AccountId: 011433970860
ContactId: 7a762209-90b3-4552-9315-82165d0f79b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1402400 ms
Total Talk Time (AGENT): 640181 ms
Total Talk Time (CUSTOMER): 477504 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/7a762209-90b3-4552-9315-82165d0f79b8_20250625T22:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] here. How are you today?
[AGENT][POSITIVE] I'm doing well how are you doing today?
[CUSTOMER][POSITIVE] I'm doing good thank you um.
[CUSTOMER][NEUTRAL] So, I wanted to um claim my insurance uh and
[CUSTOMER][NEUTRAL] The reason for a call is like.
[CUSTOMER][NEUTRAL] Uh, I have an account. Do you want to pull up my profile real quick?
[AGENT][NEUTRAL] Yes, um, first, can I get your callback number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Uh, for this number it's like [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your policy number?
[CUSTOMER][NEUTRAL] Oh, OK, uh, yeah, that sounds so glad you asked that. Right now I didn't have that, uh, card with me right now, so is there any way other way we can just identify?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, can you give me your social security number and I'll look it up that way.
[CUSTOMER][NEUTRAL] The last four digits?
[AGENT][NEUTRAL] I'll need the full social.
[CUSTOMER][NEUTRAL] And this is the American Life, um, American Public Life Insurance, right? If I'm not wrong, sorry.
[AGENT][NEUTRAL] Yes. Yes, sir.
[CUSTOMER][NEUTRAL] OK got you so my social would be um.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me look up your policies real quick.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you, sir. And then also your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] So the address is [PII]. The email address is uh my last name [PII].
[CUSTOMER][NEUTRAL] Um, sorry, uh, my last name is [PII].
[AGENT][NEUTRAL] Yes sir, thank you and then the phone number you gave me to call you back on if we're disconnected is that your cell phone number?
[CUSTOMER][NEUTRAL] Uh, no, that's, uh, that's not my number. Uh, my number would be different from what we have.
[AGENT][NEUTRAL] OK, what is your phone number?
[CUSTOMER][NEUTRAL] On the file.
[CUSTOMER][NEUTRAL] Yeah, so my number is [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] OK, thank you very much for verifying that information for me. So how can I help you today?
[CUSTOMER][NEUTRAL] So I got a uh uh I got a one of the mail in my mailbox uh from the hospital and uh in that mail uh they told me to contact you guys and try to inform the incident report like incident what happened on [PII], uh, so there was an insurance claim for the [PII].
[CUSTOMER][NEUTRAL] Like a couple of months ago and uh while they tried to reach you guys but uh I think they said like I have to communicate the first to you and like uh inform about the what happened exactly and then they will proceed from there, you know, something like that. Is there any attachments in my file or any notes?
[AGENT][NEUTRAL] OK. OK, so.
[AGENT][NEUTRAL] Let me look real quick on you've got two different policies. Is this going to be for your hospital indemnity plan or for your group accident plan?
[CUSTOMER][NEUTRAL] So it's like accident plan like group accident probably.
[AGENT][NEUTRAL] Accident? OK.
[AGENT][NEUTRAL] And is it for yourself?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think the plan is for myself and my spouse.
[AGENT][NEUTRAL] OK, and is the claim for yourself?
[CUSTOMER][NEUTRAL] Yeah, uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not sure if it is like decline or something uh but this is like I need to confirm with you guys first and then they will speak with you guys directly once you once you guys have my information at your end, you know.
[AGENT][NEUTRAL] OK, so I do see that we have a claim for Palm Beach Gardens Medical Center. Is that the facility that you went to?
[CUSTOMER][NEUTRAL] Yes, ma'am. That's the one.
[AGENT][NEUTRAL] OK, let me look and see, there's a remark on here.
[AGENT][NEUTRAL] OK, it says that the maximum payable benefit for this accident has been met. Let me look and see what the payment was, um,
[AGENT][NEUTRAL] So we have um.
[AGENT][NEUTRAL] Niffett contracting services.
[AGENT][NEUTRAL] That was paid $250 on [PII] was the date of service.
[AGENT][NEUTRAL] So there was a contracting service from the hospital that received a check.
[AGENT][NEUTRAL] For $250 let me look and see on your policy.
[AGENT][NEUTRAL] What's your benefit amount is.
[AGENT][POSITIVE] Yeah, and that maxed out your benefit.
[AGENT][NEUTRAL] For the calendar year for that policy was $250 which was the maximum amount that could be paid.
[AGENT][NEUTRAL] So when the, that one was paid first, so when the second claim came in for Palm Beach Gardens.
[AGENT][POSITIVE] The first claim already maxed out the benefit for you.
[CUSTOMER][NEUTRAL] What was the second claim if you want to elaborate that?
[AGENT][NEUTRAL] That was for Palm Beach Gardens Medical Center.
[AGENT][NEUTRAL] Um, for the ER.
[CUSTOMER][NEUTRAL] Right, uh, I went to ER, uh, on that night, uh, due to one of my accident.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I think that's all. I didn't. I just went to the ER. They just like, uh, treat me with my eye thing like I'm having an, uh, uh, uh, the like a foreign particle in my eyes and you know, so they like just put like uh antibiotic probably something and I just moved from there like I didn't stay overnight and anything else.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] This $250 that was paid.
[AGENT][NEUTRAL] Was for a procedure number.
[AGENT][NEUTRAL] 99283 and the charge amount was $1,045 and so your policy paid the maximum benefit of $250.
[AGENT][NEUTRAL] On, on the
[CUSTOMER][NEUTRAL] OK. So,
[AGENT][NEUTRAL] First claim.
[AGENT][NEUTRAL] Which was
[AGENT][NEUTRAL] And I can give you, and it was also in the ER it's for the same data service of [PII].
[AGENT][NEUTRAL] Um, I can give you the name of the company, the provider, it's.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I N P H Y N E T.
[AGENT][NEUTRAL] Contracting services.
[AGENT][NEUTRAL] That's who got the benefit amount.
[AGENT][NEUTRAL] That was sent to them.
[AGENT][POSITIVE] And I can give you the check number too.
[CUSTOMER][NEUTRAL] OK, so I'm just gonna try.
[CUSTOMER][NEUTRAL] No, no, um, I just wanna understand first and then, uh, proceed. So the, I, I'm just trying to confuse like the first claim was is the second claim. Can you try to help me to understand, uh, the, I, I, I totally got for the second claim for the ER that is what I'm.
[CUSTOMER][NEUTRAL] So that is what I gone through, but the first one which we are talking right now, so, uh, I didn't get that part which is, uh, the contracting company from the hospital we paid it 250, so can you explain that uh again please?
[AGENT][NEUTRAL] Yes, um, it was.
[AGENT][NEUTRAL] The name of the company is I N P H Y N E T Contracting Services.
[AGENT][NEUTRAL] And the charge was for $1,045.
[AGENT][NEUTRAL] For procedure 99283.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] It was paid $250.
[AGENT][NEUTRAL] With check number 203-8807. Now you may need to call the ER and ask them who, who is the contracting services and what services did they provide to you.
[AGENT][NEUTRAL] For the claim
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, so my next step would be I need to contact the ER and ask.
[CUSTOMER][NEUTRAL] What were the services provided and though can you send that copy to you guys is that?
[AGENT][NEUTRAL] No, um, just ask them what the contracting services were that were provided by this company.
[CUSTOMER][NEUTRAL] Pro
[AGENT][NEUTRAL] And that it was paid $250. Now your second claim that came in for that date of service, the [PII] was from Palm Beach Gardens Medical Center for the ER and the charge was 3,368 $3,368. That claim was denied.
[AGENT][NEUTRAL] Oops, let me go back.
[AGENT][NEUTRAL] I accidentally got out of it, but I'll get back in it real quick.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a second, I accidentally lost it, but I've got it back now.
[AGENT][NEUTRAL] Let's see, let me get this claim number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that claim was denied and this is the reason the maximum payable benefits for this accident has been met. So for the accident, the maximum payable benefit was $250 which was paid to that contracting company. So this ER.
[AGENT][NEUTRAL] Claim is not going to be paid because the benefit went to the contracting company.
[CUSTOMER][NEUTRAL] So any claim has $250 maximum pay and it went through the first claim, right? Uh, so that's the reason it has been declined for the second claim that's that's what we are speaking.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct. Yes, sir. Yes, sir. That's exactly right.
[CUSTOMER][NEUTRAL] Even though if it's like $250 is it not cover for ER emergency cases? I just want to understand sorry on that.
[AGENT][NEUTRAL] For this one, it was just that that contracting company sent in.
[AGENT][NEUTRAL] The claim information before the ER did, so they got the payment first.
[AGENT][NEUTRAL] The um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, the contracting company reported the claim on [PII] and the AER reported their claim on [PII], so the contracting company sent it first so they got the payment.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] So in case like whatever the amount remaining amount is, I have to pay for the rest of the charge from Palm Beach Garden Medical Center, is that, is that right what I'm hearing, sorry.
[AGENT][NEGATIVE] Right, that, um, and we don't give patient responsibility.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] We let the provider determine that so the only thing you can do is talk to Palm Beach Gardens Medical Center and let them know that your benefit was paid to the contracting company and is there any way that they can work with you on the payment?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And just for uh.
[CUSTOMER][NEUTRAL] My future purpose sorry uh if there is any similar scenario happened to me in the future for like down the road, so how.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Important is like to me to go like is it the question like is it this I this hospital is like an in-service or out out out out service in like in network or out network for me if there is any emergency I need to go to that that hospital like which is in in service in network provider is that the issue or why is it like I'm just $250 covering for me?
[AGENT][NEUTRAL] No, you
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] That is because let me let you know what your policy benefits are. It's gonna be just a second. Let me pull up your policy and get your benefits for you, OK?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so on this benefit,
[AGENT][NEUTRAL] The contracting company was through the ER through the emergency room.
[AGENT][NEUTRAL] And this is just to verify your benefits. It's not a guarantee of payment. So your hospital emergency room benefit maximum is $250.
[AGENT][NEUTRAL] Every time you go you get $250. Yes, that's the way your policy rates.
[CUSTOMER][NEUTRAL] Just 250.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And for any like regular inpatient doc like visits for physician, what do I have covered in my policy? Can you let me know that as well?
[AGENT][NEUTRAL] Right, for um a physician's office, it pays $50 for accident.
[AGENT][NEUTRAL] And this is only for accident with this policy. So physician's office, if you have an accident, it'll pay $50. Emergency dental, if something happens to your teeth, you get treatment within 72 hours and it pays $50.
[AGENT][NEUTRAL] Um, if you have to go inpatient to the hospital because of your accident,
[AGENT][NEUTRAL] You have a hospital admission of $250 and then every day you stay in the hospital, it pays $100 up to 30 days.
[AGENT][NEUTRAL] If you have to go into intensive care.
[AGENT][NEUTRAL] It pays up to 15 days at $200.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] You also have an accidental death and dismemberment. So a death benefit um is $15,000.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And then if you're dismembered of both your arms and your legs, it pays 15,000.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] For your arm, legs, hands, feet, or eyes, it pays 7500.
[AGENT][NEUTRAL] If you um hurt a finger or a toe and you lose it, it pays $1000.
[AGENT][NEUTRAL] It has an ambulance benefit for ground or air if you have to be airlifted or go by ambulance, it pays $250.
[AGENT][NEUTRAL] Per accident for getting X-rays, medical imaging, it pays $100.
[CUSTOMER][NEUTRAL] So just want to have two quick questions when you say intensive care, uh.
[AGENT][NEUTRAL] And that's
[CUSTOMER][NEUTRAL] Uh, so the intensive care is like up to 15 days, $200. Is it like up to $200 is for or is it just for every single day $200?
[AGENT][NEUTRAL] Every single $200 a day.
[AGENT][NEUTRAL] Up to 15 days.
[CUSTOMER][NEUTRAL] 2 a day. OK, got you.
[CUSTOMER][NEUTRAL] And when you say about I hands, uh, so I think my category comes under that $7000 what you say like just before, just a minute ago.
[AGENT][NEUTRAL] Did you lose your eye?
[CUSTOMER][NEUTRAL] I, I thought
[AGENT][NEUTRAL] Do you still have your eye or it was the
[CUSTOMER][NEGATIVE] Oh, it's about losing your eye.
[AGENT][NEGATIVE] Yes, you have to lose the eye. It's a dismemberment. Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh my God. Oh my God. OK. OK. Now, I got it.
[AGENT][MIXED] Yeah, well, I'm glad that didn't happen. No, I'm glad that didn't happen. That would be horrible.
[CUSTOMER][NEUTRAL] Well, no, so yeah, because, uh, I, I, I do see only like a bunch of 100, like $250 or $200 or $100 is covering the benefits for me. So I'm trying to think if this is the right choice I made for selecting this benefit plan. So I'm just trying to evaluate assess myself, uh, because the, the, the end like the X amount I'm getting from hospital is like $3500 something, uh, [PII], you correct me if I'm wrong.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] And uh the policy which I choose is like uh 250 covering 250 or 300 runs right.
[AGENT][NEUTRAL] Right. And you have a level one policy. So if you wanted to go to Oxford Global Resources.
[AGENT][NEUTRAL] Um, doing business as cyber, your employer?
[AGENT][NEUTRAL] When they have open enrollment, ask them what other accident plans they have that cover more benefits and then decide, you know, which one you would like to choose.
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Tell them that you would like a.
[CUSTOMER][NEUTRAL] So this is the level one.
[AGENT][POSITIVE] Yes, you're level one on this benefit plan.
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So there's other levels if you wanted to ask your employer.
[CUSTOMER][NEUTRAL] OK, can you send
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] You know, to, to show you what other levels.
[CUSTOMER][NEUTRAL] If you, if you don't mind me sending.
[CUSTOMER][NEUTRAL] Yeah, if you can.
[CUSTOMER][POSITIVE] Send me in like an email or something that would be really helpful because I'll just sit down and try to assist and see what access what benefits I have been covered, you know, so.
[AGENT][NEUTRAL] Well, I don't have the benefit information to send to you. You have to get that from your employer. They have the benefits there, um, because it's under a group plan, you'll have to go to your group and ask them which plans do they have for accident and you'd like to look at them.
[CUSTOMER][NEUTRAL] Is there any name for this group plan, uh, [PII], by chance, which I've selected?
[AGENT][NEUTRAL] It's uh, it's group accident and um I can give you the product ID. It's GA.
[AGENT][NEUTRAL] 508.
[AGENT][NEUTRAL] L E V as in Victor, and then B as in boy.
[AGENT][NEUTRAL] And it's level one and tell them that's the plan you have now, but you wanna see what other plans are available to you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That's a plan number.
[AGENT][NEUTRAL] Yes, that's the plan number, the product and the plan number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna repeat that product or plan number that is GA 508LEV as in Victor B as in boy.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] It looks like you received this plan in January, but you could probably go to your employer and just tell them, say, I want to know if there's other accident plans available for me, and if there are, can I, can I review them?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] Right, that's, that's like this plan, it's not going to help me what, what I was, what was happened on [PII], right?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And maybe they have another plan option for you that you can um get during open enrollment so that you can have a better plan. You'll just have to ask them what they have available for you.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else?
[CUSTOMER][NEUTRAL] Sure. All right, [PII], I think that's all from my friend.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, Aimm, I'm glad I was able to answer your questions. As always, feel free to call us if you need any further help. You have a wonderful night. Thank you for calling APL.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][POSITIVE] Sure, thank you.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Bye bye.