AccountId: 011433970860
ContactId: da21d199-09e2-45f2-b427-a4d20ee1d071
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 699429 ms
Total Talk Time (AGENT): 342278 ms
Total Talk Time (CUSTOMER): 345318 ms
Interruptions: 7
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/da21d199-09e2-45f2-b427-a4d20ee1d071_20250429T15:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, so it's really in the billing team. How are you?
[AGENT][POSITIVE] I'm good, thank you. How about you?
[CUSTOMER][NEUTRAL] Good, um, I have [PII] on the line and she was calling about faxing over a claim form. Um, she's already been fully verified and everything, but she was wondering, um, like if there are any requirements for what she needs to include and um asking about the cover sheet and things like that, and I was just wondering if you'd be able to help her with that.
[AGENT][NEUTRAL] Oh, sure, yes. Um, do you have a policy number?
[CUSTOMER][NEUTRAL] Yeah, I can, um, her policy number is 244-7931.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Thank you. Um, OK, so you have the member on the line.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And did you get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Um, her, uh, callback number is [PII].
[AGENT][NEUTRAL] OK. Okey dokey. Did you verify any other information?
[CUSTOMER][NEUTRAL] Um, yeah, she's already, um, have, have had her verify, um, her social and her address.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, then I'm ready for her then. Thank you.
[CUSTOMER][POSITIVE] All right. You're welcome.
[AGENT][POSITIVE] Have a good day. Thank you.
[CUSTOMER][NEUTRAL] Hi [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes, I'm still here.
[CUSTOMER][POSITIVE] OK, I have on the line and she is going to be able to assist you, uh, further with your questions regarding your claim form submission. OK, OK, thank you so much. I appreciate your help. No problem. Have a great day. You too. Thanks.
[AGENT][NEUTRAL] Good morning, Ms. [PII]. This is in the care team, and you have questions about submitting your claim?
[CUSTOMER][NEUTRAL] Yeah, I had surgery last [PII], I had, um,
[CUSTOMER][NEGATIVE] hip surgery. I had to have my uh left hip replaced. And um I had sent in the forms, but apparently I sent them messed up, but it says you never got any claim forms, um, because I had sent in part hospital indemnity, everyday solutions claim and part disability cause I was all confused with all the paperwork they gave me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But I spoke with [PII] um yesterday and she sent me all the right forms to to use and also how to get onto the portal and um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, which I'll have to have somebody help me with because I've had strokes and uh I can't remember computers too well so when I'll have a friend come over and help me get onto the portal, but um.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I wanted to fax over the claim is that the best way to do it right now? Because I need the money actually for this.
[AGENT][NEUTRAL] Mm. Yes, and that is an option. You can either uh fax it, you can either mail it, or you can upload it. So those are the three options, but yeah, fax is definitely one of the faster options than mailing. So you can go ahead and send it by fax.
[CUSTOMER][NEUTRAL] OK, and what would I put on the cover sheet?
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEGATIVE] Or it doesn't even need one?
[AGENT][NEUTRAL] Uh, usually it asks you to create one. it depends where do you send it from, but you can just put your name and the policy number so we know where to apply it to just in case you get lost, um, but that will, that will be the only thing that we're gonna need your name and the policy number.
[CUSTOMER][NEUTRAL] OK, and all um.
[CUSTOMER][NEUTRAL] Not attention to anybody, but just uh.
[AGENT][NEUTRAL] It goes directly to claims. Yeah, it goes directly to the claims department, so it is gonna go to claims. Mhm.
[CUSTOMER][POSITIVE] Because you'll get it anyway, right, benefits, OK.
[CUSTOMER][NEUTRAL] OK, and yeah, because I have a number of pages because I have the um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Get the the form of the hospitalization services with the code numbers on them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it would have to say how many pages I'm sending, yeah, itemized yeah, thanks.
[AGENT][NEUTRAL] OK. So you have the itemized.
[AGENT][NEUTRAL] Mm OK. All right. Yeah. OK. Yeah, yeah, that's why you're gonna need just the itemized bill and the claim form, and that's what um you need to send in for to initiate that claim. So yeah, you can just go ahead and fax it if it's not too large and you can fax it easier. Um, I'm not sure how many pages you got, but it's probably a large file, um, but yeah, it's, it's.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh, yeah, I have this little boy.
[AGENT][NEUTRAL] Um, like.
[CUSTOMER][NEUTRAL] I have, let me see how many pages this is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I have that the 1st 3.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then there's.
[CUSTOMER][NEGATIVE] Alright, and 6 of the itemized and then they sent me something else but I don't know what that really is or tells me. I don't know if it has.
[CUSTOMER][NEUTRAL] The right numbers on it, so that would be 2 more.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that's 6.
[AGENT][NEUTRAL] 1018.
[CUSTOMER][NEUTRAL] 89, 1011, right?
[AGENT][NEUTRAL] About, yeah, about 12 130, yeah, uh, with the, um, cover sheet and everything, it's probably gonna be about 1415, um, yeah.
[CUSTOMER][NEUTRAL] Cup of so.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, are you going, uh, out to, to, uh, have it sent by fax or do you have a fax where you can send them?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, I'm gonna see if I can do it from work, otherwise I will go to the UPSS store and have them fax it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm. Yeah, that, that will be the, the other fastest way to do it will be by fax, but the, the fastest is gonna be by the online service center if you register. So I don't know if you want to um try to register or if you want to just go ahead and fax it now, and you don't want to wait for the online service center. You can do that. So yeah, it sure is easier for you.
[CUSTOMER][NEUTRAL] Yeah, I'm not sure how to do it that's what my problem is.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] See, I had, I had some major strokes and um I used to be a computer operator. I put um when General Motors went online to Detroit, I put, I troubleshot all those the East Coast programs and got them online. It took 3 days, but we got it done, yeah. But now I'm like, uh, since the strokes, I have no idea what to do with the computer.
[AGENT][NEUTRAL] So.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So it's like, I have to wait for friends to help me. Isn't that terrible?
[AGENT][NEUTRAL] Yeah, yeah, that that what happens, I know, but.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, yeah, it'll be fine.
[CUSTOMER][NEUTRAL] Well, I'll see if I can get somebody to help me with that otherwise I'll, I'll just fax it over.
[AGENT][NEUTRAL] OK, but yeah, it is, it is a faster option. It usually takes about 24 business hours for us to receive it and put it in your policy, and then from there we'll be in line to be processed. So if you want to check to make sure that we did receive the fax, you can call us back in about 24 hours, 24 business hours. So if you send it like let's say today, you can check back more than likely by Thursday or Friday, and we should have it, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Excellent. Thank you. And how, how long after that you get the check usually?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And the normal processing time for all of our claims are 7 to 10 business days. It could take up to 14 if we need to get additional information, which usually when you send the itemized bill we have all everything we need, but yeah, um, it's usually 7 to 10 business days, OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, oh, I had one more question. At one time something showed something.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You get paid for something else. I went into rehab.
[CUSTOMER][NEGATIVE] For almost 2 weeks after the hip surgery, I had to go in there. Do you, you don't get anything for that, do you?
[AGENT][NEUTRAL] Uh, let me check your benefits. Let's see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because I never got paperwork for that. I have to send that separate.
[AGENT][NEUTRAL] Mm, OK. Uh, let's see, if you do have that benefit, yeah, we probably need just the itemized bills.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] I'm waiting on your benefits to pull up, OK? It's gonna be a minute.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Oh thank you. Oh, and I just realized the top sheet has the date signed was [PII].
[CUSTOMER][NEUTRAL] Did I do a new one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you mean the claim form or?
[CUSTOMER][NEUTRAL] Yeah, the claim form because it was the original claim form and then the other.
[AGENT][NEUTRAL] What
[CUSTOMER][NEUTRAL] The, the list she has.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yesterday's date on it.
[AGENT][NEUTRAL] OK, well, if it's the one that she sent in um yesterday, um,
[AGENT][NEUTRAL] [PII], if yeah, if that's the one that she's sending that is the correct one. I know we had one updated last year, so more than likely that's the updated one, OK.
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] Um, let's see, mhm. So on this one you have hospital confinement benefits, um.
[CUSTOMER][NEUTRAL] OK, so we do that.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so no, this one doesn't have rehabilitation benefits.
[CUSTOMER][NEUTRAL] OK, so I don't, I don't get paid for the um rehab, OK, just the hospital.
[AGENT][NEGATIVE] No. Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, and it's only the 1500 you, you don't get per day.
[CUSTOMER][NEUTRAL] Since I was there, uh 2.5 days.
[AGENT][NEUTRAL] Uh, no, you get
[AGENT][NEUTRAL] You get per day and you get the $1500. So um let me go over it and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. You have the annual first occurrence which is the $1500 and then you have a $30 daily benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, cause I had, yeah, because I was in for 2.5 days.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And the, the half day was because they sent me over to rehab.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] But I guess they claim it as a day because they have the date on there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] Yes, yeah, we'll look at the paperwork and see. Yes, yes. And if we cannot determine or if we pay less and you think it should be more, all you need to do is send us like a discharge summary and let us look at the time and date so we can determine if it was 24 hours for each day, OK?
[CUSTOMER][NEUTRAL] But I guess you'll figure it out, you know better than me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. OK. All right. Thank you so so much. I really appreciate your help.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] You're welcome, Ms. [PII]. Is there anything else I may help you with today? Any other questions or concerns?
[CUSTOMER][NEUTRAL] Nope, that's it for now.
[AGENT][POSITIVE] OK, well, thank you for calling APO. Have a good day, Ms. [PII].
[CUSTOMER][POSITIVE] You also, thank you bye bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.