AccountId: 011433970860
ContactId: b81b52d9-0205-488b-8a2a-8fa639f92750
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 756039 ms
Total Talk Time (AGENT): 320757 ms
Total Talk Time (CUSTOMER): 294074 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/b81b52d9-0205-488b-8a2a-8fa639f92750_20250310T20:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi sir, this is [PII] with American OneSource. I'm just calling on behalf of an employee, [PII], um, because he seems to be having some issues with this processing of his claims, um, specifically like the hospital indemnity claims, um, and I, I was wondering if, if you could, you know, pull that up and kind of be able to tell me what's going on with that.
[AGENT][NEUTRAL] Let's look at this policy. Do you have [PII]'s policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. Let me grab that for you right here. It should be First Hospital Indemnity. And that policy number is 2333213.
[AGENT][NEUTRAL] OK, let me pull this up here. Give me just a second.
[CUSTOMER][POSITIVE] Yes ma'am, of course.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right. And for [PII], can I get his date of birth and then if you're able to uh verify his physical address?
[CUSTOMER][NEUTRAL] Yes ma'am, his date of birth is [PII] and his physical address should be [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So let me let's see.
[AGENT][NEUTRAL] So it looks like he had one that was submitted on [PII].
[AGENT][NEUTRAL] It had multiple line items on it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] And is it still being processed or has it been denied?
[AGENT][NEUTRAL] That one actually was paid out. It was just processed today. So I don't know if you have a
[CUSTOMER][NEUTRAL] Oh, so, so he got, so they got the payout for OK, let me, can you, um, give me, is that the confirmation number or the OSC of 92466 or the 352-427?
[AGENT][NEUTRAL] Alright, let's see, 9 you said 924.
[CUSTOMER][NEUTRAL] Or whichever the one that you just said that got paid out, I'm sorry.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Is there like a confirmation number for when it was submitted because she did give me one of his confirmation numbers and it looks like this one was 36-2024 and so I'm assuming that's the one that just got paid out.
[AGENT][NEUTRAL] Yeah, so it looks like OSC it looks like 94263.
[AGENT][NEUTRAL] 94267.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There were a few of them.
[CUSTOMER][NEUTRAL] But, but one of them processed through and that APO hospital and do policy that only pays out once a year I assume correct?
[AGENT][NEUTRAL] Well, it depends. Yeah, I mean, it depends on what they're being seen for. Let me where were all these, let's see.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] policy and look at that.
[CUSTOMER][NEUTRAL] Yes ma'am, because she's kind of been submitting them on her own, which is totally fine. I just, I don't know, you know, because usually when APL, um, denies the claim they send a denial letter, right, with an explanation of what of why it was denied, so I don't know why she technically needs to reach out to me about that, you know, but, um, she is, so I'm just trying to, you know, do my due diligence.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, I was gonna say cause
[AGENT][NEUTRAL] Let's see, the one before that.
[AGENT][NEUTRAL] 3039. What was that?
[CUSTOMER][NEUTRAL] And are these all hospital indemnity that she's filing them under?
[AGENT][NEUTRAL] Yes, yeah, I'm just looking at the hospital indemnity.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So on the claim that I see that was just processed, the benefit payment, it looks like for the most part, most of it was maxed out. So like, if you look at, like this was a hospital stay on their scheduled benefits, the maximum benefit payable for hospital admission is $3000 for a maximum of one day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So like on this recent payment like they did get that um.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] They got, they got that full 3000 paid out to them?
[AGENT][NEUTRAL] Mhm, mhm, mhm.
[CUSTOMER][POSITIVE] Awesome and and would that show up would that have already showed up today in their account, um, or would it be like tomorrow that she'd see this?
[AGENT][NEUTRAL] So it is direct deposit so it will come in a couple days like I said it was just processed today if she's managing her claims online, it may not show any sort of payment yet at this time, um just because it was just processed today but she should be able to see it by tomorrow if she manages them online.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. Hey, can you give me the, the, the claim number associated with that so I can just tell her, hey, it's getting paid out for this claim. It's the only one that APL pays out a year, so you've maxed it out so don't be trying to file any more hospital indemnities, OK?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, well, yeah, and just to know too that like there were some denials for like a physician office visit, you know, um, the plan.
[CUSTOMER][NEUTRAL] Yeah, that's like, that's what your medical should take care of. It's this is you've got to be admitted to the hospital for at least 24 hour period, right? Not just going to see a doctor and getting a checkup.
[AGENT][NEUTRAL] Well, this will just cover like one office visit a year. So yeah, it's not meant to be major medical. It's, you know, it's a limited, yeah, benefit plan.
[CUSTOMER][NEGATIVE] Right, right, because, because you get co-pays for the doctor that would take care of that, so you wouldn't really even, you know, have to file something, go through the hassle of that. So, um, so she's maxed out for the year, right? I can tell her that like, hey, don't be filing any more of these hospital indemnities, they're gonna get denied.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] This is for [PII]. OK, so let's see, let me give you this claim number real quick.
[AGENT][NEUTRAL] Um, the claim number is 3572927.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes ma'am perfect.
[AGENT][NEUTRAL] Alright, and then let's see what's been used for the year and kind of go from there [PII].
[CUSTOMER][POSITIVE] Cool, cool.
[AGENT][NEUTRAL] OK, so for Edward.
[AGENT][NEUTRAL] The hospital admission benefit is maxed out.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Let's see, for Edward.
[AGENT][NEUTRAL] See what this is, one moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. And then hospital confinement.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like it pays up to a maximum of 60 days.
[CUSTOMER][NEUTRAL] Yes ma'am, and, and that would be, that would be filed separately than the hospital admission benefit or would these all be paid out um to like the same claim if it happened to be that he was in the hospital for more than 24 hours and then he had to stay a couple of days in hospice?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Right, so that would be separate. So the hospital confinement benefit, um, is not maxed out because it, well, let's see, it's a maximum.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of 60 days per calendar year. So on this claim, they were paid a hospital admission or confinement benefit of an additional $1500.
[AGENT][NEUTRAL] Um, that would be, it's 250 per day, so that would have been 6 days.
[CUSTOMER][NEUTRAL] Is that on is that on a different related claim?
[CUSTOMER][NEUTRAL] Was that, is that gonna be paid out with that $3000 that's going to them right now, is that what you're saying?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm sorry, the phone kind of cut out. Can you repeat that?
[CUSTOMER][NEUTRAL] Yes ma'am. So is that 1600 for the hospital confinement also being paid out on top of the hospital admission benefit for $3000 with this upcoming processing of that ACH?
[AGENT][NEUTRAL] Yeah, so their upcoming payment that they're getting is a total of 404,500 because 1500 was paid out for confinement.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Wow man, APL really pays well that's amazing.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so how many days, how many days were they in there? They were in there for what, like, um, 5 or 6 days, is that what you're saying?
[AGENT][NEUTRAL] Um, yeah, so on the scheduled benefits page it says 250 per day, so that would come out to be 6 days, and they are allowed up to 60 days per year calendar year.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][POSITIVE] Wow wow um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, um, and then this accident surgery benefit, is this happen to be like if there's like a complication or something, say like they did get a surgery, then, you know, two weeks later, there's a complication from it and it causes them to be, um, have to go back into surgery again. Is that gonna be covered under that accident surgery benefit?
[AGENT][NEUTRAL] Let's see what that says. A surgery.
[AGENT][NEUTRAL] We will pay the applicable accident surgery benefit per day when a surgical procedure due to an injury is performed in a hospital or outpatient facility.
[CUSTOMER][NEUTRAL] I got you. Hey, I'm not gonna make you go too specific on that because I, I, I understand that there's not much that's pretty vague, um, so I can just tell her, hey, you'll be expecting a $40,500 payout in this in this next couple of days. OK, well, well that should make her pretty happy, and I'll let her know that if any are denied you will be getting that letter you probably already have that letter so just go off of what it says, OK?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Yeah, absolutely, and that she should be able to, you know, look at her scheduled benefits page and see what she's claimed for the year and paid out and see if there's anything additional.
[CUSTOMER][POSITIVE] Oh that's awesome so it keeps track of all this stuff so they can pull it up on that portal that she's submitting them through and see how much she's maxed out of each of these options.
[AGENT][POSITIVE] I mean she should be able to yeah see off her scheduled benefits exactly what the max is and everything, so maybe that'll be helpful for her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Cool.
[CUSTOMER][POSITIVE] Yes ma'am, that's perfect hey thank you so much for your help you've been wonderful ma'am.
[AGENT][POSITIVE] Yeah, not a problem. You have a good day.
[CUSTOMER][POSITIVE] Yes ma'am you too bye.
[AGENT][NEUTRAL] Bye bye