AccountId: 011433970860
ContactId: 1ed5e8ae-833b-489f-8357-de935b802635
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441940 ms
Total Talk Time (AGENT): 267069 ms
Total Talk Time (CUSTOMER): 159763 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/1ed5e8ae-833b-489f-8357-de935b802635_20250130T17:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Uh, this is [PII]. I'm sorry, what was your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] [PII], OK. Hi, [PII]. Um, I have a critical illness, um, policy, and I have a hospital indemnity policy through APL, and, um, I need help claim making a claim in a making a claim or filing a claim.
[AGENT][NEUTRAL] OK, let me see, can I help you? Can you spell your first name for me?
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] OK, Ay, what's your phone number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] All right. Do you have your policy number?
[CUSTOMER][NEUTRAL] I do the uh critical illness.
[AGENT][NEUTRAL] OK, give me both of them. OK.
[CUSTOMER][NEUTRAL] OK, this is a critical illness is 234-6274.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] And the medical one?
[CUSTOMER][NEUTRAL] And the hospital and them.
[CUSTOMER][NEUTRAL] Uh, the hospital indemnity.
[CUSTOMER][NEUTRAL] Is 249-865-4.
[AGENT][NEUTRAL] Alright, give me one minute to look up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. I have the critical illness and verify your date of birth, your mailing address, and your email address on file for me, please, for verification.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, date of birth is [PII].
[CUSTOMER][NEUTRAL] And my address is [PII] uh zip code.
[AGENT][NEUTRAL] All right. And your email address?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] Alright thank you and that's what we got on file and you're calling because you would need to know how to do a client submit a claim.
[CUSTOMER][NEUTRAL] Yeah, I mean, can you do that for me or?
[AGENT][NEUTRAL] No, you have to submit the claim. You have to get a claim form, get the claim forms completed, submit any itemized bill that you want to be submitted with those claims, and you can either fax them to our office, you can upload them on our website, or you can mail those claims in. So let me, do you have access to our website?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I do and I have a copy of the claim forms my uh employer gave me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so, so, um.
[CUSTOMER][NEUTRAL] The section D, um.
[CUSTOMER][NEUTRAL] I guess I'm I'm gonna be checking off the critical illness benefit.
[AGENT][NEUTRAL] OK, so on the critical illness benefit, you you've been diagnosed with a critical illness disease?
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. You know that your doctor got, you see the part, the section where your doctor have to fill out, correct?
[CUSTOMER][NEUTRAL] Oh OK, yes.
[AGENT][NEUTRAL] Uh-huh. So it's your portion and your doctor portion that have to be completed.
[AGENT][NEUTRAL] And then read the instructions to tell you what you need to submit with that information because the instructions is on that critical illness claim form telling you how to file a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so you just follow those instructions and do what the instruction tells you to do.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So, can I check off multiple things in this section D because I was diagnosed with prostate cancer and um so I guess that would be considered a critical illness benefit. I also had genetic testing and that's one of the, the tabs that can be checked off and I was in the hospital for one night, so.
[AGENT][NEUTRAL] I don't, it doesn't, well, on this policy, it doesn't pay hospital benefits anyway. This is going to be a one time lump sum payment for whatever medical treatment that you're sending in for that critical illness. So DHB is not covered on the critical illness, uh, anyway, but you can check out anything that you want to check out.
[CUSTOMER][NEUTRAL] Um, do I check?
[AGENT][NEUTRAL] But the main thing is just follow the directions and making sure the doctor, cause that's what they're gonna go by what the doctor completes on that form and what he's saying that you've been diagnosed with. So, yeah. So you just get that filled out and get it submitted. And then on the medical, let me go to the medical plan for you. Let me tell you what you need to do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the direction is on that too for the medical plan, but the medical plan is you send in your itemized if you was in the hospital, you need to get your itemized hospital bill and submit it with your claim form completed. And if you have any other medical claims that you want to be seen for, you can submit that with your medical uh claim so that make sure you separate them have one way.
[AGENT][NEUTRAL] Claim with your critical illness policy number any paperwork submitted with that with that particular uh policy and then with your medical have that claim form because it's a different claim form anyway have that completed and that your itemized bills.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well I haven't gotten any bills yet, um, so I have to wait until I get the bills before I can do this then.
[AGENT][NEUTRAL] Yeah, because you have to submit if you just hit the claim form, they're gonna ask for you to submit your itemized bill showing what you're trying to get reviewed to see what can be paid on your uh medical plan so yes.
[CUSTOMER][NEUTRAL] OK, OK, because I had the, the procedure done, the removal of the prostate, um, on the [PII], so I haven't received any of that information yet, so I guess I'm premature in sending this out.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So, yeah, yeah, so what you need to get, make sure you get your itemized hospital bill cause you was in the hospital, you said. Make sure you get your itemized surgery bill, not, not a statement. It got to be the surgeon bill from the surgeon with the codes on it and the amount they charge. So, you can't send a statement in cause that won't have the information we need. So you need to ask your doctor for the item.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Surgery bill with the CPT codes on it. You need to ask for your itemized house pillow bill showing everything that they done to you while she was in the hospital with the midday discharge date. You need this any office visit, you need to send in your automized.
[AGENT][NEUTRAL] Office visits, you know, like if you went to for an office visit, it does have a benefit for an office visit for $50 and I think you get up $2 per year on this policy and it's just a quote of your coverage. It's not any guarantee of any payment, but that's what you're gonna need to submit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK. All right. Thank you very much.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] All right. You're welcome. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] That'll be all.
[AGENT][POSITIVE] All right. If you have any other questions, just give us a call back, Mr. [PII]. Thanks for calling American Public Life. You have a wonderful day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You do the same bye bye.