AccountId: 011433970860
ContactId: 3aaf32c0-51dd-4c74-9dc5-44433a307e1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 893340 ms
Total Talk Time (AGENT): 341246 ms
Total Talk Time (CUSTOMER): 217844 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/3aaf32c0-51dd-4c74-9dc5-44433a307e1e_20250527T14:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], this is [PII], and I have insurance coverage with you all and I am going to be having knee surgeries on Monday.
[CUSTOMER][NEUTRAL] And then the other one on [PII] and my employer gave me these forms on Friday to get filled out and to contact you people.
[AGENT][NEUTRAL] OK, uh, well, I can help you with your insurance policies, and Ms. [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK, let's see if that policy number is on here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If not, I can search with your um with your full social if you like, whichever is easier.
[CUSTOMER][NEUTRAL] OK, OK, my social, uh, let me give you my phone number. It will be [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alrighty, and the social whenever you're ready.
[CUSTOMER][NEUTRAL] OK, OK, here I found, I found the number, the, the policy, the policy number is 01106249.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Alrighty hold on one moment.
[AGENT][NEUTRAL] I'm just waiting for the policy to come up here and I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII].
[AGENT][NEUTRAL] And the mailing and email address on file?
[CUSTOMER][NEUTRAL] OK, the, the address will be [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then the email address?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so this one here is your work email. Did you want to change it to your personal email address?
[CUSTOMER][NEUTRAL] Uh, if they have it as my, um, work email, let's just leave it there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's fine, whichever you prefer. Well, thank you very much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. So, um, you're having, you said that you're having knee surgery, one on this coming Monday and then the next one on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so you're wanting to know the surgery benefits that your policy has and then
[AGENT][NEUTRAL] Um, what other information are you, that's all you were wanting to know just how what what the policy will cover?
[CUSTOMER][NEUTRAL] Uh, yes, yes, what the policy will cover and I just wanted to file the claim, make sure that the claim has been filed.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] Our systems are moving kind of slow. I do apologize, hold on one moment.
[AGENT][NEUTRAL] OK, so the claim, I was just checking to see if there were any other types of policies here with us. So, your medical policy, the claim is not going to be filed until after.
[AGENT][NEUTRAL] The surgery after everything is done. Mhm. Um, but I can let you know what benefits you have. Are you going to be like admitted or is this an outpatient surgery?
[CUSTOMER][NEUTRAL] The surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I will, no, I will be admitted and I will be staying over.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] No, I will not be surgery and out the same day, no.
[AGENT][NEUTRAL] Alright, and do you mind if I place you on just a brief hold while I go through your benefits?
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, so we can do this. I'll find it.
[AGENT][NEUTRAL] He's your call.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Well, it's not a router though, is it?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Um, so there were a few, um,
[AGENT][NEUTRAL] Different benefits that um could be eligible for the surgery. So first you have the um annual first occurrence hospital rider that you added to the policy. Um, it will pay $200 anytime per calendar year that
[AGENT][NEUTRAL] You're um admitted as inpatient. So if you've never used it, this, it could be used towards this, um, so that's $200 and then you also have the daily hospital um confinement benefit, which pays out $100 per day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then for the actual surgery itself, you have the surgery and anesthesia benefit, which pays up to $1000 for the surgery, and then the anesthesia benefit would be 25% of whatever is paid for the surgery. Um, so that, that part could vary. Um, but you have a few different benefits that can go towards your, your, your hospital stay in the surgery.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, um, you have two options. If you want to file a claim on your own, you can, or, you know, when they ask you for your insurance, just provide them with our insurance card. That way, if you have another insurance, they'll bill that one first. If not, they'll go ahead and bill us and we'll um pay towards the claim.
[CUSTOMER][NEUTRAL] OK, I do not have the, the insurance card, my um.
[CUSTOMER][NEUTRAL] My employer, the lady that does my insurance, she gave me the, the papers that has the policy number and everything on it. She gave this to me last week and uh tell me to fill out. So do I just, which I have already filled out my part and then it's got the page in here for the physicians.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The attending physician statement, do I just give them this form?
[AGENT][NEUTRAL] Wait a minute. What type of, what does it say on the first page? What type of form does it say?
[CUSTOMER][NEUTRAL] It says the HI 4005 limited Benefit Group Hospital.
[CUSTOMER][NEUTRAL] Amnity insurance parts for ISC and then it's got, you know, the benefits listed here underneath it just like you just told me.
[CUSTOMER][NEUTRAL] And then you flip it over and it talks about your company and then the the one that I had to fill out was the claimant statement.
[CUSTOMER][NEUTRAL] So I had to fill out, you know, my.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] It sounds like they may have, hold on one second, let me pull it because the the form sounds different than what we have. So I'm trying to make sure, it sounds like they may have their own version of the form.
[AGENT][NEUTRAL] Because, yeah, the doctor doesn't have to fill out.
[AGENT][NEUTRAL] It on the top of the form, like not the top of the paper she gave you, but on the top of the actual claim form, what's the title of the claim form?
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, it says APL American Public Life Accident and health claimant statement.
[AGENT][NEUTRAL] Right, OK, so that's the wrong claim form. That's for accident claims. You have a hospital hospital indemnity policy. So I'll go ahead and send you an email with the correct claim form and a copy of your digital ID cards, but I also have um a physical copy mailed to you. I just don't know if it'll get to you in time for Monday, so I'll send you the digital one too.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, so I'll send you the hospital indemnity claim form, but this form, so the form is only going to be needed if you don't want them to file the claim. If you want the doctors or sorry, the hospital to file the claim, you know, like after the bills and everything come out, then just give them or show them the the card that I'm gonna send you, and they can, they'll call us to verify benefits and get the claim information and they'll file the claim, but that's up to you.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so I'll go ahead and email that to you. And was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, I'm just trying to get all of my duckies in a row before I go in on Monday. Make sure I've got everything done.
[AGENT][POSITIVE] Well, once you get everything, if you have any questions or anything, definitely give us a call. We'll be more than happy to help you.
[CUSTOMER][POSITIVE] Oh, thank you so much. You're so sweet.
[AGENT][POSITIVE] You're welcome. Well, thank you. Well, thank you so much for calling APL you should be now, it's going to your work email.
[CUSTOMER][NEUTRAL] OK, uh, no, I'm not at work right now, so let's go ahead and send all this, yeah, let's, let's put it to my phone.
[AGENT][NEUTRAL] You wanna change it?
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEGATIVE] Sorry, our systems are moving really slow.
[AGENT][NEUTRAL] OK, so what's your personal email?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it's [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alright, so I'll go ahead and send you the email. I'm getting ready to send it now, so you should be receiving it in about 5 to 10 minutes. Um, and if it doesn't come in the um inbox, check your spam as well. Sometimes it goes there also for the first one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APO Ms. [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] bye bye.