AccountId: 011433970860
ContactId: 0f5f18f3-37e8-4f56-9bdd-e55bb555611a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 496140 ms
Total Talk Time (AGENT): 185224 ms
Total Talk Time (CUSTOMER): 227717 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/0f5f18f3-37e8-4f56-9bdd-e55bb555611a_20250219T22:17_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][POSITIVE] Hi [PII], my name is [PII]. I'm doing good. How are you?
[AGENT][POSITIVE] I'm doing well.
[CUSTOMER][POSITIVE] So I um have the benefit through my company for um hospital indemnity.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I was reading through some of the uh information on there and I see where general anesthesia is covered, is that right?
[AGENT][NEUTRAL] Um, I can take a look at your policy and see what benefits you have. Um, [PII], may I have a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Absolutely it's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you for that and I
[CUSTOMER][NEUTRAL] That's my mobile number.
[AGENT][NEUTRAL] I'm sorry. OK. And may I have your policy number?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] If I have it
[AGENT][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah let me uh.
[CUSTOMER][NEUTRAL] Um, do I have my policy number? I may not have it, but let's see.
[CUSTOMER][NEUTRAL] No, I, I don't see it on my paperwork. What information can I provide you with?
[AGENT][NEUTRAL] OK, um, I can look the policy up with your social if you like.
[CUSTOMER][POSITIVE] Yeah, absolutely.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You're ready?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So I'm just waiting for the policy to populate here.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Hospital indemnity, here it is.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Sure, it's uh [PII]. My mailing address is [PII] and my email address should be my work email address [PII].
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So let me take a look at your benefits. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So the policy would pay up to $150 looks like 1 day per calendar year for anesthesia, so 1 surgery per year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for anesthesia.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So one of the reasons that I'm calling is because um as you can see and if I'm not mistaken.
[CUSTOMER][NEUTRAL] Uh, the benefici the benefit, the beneficiaries are myself and my, my wife, right? I should have the coverage for spo employee plus spouse. OK, good, um, so recently she had an outpatient procedure.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] I read that some outpatient.
[CUSTOMER][NEUTRAL] Procedures are there's a coverage, so she had one and she is looking to have surgery.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, on March.
[CUSTOMER][NEUTRAL] The [PII], um.
[CUSTOMER][NEUTRAL] Where she's going to go in for a procedure, um, basically a hysterectomy, OK, and, um, and yeah, I mean she's gonna go under general anesthesia again, so I'm trying to because I've never filed a claim on, on my hospital indemnity.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because we usually, we're usually not sick but um but it's happening so I'm, I'm trying to.
[CUSTOMER][NEUTRAL] Prepare myself and and what I need to do, what I need to submit, where and when, um, for any other covered benefits on, on my policy.
[AGENT][NEUTRAL] OK, so the easiest thing to do would be when you go to the provider, doctor's office, hospital, wherever you go, just go ahead and give them our card and our phone number, well, the phone numbers on the card, but I just give them the card so that they can give us a call and verify the benefits and then they'll be able.
[AGENT][NEUTRAL] To let you know, you know, the coverage based on whatever is needing to be done and then the benefits once they verify with us. Um, but just for like the policy, we haven't processed any claims for you or your wife, so she, you could still file, you know, in March. She hasn't used anything.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, yeah, I think trying to give the provider that information is easier said than done, um.
[CUSTOMER][NEUTRAL] And and in most cases, you know, we end up having to do the leg work anyway.
[CUSTOMER][NEUTRAL] Um, so,
[CUSTOMER][NEUTRAL] So, um.
[CUSTOMER][NEUTRAL] What, what sort of documents would you need if if I wanted to go ahead and and and.
[CUSTOMER][NEUTRAL] Submit the uh claim myself.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] So if you wanted to file the claim, you would need the Medlink claim form, which is on our website. You'll need the explanation of benefits from your primary, oh, actually, hold on one moment, because this is hospital indemnity.
[AGENT][NEUTRAL] I don't know how it just switched. I'm sorry. Um, so you'll just need your hospital indemnity claim form and then the itemized bill um for wherever you're going. It just needs to have the diagnosis codes and the procedure codes and then all the charges.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] So being that she had a procedure done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Alre[PII]
[CUSTOMER][NEUTRAL] Can I submit that and then additionally can I submit the one for [PII]?
[AGENT][NEUTRAL] Well, so once you submit that first claim now, because the, the, the benefit is one per year, depending on what the examiner sees and what's applied.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, mhm.
[AGENT][NEUTRAL] I mean, I would still submit the claim in March because you don't, the only thing that can happen is it be denied. If you don't send it in and there's other benefits, you can miss out on it. So I would still send it in if it was me.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so, so that's what I'm saying send the first one that she had done earlier this month and then the one in March.
[AGENT][NEUTRAL] Mhm. I would just send them both.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I just go to your website to print out the, uh, claim form.
[AGENT][NEUTRAL] Yes sir, so it's um [PII].
[AGENT][NEUTRAL] And then um you'll go to claims and forms. As soon as, as soon as the page populates to the top right corner, you'll see claims and forms and you're just looking for the hospital indemnity form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It goes in alphabetical order.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, and what was the name of the phone again?
[AGENT][NEUTRAL] Um, hospital indemnity is the, the form will match the name of your plan, your policy.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] All right, well that's easy enough. I can do that.
[AGENT][POSITIVE] Alrighty, well, was there anything else I can assist you with today? You're welcome.
[CUSTOMER][POSITIVE] Alrighty well thank you.
[CUSTOMER][POSITIVE] No, you've been most helpful. I really appreciate it.
[AGENT][POSITIVE] Well, I'm glad I could assist you and thanks for calling APL and I hope you have a great evening.
[CUSTOMER][POSITIVE] You too take care.
[AGENT][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Alright bye bye.
[AGENT][NEUTRAL] You also. Bye-bye.