AccountId: 011433970860
ContactId: 8568e063-eb1e-4d8c-8a8b-8f8c8064759e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 853039 ms
Total Talk Time (AGENT): 226432 ms
Total Talk Time (CUSTOMER): 371106 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/8568e063-eb1e-4d8c-8a8b-8f8c8064759e_20250314T19:17_UTC.wav
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[AGENT][NEUTRAL] For calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm the HR manager at our company. Um, one of my employees who has a, uh, he's got, I think all four of the policies that we offer through y'all, um, he's in the ICU right now and I'm trying to help him by getting his claim started for him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Because he can't do it himself and I was going on and trying to set up an account for him.
[CUSTOMER][NEUTRAL] And it's saying that he can't be found.
[AGENT][NEUTRAL] OK, let's take a look, [PII]. Do you have his one of his policy numbers?
[CUSTOMER][NEUTRAL] Um, no, I don't have a policy number for him. I mean, I have our group policy number.
[CUSTOMER][NEUTRAL] And I have all of his personal information.
[AGENT][NEUTRAL] What is the group number?
[CUSTOMER][NEUTRAL] 257-559
[AGENT][NEUTRAL] And then what is the employee's name?
[CUSTOMER][NEUTRAL] Uh, come on, uh, come on in. Uh, [PII], last name [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and on the um on our website you're trying to create the log in for him correct? like his personal policy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so when you click new user, then click I'm an individual with an APL policy correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for
[CUSTOMER][NEUTRAL] I used all of his information.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] He doesn't have an email on here that's the issue.
[CUSTOMER][NEUTRAL] Oh, so should I just take that out?
[AGENT][NEUTRAL] Well, you have to have an email to set up the account.
[CUSTOMER][NEUTRAL] Can I give you his email?
[AGENT][NEUTRAL] I don't, we're not supposed to make any changes to the account unless we're speaking with the insured.
[CUSTOMER][NEUTRAL] Uh, he can't talk right now. Like I said, he's in the ICU.
[AGENT][NEUTRAL] Um, what is his email address?
[CUSTOMER][NEUTRAL] Uh, it's his first name and last name, [PII].
[CUSTOMER][POSITIVE] I appreciate you doing that for me because I'm trying to make this as easy as as I can for him.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because he's got a long road ahead of him right now.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Too bad.
[CUSTOMER][NEGATIVE] Yeah, it's, it's, it's definitely bad.
[AGENT][NEUTRAL] OK, [PII], try that.
[AGENT][NEUTRAL] Again, um, and the zip code should be [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] Right, yeah, let me get to create your account.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK, now let me come up with stuff and then I'm have to write it down so I can make sure I can give it to him.
[CUSTOMER][NEUTRAL] Of course it wants to fill in my information uh.
[CUSTOMER][NEGATIVE] It's like, no.
[CUSTOMER][NEUTRAL] Alright, let me write this stuff down.
[CUSTOMER][NEUTRAL] So that I don't forget what I'm making his stuff and then he can change it later.
[CUSTOMER][NEUTRAL] If you want.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Just hang tight with me until I get in there if you don't mind.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] OK, it doesn't like that password right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, there we go. OK, so we like.
[CUSTOMER][NEUTRAL] Alright, that will work OK, submitting.
[CUSTOMER][NEUTRAL] [PII], you need me right now, or can you wait a second? OK.
[CUSTOMER][POSITIVE] Your account has been successfully created, OK, so um.
[CUSTOMER][NEUTRAL] Obviously he is still in the hospital and he will be for quite some time um.
[CUSTOMER][NEUTRAL] How does he, what's the best way for him to do this? Go ahead and start the claim now and then just update it as he goes or what? I'm assuming this is going to affect his uh critical illness and his hospital indemnity.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what's the what's the best way for me to have him do this?
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] If he's if if you're gonna be filing claims on his own and the provider's not actually filing any claims on their behalf, then.
[AGENT][NEUTRAL] It might
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Gonna need some itemized receipts and diagnosis codes and and things like that. Um.
[AGENT][NEUTRAL] So it might be better to do it all at once. Some people do it as they go, you know, as they're getting charges in.
[AGENT][NEUTRAL] Do you know if there's anything in any of his policies that there's like a lump sum benefit he may be trying to get to try and help for now?
[CUSTOMER][NEUTRAL] Um, well, I know like the hospital policy has like a $1500 you know, just for being admitted, and then it's got like $100 a day for being in the ICU. It's got $100 a day for urgent care and he wound up in urgent care twice before they made him go to the emergency room and then he got admitted, so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right there I mean he's already up to $1900 you know, between those four things so that's why and I know he's gonna be, you know.
[AGENT][NEUTRAL] So you
[AGENT][NEUTRAL] Yeah, so you
[AGENT][NEUTRAL] You could file under the indemnity plan and do, go ahead and do the urgent care visits.
[AGENT][NEUTRAL] Um, since those have already been completed, you could go ahead and just submit those. And then for the hospitalization being admitted, um, you should be able to get something from the physician or from the doctor hospital showing he was admitted, so that could be paid. You could go ahead and do that, those, yeah, for sure.
[CUSTOMER][NEUTRAL] OK, so we can um do we need to file the claim online then to get it started?
[AGENT][NEUTRAL] Yeah so claims can be filed online they can be sent in the mail or faxed and so the first thing that you'll need is the claim form, and those are located on our site under uh claims and forms.
[CUSTOMER][NEUTRAL] OK, I see claim for claims and forms.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Um, I see file claims online.
[CUSTOMER][NEGATIVE] But it just brings me right back and it doesn't show me where to file it online.
[CUSTOMER][NEUTRAL] It only shows file a wellness claim.
[CUSTOMER][NEUTRAL] So where do we oh I guess we have to pick the.
[CUSTOMER][NEUTRAL] Pick the policy we're filing on.
[AGENT][NEUTRAL] So when you click on, let's see.
[CUSTOMER][NEUTRAL] I just clicked on the hospital indemnity. Let me see.
[CUSTOMER][NEUTRAL] Oh yeah, all that does is give me a downloaded form. Oh no, that gives me the whole policy.
[CUSTOMER][NEUTRAL] Yeah, so where do we get the online form?
[CUSTOMER][NEUTRAL] To file
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm trying to look at where you're at. So you're on the secured site because you're logged in.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Do you, do you see anything that says claims and forms?
[CUSTOMER][NEUTRAL] Yeah, there's a button up there that says claim forms and then when I click on that, oh wait, claims and forms over there.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, but it doesn't.
[CUSTOMER][NEUTRAL] It takes me to a thing that says.
[CUSTOMER][NEUTRAL] Oh wait a minute, wait, no that all just says download forms.
[CUSTOMER][NEGATIVE] All it says is to download them. It doesn't give me a way to do it online.
[AGENT][NEUTRAL] Well you have to download the form if you wanna print it out online or you can print it. Do you see the forms, a list of forms?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So they're in alphabetical order, so you'll just go to page 2 for the hospital indemnity one.
[CUSTOMER][NEUTRAL] Let's see where
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then click on download form.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but then once it's completed, how do we submit it electronically?
[AGENT][NEUTRAL] So if you download the form on your computer and fill it out, you should be able to save it like as a PDF and then just upload it through the online portal. If you print it, you would just fill it out, scan it, and then upload it.
[CUSTOMER][NEUTRAL] OK, so if we do it on the computer, do we just like type the signature?
[AGENT][NEUTRAL] Let me see where.
[AGENT][NEUTRAL] Yeah, you can fill in the signature there you can type it in.
[CUSTOMER][NEUTRAL] OK, well it looks like the hospital indemnity form is just a very short thing.
[AGENT][NEUTRAL] Yeah, it's 3 pages, it looks like.
[CUSTOMER][NEUTRAL] Oh, it is an itemized bill must the company but that's OK. This would at least get the bill, get it started, get it open for him, and then when he gets the bill we can uh add to it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or we can get the uh.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] Because I'm gonna have to help him with this because he's gonna be in there a while he's not gonna be able to scan forms and and everything.
[CUSTOMER][POSITIVE] OK, alright, OK, I see how to get into everything now, so I have a feeling I'm gonna be helping him with quite a lot of this for a little while so and that's fine that's what I'm here for. OK, well look I really appreciate your patience and you helped show me how to get around in here.
[AGENT][NEUTRAL] Yeah, not a problem, [PII]. Did you have any other questions or concerns?
[CUSTOMER][POSITIVE] Uh, no, ma'am. That will take care of it for me. Thank you.
[AGENT][POSITIVE] You're welcome. I hope you have a good rest of your day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Mhm bye bye.