AccountId: 011433970860
ContactId: 25c6b964-ad6e-4ac3-92cc-48b3b1041aa0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 597489 ms
Total Talk Time (AGENT): 238151 ms
Total Talk Time (CUSTOMER): 271399 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/25c6b964-ad6e-4ac3-92cc-48b3b1041aa0_20250307T15:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name's [PII]. I, uh, emailed a claim form in with about a month of services, and I wasn't sure if you were accepting the claim and I wanted to just get clarity on the.
[CUSTOMER][NEUTRAL] The service and the benefit.
[AGENT][NEUTRAL] OK, uh, what is the policy number, please?
[CUSTOMER][NEUTRAL] Um, the policy number is 8 I'm sorry, 683-629-097.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Uh, what's your last name?
[CUSTOMER][NEUTRAL] Uh, I'll spell it. It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, give me one.
[CUSTOMER][NEUTRAL] Oh, I just, I gave you the member ID. You need the group ID because that's all I have.
[AGENT][NEUTRAL] No, sir, policy number or policy er number, but give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh, I have to.
[AGENT][NEUTRAL] OK, and verify your date of birth, mailing address and email address for me, please.
[CUSTOMER][NEUTRAL] Um, date of birth [PII], uh, address [PII].
[AGENT][NEUTRAL] OK, and email address.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number, Mr. [PII], in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And you said you emailed a claim to our office?
[CUSTOMER][NEUTRAL] Yeah, I, I emailed to customer support [PII].
[AGENT][NEUTRAL] Um, that's not our email address because I don't show a claim was received. I'm not sure who that email address is with, but we can accept claims over via email. You have to mail it or fax it in to us, or if you set up on our online service center, you can upload it into the system.
[CUSTOMER][NEUTRAL] OK, because I, that was what I received last time. They said you could email it, fax it, um, and I said they said email is quicker, so that's what I did. So you don't accept to this custom is this, is this a valid email or should I just remove it?
[AGENT][NEUTRAL] Well, it's not our email. We have a different email address at APL, but like I said, with our company, we can accept claims via email. It has to be mailed or faxed or sent to the online service center.
[CUSTOMER][NEUTRAL] OK, um, does this email ring a bell? Because it I basically called, you know, PHCS, and this is the number they gave me for this department.
[AGENT][NEUTRAL] No, no, sir, it doesn't sound familiar to me.
[CUSTOMER][NEGATIVE] OK, this is pretty frustrating. So what's your email? I mean what's your mailing address and what's your fax?
[AGENT][NEUTRAL] Uh, mail address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hold on a 2nd. 2, would you say the [PII] was [PII]? Give me that again.
[AGENT][NEUTRAL] [PII], yes sir, [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said [PII]?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK and what's the fax?
[AGENT][NEUTRAL] Uh, fax number [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Alright, and I'm assuming the faxing is quicker.
[AGENT][NEUTRAL] It is
[CUSTOMER][NEUTRAL] OK, um, let me figure out how to digitally fax this over to you, um, OK, um, and that's the form that I have.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This, I mean this the this is the form that I have. I can read you off what it looks like is this I just wanna make sure I have the right form here because obviously I don't have the right email address.
[AGENT][NEUTRAL] And I'm looking as far as your group and that email address is for
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] A member services, which is not our email, so, but it does show customer support at [PII], but it's not our email.
[AGENT][NEUTRAL] And they help as far as wanted to cancel policies or uh benefit changes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] That's, that's what I received. I told them I was sending claims over. I just wanna make sure I have everything right, right, so this is.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] OK, so this this is uh this is basically for.
[CUSTOMER][NEUTRAL] Uh, member services is what you're saying.
[AGENT][NEUTRAL] Well, that email address, that's what I'm showing as far as your group, but completely different than APL.
[CUSTOMER][NEUTRAL] OK, so just to qualify what you do is you're, you're the additional benefits department do I have that right?
[AGENT][NEUTRAL] We're a department that as far as can verify benefits or verify claim status or you can submit claims for your medical plan to us, but they are the ones that helps us uh want to cancel policies or change policy, they are the ones that assist.
[CUSTOMER][NEUTRAL] OK, is there any way that you can verify the service that I'm sending in because the service provider was in network and I'm trying to verify that this claim will be paid and that's why I'm filing it because no one could tell me that it could be paid only that I needed to file it so does that sound right?
[AGENT][NEUTRAL] Well, we can't give a guarantee of payment. We can only verify the benefits you have with us, and I can do that for you if you like.
[CUSTOMER][POSITIVE] That would be great. That would be helpful.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, with the policy you have with us, you have benefits for inpatient confinement, meaning if you're confined in the hospital 18 hours or more, you have a hospital admission benefit and a hospital confinement benefit. Um, you also have benefits for ER, urgent care, on office visits, or physical speech or occupational therapy.
[CUSTOMER][NEUTRAL] Physical speech or occupational therapy. Yes, that is covered, um, but they, uh, Doctor [PII], who I'm saying, who's not.
[CUSTOMER][NEUTRAL] He's vision therapy, so you know.
[CUSTOMER][NEUTRAL] I was told that he was in network when I called and set up the policy so if that's the case.
[AGENT][NEUTRAL] Vision therapy.
[CUSTOMER][NEUTRAL] Mhm, the vision therapy.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] I mean, you can submit it to our office and we can review, but um those are the only 3 therapies that has listed what is covered under the plan.
[CUSTOMER][NEUTRAL] OK, what did you say it was was occupational therapy?
[AGENT][NEUTRAL] Uh, physical, speech, and occupational therapy.
[CUSTOMER][NEUTRAL] OK, is speech and occupation, OK.
[AGENT][NEUTRAL] Do you have a copy of your policy with our company at APL?
[CUSTOMER][NEUTRAL] I believe I do so I is it possible to get it again just because I've recently moved and I've got a
[CUSTOMER][NEUTRAL] Paperwork, a lot of paperwork to file through, but is there a way you can email it or resend it?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Uh, yes, I can definitely email.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yeah, that's right.
[CUSTOMER][NEUTRAL] Um, when I'm filing the claims with your department, the claim form, just wanna make sure I have this right, because if I didn't get it from the right department, I have a form that says it says APL on it at the top and it says hospital indemnity and everyday solutions claim form. Is that it?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is a claim form, yes, sir.
[CUSTOMER][NEUTRAL] OK and looks like we've got the same fax number on there too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which is the 365 I'm sorry 3 yeah 365. OK, alright, alright, but this definitely needs to be either faxed or mailed. That's correct.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, fax or mail. Yes, sir.
[CUSTOMER][NEUTRAL] Can I call and follow up after I fax it to make sure it was received? Is that acceptable?
[AGENT][NEUTRAL] Uh, you can. Uh, there are some that are able to verify and look at faxes. Um, I would say give it about 20 minutes just to make sure that it comes through and we can be able to see it, but after faxing it just give it 20 minutes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, sounds good. That's what I'll do I'll, I'll wait, uh, you know, a day or so OK?
[AGENT][NEUTRAL] OK. And is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's you've been helpful, thank you.
[AGENT][NEUTRAL] Oh, yes, sir, and I'll fax this policy off to you in a few moments, OK?
[CUSTOMER][POSITIVE] I appreciate it thank you.
[AGENT][POSITIVE] Yes, sir, and thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] Bye.