AccountId: 011433970860
ContactId: ed133363-769c-4ace-a029-97ab23b60c9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 728159 ms
Total Talk Time (AGENT): 244467 ms
Total Talk Time (CUSTOMER): 294465 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/ed133363-769c-4ace-a029-97ab23b60c9a_20250423T13:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. How are you doing this morning?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] Pretty good. I got a text saying my claim was uh received and and processing was complete.
[CUSTOMER][NEUTRAL] And I'm just trying to figure it out. I'm on the I'm on the uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The app now, uh.
[CUSTOMER][NEUTRAL] Does that mean it's, it's, it is finished or what? Can you look at my claims there and try to figure something out for me?
[AGENT][POSITIVE] Yeah, absolutely. What is your policy number?
[CUSTOMER][NEUTRAL] OK, let me get over here to it.
[CUSTOMER][NEUTRAL] OK, where'd it go? I'm half blind as it is.
[CUSTOMER][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Confirmation number policy number I believe it was on the 2593784.
[CUSTOMER][NEUTRAL] There's one that we're talking about.
[AGENT][NEUTRAL] Oh my [PII].
[CUSTOMER][NEUTRAL] I got a text about this morning.
[AGENT][NEUTRAL] OK. What is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you, and do you have a good call back.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Yeah, yeah, this number here [PII], excuse me.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Uh, I just need two other pieces of information. What is your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Did I give you the claim number or I give you the policy number 2593784 the policy, yeah, uh huh, 3592434.
[AGENT][NEUTRAL] Uh, do you have the claim number handy?
[CUSTOMER][NEUTRAL] That's what the text was the one the text referred to.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The groups of critical illness when I pull up a few files, it just shows me the.
[CUSTOMER][NEUTRAL] The files that I've sent to y'all.
[AGENT][NEUTRAL] OK, yeah, I see that we got a HIPAA request and then or HIPAA information and then um it looks like so this was claims for.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Looks like you submitted claims for [PII], is that right?
[AGENT][NEUTRAL] And then at [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, just this year. That was old back when, you know, [PII] was back when I first had cancer and then it was uh prospectomy, radical prostatectomy, took it out and I've been clean for six years, no uh cancer, then it came back.
[CUSTOMER][NEUTRAL] We found it first part of the year this year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] That's why I don't understand why they got a [PII] date on here.
[AGENT][NEUTRAL] I think there was a pathology report that was included.
[CUSTOMER][NEUTRAL] I mean why
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEGATIVE] Yeah, they had, we had to get pathology reports from way back then. I don't like again, I don't understand why they even needed that. That's almost 7 years ago.
[AGENT][NEUTRAL] So this policy was effective [PII].
[AGENT][NEUTRAL] And it looks like you've submitted the.
[CUSTOMER][NEUTRAL] No, no, no, it was, it was affect the policy was affected last year, uh, September I believe it was.
[AGENT][NEUTRAL] It looks like the policies that were effective last year were your short-term disability and your dental.
[AGENT][NEUTRAL] And then this year we've got an effective date of [PII] for your hospital and group cancer.
[CUSTOMER][NEUTRAL] It could be. I'm not, I don't even remember. I thought it was all effective last year.
[CUSTOMER][NEUTRAL] I've had so many things going on.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, so it looks like, like I said, the dental and the short-term disability was effective last September, but these policies actually became effective [PII].
[AGENT][NEUTRAL] So the charge that you submitted was for February?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the policy is not effective till [PII].
[AGENT][NEUTRAL] Are you gonna have any
[CUSTOMER][NEUTRAL] OK, I, I'll take your word for it.
[AGENT][NEUTRAL] Are you gonna have any ongoing treatment or?
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, so have you had treatment after [PII]?
[CUSTOMER][NEUTRAL] They want they wanna do radiation.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Not just doctor visits so like yeah, but they were waiting to get everything set up for the radiation treatments.
[AGENT][NEUTRAL] OK. Let me see.
[CUSTOMER][NEUTRAL] They haven't started yet.
[AGENT][NEUTRAL] Let me pull up that um benefit and see.
[AGENT][NEUTRAL] That could be um potentially anything after [PII], um, you would be able to submit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So basically what you're saying is that the uh critical illness is not any good now.
[CUSTOMER][NEUTRAL] Uh, I mean, it's been denied them the critical illness.
[AGENT][NEUTRAL] Yes, it's been denied because it was prior to [PII].
[AGENT][NEUTRAL] So if you, if you've incurred charges since [PII], then that's where we would need to start looking at those claims to see if they're um can possibly be processed, so.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Yeah, there's, you know, doctor visits, that's it, and, uh, radiology visits. They had to do the CT scans and stuff like that to get me how they put it, uh, to get me lined up literally like a target, you know, so they can do the radiation. I've had those.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, yeah, if you wanna gather those claims together, you could get those submitted, but the one that you've submitted so far, that was before the effective date, so it was denied.
[CUSTOMER][NEUTRAL] Alright, the, uh, is that those ones you're talking about, would it be the wellness claim? That wouldn't be a well it'd be the, uh, the other one, wouldn't it?
[AGENT][NEUTRAL] Yeah, it's the PET scan. Looks like that's, that's what we have on.
[CUSTOMER][NEUTRAL] As far as
[CUSTOMER][NEUTRAL] Yeah, I know, but I mean
[CUSTOMER][NEUTRAL] Yeah, would I fill that in or or send that you and you've got medical records on that already, um, the, what would I, how would I upload them? I'm talking about would it be under the wellness claim or upload just work upload documents?
[AGENT][NEUTRAL] Yeah, let me
[CUSTOMER][NEUTRAL] And put it under which category?
[AGENT][NEUTRAL] Let me see which one.
[CUSTOMER][NEUTRAL] And you, and you are talking about like the, you know, the doctor visits and uh.
[CUSTOMER][NEUTRAL] Um, whether I did the CT scan tattooed me and all that stuff.
[AGENT][NEUTRAL] It looks like, so, yeah, so under your critical illness policy, um, and this is not a guaranteed payment basic outline of your policy, you do have a benefit for invasive cancer, um, that's a $10,000 benefit.
[CUSTOMER][NEUTRAL] Is that what you're talking about?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Covers coronary artery disease, end-stage renal failure, heart attack.
[AGENT][NEGATIVE] Uh, major organ failure.
[AGENT][NEUTRAL] I'm not seeing anything for CAT scans. Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I have something under your hospital indemnity though. Let me look at that because that could be.
[AGENT][POSITIVE] Might be a small benefit under that.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, let's see what we got here.
[AGENT][NEUTRAL] OK, so under your uh hospital indemnity, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Again, not a guarantee, just a basic outline. Um, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, did you do any um
[AGENT][NEUTRAL] Have you been confined to a hospital or had a hospital admission benefit? No? OK. Any ER? Emergency room?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEGATIVE] No, no, we are, no, no.
[AGENT][NEUTRAL] We do have physician's office visits, um, that's $75 payout and a max of $6 per calendar year.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if you've had a physician office visits, that could be um compensable under this benefit.
[CUSTOMER][NEUTRAL] No, I've had 3 with the cancer doctor so far. I got another one coming up at the end of the month, next week.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you could submit for those under your hospital indemnity, and those would pay $75 of each one, up to 6 visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Up to 6, what about when I start radiation uh treatments that'll be alcohol, of course, all outpatient. There's no compensation for that, is there?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, doesn't look like there is, no.
[CUSTOMER][NEUTRAL] OK, OK. Um, I've had 3, like I said, 3 with the cancer doctor.
[CUSTOMER][NEUTRAL] Uh, one with the urologist.
[CUSTOMER][NEUTRAL] And I got a 4th 1 with the cancer doctor coming up next week. So but once I hit 6, that's it for the year.
[AGENT][POSITIVE] Correct, that's right, yeah.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] Alright, and I file it under the hospital indemnity.
[AGENT][NEUTRAL] Hospital indemnity, yeah, you'll want to follow it or file it under that policy, yeah.
[CUSTOMER][NEUTRAL] OK, now, um, also, uh, what about the, uh, uh, disability? Have y'all made, they made a determination yet about the disability and when they're gonna start, start that?
[AGENT][NEUTRAL] Uh, let's see, let me get that pulled up.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] 2506754 is the policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sure they're still working on that I'm sure.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Yeah, it looks like I've got, uh, it looks like they're still in processing, um, we got 3 different, yeah, those are still currently being processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, well thank you so much, [PII]. I sure appreciate your help today.
[AGENT][NEUTRAL] OK. Anything else I can help with, sir?
[CUSTOMER][NEUTRAL] Not right this minute, no, I'm just looking over to make sure I've got.
[CUSTOMER][POSITIVE] I've asked everything I think I I need so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, OK, thank you so much, I appreciate it.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.