AccountId: 011433970860
ContactId: 1a7e998e-41ae-419b-8159-f206530f0f97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 962549 ms
Total Talk Time (AGENT): 505331 ms
Total Talk Time (CUSTOMER): 364353 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/1a7e998e-41ae-419b-8159-f206530f0f97_20250317T16:19_UTC.wav
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[AGENT][POSITIVE] Hi, thank you so much for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes, hi [PII], this is [PII]. I'm looking to see if you can um look up my policy number so I can submit a claim.
[AGENT][POSITIVE] Oh yeah, OK, I can certainly help you find that policy number today. and Ms. [PII], um, do you mind real quick if I grab just a good callback number in case our call gets disconnected?
[CUSTOMER][NEUTRAL] No problem. [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] that's my work number.
[AGENT][POSITIVE] Perfect. And Ms. [PII], are you the policy holder on this policy we're looking for? All righty. I can search that with your social if you'd like.
[CUSTOMER][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, perfect. That pulls right up, Ms. [PII], and give me one second.
[AGENT][NEUTRAL] Alright, thank you. And if you don't mind, I'm just gonna need to verify some quick information um if you could verify for me pretty please your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then the last will just be your mailing address, your email and your phone number.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], not sure which number you have [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So I actually did I actually ended up didn't have a number on file. Can I put one of those numbers on file for you?
[CUSTOMER][NEUTRAL] Um, I won't get like junk calls, will I?
[AGENT][NEUTRAL] No, um, it's just like an added security measure on our part, but then if something were to change with your policy, we might call about it.
[CUSTOMER][NEUTRAL] OK, but it's not like it's gonna go to this, uh, you know, telemarketer.
[AGENT][NEGATIVE] Oh, we don't sell your informa no we're not gonna sell your information at all.
[CUSTOMER][NEUTRAL] OK OK. [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Perfect. And the last thing to update or not update, I'm so sorry. The last thing to verify is just that um email address on file, my friend.
[CUSTOMER][NEUTRAL] Actually, my email has changed, so it used to be [PII], but it's now [PII] My full first name [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect, I will update that for you.
[AGENT][POSITIVE] Perfect, Ms. [PII], and I did save. Wonderful. And then let me get this policy number for you. Do you have a pen and paper handy, my friend?
[CUSTOMER][NEUTRAL] I do. I have the claim form in front of me.
[AGENT][NEUTRAL] OK, perfect. It's 01.
[AGENT][NEUTRAL] 29
[AGENT][NEUTRAL] 3871.
[CUSTOMER][NEUTRAL] 01293871
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] And do I have to write that on every like piece of paper? I, I just find it um it's kind of the abyss of like what's being paid, what's not. I, I don't know, um, you know, it's kind of hard to know, so should I write the account number on each page?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] I would write it just on one of the pages that you upload and submit and you're uploading and submitting it are you doing it through the online service center?
[CUSTOMER][NEUTRAL] Um, not really sure what I'm doing right now. I'm, um.
[AGENT][NEUTRAL] Like through our online portal?
[CUSTOMER][NEGATIVE] I'm really not sure honestly I'm not very good with this type of stuff.
[AGENT][NEUTRAL] No, you're OK so we have like an online portal where you can like submit your claim documents and they come straight to us opposed to mailing or faxing them and if you're doing it through the online portal it will be linked to your your customer profile so you really just need to put the policy number on there once because it's already linked to you.
[AGENT][NEUTRAL] Um, if you want, I have that email address on file. I can send you, um, a user guide to our online service center, um, that way it will like show you, I see you have an account with us, um, already, but it'll just show you how to, um, best utilize the online service center like checking claims, submitting claims, all of that information.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Is this something I could like take a picture with my phone and and upload like I do with Aflac?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I it's not always optimized to your phone, but you might be able to take a picture to your phone, email it to yourself, save it to a computer, and upload it. Some people say that they can use their phone with the online center and it works fine, and some people cannot use their phone. So I don't want to guarantee you can use your phone, but when I make my claims, I take a picture, I send it to my Gmail, and then I log on to the computer and I just drag the picture over from my Gmail into the file and I upload it.
[CUSTOMER][NEUTRAL] OK, and um.
[CUSTOMER][NEUTRAL] I guess I have to send, I think the anesthesia that's I think part of it or no, it's the Aflac.
[AGENT][NEUTRAL] Um, I would send, I mean, honestly, I would send everything you have because it's in my opinion, better to get any benefit. I'd rather get a denied claim than miss benefits payable, if that makes sense. Um, I would certainly go ahead and send it, but let me also pull up your benefit information on this policy real quick as well, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, and it's just taking a moment to load.
[CUSTOMER][NEUTRAL] Yeah, that's OK. I'm just looking. I have um.
[CUSTOMER][NEUTRAL] Yeah, like, I don't think the ultrasound.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Just confusing on what I have done what I haven't done quite frankly.
[CUSTOMER][NEUTRAL] Because when you're in and out and doing different things, it, it's, you know.
[CUSTOMER][NEGATIVE] It's messy.
[AGENT][NEUTRAL] Yeah, OK, I do see that, um, I do want to let you know any benefit information I give you over the phone is always just a verification of coverage and not a guarantee of payment, but I do see you have a surgical and anesthesia benefit on here. So if you have information about your anesthesia, I would go ahead and submit that because there you could have benefits payable.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Is it easy enough for you to see if I, I think I'm pretty positive I submitted stuff from [PII].
[CUSTOMER][NEUTRAL] Um, from, uh, it was a breast explant and my implants taken out.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Let me see. All right, so I'm showing.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] From Saint Barnabas Medical Center.
[AGENT][NEUTRAL] It looks like we had.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] A daily hospital benefit on that and
[CUSTOMER][NEUTRAL] Yeah, but that was from, wait a minute, that was from [PII] that was from [PII], yes, OK, yep.
[CUSTOMER][NEUTRAL] But that wasn't the one I'm thinking of.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, so I'm not showing, I'm seeing some stuff from [PII], [PII], and then just that one from [PII], so it looks like.
[CUSTOMER][NEGATIVE] Yeah, no.
[CUSTOMER][NEUTRAL] So you see the [PII] like when I was in for two weeks.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like a hospital stay?
[AGENT][NEUTRAL] Yeah, it does look like a hospital stay and it looks like I have 10 days on here, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but you don't have, I'm trying to think of when after that stay it was in [PII]. I, I, I believe I had breast implant illness, so I had my breast implants taken out, um.
[CUSTOMER][NEUTRAL] Which was from a double mastectomy. So that would be covered, the anesthesia would be covered for that possibly.
[AGENT][NEUTRAL] As long as the surgery is covered on that, the anesthesia could be covered on that, yes. Um, but I'm not
[CUSTOMER][NEUTRAL] It was outpatient.
[AGENT][POSITIVE] Outpatient. OK, let me read your surgical benefit real fast for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] But it was full anesthesia. It was a 4 hour operation.
[AGENT][NEUTRAL] OK. So it looks like you have coverage here for an ambulatory surgical center, which means that you don't have to be overnight. You can be discharged the same day.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is that separate than the anesthesia?
[AGENT][NEUTRAL] Uh, so the anesthesia benefit is coupled with the surgical benefits. So it's a surgical and anesthesia benefit and they like exist together.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] So under the anesthesia, it says when a surgical procedure is performed that is covered under part one and there's a separate charge for anesthesia, we will pay the anesthesia benefit amount set in the certificate is scheduled for the anesthesia administered by a physician in connection with such procedure.
[AGENT][NEUTRAL] Um, it's how it's worded.
[CUSTOMER][NEUTRAL] OK, so I need to get doctor notes for that procedure, or do I need to get the actual anesthesiologist notes?
[AGENT][NEUTRAL] So my
[CUSTOMER][NEUTRAL] If the doctor's notes say I was put under? Does it, do you need anything more?
[AGENT][NEUTRAL] Yeah, I think you just want like your operation report or your operation notes.
[AGENT][NEUTRAL] For that one?
[AGENT][NEUTRAL] And then the same thing like those itemized charges with the procedure codes, diagnosis codes, and then along with that is that operative report.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll have to see what I can get online um.
[CUSTOMER][NEUTRAL] OK, and then I guess for the other one I'm that I have here.
[CUSTOMER][NEUTRAL] I've got
[CUSTOMER][NEUTRAL] Progress notes? No, hold on, that's different, um, note from you note from your admission.
[CUSTOMER][NEUTRAL] And that's a note from the doctor that I pulled off online.
[CUSTOMER][NEUTRAL] And then it has.
[CUSTOMER][NEUTRAL] It's like 3 pages, notes from admissions and then it has the anesthesia.
[CUSTOMER][NEUTRAL] Pre-procedure evaluation and then I have an after visit summary.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But that's not what you're looking for because that's all that was online on my portal.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, um, would you mind, so I don't actually process the claims all I can do is like read the claim form and your policy certificate with you um do you mind if I get you in touch with somebody who does process the claims and have them do a like a check into your policy and and then do a call back for you to give you like the exact information that they're looking for?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, perfect. I wanna, I just don't wanna lead you astray and I know you're trying to organize all the paperwork, so I'd hate to give you the wrong information or not give you the accurate information.
[CUSTOMER][NEGATIVE] Yeah, no, no, no problem. I'm just, you know, trying to get this if it's not on portal, it's like it's, it's almost like I have to take off a day to get all the information together it's ridiculous. It's, it's just hard. It's not always as easy.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] To have, if you know what I mean.
[AGENT][NEUTRAL] I feel like
[AGENT][NEUTRAL] Yeah, no, I absolutely understand. I feel like it should be a lot easier to have like access to the medical information and some places make you drive out to their facilities and like put in written requests. It's, um, so I totally understand, Ms. [PII]. Um, OK, so let's see, I have your number, um, do you want a call back to that [PII] number or the one I put on your policy, the [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] The [PII], yeah, the [PII] is best.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And then is there a um I'm hopefully I'll get this in early enough that you'll get a call back today but if not it would be tomorrow morning. Is there a particular time of day that you do not want a call back during?
[CUSTOMER][NEUTRAL] Actually tomorrow morning would be better. I'm off tomorrow and I'm usually up at like [PII], so Eastern time, so [PII] would be better because then I'm gonna be going out. My daughter is home from spring break, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] OK, perfect. I will let them know that you would prefer a call back tomorrow um morning early morning. Uh, we don't get in until [PII] Central time, so I think that would probably work best if they, yeah.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Um, and then
[CUSTOMER][NEUTRAL] Is that 2 hours or 3 hours now? I'm [PII]. Are you [PII] or [PII]?
[AGENT][NEUTRAL] We're [PII] right now, so we're just an hour behind.
[CUSTOMER][NEUTRAL] Oh, OK, all right.
[AGENT][NEUTRAL] And then, um,
[AGENT][NEUTRAL] So we'll aim to give you a call back tomorrow morning and we wanna know exactly what information is going to be needed to submit the claim for the surgical and anesthesia, anesthesia benefit.
[CUSTOMER][NEUTRAL] Yeah, because one of them was um in a outpatient facility.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That was in [PII]. And then I just had my uh my appendix out and that was in the hospital. It was supposed to be outpatient, but I got really sick from the anesthesia, so they kept me overnight.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In a, but it wasn't, it wasn't like a hospital room, um, but they, they did have to, I don't, I don't know exactly what you would call it, right? It wasn't, you know, they had to admit me to someplace else, but it wasn't like I had my own room. I had my own little cubby like almost an ER cubby.
[AGENT][NEUTRAL] Oh, OK, yeah, so we consider impatient on most policies and I can always look up the exact definition on yours, but we consider it typically it's confined for, um, on your policy it's confined for at least 24 hours.
[CUSTOMER][NEUTRAL] That I was.
[AGENT][NEUTRAL] OK. Um, yeah.
[CUSTOMER][NEUTRAL] Yeah, I
[AGENT][NEUTRAL] So then with that, you could possibly have some daily hospital confinement benefits as well.
[CUSTOMER][NEUTRAL] OK, it would only be the one day they let me go after a day.
[AGENT][POSITIVE] OK, perfect. So all benefits are benefits.
[CUSTOMER][NEUTRAL] But OK, so they'll call me. I will also take a look tonight and kind of see if I missed anything on my portal to see if I can find anything else.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, but it sounds like I've got two things I've got to submit for them, so.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And I will also still go.
[CUSTOMER][NEUTRAL] And then there's nothing else for like.
[CUSTOMER][NEUTRAL] Like ultrasounds, like I had gotten paid for breast cancer back in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I don't think any of my follow up stuff is paid for because that's not hospitalization, right?
[AGENT][NEUTRAL] No, so we just have the.
[CUSTOMER][NEUTRAL] Like I, I've not been put under, you know, I just go for like ultrasounds and different things.
[AGENT][NEUTRAL] Yeah, we just have the, um, on this particular policy, it's just the daily hospital confinement or an ICU coronary care confinement. You have an annual first occurrence hospital rider, so that resets every year and then that surgical and anesthesia benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That sounds good. I think the other one's on my app. I'm just trying to get the two.
[AGENT][POSITIVE] No, they can definitely blend together for sure.
[CUSTOMER][NEUTRAL] Um, sort this through my mind.
[CUSTOMER][NEUTRAL] Well, Aflac is the cancer policy, so and you guys are the hospital policy, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I I think I got it. OK, well thank you very much. I will wait for my phone call tomorrow.
[AGENT][POSITIVE] OK perfect well thank you so much for giving us a call Ms. [PII]. If there's anything else we can do to help you along the way, just give us a call we're always here we're gonna do our best for you.
[CUSTOMER][NEUTRAL] OK, and you'll send me the information to my email though, so at least I can look at that tonight before they call.
[AGENT][NEUTRAL] Yes, I'm gonna send you that online service center guide so you have full access to it and you can look at your past claims and it will break down how to how to do everything um for you in there OK?
[CUSTOMER][NEUTRAL] So I can
[CUSTOMER][POSITIVE] Great thank you you have a great day.
[AGENT][POSITIVE] Hey my pleasure you too take care.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Bye bye.