AccountId: 011433970860
ContactId: ba1a835f-46c1-4c39-97c8-df695a112e94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1042608 ms
Total Talk Time (AGENT): 399975 ms
Total Talk Time (CUSTOMER): 508482 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/ba1a835f-46c1-4c39-97c8-df695a112e94_20250219T19:30_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII]. Um, my husband and I, we were with you, with, with y'all's group, and I've never filed a claim with you guys yet and that's what I'm inquiring about. How do I go about it?
[AGENT][POSITIVE] OK, [PII], I'm happy to help with filing a claim. Um, do you know what kind of policy you had with us?
[CUSTOMER][NEUTRAL] I believe I have, I have quite a few. I have cancer. I have, when I go in the hospital, when I go to the doctor, we have, I mean, I can give you my number, the group number.
[AGENT][NEUTRAL] OK, yeah, if you have, do you have by chance like a certificate number or a policy number I can pull them that way? OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I have my little card that I carry. Alright, the policy number is 025.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] 15176
[AGENT][POSITIVE] OK, thank you so much. Let me pull this up here.
[AGENT][NEUTRAL] OK. And then [PII], just for security, I will need to verify your um date of birth and address, please.
[CUSTOMER][NEUTRAL] OK. My date of birth is [PII] and the address is [PII].
[AGENT][POSITIVE] Alright thank you so much. So let's see and then the email it looks like just make sure we have the right one on file.
[CUSTOMER][NEUTRAL] I don't know if it's underneath bar or not or mine. It's probably underneath yours.
[AGENT][NEUTRAL] Yeah it looks like it's under [PII]'s it's a [PII] address, but that's still a good email.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, that, yeah, that's his, and then I have my own and I don't think y'all have that one, but.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so yeah, it looks like here and you're right, you guys do have a couple of different policies with us. You have the accident, the cancer, the um hospital indemnity, and then the short term disability. So do you need to file a claim under a specific one or?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I mean, do I mean how do you, how, I mean we were with another company before I switched to this one is it the same way where we just submit the claim in or where do I get the claim forms from?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so our claims can be submitted um online we do have an online service portal and I'm happy to help you with that. We also accept claims via fax or in the US postal mail, um, so yeah, the claim forms can be accessed from our website as well where the portal is. Would you like that web address?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, so web address.
[CUSTOMER][NEUTRAL] I'm not too, I'm not too stiff on the computer, but I'll do my best.
[AGENT][NEUTRAL] OK, uh, so the web address is going to be [PII].
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] AM
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, I see it on the back of the card that I carry.
[AGENT][NEUTRAL] [PII], yep.
[CUSTOMER][NEUTRAL] Yes, yes, so I just go on that website and then that's why I get the the claims form printed out.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] Mhm yep you're gonna see you'll see a link right there on the top of the page when you pull that up it's gonna say claims and forms and that's where you would access your claim forms.
[CUSTOMER][NEUTRAL] Is that what I do, print them out?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, claim forms. OK, now let me, let me ask this y'all would need um the discharge summary?
[CUSTOMER][NEUTRAL] I was in the hospital, so that's why I know so you would need an itemized bill on this accident.
[CUSTOMER][NEUTRAL] Do you need a discharge summary of of the.
[CUSTOMER][NEGATIVE] Um, the reason why I was in the hospital and all that mess.
[AGENT][NEUTRAL] Um, so,
[AGENT][NEUTRAL] For the hospital indemnity policy that you have, we would need the itemized bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Itemized bill, OK.
[AGENT][NEUTRAL] With diagnosis codes from the provider.
[CUSTOMER][NEUTRAL] Diagnosis? OK.
[CUSTOMER][NEUTRAL] OK, I'm writing this down. Diagnosis codes.
[CUSTOMER][NEUTRAL] So which means I, I mean I've done this with the other company, so I need to go to the hospital, get an itemized bill, then I have the discharge summary on what, what the outcome was, and is that all you need? Yeah.
[AGENT][POSITIVE] Mhm mhm with the claim form of course yeah absolutely.
[CUSTOMER][NEUTRAL] With the claim, yes. Yes, that's what I thought.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Then I can actually what I did, I did with the other company I did fax it in because I didn't know how to do it on the computer.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh yeah you can do that so if if that's easiest for you honestly [PII], um, when you, when you find that form when you click claims and forms and then print out the form, the very first page is just instructions as far as what you need but on that page is the fax number and the address but I can give you the fax number too.
[CUSTOMER][NEUTRAL] So, OK, I, I, I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I think I just wrote it down. [PII].
[AGENT][POSITIVE] Mhm, yep, absolutely.
[CUSTOMER][NEUTRAL] OK, oh, OK, that's it, um.
[CUSTOMER][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] Since I was in the hospital, if you're gonna say hospital on the claim form or is a certain one that I need to use?
[AGENT][NEUTRAL] So you're gonna click on the hospital indemnity form.
[CUSTOMER][NEUTRAL] OK, indemnity, OK.
[AGENT][NEUTRAL] Now, does any of this, would any of this also be do you know? I mean, I don't know, you can file for whatever you were in the hospital for if you needed to, if it was like an accident, you could do it under your accident policy too. I just don't know if that's applicable.
[CUSTOMER][NEUTRAL] No, actually, actually, they say I had a stroke.
[CUSTOMER][NEUTRAL] So, I was admitted into the hospital. I did stay, they did keep me there. And so I'm assuming I could submit this in.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, absolutely, yeah.
[CUSTOMER][NEUTRAL] OK, and then let me ask you this, now we had this insurance all more than half of last year I believe. I never filed a claim because I wasn't quite sure on what I can file and don't y'all go back a year or two?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] As far as blood work?
[AGENT][NEUTRAL] Um, yeah, so I.
[CUSTOMER][NEUTRAL] Cause my understanding.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] My understanding was it was the same as the other insurance that we had that we can submit in forms.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And, and do y'all go, OK.
[AGENT][NEUTRAL] So yeah I mean you you can you can submit any claims as long as the policy was active at the time so like effective date I show for this is on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Exactly. That is what I'm saying cause I know we, we got it last year and I never filed any claims, even though we went to the doctor or whatever. I did not file any claims in 24.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Because I wasn't quite sure, so I said, well, I'll just wait to January in case anything happens.
[AGENT][NEUTRAL] Right, right, I hear you.
[CUSTOMER][NEGATIVE] And it's just unfortunately, I went to the hospital last week.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Believe me, I didn't wanna go in the hospital, but I had to, but I had to, I mean, of course.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, right, but
[CUSTOMER][NEUTRAL] OK. Well, this is what I'll do then.
[AGENT][POSITIVE] Yeah absolutely and like I said, yeah, anything that you have that wasn't filed, please, yeah, you can absolutely do that when you have time.
[CUSTOMER][NEGATIVE] OK, now what, OK, let me ask this, I guess, because [PII]'s no help to me.
[CUSTOMER][NEUTRAL] Because I do all this.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] All right. It's covered if we get blood work, certain types of blood work like cholesterol or diabetes or anything like that, correct?
[AGENT][NEUTRAL] Um, yeah, let me just double check and see.
[CUSTOMER][NEUTRAL] That is for um
[CUSTOMER][NEUTRAL] Alright, right, the last insurance, that's in case that was considered a well visit.
[CUSTOMER][NEUTRAL] Because don't we submitting a claim for well visits?
[AGENT][NEUTRAL] Right, yeah, most of them do have a wellness, but I'm just gonna just double check here. Let's see.
[CUSTOMER][POSITIVE] OK, I just wanna be sure because I wanna do the same as I did before with the other company so that I can get in the habit of doing this. Like I knew when to file, what I needed to file about I mean I got so used to it and now I I gotta start all over.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I know, yeah. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] And I believe whenever I submitted in the wellness for the other company, all I did was I had only had to call them up and I said, look, I went to the doctor, they did a wellness, they took it over the phone, the date that I went and that was it. I didn't have to show anything for that. Now, do I have to do that with you guys?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] So we do have on those under the claims and forms we do have a wellness form um yeah and it does say uh wellness on it but it's pretty, I was gonna.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's good to know.
[AGENT][POSITIVE] Yeah, it's pretty simple, I believe. It's not too detailed, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me see. I'm looking at your policy here to see.
[CUSTOMER][NEGATIVE] It's a shame. I'm kind of illiterate when it comes to this computer best. And usually my grandson comes in from college and he comes over and he helps me and I said, this is what I need, put this on here. And that's all I do is have to press the button.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, I get it. I mean, look, everything is online now. There are times where I, I feel that struggle.
[CUSTOMER][NEUTRAL] It is, uh-huh.
[CUSTOMER][NEUTRAL] Of course. And it's not like I, I could pick it up so easy because I don't.
[AGENT][NEUTRAL] Yeah, yeah. OK.
[AGENT][NEUTRAL] All right, so.
[AGENT][NEUTRAL] I don't, there's on this hospital indemnity, I'm not seeing.
[AGENT][NEUTRAL] Anything specifically that's talking about wellness, but let me see what they say, OK.
[CUSTOMER][NEGATIVE] OK, I just went on your web. I'm sitting here on my computer because I try to do the best and I'm getting ready to sign in or try to. I need to log in and all that mess.
[CUSTOMER][NEUTRAL] I'm gonna put you on speaker.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm. I'm still here.
[CUSTOMER][NEUTRAL] OK, I just wanted to make sure I could, I, I got you on speaker because I'm gonna type in while I'm on the phone with you that way I can pull out this form.
[AGENT][POSITIVE] OK yeah sounds good. Now you don't even need to click that sign in if you're just wanting to download the claims and forms you can just click where it says claims and forms.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, OK, let me do that. OK.
[CUSTOMER][NEGATIVE] Claims and forms, it says, well, I didn't pressed it. I don't, why the hell do I go back?
[CUSTOMER][NEUTRAL] Oh, I, I see claims and forms. I just press on that and it will let me print it out.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So yeah, click on that and then you're gonna need to like scroll down.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, uh, file claim 24/7.
[AGENT][NEUTRAL] 1st 11 you should.
[CUSTOMER][NEUTRAL] Fax document, paper form. OK, now where do I click on forms?
[AGENT][NEUTRAL] Keep going down you should right, but keep scrolling down. The first one you should see is an accident claim form.
[CUSTOMER][NEUTRAL] I clicked on forms.
[CUSTOMER][NEUTRAL] Uh, nope, it's not, it's not. Oh, I see it, I see it, I see it. A claim form, but is that considered accident?
[AGENT][NEUTRAL] No, no, no, so you're looking for the hospital indemnity and they're all in alphabetical order, you're gonna have to scroll down and go to page 2.
[CUSTOMER][NEUTRAL] But it wasn't
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, I see. OK, I got you.
[CUSTOMER][NEUTRAL] Direct deposit, electric funds, uh, here it is, everyday solution claim form.
[AGENT][NEUTRAL] Page 2 with the number 2 at the bottom.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let's see. It says hospital indemnity and everyday Solutions claim form.
[AGENT][NEUTRAL] You need the hospital indemnity claim form, uh-huh.
[CUSTOMER][NEUTRAL] That is it.
[CUSTOMER][NEUTRAL] Yes, and it says everyday solutions claim form. It's two forms in one.
[AGENT][NEUTRAL] You don't need the everyday solutions claim form. You need the hospital indemnity one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, go back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I see hospital in [PII]. Does it have a, a second page? Yeah. OK. I have it. There it is.
[CUSTOMER][NEUTRAL] So, it comes up to the same thing. Hospital and everyday solutions claim form.
[AGENT][NEGATIVE] You should have 3 pages.
[CUSTOMER][NEUTRAL] Uh, it does have 3 pages, yeah.
[AGENT][POSITIVE] OK, that's right. As long as this is hospital indemnity and everyday solutions at the top, you're good.
[CUSTOMER][NEUTRAL] Yes, that is what it says.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's the one I need for the hospital.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, yes, ma'am.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK. And then for wellness, they have a uh another kind for the wellness.
[AGENT][NEUTRAL] There should be, I believe, a wellness form on here, but then now I'm not seeing it. Let me take a look one second.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Short short term disability request change ownership.
[CUSTOMER][NEUTRAL] Miscellaneous treatment and service, could that be it? Miscellaneous?
[AGENT][NEUTRAL] No, let me click on oh it's on page 3. It's the very last one.
[CUSTOMER][NEUTRAL] OK, let's see. I go to 3.
[CUSTOMER][NEGATIVE] What the hell happened here?
[CUSTOMER][NEUTRAL] Alright, 3. OK, page 3. I need to get that page 3, wellness and screening, that is it. Now, do I send one in for my mammogram on that?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, if you, yeah, that you would send one in for that, yes ma'am.
[CUSTOMER][NEUTRAL] OK, cause I just had that done about a month ago.
[CUSTOMER][POSITIVE] I'm gonna send them all in. What I need to do? OK, that's the wellness.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, absolutely. So, yep, that would fall under wellness. Uh-huh.
[CUSTOMER][POSITIVE] OK, I just wanna get all this now. [PII]'s getting ready to go do a checkup. Now this will go underneath wellness and screening also.
[AGENT][NEUTRAL] Mhm, yes ma'am.
[CUSTOMER][NEUTRAL] OK, just checking.
[CUSTOMER][NEUTRAL] So I'm gonna get used to this.
[CUSTOMER][POSITIVE] All right, well, I thank you so much. I, I, I got it now. I just gotta get my printer to print it out.
[AGENT][POSITIVE] Yes ma'am. Well, if you have any other questions or concerns feel free to call, we're happy to help.
[CUSTOMER][POSITIVE] All right, well thank you so much have a good day honey.
[AGENT][POSITIVE] My pleasure. You too, [PII].
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][NEUTRAL] Bye bye.