AccountId: 011433970860
ContactId: f6e26bf3-640e-45eb-9ccd-71942c00588d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 868940 ms
Total Talk Time (AGENT): 325524 ms
Total Talk Time (CUSTOMER): 314069 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/f6e26bf3-640e-45eb-9ccd-71942c00588d_20250318T21:06_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. My name is [PII] and my husband uh was looking at his um claim online and wanted me to call to see because uh one thing, one part, it says status it says in progress and then under completed, um, it says it was completed today, but for the amount, it has nothing, so he was not sure if that means it was denied or what.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can take a look at the claim for you. And um [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It's [PII] and the policy number is 1415882.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you're on the policy as well, so I can verify with you. Um, can you verify your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's my date of birth is [PII] and the mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And let me take a look at the claim. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it all the same claim number? OK, yes, this is all the same claim. So yes, it looks like it just finished processing today and it was paid to you all. Um, it looks like it's a total of $300. I'm trying to see if it now since it just finished today, it doesn't show me whether it's direct deposit or, oh, I see. You, you are listed for direct deposit. So it'll be direct deposit, it just hasn't shown yet because that happens at [PII] tonight.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so what about his um cancer policy claim like his.
[CUSTOMER][NEUTRAL] The one for the cancer.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Is this all in one, hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see, this is, uh, I believe this is the cancer policy. Hold on one second.
[AGENT][NEUTRAL] No, this is critical illness.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Right, so I sent in, um, I sent in because we didn't realize that we can do the wellness things, so I went back from day one when he first took the policy out and sent in like the proof of all our wellness checks over the, the few years and then I sent in his um diagnosis to his um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] pathology report where he was diagnosed with cancer um 2 weeks ago or 3 weeks ago, whenever it was.
[CUSTOMER][NEUTRAL] So, um, that should have been, I guess, separate than the others.
[AGENT][NEUTRAL] Wait, I'm confused. OK, so he doesn't have a cancer policy with APL.
[AGENT][NEUTRAL] He only has a critical illness. Now the critical illness policy, that's where the claim was paid out for the, the screenings like the wellness.
[CUSTOMER][NEUTRAL] OK, but with the critical ill illness doesn't it have a, a cancer writer? It has a writer for the cancer policy.
[AGENT][NEUTRAL] Hold on one second, let me pull up the benefits. I'm looking at the claim. Hold on 1 2nd.
[CUSTOMER][NEUTRAL] OK, mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] That's what that.
[AGENT][NEUTRAL] And Mrs. [PII], do you mind if I place you on just a brief hold? I'm just going through the policy.
[CUSTOMER][NEUTRAL] Yes, that's fine.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh. You are on hold.
[AGENT][NEUTRAL] OK, now.
[AGENT][NEUTRAL] Health screening around a critical illness with cancer. OK.
[AGENT][NEUTRAL] So that's what she's referring to.
[AGENT][NEUTRAL] So what's the
[AGENT][NEUTRAL] OK, so that's why she received $300 because of those $50 payouts for the health screening test. Now we coronary artery critical.
[AGENT][NEUTRAL] Invasive cancer carcinoma.
[AGENT][NEUTRAL] So what's the claim saying?
[AGENT][NEUTRAL] N D E.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Proof of log car OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Mrs. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So in the explanation of benefits that you're receiving um in the mail, there's a, there's a form there and it's for the, the cancer part um of the claim that you submitted and it's asking that you fill out the claim form, um, and it's going to be what you fill out and send back to us is going to be used as the proof of law so that we can go ahead and process for the cancer part of the rider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, so that you don't fill out online.
[AGENT][NEUTRAL] No, from what this says on the explanation of benefits, this is coming straight from the claims department. It's not like a form that I can send you or anything.
[CUSTOMER][NEUTRAL] Uh, OK, so they mailing something in the mail.
[AGENT][NEUTRAL] Yes, so what you see online is because it's linked to our systems, but you're gonna receive uh like a physical explanation of benefits in the mail, which the form will be attached to that.
[CUSTOMER][NEUTRAL] OK, well, I was, because they didn't, I wish they would have because the lady, whoever I talked to about filing it told me to do it online. That's why I did it like that.
[AGENT][NEUTRAL] No, no, you're right. No, you did it correctly. They were going to mail this anyway. That's just how claims sends their forms back to you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, OK, so then they'll send me something and we have to fill that out and then send it back?
[AGENT][NEUTRAL] Right, and that's just for the.
[CUSTOMER][NEUTRAL] And then wait for them to process it.
[AGENT][NEUTRAL] Right, and that's just for the, the, um, whatever was submitted like the pathology report and everything for the cancer writer part of the policy. The other ones were all were paid the $50 for those past years.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, alright, and um, is the, the policy writer, am I looking at that right? Is the benefit for that the $10,000?
[AGENT][NEUTRAL] I don't want to say yes, it's up to. So depending on what they see in the paperwork and this percentage right here for the um looks like they're using the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The benefit, the name of the benefit is carcinoma and SITU. So it looks like that's what
[AGENT][NEUTRAL] That's what I see on this claim. So once they get the um claim form filled out for you, I don't want to say yes, it'll be that full amount and it's not, and it could be. I'm just, they have to process the claim.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so do we have do the, the policy because I pulled up the policy, is there like a breakdown of what they pay for what on the policy that I can read?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] As in like to try to figure out how much would be paid out?
[CUSTOMER][NEUTRAL] Do you know?
[CUSTOMER][NEUTRAL] Yeah, like what's the difference? I'm just trying to figure out what the difference is in the.
[CUSTOMER][NEUTRAL] The cancers or whatever.
[AGENT][NEUTRAL] Well, looking on the schedule of benefits, it, no, there's not like a.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's more like a breakdown in percentage, not really like dollar amount. So I don't know what they look at to determine what gets the higher percentage versus the low, uh, no, that's not on your policy, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Lowest percentage. OK.
[CUSTOMER][NEUTRAL] OK, that's what I was asking, yeah, OK.
[CUSTOMER][POSITIVE] All right then. Well, thank you. Mhm.
[AGENT][POSITIVE] Alright, was there. You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, and you said the other claims would be direct deposit.
[AGENT][NEUTRAL] Yes, ma'am. Um, now they just finished that today, so it'll it'll go out tonight at, well, technically tomorrow at [PII], but [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, and then I guess they'll do mine soon cause I sent them for me also.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] So, I know.
[AGENT][NEUTRAL] You want me to check for you?
[CUSTOMER][NEUTRAL] I don't think they started on my, you can, but I don't think they started on my shot.
[CUSTOMER][NEUTRAL] But he's not showing.
[AGENT][NEUTRAL] Oh no, yours are done too.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Looks like yours is paid out a total of 400.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, somehow they missed one of his cause we, we had the same.
[CUSTOMER][NEUTRAL] I think one of them, when I, I don't know, one of them might not it the computer must have didn't check what I put on there, so one of his was missing one, but I'm not going back through all of that.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Well, let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Oh, I see what you're saying. Hold on. What does this mean? Hold on one second.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Is there another one?
[CUSTOMER][NEUTRAL] Oh yeah, like they approved one on yesterday for $50.
[CUSTOMER][NEUTRAL] And then he had like $350 more dollars worth of stuff because both of them should have been $400 each.
[CUSTOMER][NEGATIVE] But one of the claims, when I was looking back through it, it would have no diagnosis, no, nothing checked on it for whatever reason. I don't know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] So one of the two that are denied one.
[AGENT][NEUTRAL] Is the one with the um that you're going to send the form back for and then the other one is a health screening, but what is the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Trying to see what the
[AGENT][NEUTRAL] The the the denial is the best one.
[CUSTOMER][NEUTRAL] That might be the one that don't have.
[CUSTOMER][NEUTRAL] Anything on it, so I don't know.
[AGENT][NEUTRAL] Oh, I found it. OK. So there's a [PII] bill for Dr. [PII]. It's separate than the claim that you just submitted. This one was the very first claim we processed for him. Well, it was still just a few days ago, but it was [PII]. That was the first claim we processed. There was $50 that was applied to that claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, right, right, I saw that one and then it should have been $350 more, but so one of the claims when I was looking back through one of the claims, l[PII] how you check if it what what you had done, it was nothing checked so I'm just maybe they just, but it's OK.
[AGENT][NEUTRAL] And then the other one.
[AGENT][NEUTRAL] You sure?
[CUSTOMER][NEUTRAL] Not we stressing, yeah, I'm not going back through all of that.
[AGENT][NEUTRAL] OK, cause I was gonna look.
[CUSTOMER][POSITIVE] All right. Well, that's OK. Don't worry about it. But thank you.
[AGENT][POSITIVE] All right, well, was there anything else I can help you with? You're welcome.
[CUSTOMER][NEUTRAL] No, that was it. And mine to be processed tonight or tomorrow also.
[AGENT][NEUTRAL] No, yours will be tonight as well. It's already done.
[CUSTOMER][POSITIVE] OK. OK, OK, well thank you.
[AGENT][POSITIVE] You're welcome and thanks for calling ATMs. Montague. I hope you have a good evening.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] You too. Bye-bye. Mhm. Um.
[AGENT][POSITIVE] Thank you. Bye-bye.