AccountId: 011433970860
ContactId: 4e40dd89-3256-4242-9d79-ad46cebc88df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 691320 ms
Total Talk Time (AGENT): 399596 ms
Total Talk Time (CUSTOMER): 238616 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/4e40dd89-3256-4242-9d79-ad46cebc88df_20250430T15:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I mean, I am a um client of y'all's through my employer and and currently sitting in the hospital and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It seems like I've signed up for everything that y'all offered during open enrollment and I just wanna verify my coverages and see what we needed to do to get things started.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] To file the claims.
[AGENT][NEUTRAL] Got you. OK, yes, we can definitely take a look at those benefits and how you can file those claims. um, [PII], can I first get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's I'm gonna give you my wife's number. Is it OK if you talk to her if we are disconnected?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, um, after I verify your info, I'll of course get, you know, verbal consent that it's OK to speak with her.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so mine is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then, uh, my wife, her name is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And her number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, she's she's my wife's pulling it up, uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, got you.
[CUSTOMER][NEUTRAL] Is it the 02.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it, it would begin with a 02.
[CUSTOMER][NEUTRAL] 0202579657
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alright, and I'm just gonna verify some information really quick uh [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. Last thing I need is the email address we've got on file for you. Uh, looks like it might be through your employer.
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][POSITIVE] Perfect thank you so much for verifying all of that and then of course um do we have your permission to speak with [PII] on your behalf?
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][POSITIVE] OK, thank you so much for all of that. Alrighty, give me just a moment, let me get this policy pulled up here.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. And while I'm getting that pulled up, um, I know you said you're currently in the hospital. Um, what kinds of treatment have you received? What happened?
[AGENT][NEUTRAL] Uh what's going on? What do we need to check for specifically?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, well, hold on, yeah, so I started having, um, bad pain in my abdominal area and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] drove myself to the emergency room Saturday evening. Um,
[CUSTOMER][NEUTRAL] was seen in the emergency room. Uh, they kept me down there for several hours and then ultimately it admitted me to the hospital, uh, because they said my gallbladder needed to come out.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] On Sunday mornings.
[CUSTOMER][NEUTRAL] I had a uh.
[CUSTOMER][NEUTRAL] What's it called, [PII], the
[CUSTOMER][NEUTRAL] It was a scope, an endoscope endoscope, I can't remember the code or what. So Sunday morning they did an endoscope procedure to go in and remove or try to remove some gallstones, um, from the bile ducts, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Monday, they actually went in and did the gallbladder removal.
[CUSTOMER][NEUTRAL] And, um, but my gallbladder had actually gone gan green.
[CUSTOMER][NEGATIVE] And caused a lot of infection to the pancreas and liver. And so, I'm still sitting here in the hospital and uh we'll probably be here for another couple of days.
[AGENT][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] I see. OK, all right, so yeah, quite a bit of things. I'm so sorry you have to go through that. All right, so before we go over uh benefits, um, I will say of course since we don't know the extent of other kinds of treatment that you might be receiving, um, we don't of course know how much we would be able to pay as a total.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I will say as far as filing claims the quickest and easiest way, um, is going to be, uh, have you tried giving them this information, uh, the provider?
[CUSTOMER][NEUTRAL] The provider, the, the hospital?
[AGENT][NEUTRAL] Uh, the doctor, I'm sorry, yes.
[CUSTOMER][NEUTRAL] Oh I hadn't even thought about that.
[AGENT][NEUTRAL] Um, it would generally be a lot easier on y'all, um, if of course they would file the claim for you, um, if not you can still file the claims yourself it just take a little bit of, you know, having to get the correct documents and things like that so I would try giving them this information, um, if they'll file it for you again, if not, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Best way for y'all to file would be through our online portal um and it doesn't have there's no timely filing limit so it's not like you have to get this information to us within a specific time frame um do y'all have access to a desktop or a laptop computer? Not necessarily at this moment just in general OK so the reason I ask is um our online portal doesn't really have much support for mobile devices at this time, so it would have to be on a desktop or a laptop.
[CUSTOMER][NEUTRAL] Yes. Yeah.
[AGENT][NEUTRAL] What I can do is I can email you a copy of the policy just so that you've kind of got that for your records um and in that email I'll include a link to our website um when you go to create an account it would just be that same information we just verified uh so including that same email through your employer and then there will be a spot there on the main page where you can upload claim information and whenever y'all are ready I can let you know exactly what it is that we need uh for claims.
[CUSTOMER][NEUTRAL] OK, yeah, and we already created an online log in on the website. OK, um, we just don't know, we don't know which forms to begin filling out.
[AGENT][POSITIVE] Oh awesome.
[AGENT][POSITIVE] Cool, OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Absolutely, so this is.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] Oh, OK, so just to let you know this is a hospital indemnity is the name of this plan, so that would be the claim form that you fill out, um, we would need the itemized statements.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] For any and all, you know, procedures, treatments that was received, um, including if, you know, I know you said you had to go to the ER. I don't know if you had to take an ambulance or anything like that, uh, but things like that as well. So those itemized statements, and they would have to show diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's something of course you can the providers will have that or the doctor uh facility they'll have that information you just might have to ask for it's not generally something they would just give you, um, especially if you say it's for a medical claim so that's going to be the extent of what we need. um, most of the time it will show, of course you know with you being in the hospital this long it would show the admission and discharge dates and times, but it doesn't hurt to specify that you would need that as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is going to be it. And it
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Is it if we were filling out the little hospital indemnity form, would it be miscellaneous claim or continuous what?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Under hospitalization it has more filters.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Give me just a moment let me get that pulled up so I can make sure we're looking at the same thing bear with me just a moment.
[CUSTOMER][POSITIVE] Yeah, we can get them to do it. That's great. We don't have to do with it.
[AGENT][NEUTRAL] Yeah, you wouldn't have to worry about any of that that would be ideal um the only issue is of course all providers are different, um, so some would be of course more than willing to file on your behalf, others, especially with, uh, since this isn't like traditional major medical, uh, they may not want to mess with it and in that case they are more than welcome to give us a call we do talk to providers all the time we can go over benefits, kind of explain the plan, um, but if they're just adamant that they won't do it, just know that you can, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] A hospital indemnity.
[AGENT][NEUTRAL] So are you currently looking at the hospital indemnity claim form?
[CUSTOMER][NEUTRAL] No, it's so when I look under claim forms and policy change documents to select the product below to download a form and learn how to file a claim, it's got one drop down box. I clicked hospital indemnity.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then it says filter by form site is it is it.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Everyday solutions claim form indemnity claim form.
[AGENT][NEUTRAL] Oh wow, OK.
[CUSTOMER][NEUTRAL] I guess it's indemnity platform. I don't know.
[AGENT][NEUTRAL] I'm sorry, I'm OK so that's a bit different. Here's what I.
[AGENT][NEUTRAL] Give me just a moment. Let me look because I'm looking at um just on our public website and it's hospital indemnity and everyday solutions claim form so both in one.
[CUSTOMER][NEUTRAL] OK, OK, I think I saw that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] Yeah, I got it.
[AGENT][NEUTRAL] Yeah, OK, so all it should really show is just information about Brian, you know, the information that you would enter, um, and then at the bottom just, you know, policy information and signature so it's, it's not a very in depth, uh, claim form is that the one that you're seeing?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK awesome yes.
[AGENT][NEUTRAL] So I will go ahead and send this um email to y'all as well um [PII] did you want me to send it to this email we have on file or is there a different email you'd prefer me to send it to?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, you can send it to the one on file.
[AGENT][POSITIVE] OK awesome um alright well uh did y'all have any other questions for me at the moment?
[CUSTOMER][NEUTRAL] I don't guess uh.
[CUSTOMER][NEUTRAL] And you said the email that you're sending also has.
[CUSTOMER][NEUTRAL] Like a list of what my what all my coverages are that I have.
[AGENT][NEUTRAL] That's going to be, yes, so that's I'm gonna send you your policy, um, and it's, it is very easy to read there's going to be one page uh specifically that says schedule of benefits that just clear cut and dry the benefit type and the amount frequency, things like that. The rest of the policy is going to be more of um definitions you know specifically what certain things mean.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] But you know of course once you get that if you have any questions don't understand something, um or if the provider has questions or they won't file y'all can give us a call any time um and we'll do our best to help you out you know it can be very confusing and overwhelming.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] Of course yeah thank y'all. I hope you have a great rest of your day and I hope you get feeling better soon.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.