AccountId: 011433970860
ContactId: 7a5035c3-ce9c-4a6c-bfa7-09c1476a3f07
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 587479 ms
Total Talk Time (AGENT): 326049 ms
Total Talk Time (CUSTOMER): 221553 ms
Interruptions: 5
Overall Sentiment: AGENT=1.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/7a5035c3-ce9c-4a6c-bfa7-09c1476a3f07_20250430T16:33_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello. Uh, my name is [PII], and I would like to know how can I submit the claim.
[AGENT][POSITIVE] OK, yeah, I can help you get that uh claim filed. I'm so sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, can I get a good call back number from you and I'm so sorry.
[CUSTOMER][NEUTRAL] And I do have a policy.
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] I can give you a policy number. Um, my phone number is [PII].
[AGENT][POSITIVE] Thank you and then yes I can go ahead and take that policy number.
[CUSTOMER][NEUTRAL] OK. So it's 026030110.
[CUSTOMER][NEUTRAL] And there is also group number 13854.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what was your date of birth? I'm sorry.
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] OK, I think I might have misheard that policy number. I'm so sorry, could you uh repeat that for me?
[CUSTOMER][NEUTRAL] Yes, 02603010.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][POSITIVE] There we are, OK, sorry about that.
[AGENT][NEUTRAL] OK, I'm just gonna verify some, uh, additional information really quick. Um, can I get your uh mailing address please?
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Thank you for that. Last thing I need is the email address we've got on file for you. It looks like it might be through your employer.
[CUSTOMER][NEUTRAL] So, yeah, uh, my employer's IRSD and my email [PII].
[AGENT][NEUTRAL] Got it thank you so much for verifying that. OK, so to file claims for this kind of policy, this is a limited indemnity medical plan, it's called hospital indemnity. Um, I would say the quickest way and easiest would be through our online portal. Um, do you have, is it, um, pending charges already or have you already paid uh these bills?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have not paid anything yet.
[AGENT][NEUTRAL] OK, so then another option for you would be to simply give this information to the provider uh and ask them to file it for you. Have you tried giving them this information?
[CUSTOMER][NEUTRAL] I have not.
[AGENT][NEUTRAL] I would definitely try that first. No, you're fine. Um, unfortunately some providers they're all different than each other, um, as this isn't a traditional major medical plan, some may not want to file it, um, and you know that's if if there's any confusion.
[CUSTOMER][NEUTRAL] I wasn't sure how.
[AGENT][NEUTRAL] Or anything of course they're more than welcome to give us a call as well but I would definitely see if they would file it on your behalf just so you don't have to worry about it um otherwise you can um again through our online portal would be the quickest and easiest way do you have access to a uh desktop or a laptop computer?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, I do.
[AGENT][NEUTRAL] Awesome OK the reason I ask is that our website currently does not have support for mobile devices so it would have to be on a desktop or a laptop.
[CUSTOMER][NEUTRAL] OK, makes sense. OK.
[AGENT][NEUTRAL] And then uh to set up the account, oh yes, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] So my question is.
[CUSTOMER][NEUTRAL] Yeah, yes, yes. I think the, the the connection is a little delayed um on the phone. So yes, I did want, well, I kind of found the um.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] You know, the, the web page and is am I supposed to create a new user?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, first let me ask, right, let me ask first because we do have a couple of different websites. One is going to be our public website that's [PII] uh and the other one for the online portal, it's secured. [PII] so it's the word secured in front of it with a [PII] um that's going to be where you would set up an account.
[CUSTOMER][NEUTRAL] Or it's already there.
[CUSTOMER][NEUTRAL] That's where I went.
[CUSTOMER][NEUTRAL] Oh, OK. All right.
[CUSTOMER][NEUTRAL] OK. Yup, I am on the secured one.
[AGENT][POSITIVE] Awesome, yes, so you would, yes, select a new user and it would be the top option that says it's uh you're an individual.
[CUSTOMER][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] And just to verify, um, uh, the email address we've got on file because that is what you would have to use that was um the [PII] is that correct?
[CUSTOMER][NEUTRAL] OK, OK. I see.
[CUSTOMER][POSITIVE] Uh, I think that one works as well because I have like the [PII] and I also have [PII].
[AGENT][NEUTRAL] OK, so the one that we have is the [PII], so that's the one that you would enter uh whenever you go to create the account.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The [PII], OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh OK, OK, thank you for that.
[AGENT][NEUTRAL] There's also a spot just to alleviate any kind of confusion or potential confusion there's a spot that asks for a member ID or your social um the member ID is different than your policy number and this policy does not have a member ID so you would enter in your social in that slot.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, that's good to know.
[AGENT][NEUTRAL] Yes, I know that um there's a lot of, uh, I get a lot of confusion with that.
[CUSTOMER][NEUTRAL] OK, so let me see if that will go through while you're still on the phone.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][POSITIVE] OK, yeah, it, it, it worked OK.
[AGENT][NEUTRAL] Awesome, OK, um, so of course you know the best option would be if they were to file the claim for you, but if not, um, I can let you know the information we need to file claims whenever you're ready if you'd like to write it down.
[CUSTOMER][NEUTRAL] Yes, I am ready just in case, I will try to call them and see what they can do, but I wanna be prepared if for some reason they do not wanna do it.
[AGENT][POSITIVE] Yeah, absolutely.
[AGENT][POSITIVE] Absolutely, yes, OK.
[AGENT][NEUTRAL] So of course the correct claim form you would fill out would be the hospital indemnity claim form as that's the name of this kind of policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we would need the itemized statement.
[CUSTOMER][POSITIVE] Mhm yep I do have that one I do.
[AGENT][NEUTRAL] That shows
[AGENT][NEUTRAL] It the itemized statement that shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] It does have some sort of codes.
[AGENT][NEUTRAL] If you're not sure, I would simply ask them uh wherever you went for treatment, just ask them for that information and of course if you say it's to file a claim they'll know what to give you.
[CUSTOMER][NEUTRAL] Mhm it does have some kind of codes on there uh itemized because that's the first thing I requested is the itemized bill.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, yes, absolutely, and that's going to be all that we need um there's going to be a spot you'll see uh where you can fill out the forms and then there's also a spot where you can upload documents and that's where you would uh put in that um out of my statement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, I can do that.
[AGENT][NEUTRAL] Alright and then of course yes that's gonna be all that we need um and of course if you know the providers have any questions for us or if you know once you get there you have additional questions feel free to give us a call we'll do what we can to help you out with it it can definitely be confusing.
[CUSTOMER][NEUTRAL] And that's it, that's the only thing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um if I can like when I contacted them uh what do they need? like what kind of information they will need.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You know, about your services? Like, do I need to provide them something other than policy number?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] All you would really need is that policy number um if they were to call and speak with us, they would just of course need your policy number and then to be able to verify your name and date of birth um now are you, are you looking at your card right now? is that where you got the policy number, your ID card?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, correct. Mhm, yup.
[AGENT][NEUTRAL] OK, so on that card there should be information um such as an address fax number and a payer ID um and that would be where claims would be sent.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If they were to be the ones to file the claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I see. OK.
[CUSTOMER][NEUTRAL] OK, that's all they need. OK, OK, I never done it before, so.
[AGENT][NEUTRAL] All right, yes, did you have any other questions for me at the moment? I know, I understand.
[CUSTOMER][NEUTRAL] OK, no, I think that's it. I think that is there any limits in terms of the time frame or there?
[AGENT][NEUTRAL] No, absolutely not. There is no timely filing limit, uh, so just whenever you're able to, you can get that claim information to us whenever is convenient for you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, OK, OK, because that's what I was worried about, like if you have to claim, claim within like 30 days or.
[AGENT][NEUTRAL] No, absolutely not. No, you are perfectly fine.
[CUSTOMER][POSITIVE] OK. OK, good. OK. Well, thank you.
[AGENT][POSITIVE] Of course yeah thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. You too. bye.
[AGENT][POSITIVE] Thank you. Bye bye.