AccountId: 011433970860
ContactId: 811018be-0006-45f0-acd1-20af3a709642
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1107609 ms
Total Talk Time (AGENT): 356500 ms
Total Talk Time (CUSTOMER): 312542 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/811018be-0006-45f0-acd1-20af3a709642_20250611T15:54_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] from Broker Resources. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] I'm well. I have an insured on the line who was wanting to check on her accident claim.
[CUSTOMER][NEUTRAL] And I have verified her. Do you mind helping her?
[AGENT][NEUTRAL] OK, what is her name?
[CUSTOMER][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] And her last name is, yeah, um it's [PII] and I have her policy number if you'd like it.
[AGENT][NEUTRAL] And a callback number?
[AGENT][NEUTRAL] OK, and what is that?
[CUSTOMER][NEUTRAL] 2361481 and I did verify her in line first.
[AGENT][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] And I will
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I can join you guys and I can introduce you first and then.
[CUSTOMER][NEUTRAL] And.
[AGENT][POSITIVE] Sure, thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi [PII] I have the claims department on the line for you and we'll take it from here, OK? OK, thanks for calling APL.
[AGENT][NEUTRAL] Hi [PII], this is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] I was just checking. I got a text saying that the claim was complete.
[AGENT][NEUTRAL] OK, and do you have the claim, does it give you the claim number?
[CUSTOMER][NEGATIVE] And I get and I can't get in.
[CUSTOMER][NEUTRAL] Hold on one second.
[CUSTOMER][NEGATIVE] Dropped all my paper.
[CUSTOMER][NEUTRAL] Off my desk, hold on just a second.
[CUSTOMER][POSITIVE] I can bend down low enough to get off the floor.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, 361-155-6.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] It looks like we did, we paid $800 towards this claim.
[AGENT][NEUTRAL] So the claim is complete.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see. It will come to you through a check.
[CUSTOMER][NEUTRAL] No it's 800.
[AGENT][NEUTRAL] Yes, ma'am. 800 even.
[CUSTOMER][NEUTRAL] OK, so what do they do just like 50% off of the physical therapy, or how do they do that?
[CUSTOMER][NEUTRAL] Cause I know it was like a, almost a full year of physical therapy.
[AGENT][NEUTRAL] Alright, let me
[CUSTOMER][NEGATIVE] And I'm still not right.
[AGENT][NEUTRAL] Uh, let me look real quick and see.
[AGENT][NEUTRAL] OK, I'm seeing the physical therapy. Let me see here.
[AGENT][NEUTRAL] Let me pull up your policy and let me see what it says.
[AGENT][NEUTRAL] All right, it was physical therapy, so give me just one moment while I look for that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] It looks like we pay up to $50 each physical therapy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It looks like this benefit is payable up to 10 days per plan year for covered person.
[AGENT][NEUTRAL] So we paid we paid the $50?
[AGENT][NEUTRAL] For that and let me see what else there is that was paid.
[AGENT][NEUTRAL] And it looks like we paid a portion of the physician office uh treatments.
[AGENT][NEUTRAL] I'm showing 123 of those.
[AGENT][NEUTRAL] And then one
[AGENT][NEGATIVE] And it looks like we only denied.
[AGENT][NEUTRAL] Uh, one of the days for physical therapy because that was when that, um, that was when you reached your maximum. Looks like the one that was denied was for [PII]. That was the only thing that got denied on this claim, um, because you had reached your maximum.
[CUSTOMER][NEUTRAL] So they, so they looked at the whole year of physical therapy and took 50% of each visit, I guess, so if I paid $75 each time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah, and it looks like we paid 50 for each. And then you had your physician treatment.
[CUSTOMER][NEUTRAL] And it was
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so 50.
[CUSTOMER][NEGATIVE] I thought it would have been more than $800 off if I for the the amount of physical therapy that I had, I went twice a week.
[CUSTOMER][NEUTRAL] For almost a year.
[AGENT][NEUTRAL] Oh, then it would have paid, uh, yeah, it's showing, um.
[AGENT][NEUTRAL] 10 days. So if you went, oh yeah, cause twice a week. OK, not twice in one day, yeah.
[CUSTOMER][NEUTRAL] I went twice a week but for like a year.
[AGENT][NEUTRAL] And then for your
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And so we just paid up to 10 of those um and so I'm showing a.
[CUSTOMER][NEUTRAL] Why did it do it up to up to 10?
[AGENT][NEUTRAL] Uh, your plan states that it's up to 10 days of treatment. Uh,
[AGENT][NEUTRAL] Per calendar year?
[AGENT][NEUTRAL] So it looks like that's me. I am seeing where it was showing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so that's the max, so they don't pay the whole time. They just pay up to 10.
[AGENT][POSITIVE] Right, they'll pay up to 10 days' worth and it looks like for your.
[AGENT][NEUTRAL] Uh, physician treatments. We paid $100 for each of those. So that's, and I show 123 of those on here, and those were all paid $100 for each.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I went to the doctor 3 times. I went to the.
[CUSTOMER][NEUTRAL] Um, orthopedic twice.
[CUSTOMER][NEUTRAL] So that would have been 5 times total.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh goodness OK.
[CUSTOMER][MIXED] OK, I didn't realize they they just paid. I mean, it's 800 is better than nothing, but I didn't realize they only paid up to 10.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, um, after your scheduled benefits, if you look into your policy, um, let me see where I saw it last.
[AGENT][NEUTRAL] Um, if you go down to the definitions where it shows physical therapy, uh, it shows the second paragraph will say, uh, physical therapy must begin within 365 days and rendered within 365 days of the covered accident. Uh, this benefit is payable up to 10 days per plan year for each covered person. And so, um, let me see, your plan year is, it looks like it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's that's fine.
[AGENT][NEUTRAL] [PII]. So it'll be each August to August. So if you're still going, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not going right now. They told me to do it at home.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, so I've got, let me look at this one.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] So did you get from Methodist, did you get, did they for um the doctor I have a visit on [PII].
[CUSTOMER][NEUTRAL] And then one on [PII].
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] And was it in the same claim?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] OK, I'm showing, um, for this claim, I'm showing that you went to a physician's office on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII] for this claim.
[CUSTOMER][NEUTRAL] OK and that was.
[CUSTOMER][NEUTRAL] OK, that's those two.
[CUSTOMER][NEUTRAL] So those were the doctor visits, so that, so then I have two that I sent over when I emailed over or faxed over that were from Methodist, which is from the orthopedic.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Um, when did you fax those in?
[CUSTOMER][NEUTRAL] I had 2 of those.
[CUSTOMER][NEUTRAL] Uh, when I, when I sent the last thing with all this stuff in here when I did the accidental claim form that y'all wanted again resent that and um I sent this in there along with the form from the um orthopedic.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And this was done on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] It was [PII] and then [PII].
[AGENT][NEUTRAL] Yeah, I'm not showing those dates of service, so um I would submit that as a separate claim.
[AGENT][NEUTRAL] I am seeing some faxes, but I'm not, OK, there's the one from Methodist.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Yeah, there should be 2 right next to each other. There were 6 pages that was sent.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Yeah I would resubmit those claims if they are separate.
[AGENT][NEUTRAL] Because I didn't see those dates of service in that claim.
[CUSTOMER][NEUTRAL] When
[CUSTOMER][NEGATIVE] Yeah, I, I mean, I don't understand why. I mean, I guess they got lost in transmission because I sent them over with the fax.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because it had those two, it had the accident claim form that y'all just redid and it has the attending physician form and then it had the 2 from the doctor's offices.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And actually just had one more doctor visit.
[CUSTOMER][NEUTRAL] Um, which that was in the form that I sent that she was on that she sent.
[AGENT][NEUTRAL] Yeah, I would submit those with a with a different claim with a new claim form. Well, let me see, you shouldn't need a new claim form.
[CUSTOMER][NEUTRAL] This one was 7124.
[CUSTOMER][NEUTRAL] Hold on, let me find that other one in here because that was with the other stuff I had sent when she sent.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEGATIVE] Go way too many papers in here.
[CUSTOMER][NEUTRAL] 524.
[CUSTOMER][NEUTRAL] Where did it go in here tiny.
[CUSTOMER][NEUTRAL] And I sent that doctor form back over.
[CUSTOMER][NEUTRAL] OK, here's from the doctor. So where the heck did the other ones go?
[CUSTOMER][NEUTRAL] Oh well.
[CUSTOMER][NEUTRAL] That's fine. It was just the last one I went to, but that's fine. I did summer and all this stuff.
[CUSTOMER][NEUTRAL] Hm that's fine.
[AGENT][NEUTRAL] I, I would submit those because I'm only showing the, the dates of service for the, for offices, uh, for [PII] um.
[AGENT][NEUTRAL] [PII] and I'm sorry, in [PII].
[CUSTOMER][NEUTRAL] OK, so the two from Methodist you don't have, which is 1224 and 225.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I would resubmit those.
[CUSTOMER][NEUTRAL] 2 or 25, so how, how do I, how do I resubmit those?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, did you file this claim through your online portal?
[CUSTOMER][NEGATIVE] No, because it won't let me in anymore.
[AGENT][NEUTRAL] OK, um, I will say for.
[CUSTOMER][NEUTRAL] Sent out to the new website.
[AGENT][NEUTRAL] For that, um, since we got a new provider, we no longer, uh, sign in through a username, so you will recreate an account, uh, so when you go to [PII] you'll go to create OSC account.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, well, your hus is your husband is the, uh, primary. He will need to go in and create the account, yeah, and, um, click insured. I would only fill out the information that has an asterisk on it, the required information, and everything should pull over, so all of these claims will pull over, um.
[CUSTOMER][NEUTRAL] Yes, write down all this.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But you will verify an email each time um you log in that's a new security feature.
[AGENT][NEUTRAL] Um, but your husband will make the account, um, and then all of your claims will be seen on there.
[CUSTOMER][NEUTRAL] OK, so then I just need to upload these to.
[CUSTOMER][NEUTRAL] And find the other one and upload those.
[AGENT][NEUTRAL] Yeah, you'll be able to go in there and hm?
[CUSTOMER][NEUTRAL] Do I need to do any.
[CUSTOMER][NEUTRAL] Do I have to do another claim or just upload those photos I mean upload those pictures?
[AGENT][NEUTRAL] Uh, you'll upload those pictures. You'll go to, um, once you go to the dashboard there will be 3, there should be 3 boxes, um, and there's one on the side that's a long rectangular box, and there's a green button that says start your claim and I would submit them through there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then same thing like I.
[AGENT][NEUTRAL] And all of your claim forms and anything like that will be in there as well.
[CUSTOMER][NEUTRAL] I mean we'll have to fill out another claims form?
[AGENT][NEUTRAL] Uh, I would, since you're now in a different claim because this one has been processed and paid.
[CUSTOMER][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] Um, the same thing like if I go to, um, I think you said you can go like have your mammogram and then have your yearly once I do those and I just send that too.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and I believe those will be under the file a wellness claim and and all of those claim forms, everything should be in there, uh, so you should be able to submit everything in one.
[CUSTOMER][NEUTRAL] So you're on a different
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In one place at this point, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Alright, I'll do that again
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alright, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] OK.