AccountId: 011433970860
ContactId: 9e832b77-6d97-4294-8c68-b1cc7486ff2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 884989 ms
Total Talk Time (AGENT): 383272 ms
Total Talk Time (CUSTOMER): 354847 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/9e832b77-6d97-4294-8c68-b1cc7486ff2a_20250619T16:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, uh, my name is, uh, [PII], and I'm with, uh, ATL.
[CUSTOMER][NEUTRAL] And I need to, I wanna ask you a question.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, my wife, uh, she, she on there with me.
[CUSTOMER][NEUTRAL] Her name is [PII].
[CUSTOMER][NEUTRAL] OK, she was, uh, my wife had, she had got food poisoning.
[CUSTOMER][NEUTRAL] And um she had to go to the doctor hospital in [PII] and she was, she was admitted on the [PII].
[CUSTOMER][NEGATIVE] And she had to stay for 4 days.
[CUSTOMER][NEUTRAL] Um, from the [PII] until the [PII].
[CUSTOMER][NEGATIVE] And then, uh, later on, she uh, she had broke her, uh, my wife went home after that and then she had broke her ankle.
[CUSTOMER][NEUTRAL] And uh she got metal plates and screws in it and then uh she was also alive on the [PII].
[CUSTOMER][NEUTRAL] And then she had, uh, they released her on the um on the field. They had to, she had to go to now she's in rehab, like a nursing home and she's still there, and I want to know what I need to do to file a claim.
[CUSTOMER][NEUTRAL] Uh, she's in the hospital.
[CUSTOMER][NEUTRAL] I don't, that's what I need to know what I need to do, how to file a claim. Do I need to have to file a claim for a hospital stay?
[AGENT][NEUTRAL] OK, I can help you with how to file a claim. Um, what is your policy number?
[CUSTOMER][NEUTRAL] Uh, I don't have it with me. I just know my social security number and I get it to pull up.
[AGENT][NEUTRAL] OK, um, and are you the primary insurance carrier holder?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what is your social and I can look it up.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEGATIVE] Your poor wife just had a month.
[CUSTOMER][NEGATIVE] Yeah, she has been bad on her. I don't know, she had food poison.
[CUSTOMER][NEUTRAL] And she stayed in the hospital for.
[CUSTOMER][NEUTRAL] From the [PII] until the [PII].
[CUSTOMER][NEUTRAL] And that's at the hospitals in the Gulf of [PII].
[CUSTOMER][NEUTRAL] They have all that and then she went home and then on the [PII].
[CUSTOMER][NEGATIVE] She uh she broke her ankle and, and broke it in three places.
[CUSTOMER][NEUTRAL] They she got metal plates and screws and.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So they then after that they let they she came on the [PII] and they released her on the [PII] but the the the um the ambulance came and got her on the [PII] and took her to a nursing home.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh.
[CUSTOMER][NEUTRAL] Now she's there, still there.
[AGENT][NEUTRAL] So what is, um, can I go ahead and get you to verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, my date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the address that we have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, let me pull up your policy.
[AGENT][NEUTRAL] And I am showing that we have an email on file uh with you so if you would like to file this claim um or she can file this claim um through our online portal account.
[AGENT][NEUTRAL] Uh, would you like me to send you information on how to get that started?
[CUSTOMER][POSITIVE] Yes, he's just, uh, filling my email and I can do, I can do it on, I can do it on on on my computer now.
[AGENT][NEUTRAL] OK, yeah, I'll go ahead and send you that real um as well while I'm pulling up your, um, policy, and we can go over what benefits you have and this is just your hospital indemnity policy if you'd like, I can check. Did she break her ankle from an accident?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Uh, no, no, no, she broke her ankle at home, at home.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To get it at home, yeah, it.
[AGENT][NEUTRAL] So it will be
[AGENT][NEUTRAL] OK, so it'll just be your hospital indemnity probably. OK, let me see.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] So in the email I'm going to send you um.
[AGENT][NEUTRAL] A help guide on how to create the account.
[AGENT][NEUTRAL] And then I'm also sending you a help guide for how you can access the account um and where you'd need to go to file a claim.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] You shouldn't have to decide if it's your hospital indemnity or group accident or anything like that. It'll go towards the one that it that provides the benefits, um, so you don't have to worry about that. If you ever need your, uh, policy ID card for any reason or you wanna look at what your policy has like the policy certificate that I'm gonna look at and go over with you today, all of that will be in that online account as well, um.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So I just sent that to your email so that you'll have that uh you'll want to create the account first with the email that I sent that to because that's the email that we have on file I will say um I would only fill out the required information which I believe is just your last name.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, your date of birth and email, I wouldn't fill out the rest or sometimes you'll get an error, so I just wanna let you know, um, only fill out the required information.
[CUSTOMER][NEUTRAL] Oh yeah, I want, I'll just, I'll just, I'll just fill out those three with the email with my name.
[AGENT][NEUTRAL] Yeah email last name and date of birth.
[CUSTOMER][NEUTRAL] And uh I.
[CUSTOMER][NEUTRAL] OK, that's what I do. 3.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, and this is just a verification of benefits and not a guarantee of payment. It looks like you guys have a hospital indemnity or I'm sorry, a hospital confinement benefit amount. Uh, it's a daily benefit of $50 so you said she was confined to the hospital for 4 days, so you'll get you, if it qualifies, you will get $50 for each day she was there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was she in intensive care at all?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, yeah, OK, what I'm saying, OK, she, she, she came in on the, on the [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For food poisoning and she stayed 4 days. And then she, then after that she went home and then a week and a half later.
[CUSTOMER][NEGATIVE] And she broke her ankle and stayed in the hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] And then to the [PII], OK, so they, they transfer her to uh um uh uh uh what they call that, uh, a nursing home.
[AGENT][POSITIVE] So nursing, OK.
[CUSTOMER][NEUTRAL] The, uh, they got rehab in-house, and then she, she, she came on the [PII] and she's still there. They saying that between the [PII] or the [PII].
[CUSTOMER][NEUTRAL] They said in by time to go home between the [PII] or the [PII] of this month.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She's been there, she's been there since the [PII].
[CUSTOMER][NEUTRAL] But when he released her on the field and then they turned to to a nursing home on the field.
[CUSTOMER][NEUTRAL] And she's still there and
[CUSTOMER][NEUTRAL] And uh they said that between the uh she gotta go see the doctor um on Monday.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] On the [PII], they, they say, they say they see they got a soft cast, but now they wanna put the real cast on. And then they tell about she gotta get uh crutches and they want, they want her to stay there 3 more days so they can learn how she gotta learn how to walk with those crutches, and then they say they'll let her go home.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for this, um, you'll get, you should be able to qualify for the hospital confinement benefit, which is a daily amount of $50 per day.
[AGENT][NEUTRAL] Um, if she ended up going into intensive care, that's an extra $200 per day.
[CUSTOMER][NEUTRAL] Ah.
[AGENT][NEUTRAL] Um, any sort of diagnostic testing, um, typically MRI, CT, or colonoscopy, those are covered as well. If she had a wellness exam or any other sort of test, it would be $75 per test.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see, um.
[CUSTOMER][POSITIVE] I got, I got um I got all those uh.
[AGENT][NEUTRAL] All of them? OK.
[CUSTOMER][NEGATIVE] So, uh, papers, yeah, I don't know how do I put the fax them. I don't know how I'm supposed to do that. I don't know.
[AGENT][NEUTRAL] Uh, you are able to fax them. We do have the fax number and the um.
[AGENT][NEUTRAL] The mailing address on on that claim form.
[CUSTOMER][POSITIVE] I, I, I'd rather, I got, I'd rather, I'd rather find them because, cause it's easy to that that that for me to to fashion to you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and you can just fax them to us, um, make sure that the, uh, any sort of receipt or you'll want to send in her discharge papers as well, showing that she was in the hospital. Anything with a diagnostic code or a, or a procedure code you'll want on there because you do have a surgical benefit and an outpatient sickness benefit as well.
[CUSTOMER][NEUTRAL] Yeah, I.
[CUSTOMER][NEUTRAL] Yeah, that, that's.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What, what is, what is the, um, they said what is that they got on their uh account number and ID number. I don't, I've seen it on it but I don't know what that is.
[AGENT][NEUTRAL] Let me check
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Account number, then her ID number. That's just like her ID number for her like released I guess it said ID number and it said account number.
[CUSTOMER][NEUTRAL] I don't know. I don't know if you need that.
[AGENT][NEUTRAL] Let me look
[AGENT][NEUTRAL] OK, it looks like the first page is talking it just asked for like the name, date of birth, social security number.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Social security number or policy number and then some basic information about you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, um, yeah.
[AGENT][NEUTRAL] And then section B is going to be about her.
[CUSTOMER][NEUTRAL] And then um
[CUSTOMER][NEUTRAL] OK, cause um she's in the nursing home. So the nursing home has the um release paper.
[CUSTOMER][NEUTRAL] They have the paper that when she came from the hospital, they, they gave the to where she at now, so they have.
[CUSTOMER][NEUTRAL] So I guess I just have to get it from them and fax it.
[AGENT][NEUTRAL] Yes, they should be able to fax it um.
[CUSTOMER][NEUTRAL] To you
[AGENT][NEUTRAL] If you want you can go. It should be on your portal as well in your resources, the claim documents, but you can also go to [PII] and download the hospital indemnity claim form and that's only 2, it's only 3 pages.
[AGENT][NEUTRAL] So it'll just have a statement, um, section A is just about you because you're the policy holder.
[AGENT][NEUTRAL] Um, you can put your Social Security number or your policy number on there. Section B is just going to be about your wife, uh, first name, last name, date of birth, and then you will need to sign it.
[AGENT][NEUTRAL] And then the 3rd page um you'll do it one more time it'll ask for your policy number.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Her name and her date of birth.
[AGENT][NEUTRAL] And then she will also sign it at the bottom and date it.
[CUSTOMER][NEUTRAL] OK. And so, um, everything that, um, that she had, um, they had uh surgery for the doctor that she had the surgery.
[CUSTOMER][NEUTRAL] And she had to get um MRI whatever they do, they had they had surgery. So do I need those papers as well when they had to to do the surgery on them? Do I need those?
[AGENT][NEUTRAL] Yes, you'll want any itemized bill or receipt that has procedure codes or diagnostic codes on them. Um, so in the surgery, yeah.
[CUSTOMER][NEUTRAL] Oh, OK then. I'll get, I'll get all of that.
[AGENT][NEUTRAL] Yeah, and if you don't see the procedure codes on there, you'll want to call the hospital and ask if they can send them to you or even send them to us um on your behalf uh but we will need those diagnostic codes for it to be considered.
[AGENT][NEUTRAL] Or those procedure codes. Mhm.
[CUSTOMER][NEUTRAL] OK. So it's called, so they call um diagnostic code.
[AGENT][NEUTRAL] Yes, and it should say on there if it's a diagnostic code or if you see a bunch of numbers that that aren't part of your bill um it'll typically show what it'll break down what what they are charging for each part and not just the total bill um it'll be there'll be like an anesthesia charge, a surgery charge a test charge so it'll show the different amounts for each charge and then the procedure that they charged you for.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So that's the difference between the itemized bill and just the the receipt or the bill that just shows how much you owe or how much uh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I owed
[CUSTOMER][NEUTRAL] So the only thing I need now is your fax number. I can, I can.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah, your fax number that's what I'm waiting on.
[AGENT][NEUTRAL] Oh, your fax number, OK, I'm sorry about that. I couldn't hear you.
[AGENT][NEUTRAL] Our fax number is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, I got it. OK, that's it.
[AGENT][POSITIVE] All right, well if there's nothing else, thank you for calling APL and I hope you have a great day, OK?
[CUSTOMER][POSITIVE] Alright thanks
[AGENT][NEUTRAL] Bye.