AccountId: 011433970860
ContactId: c0f96269-0640-4e8a-9c5c-fe18ae1550f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 526169 ms
Total Talk Time (AGENT): 252961 ms
Total Talk Time (CUSTOMER): 214788 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/c0f96269-0640-4e8a-9c5c-fe18ae1550f5_20250617T16:28_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Yes, ma'am. My name is [PII] and um I had a heart attack in April. And um
[CUSTOMER][NEUTRAL] Just been kind of waiting for all of the dust to settle with the bills so that I could get your payout for my policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so um I've got our giant stack of bills in from the insurance company and it looks like it it must be.
[CUSTOMER][NEUTRAL] Taken care of as far as maybe they've gotten all the information that y'all need for me to process my claim now.
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] So how does that work? Y'all contact the hospital and request the records that you need?
[AGENT][NEUTRAL] Um, let me check and see what is your policy, what type of policy you have, what we need and how we can go about this claim, OK, Miss [PII]. Um, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] Sure, it's 023.
[CUSTOMER][NEUTRAL] 94
[CUSTOMER][NEUTRAL] 730
[AGENT][NEUTRAL] Thank you. For security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Sure. Uh
[CUSTOMER][NEUTRAL] [PII] is my birthday email uh.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Would it be my personal or my work. It'd be, if it's personal, it's no more than [PII].
[AGENT][NEUTRAL] In person.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] At [PII], is that what you have?
[AGENT][POSITIVE] Yes, we do have the personal, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What else was it you wanted?
[AGENT][NEUTRAL] In the
[AGENT][NEUTRAL] Mailing address?
[CUSTOMER][NEUTRAL] The what? 0 [PII].
[AGENT][NEUTRAL] The mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, Ms. [PII], uh, have you gotten a copy of the claim form?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] No. OK. So, all right, so you're gonna need the.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Inform on the claim form you can find it on our website at [PII].
[CUSTOMER][NEUTRAL] Uh, what is it? Tell me again, you're kinda cutting out a little bit.
[AGENT][POSITIVE] Yeah, I can, I can tell. Um, I'm so sorry for that.
[CUSTOMER][NEUTRAL] [PII] claim.
[AGENT][NEUTRAL] Yes, just [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so when you go to [PII], you will click on claims and forms.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me make sure and see which one you need. Bear with me just a second. Let me pull the details of your policy.
[AGENT][NEUTRAL] One.
[CUSTOMER][NEUTRAL] So I spoke to someone about this before. Her name was [PII].
[CUSTOMER][NEUTRAL] And I've got pathology report itemized bill hospital ICD code.
[CUSTOMER][NEUTRAL] And a UBO4 which is I guess the same thing as the itemized bill that's what y'all need.
[AGENT][NEUTRAL] OK. And this was just for the heart attack, or is it, it's not cancer related, is it?
[CUSTOMER][NEUTRAL] No, I have a cancer policy and there just happened to be a some coverage in there for a heart attack and I just like happened to have a heart attack.
[AGENT][NEUTRAL] Got you. OK, OK. I understand. OK. So yeah, this is the cancer policy. Um, now, um, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me go ahead and
[AGENT][NEUTRAL] Search the claim forms and see. I think it's gonna be the cancer claim form if not if I'm not mistaken, but let me double check, OK.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, OK, yeah, so far it's gonna be that one. OK, so it's gonna be the cancer claim form.
[AGENT][NEUTRAL] On the first page of that form, you're gonna see the instructions based on what happened or what type of claim you're trying to submit.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And then you just go ahead and fill the claim form entirely, OK?
[CUSTOMER][NEUTRAL] OK, I wanna ask a question. Um, I was kind of reading through the policy and there is like a $200 coverage for ambulance.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Does that apply for the heart attack as well? I mean, I didn't, mine was um transferred from one emergency room to a hospital and I had to be taken by ambulance, but they didn't have to like do anything to me. It was just a transport. So do y'all offer the coverage to this policy for that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, not for the heart attack and stroke. The heart attack and stroke is just that benefit amount, which is a flat amount. Um, the rest of the benefits are, are for cancer.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, I just want to check because I have like a $600 bill.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] From the ambulance for the ride, so.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, I understand. And you can send it in and let us look into it, but based on what I'm seeing, the heart attack and stroke is a separate benefit. It's like an addition to the cancer policy, and that amount is a flat amount, the 2500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] All right, so like I said, let's see, hopefully I have everything in now it's been a while since this happened so we can get this done.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Because I had to miss a month of work, so this is kind of like helping me get through that.
[AGENT][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] Uh, no paycheck period.
[AGENT][NEUTRAL] Mm, mm.
[CUSTOMER][NEUTRAL] OK, well, I will get online and see what I can do and uh.
[CUSTOMER][POSITIVE] Get that handled. Thank you so much.
[AGENT][NEUTRAL] OK. You're welcome and um you can always register online if you go to the website and click on sign in, you can create an account and you can submit the claim electronically if you want to do that through the website once you register and you can keep track of the claims and everything.
[CUSTOMER][NEUTRAL] Well, I mean, somebody, either you're gonna have to communicate with the hospital or the hospital is gonna have to communicate with you for the itemized things that you're wanting that's why I was asking, do y'all do that or does the hospital need to do that?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, um, whenever there's a claim that needs to be submitted to us due to, um, HIPAA, we cannot just go ahead and call the hospital and get information because they will not give it to us because of security. So, um, you need to go ahead and contact the hospital to get any itemized bills that you're gonna need and go ahead and just upload it into the account.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or send it by mail or fax. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, thank you.
[AGENT][NEUTRAL] Yes, unless we are gonna request, yes, unless we're gonna request like medical records, like the whole medical records, then we'll go ahead and do that part. So the medical records, we can go ahead and request if we need them, but if it's just the itemized bills and that one, you need to get them from them, OK?
[CUSTOMER][NEUTRAL] Well, she told me, this lady, [PII] that I spoke to prior to you told me this is the list of what she said I need a pathology report and an itemized bill. And then
[CUSTOMER][NEUTRAL] It says the hospital ICD 10 code and then.
[CUSTOMER][NEUTRAL] Underneath that I have a UBO4 written but that I have a little arrow drone up to the itemized bill like it's the same.
[AGENT][NEUTRAL] It is, yes, the UBO4 is the same as the itemized bill. If you send the UBO4, you don't have to send anything else but the UBO4, um, and the pathology report and everything else, but you don't have to send an itemized bill and the UBO4 because they're the same thing.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK. OK. All right. Well, I'll try to see if I can get some help from the hospital with all this. Thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome. Is there anything else I may help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] Uh, we'll see. Thank you.
[AGENT][POSITIVE] OK. You're welcome. You have a good day. If you have any other questions or concerns, just feel free to call us back, OK?
[CUSTOMER][POSITIVE] OK, thank you, ma'am bye bye.
[AGENT][POSITIVE] You're welcome. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.