AccountId: 011433970860
ContactId: 70160e4f-8dd0-4ba6-b94e-355dd6445e9f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340970 ms
Total Talk Time (AGENT): 157277 ms
Total Talk Time (CUSTOMER): 115169 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/70160e4f-8dd0-4ba6-b94e-355dd6445e9f_20250326T13:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] Yes, I'm calling to see um why there wasn't anything paid out on my claim.
[AGENT][NEUTRAL] OK, so you have a claim that was processed that you're wanting to check the status on as far as what benefits were not paid. Is that correct?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And Ms. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is your policy number, please?
[CUSTOMER][NEUTRAL] For
[CUSTOMER][NEUTRAL] 2491415
[CUSTOMER][NEUTRAL] On the.
[AGENT][POSITIVE] OK, thank you. Give me just a couple of moments, please, and chance to get your information pulled up.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] That's the only way.
[CUSTOMER][NEUTRAL] The bridge and I'll check in putting up our accounting back here.
[AGENT][NEUTRAL] OK, so Miss [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. And I do also have to verify several things with you 1st, 1st.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Security. So if you could first please verify your
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] What is your date of birth, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number on file for you is the same as the one that you gave me, so that is your best contact number. Is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you. And lastly your email address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So I do see that we have one claim on file for you, Ms. [PII]. Is this for West Jefferson Medical Center?
[AGENT][NEUTRAL] For [PII], beginning [PII]? OK.
[CUSTOMER][POSITIVE] Correct. Correct.
[AGENT][NEUTRAL] OK, so in looking at the remarks on the
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Claim. It has two different remarks. The first one states in order to complete the processing of your claim, we need itemized statements of services provided listing the charges, diagnosis code, and procedure codes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the other remark on your claim states in order to process your claims, we need this the itemized hospital bills with the admission and discharge dates and times.
[CUSTOMER][NEGATIVE] So why do y'all need the bills when this is only for hospital indemnity when I was the days that I was in the hospital? Y'all aren't paying the hospital bills.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Yes, and that is required. These are required documents in order to review this type of claim.
[CUSTOMER][NEGATIVE] Fail.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] What's the benefits for this policy? What's the benefits under my policy per day?
[AGENT][NEUTRAL] On your policy.
[AGENT][NEUTRAL] We must
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just one moment, please.
[CUSTOMER][NEGATIVE] Cause they may not even have that for months.
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][POSITIVE] I've never had an issue when we had all say prior to this.
[CUSTOMER][NEUTRAL] thing
[AGENT][NEUTRAL] Yes, ma'am, when filing claims, we do have to receive certain documentation.
[CUSTOMER][NEUTRAL] That's OK. I'm just gonna be sure to let HR know that it's a hassle prior to when we had Allstate. We just submit our documentation and there was no issue. So, what, what's the benefit per day under this hospital indemnity?
[AGENT][NEUTRAL] And that does
[AGENT][NEUTRAL] Yes, I
[AGENT][POSITIVE] Well, I'm very sorry.
[AGENT][NEUTRAL] Yes, ma'am, with
[AGENT][POSITIVE] Thank you. I will pull that information for you. So I'll
[CUSTOMER][NEUTRAL] That's the only thing I needed to know.
[AGENT][NEUTRAL] Hospital admission benefit is $700 for minimum of 2 days per calendar year per covered person, and the hospital confinement benefit is $100 per day, maximum of 30 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] So the first you said $700 admission and what else?
[AGENT][NEUTRAL] That's the admission benefit, and the total confinement benefit is $100 per day.
[AGENT][NEUTRAL] With a maximum of 30 days confinement per calendar year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Alright thank you.