AccountId: 011433970860
ContactId: 2c2c6772-d880-4e27-9817-f377699a046b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 955119 ms
Total Talk Time (AGENT): 476634 ms
Total Talk Time (CUSTOMER): 329734 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/2c2c6772-d880-4e27-9817-f377699a046b_20250313T16:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I have a question um so we are fixing to go through our open um our open enrollment actually just ended and as I was looking through the policies, I, I have a question regarding um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Something so
[CUSTOMER][NEUTRAL] And, and this is from I'm, I'm actually the administrator but I'm also calling on behalf of me personally, um, so I how is there a certain time frame to make a claim or to like to file a claim is there I mean I know obviously it has to be within but like if I had.
[CUSTOMER][NEUTRAL] Um, because as I was looking through the actual like schedule of be like the benefits and stuff, I found out that like I've noticed now because I just assumed I had accidents like if I fell, if I cut, you know, something along those lines, but um I saw that one of them was for an exploratory surgery. What exactly is that? and like is there a timeline from when the procedure was to when you can file a claim?
[AGENT][NEUTRAL] OK, so you do already have a policy with APL or not first off?
[CUSTOMER][NEUTRAL] Yes, ma'am, I do. I do and I actually, and I have.
[AGENT][NEUTRAL] OK. So you have a question.
[CUSTOMER][NEUTRAL] Uh yes, and so and I carried the accident policy and so and so as I was like going through everything, you know, um, being the administrator, uh, something caught me that I could possibly and I'm not sure if I would qualify for or not or if I've missed the window of opportunity for it.
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] OK, just
[AGENT][NEUTRAL] OK, so yes ma'am, I can help you with this as far as you're basically trying to find out about a timely filing limit. Is that correct? If we have a timely filing? OK, yes. So first off, what I'll need to do is to get your information and pull up your policy. So who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And [PII], what is a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, my cell phone, it's [PII].
[AGENT][NEUTRAL] Thank you and what is your policy number, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 26,400.
[AGENT][NEUTRAL] Now, that's the group number. What's your specific policy number?
[CUSTOMER][NEUTRAL] 00, me me me me me, OK, I'm sorry.
[AGENT][NEUTRAL] Yes, that's OK.
[CUSTOMER][NEUTRAL] Um, let's see here.
[CUSTOMER][NEUTRAL] 248-047-0
[AGENT][NEUTRAL] 248-047-0. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, thank you so give me just a moment please to get all of your information pulled up [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and any information, [PII] that I provide for you today would be a excuse me, a verification of benefits and not a guarantee of payment, and I will need to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, also your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you, it is different than the one you gave me. What is another number that we could have for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Is that still a valid number?
[CUSTOMER][NEUTRAL] Yes ma'am, that is my actual physical cell phone the number that I gave you is my work cell phone, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK. All right. Thank you. And then lastly, your email address and this does appear to be your work email that's on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so now I can say that you're also the group admin like you had mentioned and have you ever set up your profile, your own personal profile in the online service center so you can have access to your specific information?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I wanna say no.
[AGENT][NEUTRAL] OK, now I, what I will do then I will email you the user guide that gives the instructions for setting up your profile. It's very similar to how you set it up for your admin but again this is gonna be specific to you and your claims information and your specific policy information so you can also submit claims to APL via this portal.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and the instructions, you know, for how to upload that will also be included in this user guide, so give me just a second. I'm gonna go ahead and send you that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, I'm gonna go ahead and I'll send that to you then when we get off the phone, but I've got the information pulled up so you've had this policy now with us, uh, since last year, since [PII] and with APL there is not a timely filing limit on claims.
[AGENT][NEUTRAL] Like most insurances, we do not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Because, so then I guess my next question is, is so back in June of last year and like I said, I've only stumbled upon this because I was, you know, reading it and like that to me accident I just assumed because I am a walking, talking, ticking accidental time bomb so.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] I was assuming it was more along the lines of like if I fell or something like that. And so, but I saw something about an exploratory surgery. And so back in June, I did. I had um some masses that were, we're questioning, they turned out to be lipomas and so the doctor went in and he removed them. So I don't know if that would be like something that would be covered or whatnot. So that's the second, that's, that's the second part of my question.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, I'm looking through this list of specific, you know.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Because I see where it says exploratory, so.
[AGENT][NEUTRAL] Yes, so what I would recommend, it does have that on there. It shows that the benefit amount on that would be $350 would be for you to submit the claim for us to review because again I can't guarantee payment over the phone, we would just have to receive the information.
[AGENT][NEUTRAL] For review first now there is a specific accident claim form that you would complete if you have access to the Internet, you can print that directly from our portal, I mean not from our portal but our main website, but if you'll give me just a second since I haven't sent this email to you yet.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I will just go ahead and attach that accident claim form because the first page on that claim form [PII] has all of the instructions.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, for completing the form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So give me just one second.
[AGENT][NEUTRAL] And then the additional documentation, you know, that you would need to include.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you just use that. I always recommend to use that first page as a checklist.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh, let's see.
[AGENT][NEUTRAL] OK, so you should be getting that within just the next minute or so. The email you're gonna be receiving is gonna come from [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I did put ape in the subject line for you too as well, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] No, ma'am, um, uh, well, OK, so I do have another question. So if I continue to go through this and find that there's other things that suit, is there a certain, is it like per.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Like, um.
[CUSTOMER][NEUTRAL] Let's see here. I'm trying to think if, if there's anything else that I found that I have endured over the past year, um, which again, I, being a walking talking time bomb, um, you know, so is there, is it like per incident, per accident, part, like, how does that work?
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] I mean I'm not seeing anything but.
[AGENT][NEUTRAL] Just
[AGENT][NEUTRAL] OK, so if, OK, so once you've set up your profile or, and you, if you're already looking at a copy of your policy, you're gonna see this in there as well, but there is um specific, like, well, there's definitions for like what an emergency room treatment is defined by this policy. And those are in alphabetical order, um, pretty much with.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The, the, the, that, excuse me, I'm, I am following, you're talking about you being a walking accident looking for a place to happen. I'm having trouble getting my words out today.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It gives you what the specific definition of each of those areas are. So for example, emergency room treatment, it says, we will pay the emergency room treatment benefit amount shown in the schedule of benefits for each day a covered person receives treatment in an emergency room as a result of a covered accident. The treatment must occur within 90 days after the covered accident occurs.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The benefit is payable once per covered accident and is payable up to 3 days per plan year for each covered person. This benefit is only payable once per day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And then it also, you know, there is the definition of exploratory surgery since that is the first thing that you mentioned, they just happen to be very close together, but it states, we will pay the exploratory surgery benefit amount shown in the schedule of benefits for each day covered person undergoes exploratory arthroscopic surgery without repair as the result of a covered accident.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This benefit is payable once per covered accident and is payable up to one day per plan year for each covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if I understand it correctly, so if it was like 3 different instances.
[CUSTOMER][NEUTRAL] Um, no users file it please try again, OK, um.
[AGENT][NEUTRAL] So you're gonna, yeah, make sure to use your
[AGENT][NEUTRAL] Are you trying to set up your personal profile?
[CUSTOMER][NEUTRAL] Yes ma'am, but it has my, it has my personal email address on it, but so let's see here.
[AGENT][POSITIVE] OK, good, well.
[AGENT][NEUTRAL] Um, it's not gonna let because we have work, it's gonna probably give you an error if you try to use your personal email to set it up.
[CUSTOMER][NEUTRAL] So I went in as in.
[CUSTOMER][NEUTRAL] And it tells me that that account already exists, so I think I can only go to.
[AGENT][NEUTRAL] OK, so apparently you have. Um.
[AGENT][NEUTRAL] Let me see if you have a personal.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it would
[AGENT][NEUTRAL] And you did select I'm an individual. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And I may have done it and just not even aware of it.
[AGENT][NEUTRAL] So you. Mhm. So you did and the, I can provide you the username and you would just have to reset your password because we don't have access to that if you don't remember that, but it's all lower case and it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. It's, it, it's saved. It is, it is saved in my.
[AGENT][NEUTRAL] JE 724.
[CUSTOMER][POSITIVE] It saves on my computer. I didn't see I didn't even realize I did that.
[AGENT][NEUTRAL] We have so many passwords and stuff this day and time, it is very hard to remember for anyone.
[CUSTOMER][NEUTRAL] Well, I, I, I mean, especially when I have to decipher between, you know, being the admin of everything, so I have my personal medical, my personal this, but, and so, and because I mean I think I was trying to find a, find a doctor for something and it would not let me because I was in the admin portion so.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Uh, yeah. Right. Yeah, you do, you have different access depending on how you're logged in. So, yes, like you can't see your claims and all that.
[CUSTOMER][NEUTRAL] You know, or I'm trying to figure something. I'm trying to figure out something personally and I'm, you know, or the admin I'm in my personal page, so, so yeah, OK.
[AGENT][NEUTRAL] Right. I understand.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, so, um, alright, so I got that set up and then I guess email number 2 would be the accident secured form. OK, so did you do.
[CUSTOMER][NEUTRAL] And then let's see, I'm trying to see what my uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, well I think I can get that taken care of and then.
[CUSTOMER][NEGATIVE] I mean, I mean, the worst thing that they can tell me is, no, no.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Yes ma'am, I would recommend filing the claim for us to review and when you set up your personal account or you can, it is already set up, but you can opt in for text notification alerts as well, [PII], you can add in direct deposit information which that user guide will explain to you, um, so that we, if we are able to pay benefits, you know, they could be electronically deposited instead of us having to mail you a check, but again that's a personal preference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you very much I appreciate you've been so helpful.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Oh, well, it was my pleasure. So is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, ma'am. I don't think so, not at this moment.
[AGENT][POSITIVE] OK, well then, thank you again for calling APL [PII], and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you very much. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye bye.