AccountId: 011433970860
ContactId: c69926f2-e271-421f-836c-ce603f3d4cac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506809 ms
Total Talk Time (AGENT): 208082 ms
Total Talk Time (CUSTOMER): 256367 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/c69926f2-e271-421f-836c-ce603f3d4cac_20250324T16:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I have.
[CUSTOMER][NEUTRAL] [PII] on the phone, what she is calling about is she is wanting to, she has a claim question.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I have her policy number and a good callback number. She has been fully verified. Um, her policy number is 2147641. A good callback number is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 5455 and as I said, she has been fully verified.
[AGENT][NEUTRAL] OK, and can you give me that policy number one more time?
[CUSTOMER][NEUTRAL] 214-7641
[AGENT][NEUTRAL] OK, let me pull her policy up real quick.
[AGENT][NEUTRAL] OK, I've got [PII] pulled up and she's calling about a claim, is that right?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] OK, thanks [PII]. I appreciate you. You can go ahead and and release her.
[CUSTOMER][POSITIVE] All right. Well, thank you and I appreciate you too. Mm bye-bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello Miss [PII], this is [PII] with the care team. Um, I understand that you are calling today because you're checking on the claim, is that correct?
[CUSTOMER][NEUTRAL] Um, I don't know if I necessarily checking on a claim, but seeing what I need to do for a new kind of claim. I don't know.
[AGENT][NEUTRAL] You want OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So what I have going on is.
[AGENT][NEUTRAL] You would like
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I submitted my first accident claim.
[CUSTOMER][NEUTRAL] Last year, I think.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I don't know. So I do have, I have a surgery tomorrow, kind of dealing with the same accident. Like once they repaired my knee they realize like how expensive the damage is. So I have another surgery tomorrow with that accident claim. So I'm trying to figure out what do I need to submit for like the family because it says like the family lodging and all that. So I do have a family member who had to drive from [PII] to come here that's gonna, that has to stay with us for 6 months.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] I mean for 6 to 8 weeks to care for me because I can't drive for 6 to 8 weeks. So I just don't know like what do I have to submit for them to like just so I can at least reimburse her for for one whole time and two she had this have to say like.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Like right now she's in another family family member's house until she comes down here tomorrow.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then like her gas driving from [PII] and back to take care of me for 6 days a week.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I understand. um, so what you're going to need is to fill out the accident claim form. Do you have that downloaded on your computer yet? OK, so.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, because I'm a doctor filling that out now.
[AGENT][NEUTRAL] OK, so on the um section a non-local transportation you'll need to fill out that information along with the family family member lodging if that's applicable and then send in any receipts that you have with your claim form.
[CUSTOMER][NEUTRAL] OK, so her receipts for her gas.
[AGENT][NEUTRAL] Yeah, anything that you have as far as the travel for her to get here, plane ticket receipt for gas, um, lodging receipts, anything like that you may have.
[CUSTOMER][NEUTRAL] OK, so she's staying with me, so she wouldn't qualify for lodgings and she has to live with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Like, would, that's what I'm asking, like, would she qualify for anything because she has to live with me?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] No, ma'am. You would have to have like a hotel receipt to show that she's paid for a room.
[CUSTOMER][NEUTRAL] OK, yeah, so it would just be her gas to install, OK.
[AGENT][POSITIVE] It's good that you have somebody.
[CUSTOMER][NEUTRAL] And then do I submit one now?
[AGENT][POSITIVE] Um, yes, oh my gosh, it's so good that she's able to help you. Um, I would wait until you have the surgery.
[CUSTOMER][NEGATIVE] Yes, because if not, I'd be in big trouble.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do I submit one now for like on the way here?
[CUSTOMER][NEUTRAL] Yeah, that's it's tomorrow.
[AGENT][NEUTRAL] I would
[AGENT][NEUTRAL] Right. I would wait till you have that and you have all your, um your itemized statements.
[AGENT][NEUTRAL] any EOBs you may have from your primary insurance if you're using your primary insurance and your itemized statements and file everything together on the same claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, as far as, OK, so I'll put her first, like her coming down here on one, but can I file like her gas receipt for her going back home separately like later because that's gonna be 6 to 8 weeks later. I'd rather get the initial claim done now so I can pay off the surgery.
[AGENT][NEUTRAL] Right, I understand. Um.
[AGENT][NEUTRAL] Yes, ma'am. You can go ahead.
[CUSTOMER][NEUTRAL] Is that fine to submit the first portion and then submit that later?
[AGENT][NEUTRAL] Yes, ma'am. You can do that. And then just put a note um that you are.
[AGENT][NEUTRAL] Submitting the lodge the lodging for her or I'm sorry, submitting the gas receipts for her to come down and go home. Um, the only thing about that is, is without having proof that you actually had the accident.
[AGENT][NEUTRAL] And the surgery.
[AGENT][NEUTRAL] All they're getting is just you saying.
[CUSTOMER][POSITIVE] I'm gonna submit her first one when she comes down here with the surgery though like I'm gonna wait till I have because my surgery is tomorrow and Usher's normally good about having an itemized receipts like within the week. So I'm gonna submit her at least coming down here first only because that way I can give her some money back too.
[AGENT][POSITIVE] Oh, OK, got you. I got you.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] I just didn't want her to have to wait 6 to 8 weeks to get money back for both.
[AGENT][NEUTRAL] To go back home, right, yes, and make sure that when you send the second one in, you send your documentation for your surgery with that one also, so that they have that backup to show that it had taken place.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then.
[CUSTOMER][NEUTRAL] I think that was the only question I had. No, I do have a, I had to order a specialized knee brace, but the only thing I don't have like an itemized receipt from that. I just have the only receipt they provided with was like the receipt showing that I had to order home medical equipment. Is that enough, or do I have to try to get the itemized receipt for that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're gonna need the itemized receipt for that because they're gonna need to have the diagnosis code and procedure code why you need that brace.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, so let me work on doing that too.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, I don't know if you know this question too, because I asked the last lady and she did not know if my so my company is.
[CUSTOMER][NEUTRAL] Switching over from APL to another one. I do plan to continue with APL and not the new one, but.
[CUSTOMER][NEUTRAL] If some of the other ones are dropped, how long do I have to go back to claim on those? So like say if my hospital ended, how long after that hospital policy stops and I still go and claim stuff that was done during that policy period?
[AGENT][NEUTRAL] Right, uh, so as long as your policy was active on the date of service, the dates that you went to the doctor or whatever, as long as it was active on that date of service, there's not a timely filing limit, so you can file at any time.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I think that was it because I'll just have to wait for them to end it and then y'all will send me the paperwork so I can make all these portable.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I think that was it.
[AGENT][NEUTRAL] OK. Is there anything else that I can help you with, Miss [PII]?
[CUSTOMER][NEUTRAL] No, ma'am. That was all.
[AGENT][POSITIVE] OK. Well, I hope you have a good surgery tomorrow and everything goes well for you and you're not in too much pain. You're welcome.
[CUSTOMER][POSITIVE] Mhm thank you.
[AGENT][POSITIVE] You're very welcome. Uh, you too, and thank you for calling APL.
[CUSTOMER][POSITIVE] Alright have a good day.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.