AccountId: 011433970860
ContactId: 10eaf9c2-96bf-433a-9da2-c5bf7fbe0fef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 495859 ms
Total Talk Time (AGENT): 133582 ms
Total Talk Time (CUSTOMER): 291808 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/10eaf9c2-96bf-433a-9da2-c5bf7fbe0fef_20250610T16:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. I called yesterday and um I requested some information from APL because I was previously under APL for my accident plan and um I didn't realize we switched over with my employer this year. So when I was filing a claim they had let me know that that was a different provider. So I did get some information yesterday from one of the, uh, customer service reps there, and they sent me over, let me see what, what is this called, the um.
[CUSTOMER][NEUTRAL] Uh, insurance information to explain, I believe the, the process and I guess it has an index, talks about the schedule, definitions, benefits, etc. Now, on this,
[CUSTOMER][NEUTRAL] Yeah, I'm sorry, can you hear me OK?
[AGENT][NEUTRAL] Yeah, uh-huh.
[CUSTOMER][NEUTRAL] OK, there you go. Someone else has called me in their line, so I was kind of confused there for a minute. So on here it, it is a little different from the other provider that um I've had. So I just wanted to understand. I was trying to file a claim for a car accident that I was um that I incurred last year [PII] and the individual I spoke to yesterday said, yeah, there's not like a, what do you call it, a timeline in terms of filing the claim, but
[CUSTOMER][NEUTRAL] Does that qualify as um an accident under your plan because I couldn't really determine that with the information that I received. I know the current provider we have, it's a whole litany of of accident items that are covered.
[CUSTOMER][NEUTRAL] But does that make sense?
[AGENT][NEUTRAL] Yeah, um, do you have your policy number?
[CUSTOMER][NEUTRAL] You know what, let me see here, possibly yes I do. 012176887.
[AGENT][NEUTRAL] OK, thank you. And can I get your first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII]'s date of birth [PII].
[AGENT][NEUTRAL] And then can you verify your address and email address?
[CUSTOMER][NEUTRAL] Yes, address is [PII].
[CUSTOMER][NEUTRAL] An email address [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, perfect. And lastly, just a callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, thank you. OK, let me pull up your policy and see what it covers. Um, usually, yes, it will define what an accident is. So, and you said this was a motor vehicle accident?
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Yes, yes, ma'am, and I guess I came up because it happened recently with my wife and the other provider that we're with Lincoln I guess right now, and they explained to me that that would qualify under their plan. So then I was inquiring what's the um.
[CUSTOMER][NEUTRAL] You know, the timeline to file a claim and that's why I got, I guess rerouted back to APL because we were under APL the provider last year.
[AGENT][NEUTRAL] OK, let's see um.
[AGENT][NEUTRAL] Uh, give me just a moment. I'm gonna read through here and make sure it's not under the exclusion.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, no, I don't see it listed as an exclusion, so you should be able to, um, submit that. Um, I know we will need a police report if, if you, you know, filed it with your insurance and they came to the site, um, so be sure and submit that along with it, um.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] But yes, I do show, I don't show it as listed as an exclusion, so.
[CUSTOMER][NEUTRAL] Now, how does that work with with you guys' insurance so I do have the police report and then the uh information from the the doctor that I went to. It was my son and I, we were in together in the accident. Now we obviously didn't end up paying anything out of pocket because the insurance for the other individual covered those expenses. So I was reading through the policy, I guess I spoke to.
[CUSTOMER][NEUTRAL] The um reimbursement of expenses incurred, so is that is that accurate?
[AGENT][NEUTRAL] Yeah, so it just pays a lump sum based on the type of accident that you receive or that you had.
[AGENT][NEUTRAL] Um, so based on the expenses incurred, so if you'll submit like you went to the doctor's office or did you go to the ER or?
[CUSTOMER][NEUTRAL] Right. Doctor's off, went to a doctor that provided treatment for the, uh, the accident. We had like, I mean, definitely several visits with the, the chiropractor doctor to go over the injury and they took X-rays and then they determined a treatment plan for that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But we didn't, our insurance, we had PIP or whatever we have with insurance that covered the cost associated with that so we are paying for our insurance, so we don't, we didn't pay anything out of pocket, I guess.
[AGENT][NEUTRAL] Right, cause your, your car insurance picked it up, is that right?
[CUSTOMER][NEUTRAL] Well, initially they did and then eventually they got the other uh insurance company to um to pay them because they were at fault in the driver, yes.
[AGENT][NEUTRAL] OK, um, yeah, so I don't show anything in here, um, and of course this is not a guarantee of payment. It's a basic outline of your policy.
[AGENT][NEUTRAL] Yeah, you should be able to submit whatever charges like if you can get an itemized statement from your healthcare provider, um, for the chiropractic visits or the doctor's office visits, just some type of itemization and then you did receive our claim form, correct, to fill out?
[CUSTOMER][POSITIVE] Yes I did I did yes ma'am.
[AGENT][NEUTRAL] OK, OK, yeah, and be sure to fill that out and then you can attach that along with it. I will say that we will need a diagnosis, so be sure any itemization that would have the diagnosis code on there from the healthcare provider and then that it also just clearly shows what services were rendered, how much the cost was, um, and then you can fill out the form and submit those along with us.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, yeah, I did receive all that because I always kind of file a claim with my other provider, right, so I went to the doctor's office and gave me, they gave me a huge, uh, I guess binder, not binder, but just folder of all the doctor's notes and the business and the documentation for that. So I'll, I'll put that all together and then, um, and then I didn't get the itemized because for the other provider they just wanted the doctor's notes, right? They didn't want the itemized invoice, but I'll get the itemized invoice as well, um, that was.
[CUSTOMER][NEUTRAL] How they were paid because the provider and the doctor obviously got paid by somebody, um, so that's what you're referring to. So yeah, I just wanted to make sure I understood that I didn't want to go through all that work and if I wasn't going to actually get anything back because I didn't pay out of pocket per se, right? So my insurance did pay. OK, sounds good. Um, that answers my question, so I'll go through that process and fill out this claim form and send in all the supporting documents related to that.
[CUSTOMER][NEUTRAL] Now I'm sorry, I have one more question for you. This goes back to, um, I talked to the individual yesterday. She mentioned that I've had this coverage since [PII] according to the, the records that we have on file. She said and.
[CUSTOMER][NEUTRAL] I did have like a couple years back my other son had a like an accident at the house. I took him into the ER of course, and thankfully it wasn't anything major, but we went through that process. So if I go back and collect that information, I can also create a claim for that. Is that correct?
[AGENT][NEUTRAL] Yes, that's correct. Um, you, there's no limit on filing any of the claims, so you could go all the way back to that effective date of [PII], so.
[CUSTOMER][POSITIVE] OK perfect well thank you so much for your help.
[AGENT][POSITIVE] OK, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too, bye-bye.
[AGENT][NEUTRAL] Expedite.