AccountId: 011433970860
ContactId: 5aa11618-dd63-4fb6-93fa-9beedc6ca312
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 785630 ms
Total Talk Time (AGENT): 400025 ms
Total Talk Time (CUSTOMER): 325613 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/5aa11618-dd63-4fb6-93fa-9beedc6ca312_20250306T16:56_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]
[CUSTOMER][NEUTRAL] I have APLs through my my work.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I want to find out what kind of balance I have on it for this year.
[AGENT][NEUTRAL] Um, when you say balance, um, what do you mean? Do you mean, uh, premium owed?
[CUSTOMER][NEUTRAL] Um, what I have available for use.
[AGENT][POSITIVE] Oh, I see available benefit amount. OK, no worries, I can check that out for you. um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] For coverage.
[CUSTOMER][NEUTRAL] Sure, 954.
[CUSTOMER][NEUTRAL] 558.
[CUSTOMER][NEUTRAL] 8510.
[CUSTOMER][NEUTRAL] And I'm sorry, I didn't get your name. What was that?
[AGENT][NEUTRAL] It's OK, it's [PII]
[CUSTOMER][POSITIVE] Hi [PII], that's a lovely name. Thank you.
[AGENT][NEUTRAL] Hello. Thank you. Um, and do you have your uh policy number?
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number is um
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 018.
[CUSTOMER][NEUTRAL] 670.
[CUSTOMER][NEUTRAL] 72 ML 7.
[AGENT][NEUTRAL] OK, thank you and then uh just gonna verify some information really quick. Uh, 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] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you and it looks like it is through an organization.
[CUSTOMER][NEUTRAL] Oh Lord, um, [PII].
[CUSTOMER][NEUTRAL] [PII] or [PII].
[AGENT][NEUTRAL] So I've
[AGENT][NEUTRAL] I do have it's at [PII], um, but I have it as [PII]. Is that not correct?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Listen, they've changed it. I have two emails for, well, I use.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] You know, for one for inside and one for outside, yes, can I change my my email address?
[AGENT][NEUTRAL] Sure, OK, so is this one correct?
[AGENT][POSITIVE] Absolutely, yes, what would you like to change that to?
[CUSTOMER][NEUTRAL] [PII], which is what I go by. I have a pet name. I don't go by [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I will get that changed for you right now.
[AGENT][NEUTRAL] Alright and um I appreciate you verifying all of that information. Um, were we needing to check uh inpatient and outpatient benefits of what was available?
[CUSTOMER][NEUTRAL] So you only do um inpatient if I've been in the hospital for 24 hours?
[AGENT][NEUTRAL] Right, um, that's typically the rule of thumb so insure your outpatient benefits so for anything that is, you know, you don't have to stay at the hospital for over a day, um, that's on a per calendar day basis, so there's no yearly maximum it pays up to $500 per calendar day and then your inpatient is $3500 max per calendar year.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, question.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] You, you pay 500 for in hospital. OK, how far back?
[AGENT][NEUTRAL] That's outpatient. 500 is outpatient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And how much if I be hospitalized?
[AGENT][NEUTRAL] So, uh, inpatient, that's yearly maximum that is $3500 max per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to see if any of that has been used?
[CUSTOMER][NEUTRAL] Um, no, um, why I ask is, uh, I was hospitalized for 3 days in
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, oldest, uh.
[CUSTOMER][NEUTRAL] Uh, of [PII], but I, I didn't use my card. Am I able to go back and claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Absolutely. Um, so your policy has been effective since [PII]. Um, so you can file claims, there's no timely filing limit. So anytime that your policy was active, you can absolutely still file those claims.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And what do I need from you to go back and claim for that?
[AGENT][NEUTRAL] Sure, OK, so for the information that we need for claims, uh, it's going to be, uh, well, let me know when you're ready in case you wanna write it down.
[CUSTOMER][POSITIVE] Go ahead, yes, I'm writing it down.
[AGENT][NEUTRAL] OK, OK, so it's going to be the itemized statement.
[AGENT][NEUTRAL] That shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK, diagnosis.
[AGENT][NEUTRAL] Yes, diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And as this was for uh an inpatient stay, we would also need the date and time of admission and discharge.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, question. I have all the records for my hospital stay.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] With all the codes and everything, so what I need is actually what I need to get, get for you is actually the itemized statements.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] which the hospital would run and then the
[CUSTOMER][NEUTRAL] Date of
[CUSTOMER][POSITIVE] The admission in time.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So you would need those two things.
[AGENT][NEUTRAL] Right, the date and time for uh when you were, um, but the for the admission and for discharge for this kind of policy also, uh, we would also need the explanation of benefits from your primary insurance essentially showing that they did contribute and if you don't have any of this information, you can get all of this from wherever you went for treatment.
[CUSTOMER][NEUTRAL] OK. OK. I will see if I can get that because then I can say, what is my per day? Is there a per day staff um for being in hospital, I was in hospital for 3 days.
[AGENT][NEUTRAL] Not for inpatient, so it's just that yearly maximum for inpatient. So once it hits, um, you've got that cap of $3500 per calendar year for inpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEGATIVE] Um, you have no idea what I would be able to claim for being in hospital for 3 days.
[AGENT][NEUTRAL] Uh, no, simply because I don't know how much was left over after your major medical paid.
[CUSTOMER][NEUTRAL] OK, then, OK, so I will see if I can get that. I never thought of that. So, um, but um if you could check and see if, so you're only doing hospital, then that's fine. I, so I'm not able to use what you're offering because I'm looking for therapy.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Uh, physical therapy.
[CUSTOMER][NEGATIVE] Yeah, and now you don't do that, so.
[AGENT][NEUTRAL] I can see if that's a covered benefit.
[CUSTOMER][POSITIVE] Could you please? I would appreciate that. Thank you.
[AGENT][NEUTRAL] Of course. Absolutely. And I did just look for good measure, um, for, you did say that was uh in [PII] that you were uh in the hospital?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, so you've not used any of that inpatient amount so you do have that full benefit amount for that year.
[CUSTOMER][POSITIVE] OK, that's good. I will, I will get this information and send it in.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. All right. And bear with me just a moment. Let me see if physical therapy is covered under this policy.
[AGENT][NEUTRAL] Alright, yes, so under your outpatient benefit, which would be that up to $500 per calendar day, um, it does state physical therapy performed in a physical therapy facility is going to be covered under that outpatient benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I did have surgery in [PII]. So then this would cover me.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh this is great. OK, what do I need now? So do I do the therapy and send, send the bills to you, or how does that go? Do I, or will they accept my card?
[AGENT][NEUTRAL] So what I would do.
[AGENT][NEUTRAL] Sure, generally what I would do no matter where you go for any kind of medical treatment or anything like that, I would present them both of these this information so your major medical and this policy um unfortunately it is generally going to be up to the individual provider if they'll file the claims for you or not.
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] Most of the time they will and if there's ever any confusion like they're not sure what kind of policy this is they've never heard of APL they are more than welcome to give us a call we talk to providers all the time so we can go through and explain the plan and what's covered um but if for some reason they.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, they, they're leaning.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Uh-huh, go ahead.
[AGENT][NEUTRAL] Well, just so that you're aware, if for some reason they just are flat no they'll say right, so if they say that they won't file the claims for you, you can absolutely still file these claims.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Pain and then get it came back.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, and um.
[CUSTOMER][POSITIVE] OK, that's good so um.
[CUSTOMER][NEUTRAL] And then I could call you if I needed forms or anything to get the forms to claim.
[AGENT][NEUTRAL] Absolutely, um, so to file the claims, uh, have you created an account on our online portal before [PII]?
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] Uh, do you know if you have created an account on our online portal before?
[CUSTOMER][NEUTRAL] I have not a clue.
[AGENT][NEUTRAL] OK, do you have um access to.
[CUSTOMER][NEGATIVE] I hate doing this thing. To be honest with you, I hate doing this thing.
[AGENT][NEUTRAL] I don't blame you. It is a lot. It is very confusing. I did this for a living and it's, it's confusing, so I completely understand. The reason I ask is if you have access to a desktop or a laptop computer, um, doing it through our online portal, uh, if you submit claims that way generally gonna be the quickest and easiest way to get that to us, um, otherwise, of course we do have a mailing address and a fax number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, um, what I will do is, so.
[CUSTOMER][NEUTRAL] I can also claim for being in hospital for
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The [PII] because that was outpatient and I would need my bill. I need my bill and my.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] I don't think I've got my um my EOB yet.
[AGENT][NEUTRAL] Sure, yeah, for all of these kinds of claims, um, we'd need that itemized statement that shows those diagnosis and procedure codes and then the explanation of benefits from your primary insurance, um, that's gonna be general rule of thumb for any kinds of claims, uh, for this policy.
[CUSTOMER][NEUTRAL] OK, so I just need to go back and get the two of the information for those 2 admissions and then and then if if there's a problem going online, I will call and request the form, but I, I can try and go online and do it, but I would have to upload, upload those receipts.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And and attach them to the
[CUSTOMER][NEUTRAL] The form the request.
[AGENT][NEUTRAL] Right, so if you were to do it through our online portal, all of the claim forms are readily available right there so you could fill them out online and then there's a spot where you can upload documents, uh, claim information so if you have uh physical copies of those you can either scan them if you have a scanner or you could just take a picture um as long as it's clear and legible that's perfectly fine.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what I've done.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, that's fine. So you know what? I am gonna be doing this. Thank you for your help. You've helped me. You really made my day, OK? And it, and so, so again your name was.
[AGENT][POSITIVE] You're very welcome. No, of course it's a lot.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII] OK, [PII]
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's great. Thank you, [PII]. I will follow up on this and get this information. OK? You take care.
[AGENT][POSITIVE] All right, you are very welcome.
[AGENT][NEUTRAL] I know that was quite a bit information overload. Did you have any other questions for me, [PII]?
[CUSTOMER][POSITIVE] No, I, I've been, been writing it down, so it's good. That's it. That's it for now. Thank you.
[AGENT][POSITIVE] Good all right well if you have any other questions don't hesitate. I hope you have a great rest of your day. It was a pleasure speaking with you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you you too bye.
[AGENT][POSITIVE] Thank you. Bye bye.