AccountId: 011433970860
ContactId: cbbe6c53-32e3-4be4-917e-af79fb1be182
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 735880 ms
Total Talk Time (AGENT): 299188 ms
Total Talk Time (CUSTOMER): 252581 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/cbbe6c53-32e3-4be4-917e-af79fb1be182_20250320T15:06_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name's [PII]. I have the supplemental benefits um through my company, and this is the first time that I'm using them. I was sent a link and um was not able to access with my username and password which I thought I had set up, um, so I'm just calling to get help with that and also just some assistance filing a claim since this is my first time using the insurance.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Absolutely, Ms. [PII], I can help you um with the online service center and your claim. Um, may I please get your policy number?
[CUSTOMER][NEUTRAL] Um, do do do, let me see what was given to me. Hold on a second.
[CUSTOMER][NEUTRAL] Where would I find that?
[AGENT][NEUTRAL] Did, did you get a card?
[AGENT][NEUTRAL] Or might say member name that could say inpatient or outpatient certificate number.
[CUSTOMER][NEGATIVE] I don't believe I did.
[CUSTOMER][NEUTRAL] Mm, I don't know my company gave me a a document that included all of the different benefits available and I know I'm paying for the supplemental benefits and then I was given, oh I have a group number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, actually, Ms. [PII], if you give me your policy num I'm sorry, your social, it'll pull in all your policies for me, anything that you have with us.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please um verify your date of birth for me?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you ma'am and then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Sure, it's [PII]. Phone number is [PII].
[CUSTOMER][NEUTRAL] And D. [PII].
[AGENT][NEUTRAL] OK, thank you very much for um verifying your policy for me. So I'm showing that you have a group accident policy with us.
[AGENT][NEUTRAL] And a group illness policy with us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Are you there? OK, I'm glad.
[CUSTOMER][NEUTRAL] Yes, I'm here can you hear me?
[AGENT][NEUTRAL] Yes ma'am, I can hear you.
[AGENT][NEUTRAL] OK, so which policy is it that you're wanting to file a claim on the group critical illness or the group accident?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The accident.
[AGENT][NEUTRAL] Accident policy, OK.
[AGENT][NEUTRAL] First, let's go ahead and see if you're signed up for the online service center since you said that you had tried that already we're gonna make sure.
[AGENT][NEUTRAL] Um, that everything's OK over there.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] You're welcome. It's gonna be just a moment while.
[AGENT][NEUTRAL] OK, I do show that you're active on the online service center.
[CUSTOMER][NEUTRAL] And what is my username? Is it my email?
[AGENT][NEUTRAL] Uh, give it to you. It's [PII] 0214.
[AGENT][NEUTRAL] And the D is capitalized. The first D is capitalized, the rest is lowercase.
[CUSTOMER][NEUTRAL] And no no period between the [PII] and the A.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, let me try that and see if I can get in because I think I was just putting my email, so that was why it wasn't finding me.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Now if you get completely out of it and then go back in.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] It'll be easier. It won't give you any any good username and password in there.
[CUSTOMER][NEUTRAL] Oh yeah, that's what it was. I just had the, I just had the username.
[AGENT][POSITIVE] Awesome
[CUSTOMER][NEUTRAL] Um, wrong because I do remember setting it up.
[AGENT][NEUTRAL] OK, and when you're in that.
[AGENT][NEUTRAL] When you're in that online service center you're gonna go to claims and forms and you'll choose the group accident claim form to to fill out.
[CUSTOMER][NEUTRAL] OK, alright, let me look at that while I have you on the line.
[AGENT][NEUTRAL] And let me look. I'm gonna look at it.
[CUSTOMER][NEUTRAL] Um, OK, so.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] I can do file uh
[AGENT][NEUTRAL] So you can choose that accident claim.
[CUSTOMER][NEUTRAL] Oh, OK. Do I select the, so I see my coverage? Do I select that?
[CUSTOMER][NEUTRAL] Or do I go underneath where it says upload documents?
[AGENT][POSITIVE] Right. You're covered.
[AGENT][NEUTRAL] That's where it says upload documents. That's where you upload your documents to submit with your claim.
[CUSTOMER][NEUTRAL] OK, so how do I initiate the process? Is that this button that says file a wellness claim?
[AGENT][NEUTRAL] No, ma'am, you're gonna choose the accident claim for.
[CUSTOMER][NEUTRAL] So I, I click on the policy number?
[AGENT][POSITIVE] Yes, go ahead and click on that to pull it up for you.
[CUSTOMER][NEUTRAL] OK, that just looks like a PDF.
[CUSTOMER][NEUTRAL] Well that's just a description of it, so maybe I need to do this claim forms.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Claim forms, accident claim form you say?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And then I download the form.
[AGENT][NEUTRAL] Right, because you're gonna need to fill it out.
[AGENT][NEUTRAL] And the, um
[CUSTOMER][NEUTRAL] OK, got you. Alright, I see that here.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] That first page of the claim form.
[AGENT][NEUTRAL] That very first part tells you everything that you need to send in with your form or upload through the online service center.
[AGENT][NEUTRAL] You'll need the statement of insured. Do you see that part where it says complete the statement of insured sections A through F?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so that's me and then if I'm filling this out for my daughter, for example, would that be am I filling out the information here first name last name of her?
[AGENT][NEUTRAL] Yes, because she is the um dependent.
[CUSTOMER][NEUTRAL] Gotcha. OK.
[CUSTOMER][NEUTRAL] And then attending physician statement, does this need to be brought to the
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Physician.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, even if it was an ER visit and she was seen in the ER.
[AGENT][NEUTRAL] And I know it
[AGENT][POSITIVE] Yes ma'am, you still have to fill out that portion. I know it says completing section G is not required. However, completing this section will reduce delays. Go ahead and fill that out because it will just make the process for your claim go faster.
[CUSTOMER][NEUTRAL] EFG, OK.
[CUSTOMER][NEUTRAL] Signature patient or personal representative, would that be me?
[AGENT][NEUTRAL] Yes, that's you because you're the um parent and they're minor minor child.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So does this attending physician statement need to be sent directly to the physician that saw her in the emergency room?
[AGENT][NEUTRAL] It should be sent to the attending physician. It would have to be the one that actually, yes, that actually saw her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, all right, let me see.
[CUSTOMER][NEUTRAL] All right, well I'll look I'll look through this and then if I have any other questions I'll let you know um what.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Where can I find the, so the policy will tell me.
[CUSTOMER][NEUTRAL] Uh, um, let's see.
[CUSTOMER][NEUTRAL] So hospital admission.
[AGENT][NEUTRAL] And I'm gonna give you your policy number.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Since you didn't know it, would you like, like me to give that to you?
[AGENT][NEUTRAL] It's 258.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] 258-43997.
[CUSTOMER][NEUTRAL] OK, thank you and I'm looking at this my daughter went into.
[AGENT][POSITIVE] You're so welcome.
[CUSTOMER][NEUTRAL] The emergency room, she, um she got a cut in the back of her mouth, um, so she had to be seen. No stitches or anything, um, just evaluation. So I think that would just be, do you know what that's considered? Just hospital? That's not hospital admission because it's the emergency room, right?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Right. It, it's not, a hospital admission is 18 hours or more.
[AGENT][NEUTRAL] So it was on your emergency room.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] So it just falls under emergency room there's a section here oh, emergency room treatment, I see. OK.
[CUSTOMER][NEUTRAL] And then if she had a follow up to be seen, would that be a physician's office treatment because of the injury?
[CUSTOMER][NEUTRAL] Or you just do one?
[AGENT][NEUTRAL] Yes, that would be physician's office.
[AGENT][NEUTRAL] You can go ahead and fill out for both um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because everything that they determine as far as your claim is based on what you submit as as your um your itemized statement goes with your.
[AGENT][NEUTRAL] Diagnosis and procedure codes, which means the diagnosis is what was it that was wrong and the procedure codes or what we did to fix it. Um.
[AGENT][NEUTRAL] And they they look at that too.
[CUSTOMER][NEUTRAL] OK, so if I think that she should have a claim for emergency room treatment and then physician's office treatment, I should do two separate claims.
[AGENT][NEUTRAL] I would do 2 separate. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, all right, perfect. Thank you so much.
[AGENT][POSITIVE] OK. It seems like you got it. You did really good for your first time.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] OK well you have a wonderful day and thanks for calling on APL.
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][NEUTRAL] Bye bye, ma'am.
[CUSTOMER][NEUTRAL] Bye bye.