AccountId: 011433970860
ContactId: da0cd1ca-93fc-483a-a834-eb8b377e6ef7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1856339 ms
Total Talk Time (AGENT): 918916 ms
Total Talk Time (CUSTOMER): 693057 ms
Interruptions: 9
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/da0cd1ca-93fc-483a-a834-eb8b377e6ef7_20250326T15:16_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII], and I'm calling on behalf of [PII], my husband.
[AGENT][NEUTRAL] And what is a good callback number in case we get disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the policy number?
[CUSTOMER][NEUTRAL] 00, you would ask me that. Hold on, let me get that.
[AGENT][NEUTRAL] You sound like me.
[CUSTOMER][NEGATIVE] I wasn't ready with that part.
[AGENT][NEUTRAL] Yeah, it's like I always try to have everything and it's always the one thing they ask that I don't have.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I can pull up this.
[CUSTOMER][NEUTRAL] That goes, OK, so we are, no, I haven't, uh, the 2605764.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] What, you've got that quick. I'm impressed.
[AGENT][NEUTRAL] And what is his date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what is the current mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. And you said your name again was [PII]?
[CUSTOMER][NEUTRAL] Oh, uh-huh.
[AGENT][POSITIVE] OK, so, thank you.
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] OK, we were checking to, uh, checking on the status of his short term disability. Uh, I got something saying that it was processed, but when I logged in it says 0, so I didn't know what that meant. I mean, does that mean it's still processing?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, because you were not listed on the policy, I do need permission from him to speak with you.
[CUSTOMER][NEUTRAL] We should have a third party authorization form.
[AGENT][NEUTRAL] On file.
[CUSTOMER][NEUTRAL] On file.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you know when that was sent?
[CUSTOMER][NEUTRAL] Um, I can probably tell you because I got an email back saying that it was approved, hold on, or saying that it had been received. Give me a second.
[AGENT][NEUTRAL] Possily because I don't see it in the notes.
[CUSTOMER][NEUTRAL] Uh, did I get an email or?
[AGENT][NEUTRAL] Did you email it to the care team, the third party authorization?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. One.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The oh I think they only did it for one, they have it in the.
[CUSTOMER][NEUTRAL] It's all I did it on 314.
[CUSTOMER][NEUTRAL] Um, and I think they may have just attached it to the, the policy number 2333213.
[AGENT][NEUTRAL] Let me check that one.
[AGENT][NEUTRAL] What's that policy number again?
[CUSTOMER][NEUTRAL] And I have
[CUSTOMER][NEUTRAL] 2333213
[AGENT][NEUTRAL] Let me check that one.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was just done for that one. I do.
[CUSTOMER][NEUTRAL] You see it there.
[AGENT][NEUTRAL] Is there any way that you can.
[CUSTOMER][NEUTRAL] OK, so do I need to send one for each policy?
[AGENT][NEUTRAL] Yes, ma'am, because that way we know that he has given us permission for each policy. But I can tell you um there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, hold on, yeah, he's here.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Yeah, I can get that. I don't want it to be any problem. OK.
[AGENT][POSITIVE] Thank you. I appreciate it.
[CUSTOMER][POSITIVE] Thank you for information for me to talk.
[CUSTOMER][NEUTRAL] For the the short term.
[CUSTOMER][POSITIVE] Hello, good morning.
[AGENT][NEUTRAL] Good morning, Mr. [PII]. This is [PII]. Do we have permission to speak with your wife regarding your disability claims?
[CUSTOMER][NEUTRAL] Yes, please, ma'am.
[AGENT][POSITIVE] All right, thank you, and that'll be for this call. I do appreciate your permission. Have a wonderful day.
[CUSTOMER][POSITIVE] All right, thank you for your help.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Alright, yes ma'am.
[AGENT][NEUTRAL] OK, thank you. OK. So there's, it's been processed and they are just needing a list of all the doctors seen for this diagnosis.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, he only saw 2. It was, he was in the hospital.
[CUSTOMER][NEUTRAL] Um, it was an emergency surgery and the only doctor that he saw, you mean like every doctor he saw at the hospital?
[AGENT][NEUTRAL] You know what, let me get
[CUSTOMER][NEUTRAL] For the doctor that is treating this, cause the only doctor that's treating it is the back surgeon, the, the neurosurgeon.
[AGENT][NEUTRAL] Yeah, let me
[AGENT][NEUTRAL] OK, let me get you to our claims department so that I want, I don't wanna, I wanna make sure we get the information needed and so they can give you more detailed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Now would I also speak with them about the other for hospital indemnity stuff or can you look at that?
[AGENT][NEUTRAL] I need.
[AGENT][NEUTRAL] I can look at that.
[CUSTOMER][NEUTRAL] OK, and you look at his hospital indemnity and I was trying to understand how they approved some things and then did not approve, they said something was not covered, but it's the same.
[CUSTOMER][NEUTRAL] Uh, as the other.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Or did I just need to separate the claims and do them individual?
[CUSTOMER][NEUTRAL] Upload them individually.
[AGENT][NEUTRAL] No, I'm, I'm checking on this. Hang on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So on that hospital indemnity policy.
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] Um, plane.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was processed on.
[CUSTOMER][NEUTRAL] Can you tell me, yeah, I guess maybe if I know what the limitation then I'll know what I need to do.
[AGENT][NEUTRAL] Uh, it's so hard, isn't it? And also, since y'all got that portal, that portal account, you can actually click on the policy numbers and that will download your policy certificate and you can view the benefits that are covered.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That might help.
[CUSTOMER][NEUTRAL] Alright, but it doesn't give you like the limitations like um we found out that the emergency visit is only paid once a year is what I was told I think.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm. And that should be on the policy certificate.
[CUSTOMER][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] Well, we didn't even know the amounts. I had to call to his HR to find that, um, but like they
[AGENT][POSITIVE] Bless your heart. You've just been flying blind, haven't you?
[CUSTOMER][NEUTRAL] Yes. Um, yes, because we didn't even know he had hospital indemnity. He's had it for the last 3 years.
[AGENT][NEUTRAL] Oh man. Yes.
[CUSTOMER][NEGATIVE] Our last two years we didn't even know so um they told me to file for the from the first back in [PII] but I haven't heard anything from those or I don't know if those were paid. I'm not sure what was paid, what wasn't paid. Are we full for this year? Have we exhaust have we exhausted everything for this year?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][POSITIVE] Yeah, so, OK, let's, I'm gonna start at the very beginning, we're gonna get you taken care of on this.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You see, I have questions. I have questions.
[AGENT][NEUTRAL] Yeah, and I was like, should I answer one at a time? and I said, no, I think it may be easier. Let's just start at the beginning.
[CUSTOMER][NEUTRAL] No, just
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Because it's so much easier when you understand it.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] You know how to file and what's covered and all of the.
[AGENT][NEUTRAL] Following, you know, OK, so Ms. [PII] with his hospital indemnity policy and like I said, if you pull up that policy certificate within that certificate there's a page called the schedule of benefits page. It'll tell you things like emergency room is covered $1000 per day, maximum of 1 day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That wasn't in there.
[CUSTOMER][NEUTRAL] I didn't see that.
[AGENT][NEUTRAL] Have you, are you at your computer?
[CUSTOMER][POSITIVE] Uh, I can be at my computer. I have it downloaded on my, I have it downloaded on my phone also.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and now it's probably gonna work better on your computer, but if you go to that portal and sign in.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once you sign in if you will click on that hospital indemnity policy number the 2333213.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It should say downloading.
[AGENT][NEUTRAL] And that's going to open up that policy certificate.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] There's a page called a schedule of benefits page.
[AGENT][NEGATIVE] And now it may be, may not be exactly the same page, but in my documents it's on page 22.
[AGENT][NEUTRAL] And we can look at that and so you'll see what's covered.
[CUSTOMER][NEUTRAL] OK, give me a second. Yeah, let me get it.
[AGENT][NEUTRAL] Cause you can go back.
[AGENT][NEUTRAL] To 4123 and file claims.
[CUSTOMER][NEGATIVE] That's what I thought, but, and that's what I did, but it didn't get approved.
[AGENT][NEUTRAL] Well, we're gonna look at that.
[CUSTOMER][NEUTRAL] Not because he had several, several.
[AGENT][NEUTRAL] Because I see some payments.
[CUSTOMER][NEUTRAL] Yeah, so this year they did one for this year because he's already been in and he just got out of the hospital again.
[AGENT][NEUTRAL] Oh, that's
[CUSTOMER][NEUTRAL] For the he had emergency surgery. Like he had 2 surgeries within 2 weeks.
[AGENT][POSITIVE] Oh my goodness. Well, bless us. Y'all have been through it, haven't you?
[CUSTOMER][NEUTRAL] Yes we have and I guess that's the other thing so that I could see what exactly what they what they approved and what they did not because when I try to download the.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Uh, statements I can't get them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It says there's an error down it says there's an error processing. We've contacted, we've let them know and I've waited a couple days and I still couldn't see it.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] You know what? Let's see, hang on just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does Mr.
[CUSTOMER][NEUTRAL] Let's see short. Oh no, I'm going to the indemnity.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm, I'm sorry, just.
[AGENT][NEUTRAL] What, what is his email? Do you know his email?
[CUSTOMER][NEUTRAL] Uh-huh. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] uh uh.
[CUSTOMER][NEUTRAL] [PII] again.
[AGENT][NEUTRAL] Oh, got you.
[CUSTOMER][NEUTRAL] The [PII] and you said it's page 21 in your documents?
[AGENT][POSITIVE] Perfect, [PII].
[AGENT][NEUTRAL] Page 22, and it may be more or less and
[AGENT][NEUTRAL] In your documents. You'll see.
[CUSTOMER][NEUTRAL] Oh see this wasn't it the one we had before didn't have this, OK.
[AGENT][NEUTRAL] Schedule of benefits page.
[CUSTOMER][NEUTRAL] OK, I have it.
[AGENT][NEUTRAL] So
[CUSTOMER][NEGATIVE] Cost of the confinement.
[AGENT][NEUTRAL] Yeah, these are the benefits in the amount that we pay them and how many days they're payable.
[AGENT][NEUTRAL] So admission is one day per calendar year. That just means when he's admitted into the hospital.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That that benefit is available one time per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if he's going to the hospital one time for the year, OK.
[AGENT][POSITIVE] But then he does have that confinement benefit.
[CUSTOMER][NEUTRAL] And then the
[CUSTOMER][NEUTRAL] That's what I thought, but they did they.
[AGENT][POSITIVE] And that benefit
[CUSTOMER][NEGATIVE] They denied it on some of the, some of his days.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We're yeah, we're gonna look at that and see. It's 60 days per calendar year.
[AGENT][NEUTRAL] And, and of course the surgery benefit is one day per calendar year, whether it's in the hospital or physician's office.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] So this page is a good page to refer to.
[CUSTOMER][NEUTRAL] OK, that's.
[AGENT][NEUTRAL] In regards to what's needed to file, you know, what you can file for.
[CUSTOMER][NEUTRAL] OK. So since he had surgery this time, then I need to file something different.
[AGENT][NEUTRAL] Let's see if
[CUSTOMER][NEUTRAL] Well, I just don't. I just said it because it.
[CUSTOMER][NEUTRAL] Yeah, I don't know.
[AGENT][POSITIVE] Yeah, yeah, hang on, you're getting it.
[AGENT][POSITIVE] We're gonna, we're gonna get you.
[AGENT][POSITIVE] We're gonna look at everything and get you taken care of. So for [PII].
[CUSTOMER][NEUTRAL] See this page wasn't in the one that I had the original. OK, so yes, the [PII], yes ma'am.
[AGENT][NEUTRAL] OK, so we have paid.
[AGENT][NEUTRAL] His hospital admission benefit for 2025. So that has been maxed out.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, for his daily hospital benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We have paid $1500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so it's $250 a day.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And that's 6 days.
[AGENT][NEUTRAL] I got to see how many days that is.
[CUSTOMER][NEUTRAL] Mhm. 6.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So then he has the remaining.
[CUSTOMER][NEUTRAL] So that's Wednesday that was.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then there was a health screening.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And we were able to pay uh from his tier one benefits we paid $50 so that one's maxed out and from 10 tier two for $25 so that is maxed out for this year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then in the policy if you wanna know what those different tiers are what those tests are, or if you need further explanation, you know, then you can go in the policy under the definitions.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And that will explain that this page is a really good page to look at when you're looking at benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that's for 2025.
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For 2024 we did pay that first occurrence, so that is maxed out.
[AGENT][NEUTRAL] And for his hospitalization, we paid 1500. That's for 24.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I only and there was way more days in the hospital than that.
[AGENT][NEUTRAL] OK, we're gonna look at that too.
[CUSTOMER][NEUTRAL] In 24.
[AGENT][NEUTRAL] And no claims paid on 20 for 2023.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So what, why would that not be? Because I can, OK, because they do, I did submit claims from 23.
[AGENT][NEUTRAL] Oh we're done.
[AGENT][NEUTRAL] We're gonna look at that too.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I'm gonna have to look at a lot of stuff here, so hang on now for claim status.
[CUSTOMER][NEUTRAL] There is one that one for 35 uh the claim number 3572927 that has a lot of documents in it.
[CUSTOMER][NEUTRAL] Because I was, I went back to upload the, the um.
[CUSTOMER][NEUTRAL] What do you call it? The, the, uh, thing from the hospital that had the codes on it. I didn't know I needed to have the codes on it.
[AGENT][NEUTRAL] 2927.
[CUSTOMER][NEUTRAL] The diagnosis codes on it.
[CUSTOMER][NEUTRAL] Uh-huh, the one that they paid for 25.
[CUSTOMER][NEUTRAL] That has a whole lot of documents in it like from 24, 20.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] And you said the claim number is 357, what was it?
[CUSTOMER][NEUTRAL] 2927.
[AGENT][POSITIVE] Oh, got you. I'm so sorry. It's right there in front of me.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, we always have to have the diagnosis code because your policy pays toward accidents.
[AGENT][NEUTRAL] So we have to have diagnosis codes and those were from.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 82823.
[AGENT][NEUTRAL] Let's see if there's any other dates needing that. So.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] There's no, there should have been more than that.
[AGENT][NEUTRAL] Now, those are the dates that need the diagnosis code.
[CUSTOMER][NEUTRAL] OK, the, the 828?
[AGENT][NEUTRAL] That's correct. 828-23.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is that the 1221 to 120 I mean the 126 to 21 that needs diagnosis code also?
[CUSTOMER][NEUTRAL] Cause I see something says not covered procedure.
[AGENT][NEUTRAL] Yeah, because it looks like an emergency room visit on [PII] was for a sickness.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Diagnosis, not an accident. Now this policy only pays toward accident diagnosis.
[CUSTOMER][NEUTRAL] No, no, see, we had two different accidents.
[AGENT][NEUTRAL] Let me see if I can
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] I mean we have two different policies. I thought he has the hospital family and then he has the accident.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So it only pays if it was the if it was an accident.
[AGENT][NEUTRAL] Under your
[AGENT][NEUTRAL] Mhm. Under your hospital indemnity. Emergency room treatment?
[AGENT][NEUTRAL] Urgent care.
[AGENT][NEUTRAL] Is for or surgery is for an accident reason.
[AGENT][NEGATIVE] Does not pay for sickness.
[CUSTOMER][NEGATIVE] don't understand, cause that's not what they told me.
[AGENT][NEUTRAL] Now, your hospitalization does not have to be restricted to accident diagnosis. But for the surgery,
[CUSTOMER][NEUTRAL] At the hospital
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And your
[CUSTOMER][NEUTRAL] Then that one, OK, so but.
[CUSTOMER][NEUTRAL] OK, so shouldn't the hospital indemnity or the hospital confinement and admission benefits shouldn't that have been applicable for those days?
[AGENT][NEUTRAL] Now, that can be for sickness. It is not, if you look in the schedule of benefits page, that is not restricted to an accident diagnosis, but if you look under the surgery benefit,
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And under the treatment benefit, it says outpatient accident or accident surgery.
[CUSTOMER][NEUTRAL] Yes ma'am, so the other for the what you said for the confinement, it did not have to be an accident, it could be an illness, so I guess that's what I'm asking that's what that, so that the [PII] and the other one that they're saying are not covered, those were illness, so it should have been covered if he was admitted into the hospital, right?
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Mhm. If the benefits were available, yeah.
[CUSTOMER][NEUTRAL] Or emergency room and admittance.
[AGENT][NEUTRAL] Now, the emergency room, he would have to come through as an accident. So the emergency room portion of that would not be covered if it was not for an accident.
[CUSTOMER][NEUTRAL] And they were, he was
[AGENT][NEUTRAL] But if he was admitted into the hospital, and it is a sickness diagnosis, the confinement, your intensive care or rehabilitation benefit could be um
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Considered for sickness as well.
[CUSTOMER][NEUTRAL] OK, so do I need to res resend those? Because in [PII] he had them and they denied them and this is not, not just the April, not just the August, it was, he was going to the hospital back in.
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Back in April, actually, of 23.
[CUSTOMER][NEUTRAL] OK, so they need a data service for which one I will find it.
[AGENT][NEUTRAL] Yeah, I'm checking.
[AGENT][NEUTRAL] Yeah I've got to go back to so hang on just a minute.
[CUSTOMER][NEUTRAL] Yes, because I didn't, I hadn't seen this.
[AGENT][NEUTRAL] Let me look at this one.
[AGENT][NEUTRAL] Now, on [PII] for the ER visit, it does say they need the diagnosis code, um, [PII], yeah, [PII].
[CUSTOMER][NEUTRAL] Or [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the hospitalization the
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] For [PII] we did pay that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Admission benefit.
[AGENT][NEUTRAL] I'm just kinda going through these. It just takes a minute to look at all these claims.
[AGENT][NEUTRAL] You're more familiar with them than I am at this point.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] She probably been dealing with it for a while now, trying to get it taken care of.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Trying to get it squared away, yes ma'am.
[AGENT][NEUTRAL] And I'm having to go through each claim, so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I am so sorry. I am looking at all these claims and Miss [PII], I forgot what dates we were looking for, what year is it? [PII]?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] We're just trying to see because like they all of my 24, all of the 24 claims they just did the one and I know I had more than that and then they did nothing for 23.
[CUSTOMER][NEUTRAL] So you said on 23 I need it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] You know what, and I'll tell you what, I can, I can transfer you to a claims adjuster that can look at this a lot quicker than I can. And besides that we need to.
[CUSTOMER][NEUTRAL] I was so like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, ask them about the list of the doctors.
[AGENT][NEUTRAL] For his disability as well.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it
[AGENT][NEUTRAL] Why don't, why don't we do that and they can look at that in a little bit more detail.
[AGENT][NEUTRAL] And research that for you. Would that be all right?
[CUSTOMER][POSITIVE] Sounds good. OK.
[AGENT][NEUTRAL] And then, and then be sure to send in that authorization form for the disability policy as well.
[CUSTOMER][NEUTRAL] Yes ma'am, that's fine.
[CUSTOMER][NEUTRAL] OK, well, yes, we didn't know we needed to do one for each one.
[AGENT][NEUTRAL] Yeah, and it, let, let me just check the accident policy real quick and see.
[AGENT][NEUTRAL] If we have it on that as well.
[CUSTOMER][NEUTRAL] Nothing. It's the only one. I just sent we submitted one thing, so I'll make sure that to put it on each one.
[AGENT][NEUTRAL] Yeah, the accident policy I believe is only active, is active, uh let's see.
[CUSTOMER][NEUTRAL] The hospital indemnity is the only one that we put it on.
[AGENT][NEUTRAL] OK. Yes.
[CUSTOMER][NEUTRAL] I didn't write it on each each account number.
[AGENT][NEUTRAL] OK, yeah, his accident policy was just active on [PII]. So, all right, well, let me get you to uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Claim support representative to assist you further, but it's been such a pleasure to assist you and
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, thank you so much for your help.
[AGENT][POSITIVE] It's my pleasure, Ms. [PII]. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Doing fine, [PII] thank you how are you?
[AGENT][POSITIVE] I'm doing well, thank you for asking. I have
[AGENT][NEUTRAL] A lady that needs some help on her husband's policy, which he has given us permission to speak to her regarding this call. Now she's gonna have a question on
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Short-term disability and hospital indemnity. Can you help her with both?
[CUSTOMER][NEUTRAL] I can try you said short term disability and hospital indemnity.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the short term disability policy number is 260.
[AGENT][NEUTRAL] 576-4 and we did discuss the claim um information and that they're needing a list of all the doctors see and she's wanting to know specifically, and again, he did give us permission. Um, is it just the doctors that were he's seen in the hospital or is it just for the, when he was there in the hospital?
[AGENT][NEUTRAL] Or is it any doctor regarding that diagnosis? So, so they just need a little bit more information on the list of doctors seeing what's needed. That's all that is. So she's good on that.
[CUSTOMER][NEUTRAL] Yes, the last year, yep, it's for the last year that they're looking, it, it looks like they're looking for a preexisting probably, and so that's why when they get that list of physicians.
[AGENT][NEUTRAL] The last year.
[AGENT][NEUTRAL] Oh, see, I didn't see anything.
[AGENT][NEUTRAL] And I looked in on bases to see.
[CUSTOMER][NEUTRAL] Yeah, um, it looks like this.
[CUSTOMER][NEUTRAL] Yeah it looks like the shape did put a note in regarding it.
[AGENT][NEUTRAL] Well, did I just overlook that?
[CUSTOMER][NEUTRAL] I'm not sure.
[AGENT][NEUTRAL] Well, it, I sure did.
[AGENT][NEUTRAL] Sorry
[CUSTOMER][NEUTRAL] That's OK. Yeah, so it's the physicians he's seen in the last year, um.
[AGENT][NEUTRAL] I see. Even though it's not regarding that diagnosis. OK.
[CUSTOMER][NEUTRAL] For neurosurgeon.
[CUSTOMER][NEUTRAL] Right, probably because usually when that happens, it means that um it's.
[AGENT][NEUTRAL] Pre-existing.
[CUSTOMER][NEUTRAL] Right, or they're looking they're doing a look back to make sure that there was no preexisting. In other words, that they weren't seen for that kind of uh.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Can I just say that that note wasn't there a minute ago?
[CUSTOMER][NEUTRAL] You can sure.
[AGENT][NEUTRAL] I think I, I think I scanned it super quick because first we were looking for because she's sent in the authorization form but it's not on this policy so we talked about so many things at one time. I apologize [PII] I just probably scanned right over there and was looking for authorization form and just didn't even go back and look. I apologize but.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Her or his hospital indemnity policy, she's got several questions regarding claims. We have tried, uh, we've been looking at it. We've looked at the policy cert in the portal together to see what's covered, so she's understanding that now, but she's asked, she's got questions for claims from [PII], and [PII], um, it did tell her that the first occurrence benefit.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, what year that was maxed out, I mean, the hospital admission benefit and her daily hospital benefit, they're his.
[AGENT][NEUTRAL] Um, what was paid in each year, and then we did talk about the emergency room and surgery being accident diagnosis only. The hospitalization can be sickness if it's not indicated as accident only and that kind of thing. So those are the things we've been talking about, but she needs a little further detailed information regarding the claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And she's really nice.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I like nice people.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, for sure.
[AGENT][NEUTRAL] And her callback number is.
[CUSTOMER][NEUTRAL] And her
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. Her authorization has been received on the hospital indemnity policy. She's um emailing the authorization form for his disability policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We only put it on the indemnity policy. Her name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and it's [PII] as well if I call her Mrs. [PII], that's OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] [PII], I think is her last name. Let me check again cause it's in the notes. See, I, I saw that.
[AGENT][POSITIVE] [PII], that's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so we just need to, you said clarification on the hospital indemnity, some of the benefits she's questioning and then the form for the disability as far as the physician, correct?
[AGENT][NEUTRAL] It called that no.
[AGENT][NEUTRAL] Mhm. It's more the claims on the hospital indemnity. They just found out that he had this policy, so they're going back and trying to file claims. So it's more of the claims.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will do my best to assist her.
[AGENT][POSITIVE] I really appreciate it if you don't mind holding just.
[CUSTOMER][NEUTRAL] And you said these were from [PII] or?
[AGENT][NEUTRAL] [PII], [PII], yeah, [PII], and [PII]. All of them, all the claims.
[CUSTOMER][NEUTRAL] The claim she's questioning about the house.
[CUSTOMER][POSITIVE] I have found that many.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All the claims under hospital phone then they got it OK.
[AGENT][NEUTRAL] All right, you ready?
[CUSTOMER][NEUTRAL] I am.
[AGENT][POSITIVE] As you'll ever be. Thanks, [PII]. I appreciate it. Let me get her on the line.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You're welcome, [PII]. OK.
[AGENT][POSITIVE] All right, Ms. [PII] thank you for your patience. I was just given um
[AGENT][POSITIVE] We've got [PII] on the line and I was giving her the background of what is needed and um the information that you're requesting and she's gonna help you further, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] My pleasure, Ms. [PII]. Thank you for calling APL. I hope you have a great afternoon. Thank you, [PII].
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] You're welcome, [PII], thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi Miss Mrs. [PII], this is [PII]. I'm in the claim support team. Hi there. Hey [PII], how are you?
[CUSTOMER][POSITIVE] I'm doing well thank you how are you?
[CUSTOMER][POSITIVE] I'm doing fantastic.
[CUSTOMER][POSITIVE] Good, OK, so hopefully I'll be able to assist you, uh, further with your claims questions um we can um.
[CUSTOMER][NEUTRAL] Yeah, so as far as uh well I'll go ahead and answer that question on the disability portion um because that one seems like a little bit more uh um.
[CUSTOMER][NEUTRAL] You know, straight to the point, it looks like we had requested a physician, uh, statement, um, and we are looking back for um.
[CUSTOMER][NEUTRAL] It would be the position