AccountId: 011433970860
ContactId: 92275f68-be10-4ca0-a759-4eb9126f472d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 968359 ms
Total Talk Time (AGENT): 543796 ms
Total Talk Time (CUSTOMER): 210915 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/92275f68-be10-4ca0-a759-4eb9126f472d_20250528T18:16_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hi [PII], um, I was just calling because I just come, um, submitted a claim online and I was just calling to make sure that I did it correctly.
[AGENT][NEUTRAL] OK, so you're wanting to just make sure that we, I can see that we've received a claim for you that you uploaded.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII] [PII]
[AGENT][NEUTRAL] Thank you. And Ms. Madam, what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] Um, hang on one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I believe it should be 2,500,440.
[AGENT][NEUTRAL] OK, thank you. One moment while I get your information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and Miss [PII], I will need to verify several things with you first for security, and any information provided will be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. And then also your home mailing address.
[CUSTOMER][NEUTRAL] Um, I believe it should hopefully be under [PII].
[AGENT][NEUTRAL] No, ma'am, that's not what we have.
[CUSTOMER][NEUTRAL] OK, is there any way you could change that for me or does that have to go through my employer?
[AGENT][NEUTRAL] I need
[AGENT][NEUTRAL] Uh, first off, I need to verify what we do have on file, and then we can go from there.
[CUSTOMER][NEUTRAL] So it would be [PII].
[AGENT][NEUTRAL] OK. Is there an apartment number or anything associated with that address?
[CUSTOMER][NEUTRAL] No, it should be [PII].
[AGENT][NEUTRAL] OK, so what.
[CUSTOMER][NEUTRAL] Is that not what you have either?
[AGENT][NEUTRAL] Uh, we do, but we have an apartment number with it.
[CUSTOMER][NEUTRAL] OK, it's not under 15 tiles then, is it?
[AGENT][NEUTRAL] No, ma'am, it's the [PII], wait, I have that part, but it has an apartment number also.
[CUSTOMER][NEUTRAL] Oh no, that was a house. I don't know why I would have an apartment number.
[AGENT][NEUTRAL] OK, so we'll come back to that in a moment. The phone number that we have on file for you is the same as the one you gave me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that is the best contact number we should have. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the last piece of information to verify is your email address?
[CUSTOMER][NEUTRAL] Yep, so that should be [PII].
[AGENT][NEUTRAL] OK, thank you. So, on the address that's on file for you, Ms. [PII], it's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] I have no idea why I would have that. Yeah, that's weird, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I can, I can change it, but yes ma'am, make sure that your employer has it changed as well because the way we receive your enrollment information for your employer.
[CUSTOMER][NEUTRAL] Also no yeah.
[AGENT][NEUTRAL] It comes on an electronic file, so if the file comes over with whatever it has on it, it's going to override any change that I make, so I don't.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't want you to think if you were to call back and it's back to the [PII], it's because the files still have that information on it and it's, there's no way we can prevent it from changing it. So, what is your current address that we should have?
[CUSTOMER][NEUTRAL] OK alright I'll.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, so I'll, yep, so it's [PII].
[AGENT][NEUTRAL] I'm sorry. What's the street again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right. [PII]
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK. So [PII].
[CUSTOMER][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] OK, so that is OK. And then the city for that?
[CUSTOMER][NEUTRAL] That could be, I don't know, maybe that's why.
[AGENT][NEUTRAL] OK. And what is, what is the city?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Oh [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh, and your zip code?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so that's [PII] [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct. Mhm.
[AGENT][NEUTRAL] OK, so for the moment that has been updated. All right, so the policy number that you gave me was for your disability policy. The claim is not on that policy. The claim was uploaded under your hospital indemnity policy.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh shoot OK.
[AGENT][NEUTRAL] On policy number 249-825-4.
[AGENT][NEUTRAL] That's where the uploaded information went to the went to. So you can upload it again and put it on.
[CUSTOMER][NEUTRAL] OK, I definitely didn't mean to do that.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't even know how I did that. All I did was just click on file a wellness claim, right?
[AGENT][NEUTRAL] So, were you filing a wellness claim?
[CUSTOMER][NEUTRAL] Uh, I didn't see any other like claims that I could file.
[AGENT][NEUTRAL] OK, so w[PII] you signed into your portal today, there was only one option for uploading a document, is that correct?
[AGENT][NEUTRAL] There's some and I'm asking you this because we are. Oh.
[CUSTOMER][NEUTRAL] Um, I didn't upload.
[AGENT][NEUTRAL] OK, so if
[CUSTOMER][NEUTRAL] I didn't upload any documents.
[AGENT][NEUTRAL] OK, so what type of claim are you trying to submit?
[CUSTOMER][NEUTRAL] Um, so, I mean, basically, I had my daughter in January, um, and then two weeks later, I had, they found a brain tumor, so I had to have brain surgery, and then it came back malignant, so I had to go through radiation treatment and I'm
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Not returning to work um for a little while longer um so that's what I'm trying to apply for the short term disability.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the, OK, so there is a specific claim form that has to be completed by you, your physician, and your employer for the disability.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, policy. There is also a separate policy or claim form rather for the hospital indemnity plan. Now, I can give you the website, Ms. [PII]. Our public website has both of those claim forms on there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And both of them have all of the instructions on the first page.
[AGENT][NEUTRAL] Of each of the forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you, let me, so if you go to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] When that page pulls up at the top you will see where it says claims and forms.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Click on that link.
[AGENT][NEUTRAL] And then scroll down the page and about middle ways down, it's gonna start listing out all of the different types of claim forms.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can actually, there's a box that says filter by product with a little green arrow in it, so you can click on that arrow.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So you should see one that says disability, and then the one right below it is for hospital indemnity.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you could mean, for example, just click on disability once you do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you think that I should fill out both?
[AGENT][NEUTRAL] Um, if you're going to be filing claims for any hospital hospitalization.
[AGENT][NEUTRAL] Then you would do your hospital indemnity.
[AGENT][NEUTRAL] For disability, you will need to do the disability form because it's two separate policies and two separate.
[AGENT][NEUTRAL] Two separate benefits all of that is separate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So once you have downloaded each of your.
[CUSTOMER][NEUTRAL] Would I qualify for for both?
[AGENT][POSITIVE] I'm so sorry. Can you ask that question again, Miss [PII]?
[CUSTOMER][NEUTRAL] Sure, I was just wondering if I would qualify for both the indemnity and the short term disability.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Again, we will have to review the benefits. Um, I can see where you did call in and speak to someone before about your benefits. Let me pull up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, because I got out of your hospital indemnity plan. Give me just a second.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so under which you can see copies of both of your policies in your portal as well with your benefit information, Ms. [PII]. So on your hospital indemnity plan you do have a hospital admission benefit.
[AGENT][NEUTRAL] Of $1000 per day and a maximum of 1 day per calendar year per covered person. Now, that is for an inpatient admission.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and the definition of a hospital confinement on your policy, I can tell you what that is. Give me just a second.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so a hospital confinement is defined on your policy of at least 18 consecutive hours to be considered one day of hospital confinement.
[AGENT][NEUTRAL] And that definition is also in your policy certificate. Um, under additional benefits on this plan,
[CUSTOMER][NEUTRAL] So you're saying if I spend more than one day then I'm covered?
[AGENT][NEUTRAL] No, I can't guarantee payment of any claim, but I'm saying that you, you were asking about, could you possibly be eligible for benefits under both of these policies. So if you were admitted to the hospital as an inpatient, that is something that we could review for potential benefits to be.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Paid on. Um, you also have a hospital confinement benefit, which is $100 per day and a maximum of 15 days per calendar year.
[AGENT][NEUTRAL] Again, on this policy, it also has an intensive care unit benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And a rehabilitation benefit. Those are the benefits under your hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So if any of these things are applicable or have been to your situation, then yes, ma'am, I would recommend it would be in your best interest to submit the claim so that we could review it for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, so
[CUSTOMER][NEGATIVE] OK, is there any way I can delete the claim that I just sent in because it's definitely incorrect.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, there's no way to do that, but I will make a note on this policy that that's um
[AGENT][NEUTRAL] That you, you know, that you and I spoke because I can't see this document yet, again, I can just see that you have one in line for review that was uploaded today.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when you, let me, um, give me just a second to see if I can see anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I don't want that to like override.
[CUSTOMER][POSITIVE] Anything that I'm gonna try to do and hopefully do correctly.
[AGENT][NEUTRAL] Yes, so this is a
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So this is a wellness claim that you submitted today?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so they would just review that. I mean the information anything uploaded will get reviewed, we can't delete it. So for example, this, you know, if your policy doesn't have a wellness benefit on it, then it would just.
[AGENT][NEGATIVE] You know, get reviewed and more than likely say that this is, you know, denied because it's not a covered service.
[AGENT][NEUTRAL] But there's not a way to actually
[CUSTOMER][NEUTRAL] OK, I understand, and it, I don't have that right now.
[AGENT][NEUTRAL] Right. You don't have, I mean, no harm in what you did is what I'm saying. There's no harm in that if there's not, if there, anytime there's a question about a benefit, yes, ma'am, we always recommend that you submit a claim for review, um, but yes, I will make a note that's regarding our conversation today.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then I'll just go ahead and fill out the correct forms this time.
[AGENT][NEUTRAL] Right. Yes, ma'am. So there'll be one for disability and then the separate one for your hospital indemnity claims. And again, both of those claim forms have all of the instructions for completing them and what you need to um submit along with them for our review.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, all set, thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL. I hope you have a very nice afternoon.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thanks same to you bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.