AccountId: 011433970860
ContactId: 364d7967-f6a5-4c75-aa7e-ca93a5f563c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 676609 ms
Total Talk Time (AGENT): 209072 ms
Total Talk Time (CUSTOMER): 202239 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/364d7967-f6a5-4c75-aa7e-ca93a5f563c8_20241231T18:46_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, uh, I'm calling from my husband, [PII].
[CUSTOMER][NEUTRAL] Uh, he has, uh, you want his policy certificate number?
[AGENT][NEUTRAL] Are you on the policy?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK, and what's your name?
[CUSTOMER][NEUTRAL] It's [PII] and last name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the policy number on that?
[CUSTOMER][NEUTRAL] 02435924.
[AGENT][NEUTRAL] Can I get a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, and how can I help today?
[CUSTOMER][NEUTRAL] OK, um, he had surgery and a couple of tendons.
[CUSTOMER][NEUTRAL] And I tried to file a claim.
[CUSTOMER][NEUTRAL] Online, but I wasn't sure, you know, about the form. She wouldn't let me fill it online.
[AGENT][NEUTRAL] Yeah, you have to print the claim form.
[CUSTOMER][NEUTRAL] Do I
[CUSTOMER][NEUTRAL] I have to print the claim form and and mail it off manually, or fax it?
[AGENT][NEUTRAL] You can upload so the APL claim form, uh, you would you would print it, fill it out, and then you would have to save it to a document and then upload it.
[AGENT][NEUTRAL] Online.
[CUSTOMER][NEUTRAL] Oh, OK. OK. So, it's like, well the doctor have to fill out the other part, that form as well? Or just his, just a claim form?
[AGENT][NEUTRAL] OK, what what policy are you filing the claim under?
[CUSTOMER][NEUTRAL] Uh, I think it's going to be accidental. I'm not sure. And another thing, it is workers' comp related and uh I think he's still eligible for it.
[AGENT][NEUTRAL] OK, so the policy number you gave me is for the hospital indemnity plan. So are you trying to file it under the accident policy? That's a different policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK, yeah, I'm sorry. I'm looking here. I have a different uh number. OK, well, so what's for, so for having outpatient surgery, could it go under hospitalization, the hospital part?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so is it as a result of an accident?
[CUSTOMER][NEUTRAL] Uh, workers' comp is at work.
[AGENT][NEUTRAL] Well, I mean not workers' comp, uh, any other accident, not workers' compensation.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, give me a second.
[AGENT][NEUTRAL] The policy certificates are also available um on our online service center um there you could look and see what is covered under each of the policies that you have.
[AGENT][NEUTRAL] Give me just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Still looking?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so do you, so which claim form do you have? Are you, do you have the hospital indemnity claim form or the group accident claim form?
[CUSTOMER][NEUTRAL] Mm, I, I think I was looking under the accident claim form. I'm not looking at, yes, I, I'm not looking at it right now, but I think it was the accident that I.
[AGENT][NEUTRAL] The accident? OK.
[AGENT][NEUTRAL] Accident, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And as I read it, it says that if it's, cause he was told that that worker, uh, when they got this insurance policy, that even if you got work hurt at work, you could still file a claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So maybe that's the form I saw that maybe the doctor had to fill out.
[AGENT][NEUTRAL] Yeah, let me take a look at it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was he admitted or was he in the hospital for a few days?
[CUSTOMER][NEUTRAL] No, just outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was an outpatient center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so back to the accident claim form I wanna take a look at that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] So there is uh a section for the attending physician to complete. I wanted to verify that. So he would take that to the attending physician and they'll need to complete that and then their office can get that faxed back over or mailed over to.
[AGENT][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] OK, they would have to send it to you, OK, and uh, but it would be under the accident, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, what was the accident?
[AGENT][NEUTRAL] What happened?
[CUSTOMER][NEUTRAL] Mm, uh, it's just, he had a couple of torn tendons.
[AGENT][NEUTRAL] I mean, but how did it happen?
[CUSTOMER][NEUTRAL] Oh, at work, he was uh
[CUSTOMER][NEUTRAL] Oh then, or opening some valves or something like that. Water valves.
[AGENT][NEUTRAL] Oh, OK. What does he do?
[CUSTOMER][NEUTRAL] He works for utilities for the city.
[AGENT][NEUTRAL] What is?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a water valve that he was opening or closing uh closing the thing.
[AGENT][NEUTRAL] OK. OK, so.
[AGENT][NEUTRAL] OK, so you would complete the he would complete the claim form. he would sign it and date it.
[AGENT][NEUTRAL] And then on the first page of that claim form it gives instructions as to what documents are required.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, can you, OK, I'm already logged in.
[AGENT][NEUTRAL] Oh, I know we would need the.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, could you help me, OK, I just signed in and then I selected claim forms and then it took me to this other forms, [PII].
[AGENT][NEUTRAL] Do, do you have your documents prepared? Do you have the claim, does he have the claim form completed and signed and dated?
[CUSTOMER][NEUTRAL] No, no. Uh, I'll have to do that, then take it to the doctor's office.
[AGENT][NEUTRAL] And uh we'll also need a copy of the itemized bill. Do you have that?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] Yeah, so if you look at the first page of the claim form where it shows the instructions, let me know when you see that instructions for the insured.
[CUSTOMER][NEUTRAL] So you anything.
[CUSTOMER][NEUTRAL] OK, where would I find the uh the form?
[AGENT][NEUTRAL] OK, do you not have a copy of the accident claim form?
[CUSTOMER][NEUTRAL] A claim form.
[CUSTOMER][NEUTRAL] Uh, no, I'm trying to find it.
[AGENT][NEUTRAL] It's it
[AGENT][NEUTRAL] OK, it's not on the online service center, it's on our website which is [PII].
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, that's where I'm at, and then.
[CUSTOMER][NEUTRAL] Uh, names and forms.
[AGENT][NEUTRAL] So at the upper right it should say claims and forms.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Click that.
[AGENT][NEUTRAL] And from there, you're going to scroll down.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And it should come to the accident claim form is actually the first one.
[CUSTOMER][NEUTRAL] OK, I see it. OK, I see it.
[AGENT][NEUTRAL] Then to the right of it is a download form button, click on that.
[CUSTOMER][NEUTRAL] Mhm. OK. And then.
[AGENT][NEUTRAL] And it'll populate the claim form.
[CUSTOMER][NEUTRAL] OK, I see it now.
[AGENT][NEUTRAL] OK, and so this is the page page one is what uh the instructions as to what documentation is required.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Definitely we'll need the itemized bill.
[CUSTOMER][NEUTRAL] OK. Even though
[CUSTOMER][NEUTRAL] OK, even if though it's workers' comp, my husband's not paying for anything, uh, you still need that itemized bill?
[AGENT][POSITIVE] Well, if you're filing for a benefit under his policy here, yes, we will.
[CUSTOMER][NEUTRAL] OK, and that would be the Amy from the doctor, right?
[AGENT][NEUTRAL] Or from the hospital? Did you say he was in a hospital?
[CUSTOMER][NEUTRAL] Or the husband.
[AGENT][NEUTRAL] Yeah, and of course
[CUSTOMER][NEUTRAL] Uh, it was an outpatient center.
[AGENT][NEUTRAL] Yeah, but he did have a surgery in a hospital?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He did have surgery. Yes.
[AGENT][NEUTRAL] OK. So there should be a hospital bill and then maybe his surgeon's bill as well.
[CUSTOMER][POSITIVE] Uh-huh. OK, I'll, I'll read it now. I found it. All right then, that's what I needed.
[AGENT][NEUTRAL] Yeah, and
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] That's what I needed the clarification on that information. OK then.
[AGENT][NEUTRAL] OK. All right. Any other questions I can assist with today, [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm, that will be it.
[AGENT][POSITIVE] All [PII]. Well, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh huh thank you goodbye.
[AGENT][NEUTRAL] Bye-bye.