AccountId: 011433970860
ContactId: 5e2a2cd5-a523-45d7-94f6-06e3c7ff0774
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387619 ms
Total Talk Time (AGENT): 206608 ms
Total Talk Time (CUSTOMER): 151652 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/5e2a2cd5-a523-45d7-94f6-06e3c7ff0774_20250402T19:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I recently had a procedure done, um, I think in January, and I have indemnity insurance, so I just want to see what steps I need to take to file my claim.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you, [PII]. What is a good callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And do you have your policy certificate number available?
[CUSTOMER][NEUTRAL] Um, would that be on my card? Yes, I do. Um, it is 02581222.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And do you mind verifying your date of birth and current mailing address?
[CUSTOMER][NEUTRAL] Yeah, my date of birth is [PII] and um my address is [PII].
[AGENT][NEUTRAL] And it's in [PII], I'm sorry.
[CUSTOMER][NEUTRAL] Uh-huh. [PII]. Mhm.
[AGENT][POSITIVE] All right. Thank you.
[AGENT][NEUTRAL] And was this in an outpatient facility or inpatient hospital or in the doctor's office? Was it a surgical procedure?
[CUSTOMER][NEUTRAL] Uh, this was a surgical procedure that resulted in an inpatient stay.
[AGENT][POSITIVE] Bless your heart.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so from the hospital, we will need an itemized bill showing the days that you were charged with room charges.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And from the hospital, you can actually request a form. It's called a U as in umbrella, B as in Bravo 04.
[AGENT][NEUTRAL] It's a UBO4.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that should have the days, you know, the room charges showing what days that you were in the hospital.
[AGENT][NEUTRAL] Now, that's for the inpatient hospitalization benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, for the surgery, we will need an itemized bill from the surgeon.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Showing um the procedures and diagnosis codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you need um.
[AGENT][NEUTRAL] And that's from the surgeon.
[CUSTOMER][NEUTRAL] So you need an itemized bill regarding like the room charges.
[CUSTOMER][NEUTRAL] For like the room.
[AGENT][NEUTRAL] Right, that's from the hospital.
[CUSTOMER][NEUTRAL] The items from the.
[CUSTOMER][NEUTRAL] And then itemized bill from the surgeon.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That's correct. With diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then there is a claim form.
[AGENT][NEUTRAL] On our website at [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And it is for hospital indemnity.
[AGENT][NEUTRAL] You will need to submit that form along with the itemized fields.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm actually on your site right now.
[CUSTOMER][NEUTRAL] OK, I'm on your site right now so if you don't mind I'll just pull it up while I have you.
[AGENT][NEUTRAL] OK, yeah, y'all have an active account.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so you said hospital indemnity insurance. Ah, here we go. OK, download form.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] And then you can also, once you have those documents they can be uploaded online as well.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, sounds good. OK, so, uh, from the hospital, I'll get the UB 04 form that should show the itemized bill for the room charges and everything. Then I'll get an itemized bill from the surgeon with diagnostic codes, and then I'll upload this indemnity claim form, and that should be it then, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] Mhm. That's correct. Now,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Also, um, now your husband, if he would prefer, he can choose the direct deposit payment and benefits would go directly to his bank account on that portal as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, sounds good. And then, um, how, how long does it take for, uh, your claims to be processed typically?
[AGENT][NEUTRAL] We ask that you give us 7 to 10 business days to process a claim. Now sometimes it does take a little bit longer depending on the information needed or if we're needing additional information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sounds good. And then um how much am I granted to get potentially or like what's the highest value that I, I could see given back to me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, so there now all benefits are given over the phone and is a verification of coverage on your policy. It's not a guarantee of payment just simply means I can't pay the claim on the phone.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, your hospital admission benefit, that is one time per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is when you were admitted into the hospital, that benefit amount is $2000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then um for your outpatient surgery.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is $1500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome well thank you so much and I understand we might not get all of that, but it's good to have a rough number of, you know, what we can get so.
[AGENT][POSITIVE] Absolutely, and you can also, since y'all have that active online account if you ever wanna view the benefits on your plan, just click on the policy number and your policy certificate will download.
[CUSTOMER][POSITIVE] Awesome, well, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then in the certificate there's a page called the schedule of benefits that kind of has it all listed out with the benefit amount for each coverage service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK awesome well thank you so much you've been very helpful today.
[AGENT][POSITIVE] It's been such a pleasure to assist you, Miss [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] I think that's it. I appreciate it.
[AGENT][POSITIVE] Oh thank you for calling APL. Hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.