AccountId: 011433970860
ContactId: 35c90e87-d90b-4c93-9945-c540a7f9cdd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474940 ms
Total Talk Time (AGENT): 180654 ms
Total Talk Time (CUSTOMER): 194614 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/35c90e87-d90b-4c93-9945-c540a7f9cdd0_20250416T15:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, I was talking with someone earlier I had um several questions about claims and uh we were disconnected.
[AGENT][NEUTRAL] I'm sorry to hear that. Do you have your policy number? We can take a look?
[CUSTOMER][NEUTRAL] I do it's 02010635.
[AGENT][NEUTRAL] OK, do you have a good callback number just in case if the line disconnects?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][NEUTRAL] Thank you. And then what's your uh name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] Great. Thank you, [PII]. And then lastly, we just need to verify address and email for security, please.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][POSITIVE] OK, thank you [PII]. Yeah, I think you were actually talking to me because I didn't get your callback number, so I'm sorry about that.
[CUSTOMER][NEUTRAL] That's OK. Yeah, I could, I could hear you at first and you couldn't hear me and then all of a sudden I couldn't hear you.
[AGENT][NEUTRAL] I know it's like it just went dead and then I just remember saying if you can hear me you can file both.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, I heard you say that. Yeah, I can hear you but you couldn't hear me because I heard you say if you can hear me and then after that I couldn't hear you. So I don't know what happened. um, but anyway, so let's see, you gave me the web address to get the claim forms. We talked about um the hospital being once per calendar year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I was asking, um, you told me to file the emergency room since he went in through the emergency room, so, um, the emergency room and the hospital stay can be filed for the same illness, is that correct? OK, so we'll do that, um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And we talked about outpatient surgery. So my next question was, um,
[CUSTOMER][NEUTRAL] I've had this policy for I don't know if it's 2 or 3 years, can you say when.
[CUSTOMER][NEUTRAL] I know it renews every March the first I think.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] You started this, so your effective date on this was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I've gone. I didn't realize we'd had it that long.
[CUSTOMER][NEUTRAL] OK, so I have never filed a claim and there's been things in the past, especially like the physician's office, um, because that's for an accident or a sickness, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So how far back can you go?
[AGENT][NEUTRAL] Let me see what it says here.
[CUSTOMER][NEUTRAL] Is it like once the year starts over it's no longer any good?
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] I know I used to have Aflac and they'd go back it didn't matter how long, but I'm not sure if everybody's that way.
[CUSTOMER][NEUTRAL] I just really haven't even thought about it until he had his hospital stay.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] 25052.
[AGENT][NEUTRAL] However, that
[AGENT][NEUTRAL] So it looks like 12 months.
[AGENT][NEUTRAL] Because it's saying that um proof of loss, so that would be like a claim at your expense, must be given to us within 90 days. It says in no event, except in the absence of legal capacity may proof be given later than 12 months after the date.
[CUSTOMER][NEUTRAL] OK, so is it 90 days or is it 12 months? They kind of say both there.
[AGENT][NEUTRAL] So it says, however, after the 90 days, the claim will not be denied or reduced if it was not possible to give proof in that time or if the proof was filed as soon as reasonably possible.
[AGENT][NEUTRAL] So, with that being said, I would
[AGENT][NEUTRAL] Feel like anything within the 12 months would be.
[AGENT][MIXED] Considered applicable. Um, it's definitely not gonna go past that, it looks like.
[CUSTOMER][NEUTRAL] OK, so file anything in the past 12 months may pay may not.
[AGENT][NEUTRAL] Yeah, I would do, yeah, yeah, because I mean.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] I guess that's getting into the weeds where it's like proof is filed as soon as reasonably possible, but like I don't think an examiner is gonna go down that rabbit hole. I think they're just gonna look at, well, it's within the 12 month time frame, so it's eligible for a benefit, you know.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, OK, so nothing after 12 months.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. All right, I think that's about it, um.
[CUSTOMER][POSITIVE] I'll call back if I have any issues.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, no, for sure. We're here Monday through Friday, uh, [PII] Central time. I'm not sure what time zone you're on, so, but we're always happy to help if you have any questions or concerns.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, do you know if the claim form has um anything for the physician or the employer to fill out or is it all just my?
[CUSTOMER][NEUTRAL] I haven't looked at them yet.
[AGENT][POSITIVE] I can double check it really quick. I don't know off the top of my head, but I'm happy to check here. Let's see.
[AGENT][NEUTRAL] I'm thinking it's probably gonna have a physician's portion, but.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And when you go to the claims and claims and forms, you want the hospital indemnity claim form.
[CUSTOMER][NEUTRAL] Because there's all.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, OK, so it looks there's a statement of the insured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, it looks like it's just the insured, so I don't see any physicians uh.
[AGENT][NEUTRAL] Signature or them to fill out, nothing is required on it.
[CUSTOMER][NEUTRAL] OK, um, there's also like a rider or something on this policy where if you have um.
[CUSTOMER][NEUTRAL] Like a doctor's visit or like
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Certain thing is there no maybe it's not on this one diagnostic, no, OK, never mind on that one. All right, that's all I needed.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, [PII], sounds good. I hope you have a good rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you. bye.
[AGENT][NEUTRAL] Uh-huh. Bye.