AccountId: 011433970860
ContactId: cf15b5ec-ead3-442d-9ed5-a897fc1cca04
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1229079 ms
Total Talk Time (AGENT): 516932 ms
Total Talk Time (CUSTOMER): 478192 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/cf15b5ec-ead3-442d-9ed5-a897fc1cca04_20250527T21:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APM. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I got a claim form, um, that I'm trying to fill out for an accident.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and I'm not exactly sure like I've, I've never used this insurance before, so I have no idea what.
[CUSTOMER][NEUTRAL] Um, I got the claim form and I've got the, um, all the stuff from the doctors. It was a walk-in clinic, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know exactly how to go about filling and what papers that I have to fill out.
[CUSTOMER][NEUTRAL] Or send in
[AGENT][NEUTRAL] OK. Well, I can help you with filing your claim. Um, 1st may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] OK, it's uh 337.
[CUSTOMER][NEUTRAL] 501.
[CUSTOMER][NEUTRAL] 353 2.
[AGENT][POSITIVE] Thank you, and your policy number whenever you're ready.
[CUSTOMER][NEUTRAL] OK. Um, let's see.
[CUSTOMER][NEUTRAL] It's 257-6700.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I have you here. I just need you to verify your date of birth, the mailing and email address on file.
[CUSTOMER][NEUTRAL] OK, it's for my husband, so should I give his information?
[AGENT][NEUTRAL] Um, no, you're on the policy as well. I just need to verify just your name and the mailing address. I'm sorry, your date of birth and the mailing address.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So on the first page of the claim form, it has um like instructions depending on what you're filing for, it'll show you what documents are needed. But for the doctors, like if you um if there are multiple doctors or if it's something like, um, you, you know, you didn't see the same one over.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Then you can also present your medical records, um, cause it'll be kinda hard to try to get a doctor's signature, you know, if it's not.
[CUSTOMER][NEUTRAL] Right, that's what I was thinking. OK, so I have the, um, I have page 2.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and, um, on the statement of insured, I put my husband's name and then all the information, um.
[CUSTOMER][NEUTRAL] And it's telling me in your own words explain the injuries and how the accident occurred. So do I need to write that, or is the doctor's not good?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, no, you can just.
[CUSTOMER][NEUTRAL] Like it says triage notes.
[AGENT][NEUTRAL] Um, you can just briefly describe in there, and the only reason we're saying, I'm saying that is because if you leave it blank, it it could be denied. So you can um put just a brief description of whatever happened and then proceed on to the next part.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see what else I needed to ask. um.
[CUSTOMER][NEUTRAL] And it goes under the accidental injury section.
[CUSTOMER][NEUTRAL] So I clicked accidental injury for section D.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now section, non-local transport. I mean he brought himself to the doctor, so.
[AGENT][NEUTRAL] Well, no, each part might not
[CUSTOMER][NEUTRAL] I can just leave that.
[AGENT][NEUTRAL] Um, pertain to you. So for those, yes, I would just mark like a, you can put like an NA through it.
[CUSTOMER][NEUTRAL] Pertain, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the lodging as well if you need to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and it says um at the bottom I just need to get him to sign.
[AGENT][NEUTRAL] Uh, sign and date.
[CUSTOMER][NEUTRAL] Um, now the, uh, yes, on page 4,
[CUSTOMER][NEUTRAL] The APL, uh, policy number, that's the number that I just gave you.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so that's the 257.
[AGENT][NEUTRAL] The 257. Mhm.
[CUSTOMER][NEUTRAL] 6700 OK and then his name.
[CUSTOMER][NEUTRAL] OK, let's see, um, and then his signature and then it says, uh, OK, the relationship that'll, I don't have to fill that out. OK, now the accident claim form, um.
[AGENT][NEUTRAL] Now, for that part, this would be where the doctor would sign. Um, if you're unable to, to get a, you know, like if there's not one doctor that he sees, then it would just be the medical records from whatever data service you're filing for.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so and then that'll be it plus all the copies of the records.
[AGENT][NEUTRAL] Mhm. And then uh I think that after the doctor, that's the, yeah, that's the last page. So yes, ma'am, that's all. I just want to make sure there was nothing else after it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, OK, and um.
[CUSTOMER][NEUTRAL] Let's see, also he had the um hospital claim, um.
[CUSTOMER][NEUTRAL] Do we have that under the same policy, you know?
[AGENT][NEUTRAL] When you say hospital claim, like, like a hospital stay?
[CUSTOMER][NEUTRAL] No, it's emergency room visit we had to go.
[AGENT][NEUTRAL] Um, let me see, hold on one second, is this
[CUSTOMER][NEUTRAL] This is we, we just got all this insurance so we have no idea um and we don't have anything that lists all of our.
[CUSTOMER][NEUTRAL] Um, policies that we have, they were supposed to be sending me something, but I don't know if she was sending out just for that accidental policy, but I think we have it like an emergency room, um.
[CUSTOMER][NEUTRAL] Policy of cancer or something, you know, there's some other stuff.
[AGENT][NEUTRAL] Yes, um, yes, so I do see that you have the cancer policy and you have the accident policy. Um, so it looks like the, let me see if I'm trying to access the benefits, but I don't see that it's on here.
[CUSTOMER][NEUTRAL] Yeah, um, and we also have think an emergency room.
[AGENT][NEUTRAL] That could be a benefit on this policy. I just can't access it. Hold on one second, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Let me see, um, OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What is up with this?
[AGENT][NEUTRAL] screening.
[AGENT][NEUTRAL] Ambulance.
[AGENT][NEUTRAL] Emergency.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Alright, thanks so much for holding. I apologize for that wait. So I'm gonna do a few things. So I was able to look like in the policy um for emergency room treatment which you do have, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like the policy will pay up to $200 per day, um.
[AGENT][NEUTRAL] For the um per day that you were in the emergency room, and then I'm also going to put a request for your actual policy to be uploaded so that you can access it online and so that we can access it if you need to call again, um.
[AGENT][NEUTRAL] That has like all the coverage and what benefit would be, you know, how much you pay if this happens and
[AGENT][NEUTRAL] Um, just like a breakdown of the, the policy.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK, I just need to, is there like a booklet?
[CUSTOMER][NEUTRAL] Um, with all the benefit information in it and all that.
[AGENT][NEUTRAL] Mhm, that's what I'm referencing. So I'm getting ready to have them generated so that when you go online, you can just click it and you'll see it there, um, but it's not, it hasn't been generated, so that's why you don't have a copy and there's nowhere to find it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, well, I didn't even look online because I had no way to look. I don't, I didn't even know the name of the policy or anything, so.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah. And I usually like,
[AGENT][NEUTRAL] So I can do.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I was just gonna say, so since you have it, um, I'll do two things. I'll go ahead and make request the digital, but I'll also have for the physical copies to be mailed to your home so you can have them.
[CUSTOMER][POSITIVE] I would appreciate it. Yes, thank you.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, now, um, he had a hospital visit, so I need to get, I guess the records from that and then um.
[CUSTOMER][NEUTRAL] Can you send me the form, the email me the form, um, for the hospital emergency room?
[AGENT][NEUTRAL] Well, it's all the accident, that's a benefit under your accident policy.
[AGENT][NEUTRAL] So it's the same form that we just
[CUSTOMER][NEUTRAL] OK, so we still use.
[CUSTOMER][NEUTRAL] OK, let me um let me see here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If there was um
[CUSTOMER][NEUTRAL] So you put it under the accident claim form and so.
[CUSTOMER][NEUTRAL] When it comes down it says benefits claims.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] There's nowhere it doesn't say.
[CUSTOMER][NEUTRAL] I mean what would I check for section D?
[AGENT][NEUTRAL] Well, you, so you already checked the accidental injury. So at this point, once you check that, they're just gonna look at the documents and see the emergency room, um, and the dates.
[CUSTOMER][NEUTRAL] No, this is something, yeah, this is a different claim.
[AGENT][NEUTRAL] So then it would be 2 claim forms.
[CUSTOMER][NEUTRAL] He's had 2 recently, so.
[CUSTOMER][NEUTRAL] Right, so I would still use the same form for the, because the first one, the accident that he had, that was at um oh he went to the walk-in clinic for that one. And this last one was the, um we had to take him to the emergency room.
[CUSTOMER][NEUTRAL] Um, so, and it's something different.
[AGENT][NEUTRAL] Alright, so is it
[CUSTOMER][NEUTRAL] So what would I
[AGENT][NEUTRAL] So let me ask you this, because you don't have a medical policy with us, the emergency room benefit is in relation to an accident. So if it's something different,
[AGENT][NEUTRAL] If it's not in relation
[CUSTOMER][NEUTRAL] Well, we didn't know exactly, yeah, um, we didn't know exactly what the problem was, and that's, we had to take him to the emergency room, the walk-in clinic couldn't have handled it. So he thought he had pulled something and it wasn't, it was, ended up.
[AGENT][NEUTRAL] So it is in relation to the accident.
[CUSTOMER][NEUTRAL] It wasn't a pool.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so then it
[CUSTOMER][NEUTRAL] Because he thought he had pulled something in his groin, but it ended up being it was an infection.
[AGENT][NEUTRAL] OK, so as long as
[CUSTOMER][NEUTRAL] So, um, and they don't.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] As long as it's in reference.
[CUSTOMER][NEUTRAL] I didn't hear you.
[AGENT][NEUTRAL] As long as it's in reference to the accident, either you can use one, you would have to use the one claim claim form because it's all that accidental injury and then the documents, they'll be able to see that it's the emergency room, even if it's a separate day, if it's still in reference to that accident, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It could still be covered.
[CUSTOMER][NEUTRAL] OK, but these two incidents this was something totally different.
[CUSTOMER][NEUTRAL] So I would fill out two separate forms, but I thought we just had like a hospital policy and we had in case we had to go to the emergency room.
[CUSTOMER][NEUTRAL] For, you know, whatever.
[AGENT][NEUTRAL] No, so you only have the accident policy with us and the cancer policy. So unless it's in relation to an accident or cancer or prevention, you wouldn't be able to use the APL policy.
[CUSTOMER][NEUTRAL] OK. Now, let me ask you this, when we go in for our checkups and things like I go for my um mammogram and I also go for my yearly checkup at the gynecologist, so I could claim that on the, that form too.
[AGENT][NEUTRAL] Um, let me see if your cancer policy has a wellness benefit. If it does, then it would be filed under the cancer policy. Um, if not,
[CUSTOMER][NEUTRAL] For the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, hold on one moment, let me check this policy.
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so under your cancer policy, you do have a diagnostic testing um that'll cover one test per calendar year um for cancer screening. So you could take advantage of that for like your um like your mammograms, um, but that will be filed under, under the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][NEUTRAL] You'll be using the wellness claim form so that you can elect or select which um test you're getting, but the cancer policy does pay out up to $100.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so we, we can, um, like my husband goes in for his wellness or whatever he can claim that.
[AGENT][NEUTRAL] Correct, under the cancer.
[CUSTOMER][NEUTRAL] Also
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, let me just double check that. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so under the diagnostic testing for your cancer screening benefit, um, it lists a bunch of tests, mammogram, breast ultrasound, um,
[AGENT][NEUTRAL] Prostate exam, so as long as it's preventative and for cancer, you can file it under your cancer policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now on this accident, uh, claim form for what is the um.
[CUSTOMER][NEUTRAL] What do you get paid for that one?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Well, that's the one that we're going to get the policy uploaded so that we can see the breakdown, but that had the emergency room benefit on it. Um, I mean, like what happened, I can look on this list and see.
[CUSTOMER][NEUTRAL] OK. Well, he thought he had a, a bite, um, like something bit him. And then it just, his arms started swelling up and he was having trouble with the, like the shoulder and all that. Um.
[AGENT][NEUTRAL] Um, so yeah, I, I.
[AGENT][NEUTRAL] There's a, there's a lot of different benefits here, um.
[AGENT][NEUTRAL] I don't want to say yes and then it's a no, the, the best thing to do is to just submit it so we can have a claims examiner process it and see what benefits go with it. Um, but you definitely do have the um emergency room benefit and then depending on what these, this list of accidents, if anything, if it does.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If it does go with anything on this list, then the examiner would definitely pay out.
[CUSTOMER][NEUTRAL] OK, alright, so I can just print out the form for um I did the first one already so I can print out the um.
[CUSTOMER][NEUTRAL] The form for the next one.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But I was just wondering, I didn't know, I guess it'll just go under accidental injury.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Cause it's a, a bite.
[AGENT][NEUTRAL] Yeah, uh, we can put it under accidental injury and then once it's assessed, um, they'll see if it's if it's considered an accident and then go, go down that route. I just can't really guarantee anything because I'm not a claims examiner and I don't.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There are a list of a list of accidents here, but I don't know.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, alright, and I see it also says um.
[AGENT][NEUTRAL] How they would categorize it.
[CUSTOMER][NEUTRAL] Accident medical expense benefits. So like is that including his prescriptions? Do I need to get a copy of that, the cost of that?
[AGENT][NEUTRAL] Mhm. That's for like if he goes to the emergency room, how many days, and that's not really for the medication.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But again, once they see all of your
[CUSTOMER][NEUTRAL] OK, so uh.
[AGENT][NEUTRAL] Records for the stay, they're gonna go through this list and see what all applies with what the records are showing and pay out for each benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, now do I also need, I see there's a thing it says prescription drugs, so is that um.
[CUSTOMER][NEUTRAL] Including, you know, do I need, I, so you don't think I need to send the amount, uh, the cost of the uh medicine prescribed with this?
[AGENT][NEUTRAL] Hold on one moment, let me see what's on prescription.
[AGENT][NEUTRAL] I mean, if you're sending in the medical records, the prescription.
[AGENT][NEUTRAL] All of that's gonna be in the record.
[CUSTOMER][NEUTRAL] I don't even know if I saw that one here.
[AGENT][NEUTRAL] Um, but let me see.
[CUSTOMER][NEUTRAL] Oh yeah. Medication orders. OK.
[CUSTOMER][NEUTRAL] I see it on the um.
[CUSTOMER][NEUTRAL] Prednisone,
[AGENT][NEUTRAL] Yeah, and then it'll show like if there's an amount of days.
[AGENT][NEUTRAL] It usually says all of that in the records and then they'll be able to see for this prescription drug um.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] How they can pay out for it.
[CUSTOMER][POSITIVE] Alrighty, OK, well thank you so much. I appreciate it.
[AGENT][NEUTRAL] You're very welcome. So I'm getting ready to send the request to have the digital copy of your accident policy um uploaded online as well as the physical copy mailed to your home address. And then, um, was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is it.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.