AccountId: 011433970860
ContactId: d27dc0a2-2307-4038-8eb3-0811df361d6c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 620960 ms
Total Talk Time (AGENT): 322515 ms
Total Talk Time (CUSTOMER): 246790 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/d27dc0a2-2307-4038-8eb3-0811df361d6c_20250117T19:28_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello. Hi, my name is [PII]. My husband is [PII], um, and I just found out that he actually has this insurance policy. He was admitted to, um, the hospital, and I need to find out what we have to do.
[AGENT][NEUTRAL] OK, I'm so sorry it kind of cut out there at the beginning, um, are we you're needing help, uh, filing a claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I guess.
[AGENT][NEUTRAL] OK, sorry about that um all right uh what was your name?
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] My name is [PII], but the person is [PII].
[CUSTOMER][NEUTRAL] [PII], my husband.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright and [PII], uh, can I get a good call back number from you really quick in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Alright, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] I do it is um 02373169.
[AGENT][POSITIVE] Alright thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, is [PII], oh excuse me, is [PII] available that I could speak with him?
[CUSTOMER][NEGATIVE] He, yes, he's on speaker. He has trouble talking.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hi [PII]. I just need to verify some information really quick. Um, can I get your date of birth please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. uh, looks like it is a Yahoo account.
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, I appreciate you verifying that information, [PII]. Uh, do we have permission to speak with [PII] on your behalf?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Yes, ma'am. I, I've had a stroke. It's hard for me to talk.
[AGENT][NEUTRAL] Yeah, I'm so sorry to have to make you um as she's not listed I did have to have that verbal consent um I appreciate it though I can I can speak to her from here thank you.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright appreciate all of that. OK, so we're just needing help on how to file a claim, is that right?
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so let's take a look here.
[AGENT][NEUTRAL] So y'all have a couple of different options. I will say um the quickest and generally the easiest way to get claim information to us is going to be through our online portal. Do y'all have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No. All I have is my phone.
[AGENT][NEUTRAL] You don't
[AGENT][NEUTRAL] OK, um, well, the reason I ask is that uh the website really doesn't have much support for mobile devices, so that may not work, um, OK, other options would be, um, I've got a mailing address and a fax number.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm. Yeah, I think.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, I mean, I might go to my office at some point in time. I just don't know is there like a, a window of how long because he, he got admitted on the [PII] to ICU and we're still in the hospital, so and we just now remembered.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] Oh, no, no.
[AGENT][NEUTRAL] I understand OK.
[AGENT][POSITIVE] No worries, yeah, you don't have to stress about that. There is no timely filing limit um so as long as y'all can file that at your convenience that's perfectly fine.
[CUSTOMER][NEUTRAL] OK, so I just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so does it say, I mean, is there a certain amount that he gets per day or is there a certain amount period or how does that work?
[AGENT][NEUTRAL] Let's take a look here.
[AGENT][NEUTRAL] So he was uh hospitalized as inpatient, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, let's take a look here. Give me just a moment. I'm gonna get the.
[AGENT][NEUTRAL] Policy pulled up here.
[AGENT][NEUTRAL] Bear with me just a moment. I'm thinking about it.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Here we go. OK.
[AGENT][NEUTRAL] So you've got, let's see, hospital admission benefit. So that's going to be.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Maximum of 1 day per calendar year, so that's a $3000 benefit of just simply being admitted to a hospital, um, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was there surgery required at all?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is he currently in an emergency room?
[CUSTOMER][NEUTRAL] No, he was in he was in intensive care, critical care for 6 days, yeah, intensive care, mhm.
[AGENT][NEUTRAL] Intensive care, OK.
[AGENT][NEUTRAL] Alright, let's take a look here.
[AGENT][NEUTRAL] From what I see that looks like that's going to be the only.
[AGENT][POSITIVE] Applicable benefits to this situation.
[AGENT][NEUTRAL] But let me look a little bit closer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I was thinking when I signed up, I was supposed to get so much a day. Yeah, I don't know. I don't know.
[CUSTOMER][NEUTRAL] Is she still here? Are you still here?
[AGENT][POSITIVE] Oh yes, I'm so sorry. I'm still digging.
[CUSTOMER][NEUTRAL] OK, OK. No, I thought my phone hung up. I thought my phone hung up.
[AGENT][NEUTRAL] No, no, sorry, I just wanna make sure I get all this information.
[CUSTOMER][NEUTRAL] No, my phone just kinda went in. Yeah, that's fine.
[AGENT][NEUTRAL] Let's see. Yeah, that looks like the extent of it. Um, there are other benefits, of course, on this policy, but they're gonna be in regard to if there was a surgery or, um, you know, emergency room urgent care physician's office visit. Um, that's pretty much the extent of it.
[CUSTOMER][NEUTRAL] Yeah, yeah, he did, yeah.
[CUSTOMER][NEUTRAL] Yeah, he went into the emergency room and was in the emergency room and then he got admitted into critical care, so.
[AGENT][POSITIVE] I see. OK, so that could be a benefit as well then. So that one is uh $300 for simply going to the emergency room. Um, I'm more than happy if y'all want. I can send you a copy of this policy just so you'll have it for your record. Um, it's real easy to read, it's not just so much jargon, I promise, um, but I can email that to y'all if you want.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that'll be fine.
[AGENT][NEUTRAL] OK, uh, let's see, just to this email address that or the I'm sorry, the [PII] that we've got the HFDC shift.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alrighty I'll go ahead and send that to you now um did you have any other questions for me at the moment?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] No, just, um, on the back of the card it said to give that card to the hospital but we didn't have anybody we could give it to because he went straight in. So do I still need to try to give them a copy of this policy or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] I would um simply because if they were willing to file the claims for you it's just that much less for you to have to worry about um but unfortunately it will be.
[CUSTOMER][NEUTRAL] On that
[CUSTOMER][NEUTRAL] Yeah, OK, OK, but I don't, but I can just go on, yeah.
[AGENT][POSITIVE] You absolutely can if they give you any kind of push back or anything like that like they're not able to take it um y'all can absolutely file this claim yourself yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, OK, so and they'll just they'll go into his records to see proof where he's been here, right?
[AGENT][POSITIVE] Yeah, so what, um, when y'all get all of it together, um, the the providers will have everything that you need we would simply need um itemized statement that shows diagnosis and procedure codes so you know what he came in for and what kind of treatment he received, um, admission date, uh, discharge date, and of course they'll have all of that and then you could send that to us and we'll be able to get those claim paid for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, I'm probably about to specifically ask for that. If I don't, because, because the card says the I'm gonna have to specific if I go online myself and try to file this, I don't have access. I don't know what his diagnosis code is, you know what I'm saying?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, the, oh yeah, the provider will have that though, so if you could ask them for that, they'll be able to send you that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess I'm just a little bit confused because you said I didn't have to have it, I mean, not that, but I could go on my own and just fill everything out but with, you know, without a diagnosis code.
[AGENT][NEUTRAL] Yeah, you absolutely can we do have to have those documents we do have to have those documentations though that include that information but you can upload that.
[CUSTOMER][NEUTRAL] OK, so I just need, I just, I just need to try to figure out a way to give him a copy of this card and let them go ahead and do it, I guess because there's gonna be a whole lot of questions that I do not have answers to and.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] I absolutely would because.
[AGENT][POSITIVE] Yes, and again, well, if they're not sure you can give them this phone number. We talk to providers all the time, so we're more than happy to talk to them too if they need to speak with us or if there's any confusion.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, so basically we can't even file this until he's gonna be discharged.
[AGENT][NEUTRAL] Right, we do have to have those documents.
[CUSTOMER][NEUTRAL] Yeah, and then he's going to rehab when he leaves here, so there's, that's a whole another situation. So, OK, alright, yeah, you can just send it to me, that'll be fine.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Alrighty I will go ahead and get that email to y'all right now if you have any other questions feel free to give us a call back. I know it's a bit confusing.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] Yeah, well, thanks for uh for calling. I hope y'all get to feeling better soon.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][POSITIVE] Thanks bye.
[AGENT][POSITIVE] Thank you