AccountId: 011433970860
ContactId: 716d66ae-3ca2-412d-8cd4-1d74879e9459
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410100 ms
Total Talk Time (AGENT): 244226 ms
Total Talk Time (CUSTOMER): 130348 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/716d66ae-3ca2-412d-8cd4-1d74879e9459_20250527T19:17_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi. Um, my daughter was playing lacrosse. Um, she's a senior in high school, and she got hit and blew out her ACL and she had surgery and everything, but, um, I was told at work, I forgot about that we had accident insurance, and so I'm not sure what I'm doing. And I went on the website and I'm just confused, so I don't know if we can file a claim or not. It's expensive.
[AGENT][NEUTRAL] OK, so you're the primary policy holder, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And you're wanting to find out about filing a claim for your daughter?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes and I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII]. What is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] 2310083
[AGENT][NEUTRAL] OK, thank you. One moment please while I get that information pulled up your policy information.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And then your daughter's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. Your home mailing address, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is also the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you and then the last piece of information is your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, so we do have something different on here. I'm not sure if that is.
[CUSTOMER][NEUTRAL] Oh, you probably have my work ones [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am. OK. Thank you very much for verifying all of your information.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so you're gonna be filing a claim for her surgery for all of it, is that correct, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah, for all of it, whatever's covered.
[AGENT][NEUTRAL] OK, so first off I can see that you are set up in the online service center portal so you can upload your claims information directly into the portal.
[AGENT][NEUTRAL] Do you already have the accident claim form, the group accident claim form?
[CUSTOMER][NEUTRAL] OK, so I wasn't sure what I needed to do.
[CUSTOMER][NEUTRAL] So I, I just get one of these claim forms and download it or?
[AGENT][NEUTRAL] Right, you could, right, you would go to, you can print it or download it directly from our website at [PII] and under claims and forms the accident claim form would be the first one that you will see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And you should see a blue download form button out to the right.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I got, I have the form here so.
[AGENT][NEUTRAL] And when
[AGENT][NEUTRAL] OK, and that first page has all of your instructions for completing the form as well as the additional documentation that you would need to also submit.
[CUSTOMER][NEUTRAL] Yeah, and I can
[AGENT][POSITIVE] So it's easy to just use that as your checklist.
[CUSTOMER][NEUTRAL] Go through this one, OK, OK, and then once I go through this, then I would upload it onto the website?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. Exactly. You would sign into your portal and follow the steps to file a claim. And then um you would just select this policy, your daughter's name, and it'll walk you through uploading. Now, I can tell you that tomorrow, Ms. [PII], there are some new.
[AGENT][NEUTRAL] There's a new implementation going into effect for the portal, so when you do go to sign in, it's and I don't wanna tell you what it's gonna say exactly because I'm not 100% sure myself how exactly it's gonna look, but you, um, it'll give you the prompts of what you need to do.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. That, that sounds good. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. So we fill out this form. Do I need to get all my, I guess.
[AGENT][NEUTRAL] And, and then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All the explanation of benefits.
[AGENT][POSITIVE] Correct. Yes ma'am.
[CUSTOMER][NEUTRAL] Then I would just download this and attach them, OK.
[AGENT][NEUTRAL] Right. And then if, um, yes, what are, because if you'll notice on the claim form, there's gonna be different instructions for different types of accident-related injuries.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, you know, depending on
[AGENT][NEUTRAL] What's required and it will tow you out next to each of those.
[AGENT][NEUTRAL] The document and the additional documents that you would need.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And of course, we do have to have the itemized bill.
[AGENT][NEUTRAL] Um, for all of her.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Injury related, yeah, all of that.
[CUSTOMER][NEUTRAL] Yeah, and then I guess you need the, the doctor to sign as well.
[CUSTOMER][NEUTRAL] On this
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Is that
[AGENT][NEUTRAL] Now, I don't believe on here, yes, there is a the the attending physician's statement, I believe is like page 5 of 5.
[AGENT][NEUTRAL] And yes, there would be, um, then there's a place for the.
[AGENT][NEUTRAL] Physician signature on that, but yes, there is a physician form.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][POSITIVE] All right, I will get started on gathering everything and.
[CUSTOMER][POSITIVE] Get it submitted. Thank you so much. I just was confused, but I appreciate it. Thanks.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] Yeah. I will know. Do you have any other questions that I could try and help you with, Miss [PII]?
[CUSTOMER][NEUTRAL] Not today. I think I just need to get started here.
[AGENT][POSITIVE] OK. Well, if you have any other questions, give us a call and we'll be more than happy to help you.
[CUSTOMER][POSITIVE] I appreciate it thanks bye.