AccountId: 011433970860
ContactId: 40292f9d-f8ec-4cf0-bd33-dc06e37b5723
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 795989 ms
Total Talk Time (AGENT): 313951 ms
Total Talk Time (CUSTOMER): 384942 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/40292f9d-f8ec-4cf0-bd33-dc06e37b5723_20250122T21:30_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, what was your name?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Hey [PII], sorry I couldn't hear you um my name's [PII]. I was calling. I've got a policy with you guys and I need to, I need some help filling out some claim forms.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, [PII], can I get a good callback number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Do you have your policy number with us?
[CUSTOMER][NEUTRAL] I knew you're gonna ask that. I don't.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see here.
[AGENT][NEUTRAL] And what is your social?
[CUSTOMER][NEUTRAL] My social is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what is your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What about your date of birth and email address?
[CUSTOMER][NEUTRAL] Date of birth would be [PII].
[CUSTOMER][NEUTRAL] And then email I don't know which one just [PII].
[CUSTOMER][NEUTRAL] Or [PII].
[AGENT][NEUTRAL] OK, it was actually the first one.
[CUSTOMER][POSITIVE] Oh perfect OK.
[AGENT][NEUTRAL] OK, so you said you need help filling out claim forms?
[CUSTOMER][NEUTRAL] Yeah, I just knew, uh, there's some type of uh hospital plan um that we had picked up and my wife ended up needing to go to the hospital as she had a, as we had a baby.
[AGENT][POSITIVE] Oh congratulations.
[CUSTOMER][POSITIVE] Well, thank you, thank you, uh.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] I so I I got I spoke I got this coverage through financial advisors benefits, um, so I spoke with them I think they got me the right form.
[CUSTOMER][NEUTRAL] I'm just as I'm as I'm filling the form out um I just have a couple questions on.
[CUSTOMER][NEGATIVE] What I what I put down.
[CUSTOMER][NEUTRAL] In a couple certain areas.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So a first oh go ahead.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, go ahead. I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I, I was just gonna say first of all, is there a um.
[CUSTOMER][NEGATIVE] Like, can you give me my policy number? I don't, I don't even have it. I've looked through all of my old documents and emails, um.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What is that policy number?
[AGENT][NEUTRAL] Most, most definitely. Um, your policy number is going to be 250.
[AGENT][NEUTRAL] 4918.
[CUSTOMER][NEUTRAL] OK, that's good to have. And then if I were to like go on and log in just to kind of see my different benefits, is that just at [PII]?
[AGENT][POSITIVE] Um, actually, it's gonna be secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Secure. A.
[AGENT][NEUTRAL] Have you ever created an account before?
[CUSTOMER][NEGATIVE] No, not yet, which shame on me.
[AGENT][NEUTRAL] OK, so when you do that, um, let me tell you this, the best way to do that is go to new user gonna ask for your, you know, your demographic information whenever it asks for your member ID, use your social security number with the dashes.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][POSITIVE] User ID equals social security number perfect. I would have never figured that out.
[AGENT][NEUTRAL] No, your member ID.
[CUSTOMER][NEUTRAL] Oh, member ID OK.
[AGENT][NEUTRAL] Yeah, don't use the member ID I just gave you. Use your social.
[CUSTOMER][NEUTRAL] Yeah, I wasn't gonna use my social the user ID that would OK.
[AGENT][NEUTRAL] That is gonna be the.
[AGENT][NEUTRAL] That would be the easiest thing to do, um, and then you will use the email that you just gave me that we verified.
[CUSTOMER][NEUTRAL] With dash
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] That way everything matches.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, OK, so I'll get online and look that up, um, later, but so as I've got the accident claim form, it's 5, about 5 pages.
[CUSTOMER][NEUTRAL] Um, are you able to kinda walk me through this real quick?
[AGENT][POSITIVE] Yeah, most definitely.
[CUSTOMER][NEUTRAL] Um, so I, yeah, I got the accident claim form, um, claim form 0722 at the bottom.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] At the top, let me just tell you this, at the very top, it's gonna ask um.
[CUSTOMER][NEUTRAL] Oh, go ahead.
[AGENT][NEUTRAL] I'm not sure if it says policyholder or insured's information.
[CUSTOMER][NEUTRAL] It says about the insured.
[AGENT][NEUTRAL] You're the you're the insured.
[CUSTOMER][NEUTRAL] That's kind of what I thought, and then she would be the patient.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Right. Yes, sir.
[CUSTOMER][POSITIVE] Perfect. OK, so I got that right. That was easy, uh, the date of accidents.
[CUSTOMER][NEUTRAL] I, I put just the date he was born.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Um, and then I, and then in my own words explaining I just put pregnancy.
[CUSTOMER][NEUTRAL] Um, and then section D, I just checked accident medical expense benefits.
[AGENT][NEUTRAL] That's fine, um.
[CUSTOMER][NEUTRAL] Is that
[AGENT][NEUTRAL] Do you have the itemized billing statement? You don't, the physician's statement, you don't have to worry about that because there's no way you're going to get the actual physician and all that. Um, as long as you have the itemized billing statement.
[CUSTOMER][NEUTRAL] I do
[CUSTOMER][NEUTRAL] Just yeah.
[AGENT][POSITIVE] Just fill the sections out, you're good to go.
[CUSTOMER][NEUTRAL] Then we're good to go. I don't I don't need the.
[CUSTOMER][NEUTRAL] Physician, OK, so then I won't do the physician one,
[AGENT][NEUTRAL] No, mm.
[AGENT][NEUTRAL] No, but let me tell you this, all the sections on that claim form that require a signature and a date, make sure you sign that because if you don't, the claim will be denied.
[CUSTOMER][NEUTRAL] Oh, OK, yep, we'll get that signed so even if we didn't fill anything out uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, make sure you sign it.
[CUSTOMER][NEUTRAL] On the
[CUSTOMER][NEUTRAL] Make sure we sign it anyway and then it says there's a couple spots where it says signature of insured slash beneficiary.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's gonna be you.
[CUSTOMER][NEUTRAL] Is it, is that just me? OK, I don't need her to sign anything.
[AGENT][NEGATIVE] Just you. No.
[CUSTOMER][NEUTRAL] Perfect and then um OK so I'm gonna send and then will they look through like I was looking through like I said I had an overview of the policy but not not my specific one.
[CUSTOMER][NEUTRAL] They had like different levels of.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Care for a certain amount of days and then that looks like you got some money for um.
[CUSTOMER][NEUTRAL] Hold on I'm looking it up again, uh.
[CUSTOMER][NEUTRAL] For like anesthesia and stuff like that, um.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] What I mean, so should I just send in everything we got from the hospital?
[AGENT][NEUTRAL] Yes, sir. um.
[CUSTOMER][NEUTRAL] Is that the best way to make sure we got everything?
[AGENT][NEUTRAL] If it's an itemized bill that you got from the hospital, it will have the dates that she was admitted, the date she was discharged. It will have her surgery from having the baby. It will have any anesthesia that she had, if she had an epidural, anything like that. It will have all that information on the anesthesia, I mean on that atomized bill. However, on that itemized bill, does it have her diagnosis code?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Or does it have on the itemized bill if she had a vaginal or C-section?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me look at it.
[AGENT][NEUTRAL] Because looking at the policy, um, let's see.
[AGENT][NEUTRAL] You have a HI 4005, that's just the type of policy you have. Um, I would be one of the ones processing that claim actually. So if it doesn't tell me whether she had a vaginal or a C-section, I would have to deny that claim because I don't have a diagnosis code to go with the go with the claim, so I wouldn't know what she was in the hospital for if that makes sense, even though you're telling me on the claim form it's a pregnancy and a delivery, I don't know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Got you, yeah, I know the the rules, um.
[AGENT][NEUTRAL] I'm sorry. I know it's a lot.
[CUSTOMER][NEUTRAL] That's OK, that's right, you don't make them, um.
[CUSTOMER][NEUTRAL] OK, so I've got, I've got our Methodist bill here that's.
[CUSTOMER][NEUTRAL] Delivery room slash labor. I don't know if that's.
[AGENT][NEUTRAL] No, that's just telling me like what kind of room she was in. However, if the itemized bill does not tell you, if you have discharge papers saying why she was, you know, what type of
[CUSTOMER][POSITIVE] Clear enough
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] You know, delivery she had.
[AGENT][NEUTRAL] Anything that will tell me, then you can submit that with the bill.
[CUSTOMER][NEUTRAL] There's a financial number on there, is that what you're talking about?
[AGENT][NEUTRAL] What does it say if you don't mind me asking?
[CUSTOMER][NEUTRAL] It says it just says financial number 511-227-56.
[CUSTOMER][NEGATIVE] I don't know what the heck that is.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Alright, keep looking here.
[AGENT][NEUTRAL] I'm sorry, I know it's a lot.
[CUSTOMER][NEUTRAL] That's OK, that's OK and I know how this stuff works.
[AGENT][NEUTRAL] I'd rather tell you what you need then you go back and forth with the claim.
[CUSTOMER][POSITIVE] Yes, exactly, let's get it knocked out once, um.
[CUSTOMER][NEUTRAL] OK, so the main one doesn't look like it.
[CUSTOMER][NEGATIVE] It's just a 3 little tiny 3 pager that breaks down the room and board, the pharmacy costs, the IV solutions, the labs, um, I don't see anywhere where it says like it doesn't give you the code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which I think was what you're talking about.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then it doesn't say anything about.
[CUSTOMER][NEUTRAL] C-section or vaginal.
[AGENT][NEUTRAL] Let me ask you this, um, on your, on your itemized bill.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] On the left-hand side, if you're looking down through, how many days was she in the hospital?
[CUSTOMER][NEUTRAL] Uh, like we were there overnight and then done.
[AGENT][NEUTRAL] OK, on the left hand side of your itemized bill, does it say like 111, 110, anything like that? 250, does it say any of those codes?
[CUSTOMER][NEGATIVE] No, I think this one's too broad. It's not getting so hold on, we and we might have gotten an even more.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Detailed one let me.
[CUSTOMER][NEUTRAL] OK, I think I might have found.
[CUSTOMER][NEUTRAL] I found one that is very detailed says room charges, claim number patient control number um.
[CUSTOMER][NEUTRAL] And then it has all the the codes.
[CUSTOMER][NEUTRAL] On like the far right
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So maybe that, but that's seeing it's a different amount from what the other bill is.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So it could be that.
[AGENT][NEUTRAL] Does she have any uh discharge papers?
[CUSTOMER][NEUTRAL] Let me, uh, I, I.
[CUSTOMER][POSITIVE] Well, I, I can, I can, she would have those. I can call her and ask um.
[CUSTOMER][NEUTRAL] See, I don't remember them giving us anything um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But if it's something we need to, is there a time frame limit I've got on this?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, you don't have a time limit.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So I can request those if needed um.
[AGENT][NEUTRAL] Yeah, um, let me tell you this, um, a lot of people think that they have to send in 50, 100, 150 pages. You don't have to do that.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] That's what I'm about to do.
[AGENT][NEUTRAL] Yes, you do not have to do that. Um, you honestly just have to send in the itemized bill and if the diagnosis code is not on there, then, then you can either request the diagnosis code from the hospital, or you can go up there and say, hey, I need some medical records that show what I was here for.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yep, OK, and you.
[AGENT][NEUTRAL] And that's, that's all you have to do.
[CUSTOMER][NEUTRAL] You call them diagnosis codes, is that what?
[AGENT][NEUTRAL] Yes. Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's honestly all you have to do it, it's honestly um as simple as that and that's all I'm looking for when I process the claim.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, I will get those. I, I think I know what you're talking about um I'll get those and then just is the best way to just email it in, uh, fax it, uh.
[AGENT][NEUTRAL] No, actually, if you, you can fax it, you can mail it, but honestly, if you create that account online, you can file the claim through that portal.
[CUSTOMER][POSITIVE] Oh, we can help
[CUSTOMER][POSITIVE] Oh perfect. OK well then I'll plan on doing that uh awesome. OK, thank you so much [PII]. I appreciate your help today.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, that should be it for now.
[AGENT][POSITIVE] OK, well if you have any more questions definitely give us a call back and we'll help you, we'll walk you through the process, you know, we'll do anything we can to help you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Perfect appreciate it thank you so much.
[AGENT][POSITIVE] Yes sir, well thank you for calling APL have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Alright, bye bye.