AccountId: 011433970860
ContactId: 36e5910e-136e-4cb7-8262-0cc1799ccc9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 481440 ms
Total Talk Time (AGENT): 285631 ms
Total Talk Time (CUSTOMER): 92430 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/36e5910e-136e-4cb7-8262-0cc1799ccc9d_20250207T22:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I was calling to check my benefits and, uh, find out how to file a claim.
[AGENT][POSITIVE] OK, I'm happy to help with that. Do you have your policy number by chance?
[CUSTOMER][NEGATIVE] I don't have anything with me, no.
[AGENT][NEUTRAL] OK, we can look it up by your name, social, so whichever you'd prefer to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, either way, it's, I can give you my name is [PII].
[AGENT][POSITIVE] All right, [PII], thank you. Let me take a look here.
[AGENT][NEUTRAL] What state do you live in, [PII]?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for verification, can you give me your date of birth and address, please?
[CUSTOMER][NEUTRAL] Mhm. [PII], and my address is [PII].
[AGENT][POSITIVE] All right, thank you so much and the email address on file it looks like is [PII]. Is that still good?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] OK, so as far as filing claims go, those can be done either online [PII] we have an online service center you can send them via fax or you can mail them. It's really what's easiest for you um do you have access to the Internet? Would online be easiest or?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, that's fine.
[AGENT][NEUTRAL] OK, awesome. So, the website, I'm not sure if you've ever been there, but our web address is [PII]. So that's [PII], the word [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, when you get to the website, uh, there are a few things, um, if you pan to the right on the home page, you'll see a link there for claims and forms, and then further right you'll also see a link to sign in.
[AGENT][NEUTRAL] Um, you, you have what we call a hospital indemnity plan. So the first thing that you need is a claim form for your claim, and that would be located under the claims and forms.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All the forms are in alphabetical order, so you'll just scroll down until you see hospital indemnity.
[AGENT][NEUTRAL] And it'll be on page 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, when you download the form, it gives you directions on page one as far as what's needed. Uh, we just really need the claim form filled out with an itemized bill and diagnosis codes from your provider for the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, as far as signing in and creating uh a log in, you would have click on that sign in link on our home page that's to the far right of that claims and forms link.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That takes you to the secured portal and of course you're gonna click you're a new user um within you're an individual with a policy and then you're gonna put in your information um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Most importantly, uh, the email address that you have on file that Gmail, you just need to make sure you enter that when you're registering for the portal all that information just needs to match what we have on file.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, is there, uh, my, my surgery that, that I was hospitalized for just one night was, um,
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] In [PII], so
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that, I guess, does that matter or?
[AGENT][NEUTRAL] Yeah, no, there's no as far as like time frame goes we don't have like a.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, a set time you have to file the claim by, so you can definitely still file for something back then.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Once you get the log in created and you get into the uh site um you'll see under my claims there's a green button there that will say upload files and that's really all you have to do to upload your claim information there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the itemized bill and the something with the diagnosis, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So looks like as far as the benefits go, let me see what your plan pays towards.
[AGENT][NEUTRAL] Hospital admission, let's see.
[AGENT][NEUTRAL] So let me see what they define as admission.
[AGENT][NEUTRAL] Cause it has a hospital admission benefit of $2000 per day, and it looks like it's a maximum of 4 days in the year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so yeah, that would be paid as long as you were in the hospital for 18 consecutive hours.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it looks like after that it shows then it pays $50 per day.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Up to 5 days also.
[CUSTOMER][NEUTRAL] In addition to 2000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And yeah, it looks like it pretty much covers
[AGENT][NEUTRAL] The admission, um, did you have any other questions on the plan that I could answer or?
[CUSTOMER][NEUTRAL] Uh, no, that's probably it. Um, I don't know what to ask for for medical records, something with the diagnosis, just like, uh, maybe the discharge summary or something.
[AGENT][NEUTRAL] Yeah, so any provider that you've seen or doctor, whether or not it's the hospital or the doctor, they should be able to give you um an itemized bill and if you ask them for that with diagnosis codes, they should know exactly what that is, um, to, to submit towards the insurance, they should understand that.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. OK, got it. OK.
[AGENT][NEUTRAL] Alright, [PII], anything else I can help you with?
[CUSTOMER][POSITIVE] That works.
[CUSTOMER][POSITIVE] Mm, no, that was it. Thank you.
[AGENT][POSITIVE] You're very welcome. Thanks for calling [PII]. I hope you have a nice day.
[CUSTOMER][POSITIVE] Thanks. You too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.