AccountId: 011433970860
ContactId: 2d69529a-2b19-427d-8f9e-c36d458beed2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 620109 ms
Total Talk Time (AGENT): 358876 ms
Total Talk Time (CUSTOMER): 172060 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/2d69529a-2b19-427d-8f9e-c36d458beed2_20250102T17:18_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yeah [PII], this is [PII], and I know I have um a hospital indemnity plan with you guys through Citrus County Schools, so I'm just trying to find out what I need to do to start a claim with you guys. I have to, I'm actually already been in the hospital now since Monday.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I have to do a heart bypass surgery on next Monday.
[AGENT][POSITIVE] OK, yeah, so I can definitely help you with getting that process started, [PII]. Do you happen to have your policy number handy?
[CUSTOMER][NEGATIVE] No, they didn't let me go home they wouldn't even let me go home to grab any paperwork so I was hoping that maybe you guys can find it another way.
[AGENT][NEUTRAL] Oh, absolutely. I can certainly look that up for you uh through your social security number. Um, let me pull up that screen.
[CUSTOMER][NEUTRAL] It that is
[AGENT][NEUTRAL] And whenever you're ready, Mr. [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And would you be able to verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, I appreciate that. And also if you can verify for me your mailing address.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's in [PII].
[AGENT][POSITIVE] Wonderful. And then I just have two more things, Mr. [PII], if you could verify for me your email and your phone number.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][POSITIVE] Perfect, thank you so much. Um, so,
[AGENT][NEUTRAL] Uh, as far as the hospital indemnity claims go, um, we have a hospital indemnity claim form, and I can email that to you. Um, what's awesome is that first page of the claim form, it's gonna let you know any um supporting documents we might need.
[AGENT][NEUTRAL] So your itemized hospital bill and you can kind of use that as like a checklist to help figure out what sort of documents you need to collect and submit and then you would just fill out the form it's pretty quick you can do it like on your computer you don't have to print it and handwrite it unless you want to and then you can just upload that through our online service center and.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like just submit it online and what I can do is I can also email you out a user guide to set up that online service center but it just allows you to email like or upload things.
[AGENT][NEUTRAL] Um, so that way you don't have to like find someone who has a fax or mail it and make sure it doesn't get lost in the mail. It should just keep it all pretty easy and simple to upload and submit it in one place and then you're able to follow your claim through the process. You'll get confirmation that it's received and then you can check your claim status. Um, I do see that you have your direct deposit set up with us, but if you had to change any of that, you could do it online as well, um, and I can get those documents sent out to you that way you have them available.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, um, I won't be able to get any of those documents until after the surgery and after I'm sent home, hopefully by next Friday I'll be able to do that.
[AGENT][NEUTRAL] Yeah, and we, Mr. [PII], uh, we do not have any like time limit for filing a claim. So if you need a month or two to like recover and then you want to get everything together to get a claim going, um, you're more than welcome to we don't, there's no time limit on our side that you need to feel like you have to rush to get things done before then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and I don't know if you can answer this for me or not. What is.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I'm trying to think, uh, what is the benefit? I, I guess.
[AGENT][NEUTRAL] Oh yeah, so I can go over some benefit information with you. I do wanna let you know that anything I give you over the phone is just a verification of coverage it's never a guarantee of payment, OK?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Right, I understand.
[AGENT][NEUTRAL] And let me, I'm just pulling up that document right now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. So it looks like you have
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] You have an annual first occurrence hospital rider, um, and so what this does is it says the first time you are dependent or confined in a hospital for a calendar year, um, you would get this benefit um for injury or sickness and
[AGENT][NEUTRAL] Oh wow. OK. Um, I kind of thought I'd have a benefit amount. Let me scroll down a little further. I think it's in a different spot.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] And that's per calendar year?
[AGENT][NEUTRAL] The annual benefit is per calendar year, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's like a first occurrence confinement and hospital benefits.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] I am
[AGENT][NEUTRAL] Not seeing a like a benefit amount listed next to it, and I'm so sorry. I do see that you also have, oh no, OK, I see it. It was, it was on the first page with the first one. I'm so sorry. So that annual first occurrence is $1500 and that is per calendar year. And then you also have a daily hospital confinement benefit of $30 a day.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Now, I know because I was just in the hospital and had stents put in in May.
[CUSTOMER][NEUTRAL] Um, last year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and now I ended up getting checked out on Monday and the tents that they put in in May are partially blocked, so that's why they gotta do the, the bypass.
[CUSTOMER][NEUTRAL] So since I know I did get some payout last year.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And now we're into this year.
[CUSTOMER][NEUTRAL] How do you know if that affects anything or does that go on for this year then?
[AGENT][POSITIVE] Yeah, absolutely, so.
[CUSTOMER][NEUTRAL] Since I'll still be in the hospital.
[AGENT][NEUTRAL] Um, this policy is set for a calendar year, so it means that benefit, it looks like it resets at the start of the calendar year, that first occurrence, um, so [PII], um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Kind of start all over again.
[AGENT][POSITIVE] And then yeah, for that one it does um the way it says is the way the policy I'm so sorry the way the policy words it is.
[AGENT][NEUTRAL] Confined to a hospital in a calendar year for a period of confinement for which the benefits are payable. Um, so meaning like as long as you're still effective during the time you're confined, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then later on that first occurrence benefit it says it again is the first time in a calendar year um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It says due to injury or sickness.
[AGENT][NEUTRAL] Um, and then.
[AGENT][NEUTRAL] I am trying to look under the definitions to see if.
[AGENT][NEUTRAL] And the limits and exclusions to see if there's anything.
[AGENT][NEUTRAL] Regarding like that would be limiting you, but I don't see any offers read, but I also something I can do my friend, is I can, I mean, I don't know if you want it, but this policy document, it's like 28 pages and it does list out all of your policy information and I can email that to you as well.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh awesome I appreciate that.
[AGENT][NEUTRAL] OK perfect I will put it together in an email for you and I will just send them all together that the claim form and then the guide to set up the online portal with us OK?
[CUSTOMER][POSITIVE] OK, yeah, that'll work.
[AGENT][NEUTRAL] And then is there anything else I can do to help you, my friend?
[CUSTOMER][NEUTRAL] I think that's it for now, ma'am. I'm just.
[CUSTOMER][NEUTRAL] I know I'm able to do this stuff right now so I'm just trying to get stuff rolling and.
[CUSTOMER][NEGATIVE] And try to know what I need to do after I go home, you know, then it's gonna be a little bit more difficult.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] No, I think that's so, so smart is to get things kind of together and in order now so that way you feel prepared to tackle it while you're recovering or after your recovery.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] So, alrighty, I appreciate it.
[AGENT][POSITIVE] Oh, it's my pleasure that this email I know you're, you probably won't get it while you're in the hospital right now, but I'll have it sent out to you within 2 or 3 more minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually I
[CUSTOMER][NEUTRAL] I have my laptop with me so I will be able to access that.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Perfect, yes, I should have it out to you in 2 or 3 more minutes and then um if there's anything else you need, don't hesitate to reach out to us.
[CUSTOMER][POSITIVE] OK, I appreciate it ma'am thank you.
[AGENT][POSITIVE] Hey, my pleasure, thanks for calling APL. You have a wonderful day and uh best of luck with everything you have come coming on.
[AGENT][POSITIVE] In the new year I hope it's a good one for you.
[CUSTOMER][POSITIVE] Oh, I hope so. Thank you very much.
[AGENT][POSITIVE] Take care my friend. My pleasure.
[CUSTOMER][NEUTRAL] Mm bye bye.
[AGENT][NEUTRAL] Bye-bye.