AccountId: 011433970860
ContactId: df6dd50a-3943-4bf1-bef9-cfe684f8b136
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 828440 ms
Total Talk Time (AGENT): 250894 ms
Total Talk Time (CUSTOMER): 142451 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/df6dd50a-3943-4bf1-bef9-cfe684f8b136_20250228T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good morning. Um, this is [PII], and I have here with me my husband, and we have a question regarding our claim.
[AGENT][NEUTRAL] OK, do we?
[CUSTOMER][NEUTRAL] For hospital indemnity?
[AGENT][POSITIVE] OK, I'm happy to check on a claim. Do you have your policy number?
[AGENT][NEUTRAL] Or a claim number?
[CUSTOMER][NEUTRAL] Yes, it's
[CUSTOMER][NEUTRAL] The uh what is the claim number? Uh, policy number we got. The policy number is 02582315.
[AGENT][NEUTRAL] OK, let me pull that up here.
[CUSTOMER][NEUTRAL] That's kind
[AGENT][NEUTRAL] All right, thank you so much. And then on the policy, I just need to verify please your date of birth and address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you so much. OK. And then who is the claim for?
[CUSTOMER][NEUTRAL] For, for me, for [PII].
[AGENT][NEUTRAL] OK, it's under your name. OK, and then do we have a claim number? Is that the one ending in 8529?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I've got that pulled up here. What kind of questions or concerns did you have in regards to this, [PII]?
[CUSTOMER][NEUTRAL] OK, so, uh, this is [PII], this is her husband. So on, uh, there's two separate confinements. It's not just one confinement, and it's slumped into one claim number.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Let me look at.
[AGENT][POSITIVE] I'm just pulling up the claim information here. I appreciate your patience.
[CUSTOMER][NEUTRAL] OK, because it was
[CUSTOMER][NEUTRAL] Yeah it was 116, 117 was one confinement then 121 through 123 was a separate confinement.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Clear.
[CUSTOMER][NEUTRAL] I just told her meds.
[CUSTOMER][POSITIVE] Cool. My sister.
[AGENT][NEUTRAL] I'm still here. It's just I'm pulling up each one of these and
[AGENT][NEUTRAL] Quite a few pages on them, so it's just taking me a second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] OK, so it does look like, I see the different dates. On the schedule of benefits, it looks like the hospital admission benefit is 2500 and then it's a maximum of 4 days, and then the confinement benefit on the plan is 50 for a maximum of 5 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's only claimable one time in a calendar year?
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's a per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, so that's where.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Why on the, on the paperwork that it say uh.
[CUSTOMER][NEUTRAL] Hold up, I'm just looking at something because she has the, the book.
[CUSTOMER][NEUTRAL] She says that uh
[CUSTOMER][NEUTRAL] Pregnancy complications is supposed to be covered on there.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Pregnancy looks like it definitely should be under this. I just don't see that where there was anything additional payable because the, the benefit payment sent was 2550.
[AGENT][NEUTRAL] So I'm just not seeing anything else in here as far as like.
[AGENT][NEUTRAL] Benefits being paid out, you know, um, anything additional except for.
[AGENT][NEUTRAL] Just those confinements that, you know, I've given you with the per calendar year per covered person.
[CUSTOMER][NEUTRAL] Uh, but I, but I'm
[CUSTOMER][NEUTRAL] So since they're two separate things.
[CUSTOMER][NEGATIVE] One wouldn't be covered, the complication wouldn't be covered.
[CUSTOMER][NEUTRAL] Separate from the other.
[AGENT][NEUTRAL] I think it's
[AGENT][NEUTRAL] Not considered two separate.
[AGENT][NEUTRAL] Um, the plan itself just pays for the hospital confinement once per calendar year. Um, it, there is no, does that make sense the way it reads?
[AGENT][NEUTRAL] It says.
[AGENT][NEUTRAL] Hospital admission benefit 2500, maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, it's not gonna cover anything beyond that.
[AGENT][NEUTRAL] And then with the confinement it's the $50 maximum of 5 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] What other questions did you have still?
[CUSTOMER][NEUTRAL] Alright, I guess that's that and then uh.
[CUSTOMER][NEUTRAL] For baby because she has baby on the on the uh insurance as well, will baby be covered for that then?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so the effective date for the infant, which is uh [PII], correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, is, uh, date of birth which is [PII], you know, is that effective date. So, yeah, sorry. Um, so yeah, the, the coverage is effective from date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so when can we anticipate that portion to be?
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Any sort of let's see, I don't know if we haven't let me see if there's any claims on file.
[CUSTOMER][NEUTRAL] Paid out.
[CUSTOMER][NEUTRAL] I guess not. I guess she's still saying not yet. What would be the procedure for that? I mean, we have like the, she was in the NICU for 7 days.
[CUSTOMER][NEUTRAL] After after birth.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The easiest way honestly is that the providers will do it for you. Um, the hospital or the doctors will just submit them on your behalf for the services rendered if.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They're not if they have not done that or if you guys wanna expedite it and do it yourself you can um they can be submitted online we have an online service center I usually say providers doing it is best because they generally know everything that needs to be submitted.
[CUSTOMER][NEUTRAL] Can you
[AGENT][NEUTRAL] Less of a hassle.
[CUSTOMER][POSITIVE] Can you please uh email her a copy of the forms I need to fill out? That way we can deliver them to the hospital. All right, awesome.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, absolutely, yeah, happy to do that. So yeah, and then I can also if for some reason you wanna um sign up online if you guys wanna track claims through the service center, I'll send you a user guide for that too, um, and you can manage your policy there also.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, awesome. Thank you.
[AGENT][POSITIVE] Yeah, not a problem. Is there anything else I can help with?
[CUSTOMER][POSITIVE] No, that's it for right now. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye now.
[AGENT][NEUTRAL] OK.