AccountId: 011433970860
ContactId: d1fd9b94-b36e-4952-82e5-544f6bb7fbf8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 563190 ms
Total Talk Time (AGENT): 262722 ms
Total Talk Time (CUSTOMER): 218899 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/d1fd9b94-b36e-4952-82e5-544f6bb7fbf8_20250304T18:19_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I had a couple of questions regarding my husband's benefits and to report a hospital stay.
[AGENT][NEUTRAL] OK, and I'm sorry, your name is?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh-huh, my name is [PII].
[CUSTOMER][NEUTRAL] His name is [PII], and I can give you his ID number. Give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] Uh what did I do with the card?
[CUSTOMER][NEUTRAL] Give me a second to
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Certificate, do you need the certificate number?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, the certificate number is 0233.
[CUSTOMER][NEUTRAL] 321 3
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And I apologize your name is again?
[CUSTOMER][NEUTRAL] My name is [PII], and what do we need to do to put on file so that I'm able to call to check on this for him?
[AGENT][NEUTRAL] Um, well, we would need a third-party authorization form or a POA.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I can send the POA. I have that.
[AGENT][NEUTRAL] Uh, yes, ma'am. If you can send that to our customer service department or you can email it to us, because in order to speak with you.
[CUSTOMER][NEUTRAL] OK, how do I send it to the
[AGENT][NEUTRAL] Um, the
[CUSTOMER][NEUTRAL] The customer service department, mhm.
[AGENT][NEUTRAL] Yes, ma'am. The email address is [PII].
[CUSTOMER][NEUTRAL] OK, and he's right here. I was just trying to get that part out of the way.
[AGENT][NEUTRAL] OK, well, I can verbally speak to him. Sure.
[CUSTOMER][NEUTRAL] OK, give me a second, I'll put him on the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Hello, good morning.
[AGENT][NEUTRAL] Uh, good morning. This is Mr. [PII]?
[CUSTOMER][NEUTRAL] It is, ma'am.
[AGENT][NEUTRAL] Uh, verify your date of birth, mail address and email address for me, please.
[CUSTOMER][NEUTRAL] [PII]. My address is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And your
[CUSTOMER][NEUTRAL] And my email is [PII].
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] OK, thank you so much. And you've given us permission to speak with your wife. Is it [PII]?
[CUSTOMER][NEUTRAL] Toy T O I.
[AGENT][NEUTRAL] Toy. Oh, OK.
[CUSTOMER][POSITIVE] Like with Toy Story, just with the eye.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. And OK, it's just giving us permission to speak with her today, any kind of further, if she's helping you, we would need a third party authorization form that is available on our website.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we'll print it out and give it back to you.
[AGENT][NEUTRAL] OK. OK. I, I can speak with her.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and Ms. [PII], you say you were calling for benefits?
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] Yes, I wanted to see what the benefits were because on his um enrollment documents or the plan documents it doesn't specify like what plan they're on and what the benefits are.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK. I just wanna type in notes that your husband gave us permission to speak with you today, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And you're needing benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, well, is this, uh, is there any specific benefits or just in general?
[CUSTOMER][NEUTRAL] Just in general, the hospital indemnity.
[AGENT][NEUTRAL] OK. Well, with this policy, um, he has benefits for inpatient confinement, uh, surgery if performed in a facility or in a physician's office, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's an outpatient wire covers for ER urgent care, office visits for um.
[CUSTOMER][NEUTRAL] What's the, that's what what is the uh urge the ER benefits.
[CUSTOMER][NEUTRAL] The amount
[AGENT][NEUTRAL] Uh, see.
[CUSTOMER][NEUTRAL] Because they gave us a list of everything, but they said plan 1 and plan 2 or plan A and Plan B or something like that. So I was just trying to see which plan he fell under.
[AGENT][NEUTRAL] OK, uh, well, not a guarantee of payment, just a verification of coverage for ER and let me double check if it has to be for just injury only or if it's for sickness. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like uh for accident only, um, it pays.
[AGENT][NEUTRAL] Once per count a year up to 1000 for ER.
[CUSTOMER][NEUTRAL] OK, and what is the hospital indemnity plan?
[AGENT][NEUTRAL] Uh, hospital indemnity, meaning that it's just a certain max that we will pay for coverage services like, um, for instance, the ER, the max we will pay is up to 1000, um, whether you have other insurance or not or
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Whether how much was um charged, the max we are going to pay is just that $1000.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK, so that's what his plan says because what they, the plan that they gave us says something different.
[AGENT][NEUTRAL] Well, that's the way the plan works, and indemnity policy, it just pays the benefit according to the policy. Like, for instance, hospital admission, meaning if he is admitted into the hospital, um, the max we're going to pay is just $3000 and that's just the max or a daily hospital confinement benefit that pays up to $250 per day, up to 60 days.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the max we're just gonna pay is up to $250 per day and a max of 60 days per year.
[CUSTOMER][NEUTRAL] OK, and then where did you get the 3000?
[AGENT][NEUTRAL] That's for the hospital admission benefit, being admitted into the hospitals and patients.
[CUSTOMER][NEUTRAL] OK, so the admission benefit is 3000 and then $250 a day up to 60 days per year.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so is that the 3000 and then so like if he was admitted today.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then that benefit would be 3000.
[AGENT][NEUTRAL] It could be, yes. We can't give a guarantee, just verify, but yes, ma'am.
[CUSTOMER][NEUTRAL] Could be OK, right, I'll just, just, yes ma'am, just for, just for conversational purposes and then it would start 250 per day after that.
[AGENT][NEUTRAL] And per day that he
[AGENT][NEUTRAL] Right, from the day he's confined, it will start from the first day until he is no longer confined in the hospital up to 60 days, pay $250 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and OK.
[CUSTOMER][NEUTRAL] Alrighty, and I think that's all that I needed. Did I need to report because he's in the he he was admitted into the hospital two days ago. Do I need to report that or do I just need to wait until I'm able to get an itemized?
[AGENT][NEUTRAL] Um, well, we will need an itemized bill or you can give the information to the hospital if you want them to file, um.
[AGENT][NEUTRAL] But we, we can't.
[CUSTOMER][NEUTRAL] OK, what information would I give to them?
[AGENT][NEUTRAL] Uh, the policy number and our phone number, that way they can call and verify any benefits. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm sorry, I didn't catch your name.
[AGENT][NEUTRAL] And it's [PII]
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Thank you Ms. [PII]. OK, I think that that's all that I needed, uh, I have update uploaded some prior claims.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And I do show claims have been received, but they are just in line for processing.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, I just, I, I just got the itemized statements, uh, from the hospital. OK, that's all that I needed to know, and I appreciate your help. I'll give, uh, so from now on we just need to when we check into the hospital, uh, if he's admitted, then we need to go ahead and give them the information, as one of the policies.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes, ma'am. You can give the provider the information and they can file or if you want after he's been discharged, y'all can file a claim. Either way it's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, then maybe, but I'll, I think I'll just do both and just check, follow up. OK, that's all that I need. Thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII]. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Mhm.