AccountId: 011433970860
ContactId: 91f6c5c1-f041-4e40-949f-fef3456f7069
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 806599 ms
Total Talk Time (AGENT): 188537 ms
Total Talk Time (CUSTOMER): 579911 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/91f6c5c1-f041-4e40-949f-fef3456f7069_20250513T16:43_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes, hello?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh hi um is this the claims department?
[AGENT][NEUTRAL] Yes, can you hear me?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh hi my name is [PII]. I'm a broker. I was transferred over to you because I have some claims questions. How are you today?
[AGENT][POSITIVE] I'm good how are you? I'll be happy to assist with claims today.
[CUSTOMER][POSITIVE] I am, oh thank you so much. I'm very excited. I just wrote my first case with APL. I'm very excited, um, decent sized group about 80 0 $80,000 in premium. So, um, employer, yeah, employer paid, um, I have the most amazing, um, manager [PII] is the best, and I actually know him from my past with with we, we, um, did business together all state benefits. I was a manager with Allstate benefits, so we, we go way back.
[AGENT][POSITIVE] Yay!
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Oh yes, oh yes.
[CUSTOMER][POSITIVE] Um, so excited he's on board with you guys, um, cannot wait to open more groups because I will tell you honestly, the process has been so streamlined and incredible.
[AGENT][POSITIVE] Oh, that's good to hear.
[CUSTOMER][POSITIVE] I'm so excited. So with my group, I've got some claims coming in. So what I am trying to do is um be very proactive. Um, my goal is, um, I, I don't sit at my desk all day long and file claims, obviously, and I've trained many of my policy holders over the years to be self-sufficient and, you know, upload, fax them, you know, do it on their own. So I'm putting together a nice email.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So people know how they can file their claims. Here is, here is, um, what is, um, interesting to me. You guys are the first carrier that issues that I've ever had issue a card.
[CUSTOMER][NEUTRAL] And I need to know exactly how that works to my, to work, to my understanding.
[CUSTOMER][NEUTRAL] Um, because I know how to file, they know how to file claims otherwise. But, um, they have their AM public card.
[CUSTOMER][NEUTRAL] And let's say for example, there are 2 plans in this group. I have the accident indemnity plan.
[CUSTOMER][NEUTRAL] And then I have the hospital indemnity plan.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And let's just say I have a client that goes to the ER for just a sickness issue. All right? And they show their health insurance card. This is what I'm understanding. They show their health insurance card.
[CUSTOMER][NEUTRAL] And then they show their AM public card. And from what I have heard.
[CUSTOMER][NEUTRAL] The benefit for their ER visit, which in this, in this case, it's $750 on their plan, is somehow deducted from their bill. How does that exactly work? So I can let them know.
[AGENT][NEUTRAL] OK, um, now that's gonna depend on.
[CUSTOMER][NEUTRAL] Now
[AGENT][NEUTRAL] If the provider files the claim because we're gonna pay first off, we're gonna pay whoever files first.
[AGENT][NEUTRAL] So the employer is sending the claim in not the employer if the um provider is sending the claim and then we're gonna process and pay benefits and pay it directly to the provider.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, OK, so it's paid right, right, and the client knows that what they do it that way they're not gonna get, OK, so it's paid to the provider, OK, so I'm almost wondering if I don't encourage them to do that, um.
[CUSTOMER][POSITIVE] I mean, it's not a bad thing.
[AGENT][NEUTRAL] It would be nice to do that, um, but they may run into the fact where some people like we, we don't file that you're gonna have to do it on your own but if they can.
[AGENT][NEUTRAL] If they do have a provider that's willing to file for them then that would be great, um, otherwise they would have to do it themselves.
[CUSTOMER][NEUTRAL] Yeah, because, OK, so because I do have a client who gave him her she, she went to the ER, she gave them their card.
[CUSTOMER][NEUTRAL] And um yeah, he gave them their card and they ran it.
[CUSTOMER][NEUTRAL] So I'm gonna assume it was filed.
[CUSTOMER][NEUTRAL] And so when she gets her bill from her health insurance,
[CUSTOMER][NEUTRAL] It should reflect, hopefully, that 750 payout somehow, right?
[AGENT][NEUTRAL] If she has.
[AGENT][NEUTRAL] OK, if she has a hospital indemnity and a major medical, then we should always get the claims second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so what do you mean by that?
[AGENT][NEUTRAL] Meaning normally.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Normally, um, this is with the hospital indemnity.
[AGENT][NEUTRAL] A lot of times we're their only insurance.
[AGENT][NEUTRAL] But if you're saying this particular group or this particular person has other insurance, then we would need to be billed after the fact.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, oh yeah.
[AGENT][NEUTRAL] The claims would always need to go to the major medical first.
[CUSTOMER][NEUTRAL] OK, so I'm, yeah.
[CUSTOMER][NEUTRAL] OK. OK. So I'm thinking for simplicity. I'm gonna tell them, let's not do this. um I think it's confusing for them.
[CUSTOMER][NEUTRAL] Um, I think that we need to stick with treating claims, supplemental claims on an as a normal filing where they can either, you know, go online to our secure portal and do it, or fax them in or if they need to send them to me, that's fine. OK, that's OK. This is good because I think this whole thing is a little confusing.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][MIXED] Um, so, and I think it's great. It's an option, but you know, you know how complicated this is for people. They get very confused very easily. So I'm gonna tell them, ignore, I'm gonna tell them to ignore the a.m. public card.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. Yeah.
[CUSTOMER][NEUTRAL] And just file the claims, you know, this way and this way and this way. OK, well that's what I needed to know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][MIXED] That, that makes it very simple. I'm going back to old school and what I've known for 21 years on how to file these claims. So I love it. I think it's cool, but I just think that's complicated for them to understand.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][POSITIVE] So, yeah. And plus, I think it's always fun for people to get paid money. I mean, getting a check for $750 is kind of fun.
[CUSTOMER][NEUTRAL] And then use that money however you need to use it.
[CUSTOMER][NEUTRAL] So, OK.
[AGENT][NEUTRAL] Well, yeah, it's fine as long as there's no balance due.
[AGENT][NEUTRAL] As with the provider.
[CUSTOMER][NEUTRAL] Yeah, oh well, there would be a balance. The reason they, yeah, oh, there's a balance. Yeah, they can't have too much fun. The ER there through their medical, through their company, they have a $3000 deductible when they go to the ER. So that's why the group came to me and they're like, OK, they're, I, exactly, they're like, OK, we got to find some supplemental insurance and.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Good God.
[CUSTOMER][POSITIVE] You know, that's why I came to [PII]. I'm like, OK, you said we can customize. This is like 150 employees. Um, what can we do? So they were very happy to get a $750 you know, benefit. And then we put the accident indemnity in place because then if they go to the ER from an accident, they get $2500 from the accident indemnity plus the $750 from the hospital. So that'll take care of their $3000 there.
[AGENT][NEUTRAL] Right. Right. Right. OK. Yeah, that is.
[CUSTOMER][POSITIVE] So that's great. Um, so we, we solved half of it. Yeah, we solved half of their problems, but, um, yeah. OK. Well, this is phenomenal. I really, really appreciate your help. Um, that to me, that just makes things much simpler. I'm just gonna tell them just to ignore that card.
[CUSTOMER][NEUTRAL] Um, and then, and then I'm assuming you know, should they fax in this the fax, hold on, I'm looking at the claim form right now. Let me look at this hos the claim forms are very simple.
[CUSTOMER][POSITIVE] Um, they like very simple, um.
[CUSTOMER][NEUTRAL] Let me see here. I mean, there's not much information they really have to.
[CUSTOMER][NEUTRAL] I'm trying to see what paperwork in addition.
[CUSTOMER][NEUTRAL] Do you guys want additional paperwork with the claim form, or are we, are you going to reach out to get it? It doesn't look like.
[CUSTOMER][NEUTRAL] Cause normally I tell them, you know, this is what you need to attach with your paperwork, kind of thing.
[AGENT][NEUTRAL] Um, so we don't require a claim form to be submitted to process as long as we have that, um, and you said this is for the HI I believe um they just need the diagnosis and um the bill.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For the HI.
[CUSTOMER][NEUTRAL] OK, so HI a diagnosis, so OK, so HI is the diagnosis.
[AGENT][NEUTRAL] What's your group number?
[CUSTOMER][NEUTRAL] So this group number, yeah, that's a good question. So this group number is, hold on one second, I have it right here, it's 26999.
[AGENT][NEUTRAL] Ohio Heartland Community Action.
[CUSTOMER][NEUTRAL] Yeah, yep.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I just wanted to.
[AGENT][NEUTRAL] Make sure yeah this this is the.
[AGENT][NEUTRAL] Yeah, this policy, yes, so we would just need um the billing information and the diagnosis.
[CUSTOMER][NEUTRAL] So yeah, so they need, so you need something with the diagnosis and then the billing information you mean the the bill from what they had done?
[AGENT][NEUTRAL] Right, like an itemized bill that shows the procedure code like what what they had done, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] So that in addition to their claim form, should they fax it and all that stuff, OK, and probably the same I assume with the accident plan too, the diagnosis and the bill. OK, that's awesome. No, that's great. That's perfect.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] So this is, this is good. Well, I know that I have one that was in one was sent in last week, I believe, um.
[CUSTOMER][NEUTRAL] And I think that was just for a a physician benefit on the claim form. I don't know if you can see anything in pro progress for that.
[AGENT][NEUTRAL] I would just need their policy do you have their policy number or their name?
[CUSTOMER][NEUTRAL] Can't remember her name.
[CUSTOMER][NEUTRAL] Yeah, let me see here. Oh, I think, um, I think it was for [PII]. So I don't have her policy number, but it's [PII] I think she's the one that we sent something in already.
[CUSTOMER][NEUTRAL] Yeah, it is because I sent it I sent her forms to the claims email.
[CUSTOMER][NEGATIVE] And then the claims the care team bounced back and said yeah we don't like that don't do that.
[CUSTOMER][NEUTRAL] Um, so that's when they told me to.
[CUSTOMER][NEUTRAL] Me either upload it or fax it or the client can go to [PII] and file claims that way or fax it, is that correct? You don't want them via email.
[AGENT][NEUTRAL] OK, it looks like that was.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, so it looks like that was processed today, so that, um, that $50 payment will go out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh my God, that's great.
[AGENT][NEUTRAL] That will go out tomorrow.
[CUSTOMER][POSITIVE] I, you know what, and I will let her know that's excellent, that's excellent.
[CUSTOMER][POSITIVE] Yeah, I wanna get people to go on [PII] and register because they can set up direct deposit that way, right?
[AGENT][POSITIVE] Right, it's, yeah, it's easier, yeah.
[AGENT][NEUTRAL] Instead of them mailing it in or faxing it in, yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, OK.
[CUSTOMER][POSITIVE] Or faxing it or yeah that's well and I'm and then I'm telling them guys you don't wanna wait on me you know I don't sit in the office all day long to do claims so this is gonna be quicker for you guys to do it this way. OK, well this is awesome. I'm so excited, um, you know, and thank you I'm, I'm excited to let [PII] know that her $50 is being processed and she can expect that so our first, our first claim so um and she, we do.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Yay.
[CUSTOMER][POSITIVE] Yeah and we do have a couple of um ER visits now coming in so that's why I thought you know I really wanna put this email together and you know have them start doing this process now and just just get this in motion so this is good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Well, I think this is all the questions I have.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Yeah, I think we're good. So I'm gonna tell them ignore the cards, let's just do it this way. So, all right, that makes sense.
[AGENT][NEUTRAL] OK. Well.
[AGENT][POSITIVE] Well thank you so much for bringing the business to APL we appreciate you.
[CUSTOMER][POSITIVE] Oh, I'm excited. I'm gonna be bringing more, OK, so I just gotta, I just gotta find the groups, but I, I want more, I guess [PII] said I'm eligible for a trip now and I'm like, oh, I want that trip. So yeah, we're doing it.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you so much. I really appreciate your help. I hope you have a great rest of your day, OK?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] You do the same thank you for calling APL bye bye.
[CUSTOMER][POSITIVE] Absolutely bye now bye bye.
[AGENT][NEUTRAL] Bye.