AccountId: 011433970860
ContactId: f6459ba2-1e09-49cf-bfdc-46b260ae5b6b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 914429 ms
Total Talk Time (AGENT): 362033 ms
Total Talk Time (CUSTOMER): 307523 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/f6459ba2-1e09-49cf-bfdc-46b260ae5b6b_20250102T19:31_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I have a couple of questions. Maybe you could direct me. I wanted to see if uh this policy paid anything. Uh, I keep forgetting to check it, um.
[CUSTOMER][NEUTRAL] I have 3 policies with you all. I'm looking at the one for heart disease. What I want to know is, I'm will be 86 in a couple of weeks.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, I have this heart problem that I have to keep a watch on. I have a bad valve. I've had it for quite a while. And um,
[CUSTOMER][NEUTRAL] Every now and then, they have to do a
[CUSTOMER][NEUTRAL] Oh, a special what test is that they do.
[CUSTOMER][NEUTRAL] Oh, I forget they do it, not an EKG, but they, you have to have this other test.
[CUSTOMER][NEUTRAL] Well, do you pay for any testing on heart disease?
[AGENT][NEUTRAL] OK, so you have a policy with APL that you, you have a general benefits question on, is that correct?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] OK. So, yes, ma'am.
[CUSTOMER][NEUTRAL] Oh what is this?
[AGENT][NEUTRAL] So I can partially help you with this. I'll have to pull your policy information up first and verify some things with you for security. So first off, who am I speaking with, please?
[CUSTOMER][NEUTRAL] This is [PII], and I think I have my policy number here.
[AGENT][NEUTRAL] OK, Ms. [PII], what is a good callback number for you in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you. And then, yes, ma'am, I'll need your policy number.
[CUSTOMER][NEUTRAL] OK, it's, it'd be the same as my husband, right? We, we have to, OK, this, this is heart attack and. It's 473106.
[AGENT][NEUTRAL] OK. Thank you. One moment, please.
[CUSTOMER][NEUTRAL] What is that test called? um.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The mine's going to.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] That doesn't have anything to do with an age number. I can assure you, Ms. [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm, I have that.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] So I've located your policy. So what we'll need to do, like I stated to you a moment ago, is to verify some things for security first. So first off, um, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct? OK, thank you. And lastly your email address please.
[CUSTOMER][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. So thank you very much. So let me just look at some of your benefits, but you don't know what the, I'm sorry, go.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, mm, uh, I can't, why, hm.
[CUSTOMER][NEUTRAL] Every now and then he has to run that cardiogram looks OK. Um, and every doctor I go to says you have a bad heart murmur. I know I'm keeping it in check. Um.
[CUSTOMER][NEUTRAL] I can't think of, but do you, do you pay for testing sometimes? I just, I just can't think of it. Uh, what?
[AGENT][NEUTRAL] Yeah, I'm
[CUSTOMER][NEGATIVE] Without the name of the test, you can't help me, right?
[AGENT][NEUTRAL] And I have to just look at to see exactly, it's cut, well, to see, I can't guarantee payment on anything, but to see if there's testing benefits on this policy, I can see that this policy just has
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, initially, what I'm seeing is a daily, like a hospital benefit if you were admitted as an inpatient.
[AGENT][NEUTRAL] On here.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] On this policy.
[CUSTOMER][NEUTRAL] I think I, yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so there's your hospital.
[AGENT][NEUTRAL] And the way I have to look at your benefits, this gives us a little more in-depth because of the, you've had this policy with us for quite some time.
[CUSTOMER][NEUTRAL] Yeah, I know, I have.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] So we have to, we have to look at all the benefits a little differently.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, you mean they've changed?
[AGENT][NEUTRAL] No, ma'am. It's just how we have to look at them. There's not been any changes. It's just
[CUSTOMER][NEUTRAL] Ohh.
[CUSTOMER][NEUTRAL] What is the name of that chest.
[AGENT][NEUTRAL] OK. So your benefits for your testing is all related to being an in, from what I'm seeing is an inpatient while you're confined to a, to a hospital as an inpatient.
[CUSTOMER][NEUTRAL] Oh, OK
[CUSTOMER][NEUTRAL] OK, so that would include that.
[AGENT][NEUTRAL] Every
[AGENT][NEUTRAL] I said that I'm looking for, you know, looking at it, it all specifically states that I confined as an inpatient.
[CUSTOMER][NEGATIVE] OK. Now, that answers the first question. The second on the cancer policy. oh, I had a real scare, hon.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have to, I have several nodules in my left lung.
[CUSTOMER][NEUTRAL] And I have one on my adrenal gland.
[CUSTOMER][NEUTRAL] And I'm supposed to get, I sometimes forget it. Every 6 months, I'm supposed to get a um CAT scan to see if they have grown. Well, the last CAT scan I got of my lungs, maybe 3 months ago, 2.5 months ago. The results came back.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I, one of the little, most of the
[CUSTOMER][NEUTRAL] Nodules are 2 millimeters, but one had grown to 9 millimeters, and they were concerned about that because of its quick growth. So they, I had to have a PET scan.
[CUSTOMER][NEUTRAL] Because it was requested, because of the growth. So I thought, hm, well, I guess they don't pay for that either.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh that is uh.
[CUSTOMER][NEUTRAL] I'm wondering, can you, you need my cancel policy?
[AGENT][NEUTRAL] Let me, no, ma'am, I, I can cross reference that to, to get that pulled up for you. So give me just a second.
[CUSTOMER][NEUTRAL] I mean, that, that's really a prevent. I, I, I just knew that's what I had when he had grown from 2 mill to 9 millimeters scared me to death.
[AGENT][NEUTRAL] But your results came back OK?
[CUSTOMER][NEUTRAL] Yes, they did.
[AGENT][POSITIVE] Wonderful. That's excellent news. I know that was a relief.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Alright, so let me get your cancer policy pulled up.
[CUSTOMER][NEUTRAL] And while you're looking, I have another.
[CUSTOMER][NEUTRAL] Another question referring to this cancer, so you might want to keep that pulled up when you do.
[AGENT][NEUTRAL] And there is
[AGENT][NEUTRAL] Uh, let me look at your screening benefit.
[AGENT][NEUTRAL] That's a $75 per calendar year benefit. Let me see if it specifies on here.
[AGENT][NEUTRAL] Um, what if it gives a specific list of tests, so give me just a moment.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK. And so what, um, so you do have that cancer screening benefit, Ms. [PII]. Now again, we would just have to receive the claim for review to see if that would be covered, the test that you're having.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Every so often, looking at these nodules that you have.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it's possible that there could be, you know, that that could fall under your
[CUSTOMER][NEUTRAL] Cancer screening
[AGENT][NEUTRAL] Your wellness. Yes, ma'am. Uh-huh, under your screening benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So what do I do? Do I send in?
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, did you use the internet very much?
[CUSTOMER][NEUTRAL] I can depending on how, how difficult it is, but uh I could.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Well, and the reason, well, I'm asking that because we now have a portal.
[AGENT][NEUTRAL] In which I could email you the user guide for how to set up your profile in our portal so that you can file claims. You do have to do it from a computer. You couldn't upload things from your phone, but there's now a wellness form in the portal and you just complete it. You just answer the questions on there and then submit it that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and uh did you send this to me through email?
[AGENT][NEUTRAL] I can email you the instructions.
[AGENT][NEUTRAL] For how to set.
[CUSTOMER][NEUTRAL] How do you usually
[CUSTOMER][NEUTRAL] How do you usually send them?
[AGENT][NEUTRAL] Well, I would.
[CUSTOMER][NEUTRAL] Hey, come in.
[AGENT][NEUTRAL] I would email you the instructions on how to set up your profile. I would attach those instructions and then you can either set up your online service center account by following those instructions or you can submit via fax.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or mail. We just cannot accept claims information of any type via email.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well, why don't you just send that to me then, and I'll go from there.
[AGENT][NEUTRAL] OK. So if you, um,
[AGENT][NEUTRAL] Yeah, and if you need any help, Ms. [PII], all you'll have to do is to call us back, but you don't know exactly what that test is that you have done every 6 months or so.
[CUSTOMER][NEUTRAL] It says TT
[AGENT][NEUTRAL] Is this, oh, it's a CT scan? OK. So again, it would.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm coming home just a second.
[AGENT][NEUTRAL] Yes, ma'am. We'll just have to receive the information.
[AGENT][NEUTRAL] I, I will go ahead and include
[AGENT][NEUTRAL] The claim form for you as well in case you decide that you're just going to fax it or mail it because
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] it does have on here cancer screening if they're doing it with a cancer screening, it states any other cancer screening test approved by the National Cancer Cancer Institute or the American Cancer Society.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, hon, well, if you'll go ahead and do that, I have another question, but I'm gonna have to go now. So if you, we'll just go from there if you'll send that to me now how you say, OK, and you have my email?
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] I will send
[AGENT][NEUTRAL] Uh, the one that you verified with me is the one that I'll send it to. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, OK, thank you so much for helping me. I appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, you are certainly very welcome, Ms. [PII], and if that's all then at the moment I can help you with, thank you again for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][POSITIVE] And a happy New Year. Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye.