AccountId: 011433970860
ContactId: ef0c7628-195d-40f2-a409-db9daf6b2fe1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 991289 ms
Total Talk Time (AGENT): 348800 ms
Total Talk Time (CUSTOMER): 538652 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/ef0c7628-195d-40f2-a409-db9daf6b2fe1_20250108T16:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I wanted to see if I could get some information from someone about a claim and how that all works.
[AGENT][POSITIVE] Uh yes ma'am, I can help you with claim.
[CUSTOMER][NEUTRAL] Uh, I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I had um a partial nephrectomy [PII] and uh what they took out was um renal cell carcinoma stage one.
[CUSTOMER][NEUTRAL] And so how do I go about uh facing a, a cancer claim? Is that constitute or go under the cancer umbrella, or how does that work?
[AGENT][NEUTRAL] Yes ma'am, that would be under your cancer um can I please get your name and your callback number just in case the call is dropped I'll be able to call you right back.
[CUSTOMER][NEUTRAL] Sure, of course. My name is [PII].
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And what is your policy number, please?
[CUSTOMER][NEUTRAL] Oh goodness, I'm trying to log on, hold on.
[AGENT][NEUTRAL] OK, I can look it up with your social security number if you'd like to give me that. I'll pull it in for us.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, that might be faster cause my computer is not wanting to wake up right now. Uh, it is.
[AGENT][NEGATIVE] They never do when you're on the phone, especially.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Of course, like, uh, I've been getting able to log in all these times, but I don't know why.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh yes, it is um [PII].
[AGENT][NEUTRAL] OK, give me just a sec to look that up for us.
[CUSTOMER][NEUTRAL] OK, see now I got in.
[CUSTOMER][NEUTRAL] And when I look at the dashboard, uh, when I started working at the service centers when I picked up the insurance with uh you guys in [PII], but I've noticed that it says lapsed and then it says [PII] and it says lapsed and then now it says active um but it's been this one through the years correct?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes ma'am, um, different policy changes, uh, let's verify your policy real quick for security reasons can you please give me your date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And then I'll also need for you to please verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] OK, my address is [PII], and you said my phone number?
[AGENT][NEUTRAL] Yes ma'am, is the phone number you gave me your cell phone number?
[CUSTOMER][NEUTRAL] Yes, that's the only number I have.
[AGENT][NEUTRAL] OK, thank you. And then also your email address.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK thank you Ms. [PII] I appreciate you verifying your policy so to answer your questions about the policy being active and then lapsed and then active and then lapsed, so the reason that is is because the plan changed the the the product name changed so on a product name changes we have to issue a new policy.
[AGENT][NEUTRAL] So I do see that you have the new GCP 24 policy uh through the Bank of Oklahoma.
[AGENT][NEUTRAL] And that you are on direct pay.
[CUSTOMER][NEUTRAL] Yes. And when I see that, like the others, I had been able to um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Click on it and it would show me the pol when I click on the policy number. But the one that's active, I click on it and it tells me, um, I guess that it's not there. It says oops, there seems to be a problem. It appears your document is missing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] It says APL customers
[CUSTOMER][NEUTRAL] Notified
[AGENT][NEUTRAL] Yes ma'am. OK, so what I can do is while we're on the phone together I can send in a request to have that uploaded into the online service center for you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what I'll also do is also request, did you get a copy of your policy when it was issued?
[CUSTOMER][NEUTRAL] I may have, I don't know where it might.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I'll also order you a new copy to be mailed to your home address so you have that on hand.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, that would be wonderful. Thank you for doing that.
[AGENT][NEUTRAL] You're very welcome and um so you're just looking basically for information on how to file the claim is that correct?
[CUSTOMER][NEUTRAL] Yeah, because I went online because it says you can do them online and I all I see is the wellness claim and so I did upload and I don't know if this was right or wrong, uh, because I noticed that I had the wellness claim for [PII], but I didn't have one for 20.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 2 or 20.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4, I guess. Yeah. And so I did those, those are able to be paid or not, but I, I did select that. Now, I do have the, the letter, the mammogram. I'm, I'm skipping all over. We started with the cancer and now I'm in the wellness, sorry. Uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] But I do have the mammogram, um, the letters they send saying it was clear for those years, uh, so I don't know, do I upload that where it says upload files or?
[AGENT][NEUTRAL] Right. You can upload that for your wellness where it says upload files. But for the cancer claim, you're actually going to need the cancer claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And so I have
[AGENT][NEUTRAL] So I
[AGENT][NEUTRAL] Yes, ma'am, go ahead.
[CUSTOMER][NEUTRAL] Is that do I have to download that? Is that how that works or because I don't electronically anywhere, right? Or there is an electronic one?
[AGENT][NEUTRAL] Yes, ma'am. You
[AGENT][NEUTRAL] You can download it let me give you the um APL web site where you can get that from.
[CUSTOMER][NEUTRAL] OK, I think that's where I'm at where it says claim form.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then cancer, cause I think I saw it whenever I was working on the others. um
[AGENT][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] And let me see. I think it's here. File a cancer claim, so I download this one.
[CUSTOMER][NEUTRAL] And do you know, can I like type on it and then submit it or is it something that I have to print?
[AGENT][NEUTRAL] You should be you should be able to type on it once it's downloaded.
[CUSTOMER][NEUTRAL] OK, let me see. I think it says to sign in. Let me do that again.
[CUSTOMER][NEUTRAL] And I'm guessing on this, like what I need, I think I was reading some of the things on here as well, no, it's taking me back.
[CUSTOMER][NEUTRAL] I thought I saw it the other day. Let me see. Oh yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That's upload.
[CUSTOMER][NEUTRAL] Sorry, I'm talking to myself.
[AGENT][NEUTRAL] That's OK. Talk it through.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I have to do the same thing.
[CUSTOMER][NEUTRAL] Plain forms maybe I saw it here.
[CUSTOMER][NEUTRAL] OK, yes, it's down here at the bottom, so download form.
[CUSTOMER][NEUTRAL] OK, so I see it there. Let me download.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I think this might have been where I was reading. So basically um I would need like the EOB to upload.
[CUSTOMER][NEUTRAL] And the pathology report?
[AGENT][NEUTRAL] Yes, you're gonna
[AGENT][NEUTRAL] Yes, you'll need the EOB, the pathology report, and also the itemized statement with your diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Now, is that, cause I, I know I have those to the EOB and the pathology. Um, but the itemized statement, is that kind of something that I would probably need from my doctor, or?
[AGENT][NEUTRAL] Yes, ma'am. You can get that from your physician.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] And you said it's just an itemized statement with what kind of code?
[AGENT][NEUTRAL] The diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Diagnosis.
[CUSTOMER][NEUTRAL] Procedure code.
[CUSTOMER][NEUTRAL] OK. And um then I did see something.
[CUSTOMER][NEUTRAL] Where it talked about
[CUSTOMER][NEUTRAL] I guess the surgery and it says something with 45. I don't know if that's still the same, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Policy that I have. Now, can you help me then where it says $45? Is it like $45 to
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Whatever the surgery cost was or?
[AGENT][NEUTRAL] Yes ma'am, let me look, uh, I'm gonna pull your policy in so that.
[AGENT][NEUTRAL] We can read it.
[AGENT][NEUTRAL] Let's see what it says.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I saw there was a lump sum and if that's kind of the same, that was uh the 2000.
[CUSTOMER][NEUTRAL] But then some of the other stuff I just wasn't quite certain.
[AGENT][NEUTRAL] Right, it is gonna be that um.
[AGENT][NEUTRAL] The lump sum, the first occurrence benefit for cancer, and this is just to verify your coverage. It's not a guarantee of payment. Um, that first occurrence benefit for cancer is $2500 so your, your $45 also is what's payable.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, towards that procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I saw something about the anesthesiologist, so I guess they would pay like a percentage possibly for that.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the trip cause I live in Corpus, but I had the surgery done in [PII], which is longer than, was it 50 miles or 100 miles, something like that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 50. Yes, ma'am.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah. So then I, how do I
[CUSTOMER][NEUTRAL] I, I guess in the form, I think I saw where you just put like your start date and and I mean start place and end place.
[AGENT][NEUTRAL] Yes ma'am, and then you'll also see on that cancer claim form that first page tells you everything that you need to send in depending on what it is that you're you're claiming, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That first page has very specific instructions for you. So if you get.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you get to where you need to look back to it.
[CUSTOMER][NEUTRAL] The street, the
[AGENT][NEUTRAL] I would have to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, OK, cause, uh, and they would kind of like after going through the documents that I submit would say, OK, your policy may pay for this or may pay for that, so it would have all the um I guess they would whoever took the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The claim would kind of look and adjust, make adjustments as needed, right?
[AGENT][NEUTRAL] Right, they would um they would look on there and see what your, your policy covers and uh uh do the claim based on what it covers um for covered benefits. Now it does say um an operative report may be required if filing a claim for multiple surgeries um.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you have multiple or just one?
[CUSTOMER][NEUTRAL] No, it was just that one, the part on the, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, OK.
[CUSTOMER][NEUTRAL] Yes. And, and they said, you know, I wouldn't need any chemo. Like I did see where it says chemotherapy and it said 20,000. So normally, if someone is going through chemotherapy, do they pay up to that amount or what, I mean, luckily, thankfully, I'm not gonna do chemotherapy, but just for the future, you know, just curious.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes ma'am, they pay up to that amount.
[CUSTOMER][NEUTRAL] OK, so they pay like monthly up to the 20,000, is that what that is?
[AGENT][NEUTRAL] Right, once you reach the 20,000 and your benefits would exhaust.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. I just wanted to make certain what I um
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, cause, you know, like I said, I probably have the policy somewhere, but of course, you don't think you need those things until you need them. And now I'm like, I'm not certain how this all works, but
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So I am going to give you your policy number so that you have that.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, that policy number is 255.
[AGENT][NEUTRAL] 8466.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I'm ordering you a card right now so it can be mailed to your home address, that, that way you have it.
[CUSTOMER][NEUTRAL] OK, that's
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh OK
[CUSTOMER][POSITIVE] That would be wonderful. Thank you so much.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] And then I will work on getting, like I said, I, I know I have the EOB and the pathology report, but I'll probably need to figure out the itemized statement with the codes and the diagnosis. So I'll have to see about getting that from the doctor.
[CUSTOMER][NEUTRAL] And then I think
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. All right. Um, and then the, we going back now to the wellness. So the mammogram, the, the documents that I received, I would just go to upload documents. Let me see.
[CUSTOMER][NEUTRAL] And then,
[CUSTOMER][NEUTRAL] Applicant
[CUSTOMER][NEUTRAL] And it's the active one.
[CUSTOMER][NEUTRAL] And I just upload them and they'll kind of know what it's for then, right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And when you fill in that wellness client information that coincides with what the documents that you're sending in.
[CUSTOMER][POSITIVE] OK. That'll work. Then I think that's it. Thank you so much for your guidance and help today. I appreciate it.
[AGENT][POSITIVE] Well, you're so welcome, Miss [PII]. Is there any other questions or anything else that I can help you?
[AGENT][NEUTRAL] With before we go.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] I think that might be it for now.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] If you decide later on that you have some or you need help with anything, please pick up the phone and call us and we'll walk you through it.
[CUSTOMER][POSITIVE] OK, thank you so much. I appreciate your help today, dear.
[AGENT][POSITIVE] You're very welcome, Ms. [PII], and you have a blessed day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.