AccountId: 011433970860
ContactId: 9f54a0e6-8b5e-42ac-bea9-6f84d0bccaca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 706979 ms
Total Talk Time (AGENT): 222821 ms
Total Talk Time (CUSTOMER): 286154 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/9f54a0e6-8b5e-42ac-bea9-6f84d0bccaca_20250519T14:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is uh [PII]. I'm actually trying to file a claim.
[CUSTOMER][NEUTRAL] Um, and the only thing I have is the brochure that's in the system in our agency, so I need to, I guess, understand how to file online and if I have a certain number because I never got a certificate either.
[AGENT][NEUTRAL] OK, um, do you have, I can look up your policy by your social or last name?
[CUSTOMER][NEUTRAL] Social's fine. It's [PII] and last name is [PII].
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then can you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have a good callback number in case we are disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And then Mr. [PII], I just need two more pieces of information, your address and your email address.
[CUSTOMER][NEUTRAL] [PII] and my email address is [PII].
[CUSTOMER][NEUTRAL] So it's [PII] without the [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and then you said you're trying to set up your account, is that right?
[CUSTOMER][NEUTRAL] I'm trying to file a claim, ma'am. I messed up my knee, uh, mowing, so.
[AGENT][NEUTRAL] OK. Um, do you have an account on our, um, online portal?
[CUSTOMER][NEGATIVE] No, I do not like I said I didn't receive anything at all, so I'm out here in the wind.
[AGENT][NEUTRAL] OK. Are you
[AGENT][NEUTRAL] OK, um, I can send you the information to or we can walk through it, um, it has to be set up on a laptop or desktop or I can give you, I can email you the claim form and then if you want to read over the claim form and then attach the information that we need.
[CUSTOMER][NEUTRAL] I can do it online so if you wanna walk me through that would be fine.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] I'm at my desktop right now.
[AGENT][NEUTRAL] OK, great. Um, it's just the fastest way to upload claims and such, so that's why I suggested it. Um, let me get this pulled up real quick.
[AGENT][NEUTRAL] So, you'll go to [PII].
[CUSTOMER][NEUTRAL] Wait a minute, [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Uh, and then once you go there you'll see that there's a log in, um, you'll click new user.
[CUSTOMER][NEUTRAL] And then I am an individual with an APL insurance policy.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I had to put all my information in.
[AGENT][NEUTRAL] Yeah, uh, note on box 2, it'll be your full social, no dashes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK it says I've been created here so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, it's just uh.
[CUSTOMER][NEUTRAL] Throw me all kinds of stuff here.
[AGENT][NEUTRAL] Oh, you're fine.
[AGENT][NEUTRAL] Oh, hey, yeah.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Totally understand. Take your time. No worries.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] Uh, my phone's died, um.
[CUSTOMER][NEUTRAL] I was waiting to go get the cord um.
[CUSTOMER][NEUTRAL] Let me skip that, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] On the the follow up and and I guess wellness claim to our policy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can I see the actual things is my certificate somewhere because I don't see a certificate right here.
[AGENT][NEUTRAL] Um, yes, there should be your certificate. Um, let's see, it'll be on your dashboard. Let me make sure.
[CUSTOMER][NEUTRAL] It says contact us claim forms and help.
[CUSTOMER][NEUTRAL] Uh, policy contact preference paid out.
[CUSTOMER][NEUTRAL] I don't see it, ma'am.
[AGENT][NEUTRAL] Uh, let me hold on 11.
[CUSTOMER][NEUTRAL] Uh, let's see, I've got a hyperlink for the policy number, so let's see.
[CUSTOMER][NEUTRAL] Yeah this is the actual policy, the hyperlink let me have it, so.
[AGENT][NEUTRAL] OK, yes, um, that will, so let me see, let me pull up your policy real quick.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Did you go to the ER?
[CUSTOMER][NEUTRAL] I went to my primary care, um.
[CUSTOMER][NEUTRAL] Uh, just
[CUSTOMER][NEUTRAL] I, I wanted to go to the primary care because I don't wanna incur the huge cost to the ER and I waited a couple, uh, days in order to do that to, to be seen, so, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Because they didn't have a ready appointment for me obviously.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And right now I'm getting ready to go through an MRI. I've got to schedule it, um, I may have some ligament or cartilage damage, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, now, obviously I'm trying to scroll through all of this. I didn't see the.
[CUSTOMER][NEUTRAL] Can you just share with me the um wellness the follow up wellness type benefits?
[AGENT][NEUTRAL] Uh, sure.
[CUSTOMER][NEUTRAL] Because that's not clearly the.
[CUSTOMER][NEUTRAL] And I probably can go back. You guys don't have a timeline on that, do you?
[AGENT][NEUTRAL] Uh, no, we don't.
[AGENT][POSITIVE] Yeah, you, you can file it any time.
[CUSTOMER][NEUTRAL] Some company
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see, so it looks like.
[AGENT][NEUTRAL] Screening benefit is 2 per covered person, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, um, and then let me see.
[CUSTOMER][NEUTRAL] I guess I was looking for the actual list of things that you can do.
[AGENT][NEUTRAL] Yeah, that's on page, looks like page 6 and 7.
[AGENT][NEUTRAL] It lists your scheduled benefits that are covered.
[CUSTOMER][NEUTRAL] Oh, I went.
[AGENT][NEUTRAL] Um, and then at the end of that, it shows the screening benefit, um, pays $50. Um, let's see.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEGATIVE] Oh wait a minute, I don't, I'm on my page 6 and 7 and I don't see that because it gives me an outline on page 6.
[CUSTOMER][NEUTRAL] And then actually no wait a minute.
[CUSTOMER][NEUTRAL] 678.
[AGENT][NEUTRAL] Oh, actually, it'll be page 456.
[CUSTOMER][NEUTRAL] Page.
[AGENT][NEUTRAL] I'm looking at my PDF file, so, um,
[AGENT][NEUTRAL] It should indicate page 45, and 6 scheduled benefits, starts listing out um.
[CUSTOMER][NEUTRAL] And it's listing the actual benefits within the plan, but it just says accidental screening.
[CUSTOMER][NEUTRAL] Or accident screening at the $50.
[CUSTOMER][NEGATIVE] And it's a 2 per cover person 4 for family, but it does not.
[CUSTOMER][NEUTRAL] Tell me what those are.
[AGENT][NEUTRAL] Uh, it will cover, and this is on page 16.
[AGENT][NEUTRAL] Um, accident screening benefit.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, if services are rendered by a physician, rendered while the covered person is not inpatient.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] It should pay. Let's see. Let me see if there's any other definition.
[CUSTOMER][NEGATIVE] That's not very
[CUSTOMER][NEUTRAL] Precise, I mean it's.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Uh, it's page 22.
[AGENT][NEUTRAL] Accident screening, any of the following, uh, would be for
[AGENT][NEUTRAL] Hemoglobin A1C, baseline testing for concussions, bone density, stress tests.
[AGENT][NEUTRAL] Uh, weight reduction program, exam by dentist or optometrist, routine physical, or any generally medically accepted outpatient screening tests to evaluate risk.
[AGENT][NEUTRAL] So it pretty it pretty much would cover the whole gamut of what's, you know.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Be recommended for screenings.
[CUSTOMER][NEUTRAL] Now is there any change moving forward uh because some of the states are pulling that wellness benefit out?
[CUSTOMER][NEUTRAL] Is there anything relative to PA now that's going on with that?
[CUSTOMER][NEUTRAL] Do you know?
[AGENT][NEUTRAL] Um, not that I'm aware of. We haven't received any information.
[CUSTOMER][NEUTRAL] OK, all right, fair enough, and I can go back to the original effective date with these testings correct?
[AGENT][NEUTRAL] That is correct. You can go back to [PII], yeah.
[CUSTOMER][NEUTRAL] Oh, alright, fair enough. Well, I will definitely do that. I'll go on and get my uh claim uh implemented for the knee, um, and obviously I need to do the direct deposit to have that deposit in my account. Do I need to do that prior to the submission or can I do it with the submission or does it matter?
[AGENT][NEUTRAL] I would do it prior that way we have time to receive it and then get it processed that way it doesn't cross with us processing the claim and potentially sending out a paper check.
[CUSTOMER][NEUTRAL] OK, alright, and then the last question is generally how long does that take you guys to process the claim?
[AGENT][NEUTRAL] Um, once we receive the claim and if it's all the information that we need, um, it typically takes about 7 up to 7 working days.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right well I appreciate your time, ma'am. Thank you so much you have a wonderful day, OK?
[AGENT][POSITIVE] OK, thank you for calling [PII]. I hope you have a great day too.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] I