AccountId: 011433970860
ContactId: 547ef1bb-27a2-4f7a-a856-e993953a92fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 962890 ms
Total Talk Time (AGENT): 285058 ms
Total Talk Time (CUSTOMER): 311802 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/547ef1bb-27a2-4f7a-a856-e993953a92fc_20250425T18:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. Um, I was with Covington Alcina and have a couple of policies through its APL. I'm no longer with the company and I have a couple questions about the policies that I have.
[AGENT][NEUTRAL] OK. Uh, do you have one of your policy numbers?
[CUSTOMER][NEUTRAL] Uh, let me see what I have here. I have one of the booklets. Where do I see the policy number?
[AGENT][NEUTRAL] Uh, there should be a policy certificate number. It might be on one of the first few pages.
[AGENT][NEUTRAL] Or outlines the
[CUSTOMER][NEUTRAL] OK, just one second.
[AGENT][NEUTRAL] Or I can look it up by your last name or social.
[CUSTOMER][NEUTRAL] I think my social uh [PII]. 0, I think I just found a certificate number.
[AGENT][NEUTRAL] OK, I'm getting that pulled up. One moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, it looks like, yes, I've got you with two policies. Are you wanting to check on the accident or the hospital indemnity?
[CUSTOMER][NEUTRAL] I guess hospital indemnity indemnity we'll start with that.
[CUSTOMER][NEUTRAL] Now question for you, it looks like it went into effect [PII]. My husband was in the hospital in the emergency room. Are there any claims I'm able to submit?
[AGENT][NEUTRAL] Uh, yes, let me see what your policy um provides coverage for.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Pulling that up, um, not a guarantee of payment, just a basic outline of the policy.
[CUSTOMER][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] Um, or ER let's see what we have.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you. I would not take the road from water unless I have no other choice.
[AGENT][NEUTRAL] Did he have surgery or um was there a confinement?
[CUSTOMER][NEUTRAL] Uh, so he did. He had a right hip, he had a right hip replacement, I think it was [PII] was his right hip replaced or maybe [PII], right hip replacement, and then a couple weeks ago, shortly after that he went to the ER like 4 days later.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Looks like under this policy, you've got a $4000 benefit amount for surgery um and anesthesia.
[AGENT][NEUTRAL] I don't see anything for ER, um, let me make sure there's nothing else.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it looks like we've got hospital confinement.
[AGENT][NEUTRAL] That pays a daily amount of 150.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] And it was just so you know it was outpatient surgery, so he never stayed all night.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Um, and then we've got a first occurrence hospital rider, which is 1500.
[AGENT][NEUTRAL] Um, let me see what defines first current.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] Have you ever filed any claims for that?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] On this policy?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like it does, um, it has to be related to a confinement.
[AGENT][POSITIVE] So you'd have to be impatient.
[CUSTOMER][NEUTRAL] OK, no, he was not confined, it was outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's a strange thing it suffer so much.
[AGENT][NEUTRAL] OK, so it looks like then what's eligible for um compensation would be the surgical benefit.
[CUSTOMER][NEUTRAL] Let me see
[AGENT][NEUTRAL] Um, uh, like I said, that's 4000 and then there's an anesthesia amount that's 25% of the surgical benefit amount.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, and then have I had the policy long enough for everything to be enforced, you know what I mean by that? Like so I can submit claims for those?
[AGENT][NEUTRAL] Uh, yeah, let me see if there's any preexisting.
[CUSTOMER][NEGATIVE] You should not.
[AGENT][NEUTRAL] Yeah, you don't have a preexisting clause, so you're fine.
[CUSTOMER][NEUTRAL] OK. Now, two questions. I guess, first, how do I submit claims for the surgical and the anesthesia part?
[CUSTOMER][NEUTRAL] And just so you know, I do have insurance through Florida Blue, so I ran it through my primary insurance first.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, yeah, for this, no, it doesn't matter. This is uh separate of your major medical. We don't, we don't need the coordination for your um primary, so, um, OK, so we would need like either itemizations of the stay that shows what you know, surgical procedure transpired with the diagnosis, um, that could be by way of, like I said, itemization, medical records.
[CUSTOMER][NEUTRAL] Does that matter?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the actual claim from the hospital, um, just something that shows date of service, what services were rendered, and then what the diagnosis was, and then how much was charged, of course.
[CUSTOMER][NEUTRAL] OK. And then, uh, can I submit like the surgical claim and the anesthesiologist like all at the same time or do, is it separate claims?
[AGENT][NEUTRAL] No, you can submit at the same time.
[CUSTOMER][NEUTRAL] OK, at the same time and how once I have that information, how do I go about submitting a claim?
[AGENT][NEUTRAL] Um, have you set up your, uh, online account on our online portal?
[CUSTOMER][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] OK, um, let me see, I can.
[CUSTOMER][NEUTRAL] Are you able to see that?
[AGENT][NEUTRAL] Yeah, let me check real quick.
[AGENT][NEUTRAL] OK, give me one moment, it looks like it's searching. Uh, no, I don't show that you've ever created your account.
[CUSTOMER][NEUTRAL] OK, and do I go to that [PII] to set it up?
[AGENT][POSITIVE] Yes, and I can send you a user guide if you like. I can send that to your email and then that'll walk you through how to set it up if that's helpful.
[CUSTOMER][NEUTRAL] OK, that'll be good and then what email do you have for me?
[AGENT][NEUTRAL] Or we can
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Oh, actually, let me verify a few things that I forgot to do. So what is your birthday?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your address?
[CUSTOMER][NEUTRAL] At [PII].
[AGENT][NEUTRAL] And then what is your email address? I've got a Gmail.
[CUSTOMER][NEUTRAL] Oh, let's do [PII] or if you have [PII], that works too.
[AGENT][NEUTRAL] I've got the [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, let's use that one perfect.
[AGENT][NEUTRAL] OK, and then do you have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much. OK, so I will email.
[CUSTOMER][NEUTRAL] And then question, oh go ahead mhm.
[AGENT][NEUTRAL] OK, um, I'll email that user guide that'll tell you how to set that up um and then from there you'll be able to upload the claims when you get them and when you're ready to file, so.
[CUSTOMER][NEUTRAL] OK, now my date with the employer last day was [PII]. I'm going to get one more paycheck for severance for two weeks out. My question it was payroll deduction. Am I able to keep the policy as a private policy or no does it stop like once?
[CUSTOMER][NEUTRAL] It's no longer coming out of payroll.
[AGENT][NEUTRAL] Um, let me see if they port this. Hm.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Clauses for du Lord of. Speak and.
[AGENT][NEUTRAL] Hold on just one second.
[CUSTOMER][NEUTRAL] Mhm it's if you want the password.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, let me, let me, do you mind if I place you on a brief hold? I'm trying to find the location where it tells that information.
[CUSTOMER][POSITIVE] Oh, not at all. Take your time, yeah.
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, I'm so sorry about that. Thank you for holding.
[AGENT][NEUTRAL] I don't see I don't see a portability rider on this policy, so if if I don't see the portability rider, typically it can't be ported if it can for some reason, um, but it's not, it's not on your policy. I'm not sure why it wouldn't be, but they, you will get a letter in the mail and it'll tell you um your options for continuing the coverage, but I don't see a portability um option on your policy.
[CUSTOMER][NEUTRAL] That's fine, yeah.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, does it usually last through the end of the month or the day that you were no longer with the company or do you know?
[AGENT][NEUTRAL] Uh, typically it should last for the end of the month in which you terminate.
[CUSTOMER][NEUTRAL] OK, last through the end of the month once that I'm terminated. OK, so that should be through the end of April if that was the [PII]. OK, perfect. And then you'll, you sent me the, you said that you would send me a link. I'll get that set up and then see if maybe we can get something back for some of the surgical benefit and then the anesthesiologist.
[AGENT][POSITIVE] Yes, that's correct. I'll get that to you. Give me about 5 minutes.
[CUSTOMER][NEUTRAL] Oh, OK. And then, uh, the other policy, what is the other policy that I have?
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You mentioned two policies.
[AGENT][NEUTRAL] Yeah, let's look at that one and see what's going on there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I think I have. Is it I and dental through you guys too, or not? Is that something separate?
[AGENT][NEUTRAL] Uh, that's separate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh it's good for this.
[CUSTOMER][NEUTRAL] to talk about too.
[AGENT][NEUTRAL] OK, this one looks like an accident policy.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, accident only insurance. OK, perfect. It's.
[AGENT][NEUTRAL] Yeah, so this one would be specific to accidents, um, if, so if you've had any accidents, um, you can absolutely file, uh, OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes, no, so it sounds like this one will just terminate at the end of the month.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, perfect. And then um it doesn't, I guess how long do I have to get claim information to you from his surgery? Is it like within.
[AGENT][NEUTRAL] Um, we
[AGENT][POSITIVE] That there's no time limit actually, so you can submit it at any time.
[CUSTOMER][NEUTRAL] OK, perfect. Uh, that, oh, and can you look, do I have dental and eye insurance through you guys too, or is it a different company? Sorry, I should know, but I don't remember.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Looks like a different company because I don't have anything set up. We don't actually offer a vision we do have dental, but I don't see a dental policy for your uh for yourself so or family.
[CUSTOMER][POSITIVE] OK then I'll have to see who that was. OK, I appreciate your help today. Thank you very much.
[AGENT][POSITIVE] OK, well, thank you for calling [PII]. I hope you have a good weekend.
[CUSTOMER][POSITIVE] You too. Take care. Mm bye.
[AGENT][NEUTRAL] Bye bye.