AccountId: 011433970860
ContactId: e390c4ba-1b01-4415-bab8-6569ccbbb184
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1017359 ms
Total Talk Time (AGENT): 391349 ms
Total Talk Time (CUSTOMER): 362780 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/e390c4ba-1b01-4415-bab8-6569ccbbb184_20250612T15:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] How was [PII] you say?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] [PII]. Good morning, Ms. [PII]. How are you today?
[AGENT][NEUTRAL] Um, good. How are you?
[CUSTOMER][NEUTRAL] I'm well. I'm calling because I have your insurance and was not sure how to complete a fill in a claim. Uh unfortunately I was in the hospital on Mother's Day, and I was there from the [PII], and I just needed to know how to go by completing the paperwork.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can verify with you on how to submit a claim and your name is?
[CUSTOMER][NEUTRAL] [PII] not.
[AGENT][NEUTRAL] OK, and Ms. [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] 00 let me see, no, unfortunately I, I've had this insurance for a long time and just never ever used it.
[AGENT][NEUTRAL] Oh, OK. What's your social, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and verify your date of birth, [PII], uh, mailing address and email address, please.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Um, uh, you may have not.
[CUSTOMER][NEUTRAL] At [PII].
[AGENT][NEUTRAL] Oh, I don't, no, ma'am, I don't show an email in our system.
[CUSTOMER][NEUTRAL] As an email?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, which one would you rather have in there?
[CUSTOMER][NEUTRAL] Um, that's.
[CUSTOMER][NEUTRAL] Um, you can use my work email which is [PII].
[CUSTOMER][NEUTRAL] A diversified.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so it's not at [PII].
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][POSITIVE] Yes ma'am, [PII], mhm, yes ma'am.
[AGENT][NEUTRAL] OK, thank you. And do you also have a callback number, Ms. [PII] in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And which policy was it for? Because I show you have an accident policy and also show a cancer policy.
[CUSTOMER][NEUTRAL] Um, I would, with the accident, I think it would be considered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have one of our claim forms?
[CUSTOMER][NEUTRAL] Uh yes ma'am, um, let's see.
[CUSTOMER][NEUTRAL] I was emailed that by our um the lady here that does that so yes ma'am, I have one for accident claim form.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Um, along with the claim form, um, we will need the itemized hospital bill or anything, any other billing in regards to that, and, um, accident, especially for the initial.
[AGENT][NEUTRAL] Uh, billing that you may request from the provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm trying to think what else.
[AGENT][NEUTRAL] It should be on the claim form just kind of give a.
[AGENT][NEUTRAL] A little breakdown of just kinda explain what may be needed. Give me one moment.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] Please sections A through F.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So it's basically any, any billing that you can submit to us. Um, when did your accident happen on [PII]?
[CUSTOMER][NEUTRAL] Yes, and um.
[CUSTOMER][NEUTRAL] It was actually I was um home.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, love, um, consciousness.
[CUSTOMER][NEUTRAL] And was picked up by an ambulance and um brought to the hospital.
[AGENT][POSITIVE] Oh blessed. I'm glad you're OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I guess that would be the um itemized hospital bill. I guess they will have the initial diagnosis.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you got out on, you said on the [PII]?
[CUSTOMER][NEUTRAL] Um, I was, uh, admitted on the [PII] and discharged on the [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Excuse me. OK, so yes, ma'am, the claim form and uh any itemized billing.
[AGENT][NEUTRAL] That will show uh the diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then you can either uh fax it, mail it, and we do have an online service center to where you can set up an account to upload your claim documents.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so just complete the form.
[CUSTOMER][NEUTRAL] Um, send them the, um, the bill itemized bill, um, not an explanation of, uh, OK, not that, but just an itemized bill from the hospital itself.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, it does on the claim form has a tenant physician form.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Sign decision supporting documents is your name give me one moment.
[CUSTOMER][NEUTRAL] It's a medical bill.
[AGENT][NEUTRAL] Let me look and see what else is in that.
[AGENT][NEUTRAL] Please text you.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] It does have a attending physician's statement on here.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Trying to think what that is for.
[AGENT][NEUTRAL] Right into coma paralysis diagnosis treatment.
[AGENT][NEUTRAL] dates.
[AGENT][NEUTRAL] It's.
[AGENT][NEUTRAL] Never been in a similar condition.
[AGENT][NEUTRAL] It says it, um, I guess attending physician to fill out this form.
[AGENT][NEUTRAL] Infections age, but.
[AGENT][NEUTRAL] I'm not
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Well, if you're already out of the hospital.
[AGENT][NEUTRAL] Have you gone after you were discharged back to your regular doctor?
[CUSTOMER][NEUTRAL] I went to, yes ma'am, I went to a visit after.
[CUSTOMER][NEUTRAL] I went to a visit on the [PII] after that visit, and then I have another appointment scheduled for uh next week on the [PII].
[AGENT][NEUTRAL] OK. It's like a monthly visit just to kind of, OK. Um, I guess you can get your doctor, uh, to fill out that attending physician's portion of that form.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Then like I said, once uh you have all that, you can either mail it, fax it, or um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Submit it through our online service center if you would like to set up on there.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I'm I'm about patient.
[CUSTOMER][NEUTRAL] I'm just trying to see what a portion was for him to complete.
[CUSTOMER][NEUTRAL] Since I didn't see that part, um.
[AGENT][NEUTRAL] Should be section section H.
[CUSTOMER][NEUTRAL] OK, 86, I see it now, OK.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Yes, ma'am. And it say uh the top attendant physician statement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and while I'm on the phone with you, um, so I can have it on here, do you have my policy number?
[AGENT][POSITIVE] I do, yes ma'am, let me know when you're ready I can give that to you.
[CUSTOMER][POSITIVE] I'm re[PII].
[AGENT][NEUTRAL] OK, it's 221-701-4.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, so I'll make sure I bring this with me on my visit to him.
[CUSTOMER][NEUTRAL] Have him complete that part.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And uh section D.
[CUSTOMER][NEUTRAL] I'm assuming that it would just be um.
[CUSTOMER][NEUTRAL] Accident medical expense.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Is what I would have, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] Just wanna make sure when I.
[CUSTOMER][NEUTRAL] Send it back, everything is completed.
[CUSTOMER][NEUTRAL] I think that's the only questions I had. Now the way this insurance work, um, this is for like hospital, this has nothing to do with like um.
[CUSTOMER][NEUTRAL] Well, this business or anything like that, correct? This is only for if I'm in a hospital or.
[CUSTOMER][NEUTRAL] Um, anything like that, correct?
[AGENT][NEUTRAL] Uh, due to an accident, yes, ma'am.
[AGENT][NEUTRAL] OK, give me one moment, I'm trying to pull up your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I don't know if you have a copy of your policy, but there is a page in it color certificate of, uh, schedule, uh, benefits of of benefits, I'm sorry, and it just breaks down, uh, the.
[AGENT][NEUTRAL] And then the amount of how much is payable like for a hospital commission, uh, admission or confinement, um.
[AGENT][NEUTRAL] If you
[AGENT][NEUTRAL] It has to like break it down to each type of accident. Like if you broke a finger or you broke your leg, of how much is covered. If you rode by ambulance or if you uh had to go through physical therapy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Now do I need to get something from the ambulance people as well?
[AGENT][NEUTRAL] If there is a concussion.
[AGENT][NEUTRAL] Um, I would say if you can get the billing from them, you can submit that to us as well. So anything in regards to that accident, I would say to submit it in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, so they can review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Will do and do I have a time limit on when I have to have this all completed?
[AGENT][NEUTRAL] Uh, no, ma'am. There's no time limit as far as submitting a claim. The policy just, uh, stipulates you have a certain amount of time to go to the doctor or to the facility, um, from the accident.
[CUSTOMER][NEUTRAL] Hi there
[AGENT][NEUTRAL] But no, there's no time limit to actually submit the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and did you all have, I don't know if he had this or not, but one of my, uh, one of the guys he just wanted me to ask you, he have, uh, um, some dental work that was done and he had surgery. Is this something he can complete for that?
[AGENT][NEUTRAL] For dental services?
[CUSTOMER][NEUTRAL] Surgery?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Due to an accident. So he had to have dental surgery due to an accident?
[CUSTOMER][NEUTRAL] Uh, I will have to ask him what was it due to, but um he was asking the, the same question, but I would, I'm gonna make sure he call you all um to find out what he can and cannot do. OK, I will.
[AGENT][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Only said he called. thank you so much. I'm gonna get started on getting all of this um done and um.
[CUSTOMER][NEUTRAL] I have um
[CUSTOMER][NEUTRAL] There are a couple of look like there's a couple of different bills I'll be receiving um one was for like while in the hospital they did an outpatient um GI so I guess all of that will be just scan all of those to the um same. I won't have to do a different claim for each one, right? I can just all of that is due to the hospital stay just include all of that.
[AGENT][NEUTRAL] Well, it should say on the billing, the procedures that were performed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so I just wanted to make certain that I didn't have to thank you, do a different claim for each one, so it'll be that this one claim form I'm completing will be for the services that was done my whole time that I was there. Red is considered inpatient or out, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. uh, and I'll, um, I'm gonna do it online where I can upload anything just in case there is some stuff that I need to resubmit or any additional questions that I asked. I can just upload it in that um or.
[AGENT][NEUTRAL] Uh yes, ma'am, and when you go into the site, it has been um updated, so.
[AGENT][NEUTRAL] When you go into the site, select create a new online service in our account and then select insured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then it's gonna ask for your last name, social, zip code, email address, and date of birth. And once you've entered that information, uh, it would then email you a verification code to where you can enter that code that it's gonna ask for and also put in uh set up your password.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for all your help, Miss [PII].
[AGENT][POSITIVE] All right, you're welcome, Ms. [PII]. And is there anything else I can assist you with today?
[CUSTOMER][MIXED] Uh, no, this is a little overwhelming, but I, I'm gonna, I, I think once I get it all done and start doing it, it should start making sense to me.
[AGENT][NEUTRAL] OK. Well, and also, like I said, once you get on the online service and you will be able to view your policies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and that's um that's [PII] or?
[AGENT][NEUTRAL] Uh,
[AGENT][POSITIVE] No, ma'am, it's secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Uh yes ma'am, you're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Have you as well bye bye.
[AGENT][NEUTRAL] Bye.