AccountId: 011433970860
ContactId: 7229a7b1-17f2-46dd-801a-bcd7bcf08b00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 636700 ms
Total Talk Time (AGENT): 253887 ms
Total Talk Time (CUSTOMER): 205161 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/7229a7b1-17f2-46dd-801a-bcd7bcf08b00_20250616T21:21_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] Hey [PII], I was just calling about um a claim that I got in the mail. I just wanted to get, I just want to ask some questions about it.
[AGENT][NEUTRAL] OK, well, I can help you with your claim. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, so [PII] is my name and then contact number [PII].
[AGENT][NEUTRAL] Thank you for that. And your policy number?
[CUSTOMER][NEUTRAL] Uh, oh, so 0259.
[CUSTOMER][NEUTRAL] 4137
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, [PII], um, you said mailing address?
[AGENT][NEUTRAL] Yes, an email.
[CUSTOMER][NEUTRAL] 2, OK, [PII]. Um, I'm pretty sure the email, it's either [PII] or [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And so the claim that you're wanting to um speak in reference to, um, hold on one second, let me go to your claims.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Let me see. OK. Um, I'm showing that it's
[AGENT][NEUTRAL] That we're waiting for eligibility from your from your employer. And what questions did you have?
[CUSTOMER][NEGATIVE] Oh, so basically I got, I got something in the mail and it says this is not a bill, but it says just the price of everything and patient responsibility, um, being 520 so I'm just confused because it says it's not a bill so I do I pay it or do you like, uh, yeah, I'm just confused because it says this is not a bill.
[AGENT][NEUTRAL] Um, hold on one moment. Let me see if I can, um, find the same thing so I can look at it. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's probably this one.
[AGENT][NEUTRAL] I'm just waiting for the image to come up here. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this is it. So, no, this is the explanation of benefits from us. So no, it's not a bill. You're going to receive, uh, this is just basically a copy of the decision um that we sent to the provider. So the provider now is going to see if there is any other discounts or benefits that they can apply to the balance and then you will, you will receive a bill.
[CUSTOMER][NEUTRAL] OK, I'm, I'm confused, so are you, are you.
[AGENT][NEUTRAL] If there is an outstanding amount.
[CUSTOMER][NEUTRAL] Oh, OK, so this doesn't mean that you guys aren't gonna pay this it's just what the what it is right now.
[AGENT][NEUTRAL] Right, so basically, so this claim hasn't been denied or anything. We haven't given them a decision. Once we receive the um eligibility from your employer just saying, hey, he was working on an assignment, you can go ahead and pay out on the benefits, then we will go ahead and continue processing and give a full decision.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, OK, cool. I just wanted to make sure so then there's nothing there's I don't need to do anything right now.
[AGENT][NEUTRAL] No, sir, there's nothing for you to do right now. Um, once we get that, we'll go ahead and process.
[CUSTOMER][NEUTRAL] OK, cool. And I had, I had another question that um is different from this one. so do you guys, so um do you guys also cover um like if I went to urgent care, do you guys cover that as well? Would I submit through you or is, is that something else?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, hold on, let me see what all you have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so with us, you have the hospital indemnity policy, which is the medical policy. You have an accident policy, a group term life policy, and then the dental. Um, let me pull up the medical and see what it covers. 7474.
[CUSTOMER][NEUTRAL] Yeah, because I, I, I remember calling, I think it was you guys and you said it would, you would cover up to 75 if I remember correctly, but just wanna make sure.
[AGENT][NEUTRAL] Sure, hold on one second.
[AGENT][NEUTRAL] Alright, so I'm just waiting for the image to come up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So yes, for office visits, um, the outpatient sickness rider is up to $75 per visit with a max of 5 visits per calendar year.
[CUSTOMER][NEUTRAL] OK, and that that falls under urgent care too, right?
[AGENT][NEUTRAL] Yes, urgent care will go into that.
[CUSTOMER][NEUTRAL] OK, so if I, if I wanted to submit um uh a claim for the urgent care, how, how would I go about doing that?
[AGENT][NEUTRAL] Um, so you should, so have you received your medical ID cards?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hold on, let me.
[CUSTOMER][NEUTRAL] So they, they didn't, they didn't take like um I remember when I called like I was calling and they didn't take like you guys directly so they the person said to just pay it up front and then submit the claim on the site um but I let me check if I have the card.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] Uh, yeah, I don't have them physically, but I have them, um, like I had them send it to me.
[AGENT][NEUTRAL] Yeah, so you would just um
[CUSTOMER][NEUTRAL] So I have it on my email.
[AGENT][NEUTRAL] OK, so you would just reach out to the provider, the urgent care facility, let them know that you have this policy. They're probably gonna ask you for a copy of the card front and back and just send that to them. They'll call us to verify benefits, um, and they'll file the claim on your behalf. Um, I mean, you do have the option to file a claim if you want to, but usually the provider does.
[CUSTOMER][NEUTRAL] Yeah, so, so I actually I went already they they they basically said that they don't, um, I, I guess I didn't take it or whatever, but like, like when I called before I went, the person from APL basically said that um just get like the information and then submit it through the website then you can submit the claim yourself if they aren't willing to do it.
[AGENT][NEUTRAL] OK, so you'll need the itemized bill from them, not, not your patient bill.
[CUSTOMER][NEUTRAL] OK, yeah, I have that.
[AGENT][NEUTRAL] Not your patient bill, ask them for the
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Itemized bill, they might call it a universal bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It needs to have the diagnosis code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, itemized bill.
[CUSTOMER][NEUTRAL] Bill or universal bill.
[AGENT][NEUTRAL] Depending on the depending on the location, it they may call it either or it's the same thing.
[CUSTOMER][NEUTRAL] And it needs to have what?
[AGENT][NEUTRAL] Um, it needs to have the diagnosis codes.
[AGENT][NEUTRAL] The procedure codes?
[CUSTOMER][NEUTRAL] I diagnosis codes.
[CUSTOMER][NEUTRAL] Procedure code.
[AGENT][NEUTRAL] And all the charges.
[CUSTOMER][NEUTRAL] all charges. OK, so when I'm calling, just ask for the itemized bill or universal bill, diagnosis codes, procedure codes, and all charges.
[AGENT][NEUTRAL] Yeah, all of that is on the diagnosis code, procedure code, charges, that's all on the bill.
[AGENT][NEUTRAL] And then
[CUSTOMER][POSITIVE] OK cool I'll ask them for that and then yeah.
[AGENT][NEUTRAL] And then you'll also need the um hospital indemnity claim form on our website.
[AGENT][NEUTRAL] So you're going to go to our website [PII], [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, click on claims and forms.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And under claims and forms, you're looking for a hospital indemnity. It's in alphabetical order.
[CUSTOMER][NEUTRAL] Indemnity, OK.
[AGENT][NEUTRAL] And then you just download that form and then um submit it on the online portal. Um, have you signed up for the online service center?
[CUSTOMER][NEUTRAL] Um, I think I did. Uh, if not, I could just sign up.
[AGENT][NEUTRAL] OK, um, so then it'll be that same.
[CUSTOMER][NEUTRAL] I is the online portal is.
[CUSTOMER][NEUTRAL] Yeah, continue.
[AGENT][NEUTRAL] On the same website where you're where you're getting the claim form from, you'll also see the link that says sign in, that'll take you straight to the online service center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, link on site. OK great and then on that is where I submit the thing.
[AGENT][NEUTRAL] Right. Once you sign up for the um online service center account, you can file your claims there.
[CUSTOMER][POSITIVE] OK great thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that was it, thanks.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Yep you too bye.
[AGENT][POSITIVE] Thank you. Bye bye