes, um, and so your plan has been active since [PII], um, and of course it is currently active, so there's no timely filing limit. So if you can think of anything that you've not filed from that effective date for you, let's see, we've got [PII] and is it uh [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Tomorrow, OK, I think there's a space there that should not be there. OK, so either of them as well because they're all covered under your policy from that effective date, absolutely send that claim information to us, see if we can't get those um benefits paid for you.
[CUSTOMER][NEUTRAL] OK. Also, so what I gonna ask?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What was that? I'm sorry.
[CUSTOMER][NEUTRAL] From [PII]. What policies is that?
[AGENT][POSITIVE] Correct. This is your hospital indemnity. Um, I can hop on over to your cancer. Your cancer's been active much, much longer. Let's take a look at that one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this policy has been effective since [PII] and I can take a look. This policy might also have a wellness benefit. Um, let me take a look, so you might be able to follow those. Most of the time with these though they're going to be um what they call preventative uh tests, so like a mammogram, colonoscopy, Pap smear, uh, things like that. They usually cover those um once per calendar year.
[AGENT][NEUTRAL] Let me get that policy pulled up. Did you want me to send you this policy too, [PII]?
[CUSTOMER][NEUTRAL] You said
[CUSTOMER][NEUTRAL] Yes, yes, ma'am. What's, what's, what's the one count in the year? Because I had a colonoscopy done too.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, yeah, yeah, so you let me get the benefits pulled up here and I'll, I'll let you know more of that. Give me just a moment.
[AGENT][NEUTRAL] Goodness, if I can spell. Let's see.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So yes, um, [PII]iagnostic and prevention benefit is what it's called. So each calendar year will pay uh the indemnity amount which I'll be able to find it out in a moment, but under this policy, it does list all of the covered screening tests that would be considered. So again, mammogram, breast ultrasound, um, colonoscopy is absolutely on there, blood tests, chest X-rays, pap smears.
[AGENT][NEUTRAL] Um, there are a few others as well, and let's see.
[AGENT][NEUTRAL] They are of course available.
[CUSTOMER][NEUTRAL] Yeah, I just had a uh.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] I had, I had a, a, a mammogram and a pap smear done.
[AGENT][NEUTRAL] Let's see, I do believe, OK, this benefit is payable for one test per covered person per calendar year, so you would be able to select one of them for each year and again that's going back to [PII]. So if there were any that you have not filed uh since then, you can select one of these kinds of tests that you've had per calendar year since the beginning of this policy and you can file those claims.
[CUSTOMER][NEUTRAL] OK, so like 1819, 2021, 23, and 24.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] If I went to get a uh past in [PII], that's like once a year, so I get paid [PII].
[AGENT][NEUTRAL] Well, I will say.
[AGENT][NEUTRAL] This policy, so it's effective date was [PII], so I guess unless it was in December, um, but otherwise, yeah, so, OK, here we go, so the benefit amount it's $45 per test.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that benefit amount?
[AGENT][NEUTRAL] And I believe the rest of this policy is going to be in regards to if there was a positive diagnosis of cancer.
[AGENT][NEUTRAL] And you do have um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Dependent on here as well you do have uh [PII] and [PII] as well under this policy so if either of them had that and their effective dates the same as yours so if they've had to have any of these kinds of diagnostic tests, um, you can file claims for that as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me go ahead and get this policy sent to you as well.
[AGENT][NEUTRAL] So you've got it for your reference.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Here we go. OK, did you have any other questions for me?
[AGENT][NEUTRAL] I know it's kind of information overload. I apologize. It can all be a bit confusing.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm, not right now.
[AGENT][POSITIVE] OK, well, definitely you know if you take a look, you think of anything else, uh absolutely give us a call back we'll do what we can to help, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There we are, OK, and I just sent your cancer policy to you as well, so you should have both of those now.
[CUSTOMER][NEUTRAL] Yeah, so all the policies that I um I have with y'all you something in my email.
[AGENT][NEUTRAL] I sent you the, yes, you've got the two policies with us and I did email you both of those policy certificates.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And it's just, you're just saying that it's, it's telling me the different pace that uh.
[CUSTOMER][NEUTRAL] If I went to the doctor, the, the emergency room I stayed in the doctor, it's telling me the price of
[CUSTOMER][NEUTRAL] Of it.
[AGENT][NEUTRAL] Yes, yes, it will, uh, very clearly there's again there's gonna be that one page that's going to be it's my best friend I'm sure, um, where it just states what it is, how often, and the dollar amount, um, but if you needed clarification as to what is considered under that then you can reference those other pages.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] With with the hospital um thing you, you need the uh verification for that, right? So with the weddings I could just write that down.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's perfectly fine.
[CUSTOMER][NEUTRAL] Oh like on up.
[AGENT][NEUTRAL] So a hospital visit visits are, as you said, if you're when your daughter went to the emergency room, for example, that's the kind of stuff that we need those itemized statements um that show those codes.
[CUSTOMER][NEUTRAL] OK, but I'm talking about the hospital stay. This deal is a hospital thing, right? Hospital.
[AGENT][NEUTRAL] Right, right, that that's the information that we would need for anything besides the wellness exams.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and what's your name?
[AGENT][POSITIVE] You are very welcome. It's [PII]
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Was there anything else I could help you with [PII]?
[CUSTOMER][POSITIVE] No man, thank you so much. You have a good day.
[AGENT][POSITIVE] All right yeah you're very welcome yeah have a great weekend thank you.
[CUSTOMER][NEUTRAL] Yes, ma'am, do the same. Bye-bye.
[AGENT][POSITIVE] Stay safe, bye bye.
[CUSTOMER][NEUTRAL] Never.