AccountId: 011433970860
ContactId: eef51cb1-5c12-4030-a3aa-7dd2023e904f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1096560 ms
Total Talk Time (AGENT): 458886 ms
Total Talk Time (CUSTOMER): 327906 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/eef51cb1-5c12-4030-a3aa-7dd2023e904f_20250313T12:30_UTC.wav
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[AGENT][NEUTRAL] You're calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, uh my name is [PII].
[CUSTOMER][NEUTRAL] And I was calling about my son is because he was in [PII] in [PII] and I was just calling about uh what does this insurance cover for him. Uh he's gonna have to go to rehab after he get out of the hospital.
[CUSTOMER][NEUTRAL] And um I have all his information.
[AGENT][NEUTRAL] OK, uh, [PII], what's the policy number?
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hold on, the policy number is.
[CUSTOMER][NEUTRAL] The policy.
[CUSTOMER][NEUTRAL] It's 02597844.
[AGENT][NEUTRAL] OK, what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you, let me pull up the file.
[CUSTOMER][NEUTRAL] It's a dental man, hold up.
[AGENT][NEUTRAL] OK. I can locate it under that though. I, I'll be able to see all of the policies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Whose policy is this, does this belong to?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what relationship are you to, [PII]?
[CUSTOMER][NEUTRAL] I, I'm his mother.
[AGENT][NEUTRAL] OK, so [PII] is the one that's in the hospital.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] And what is his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and verify the mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you know what his email address is?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that he is in [PII]?
[CUSTOMER][NEUTRAL] Yes, he dropped down out of [PII] yesterday. He had been in, he had been in [PII] ever since the [PII]. He, he actually went to like three different hospitals until, until he got to this hospital now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. How is he doing?
[CUSTOMER][MIXED] Well, they took him off life support like 2 days ago, and he's doing real good, but he lost all his muscle mass while on the ventilator. So they came in yesterday and said that he needed to go to rehab and I was just see, you know, what his insurance covered, do it cover that?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK. I can, I can get that.
[CUSTOMER][NEUTRAL] Cause I know
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I know when the doctor came in she was trying to find him a rehab, but she said that his insurance gonna, you know, have to, it gonna make a difference in it, so I just want to call to see, you know, what.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would be.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And then we need to see um.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] How do we go by paying it since he's not able to work?
[CUSTOMER][NEUTRAL] Right now.
[AGENT][NEUTRAL] Pay, pay what?
[CUSTOMER][NEGATIVE] To pay this insurance because he's not working, yeah.
[AGENT][NEUTRAL] The premiums, the premiums? OK, got it.
[CUSTOMER][POSITIVE] They work in 2 weeks.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me see. I'm looking at his policy.
[AGENT][NEUTRAL] Is he in a regular room now?
[CUSTOMER][NEUTRAL] Yes, he got moved to a regular room yesterday.
[AGENT][NEUTRAL] OK, so there is an ICU benefit under the policy as well as of course.
[AGENT][NEUTRAL] You know, if they moved him, it's, you know, he'll get a there's a benefit for just a regular room, so for ICU or in intensive care, um, it says that this uh policy covers $100 per day, a maximum of 20 days.
[AGENT][NEUTRAL] Per calendar year per covered person. There's a hospital admission benefit under this plan. That means the first time he's admitted to a hospital, uh, in any calendar year, uh, there's a $500 benefit per day, one time a year, and then for each day that he's confined, the benefit is $50 per day.
[AGENT][NEUTRAL] A maximum of 30 days per calendar year per covered person.
[AGENT][NEUTRAL] So that's 3 different benefits. Um, the hospital admission, the hospital confinement benefit, and then the ICU benefit. And you said that he's going to rehab?
[CUSTOMER][NEUTRAL] Yeah, they end up having, OK, he went to Aberdeen Hospital. They do that for him, so they sent him to [PII]. [PII] didn't do, no, they, everything they was doing was selling, so he had to get on the helicopter and he had to come to [PII]. So I want to know, you know, what, what insurance help with all that right there, plus the rehab that he got to go to.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. I do show, show also a rehabilitation benefit at 25 per day, a max of 30 days per calendar year. So, let's see. You said.
[CUSTOMER][NEUTRAL] So then they would take that for $25 a day.
[AGENT][NEUTRAL] For, for rehab, for the rehabilitation benefit, that's what this policy says.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] Bear with me here.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] There's also an ambulance benefit. It says we will pay the ambulance benefit per day when a covered person is transported by air or ground ambulance to a hospital or from one medical facility to another, um, where a covered person is admitted. So that applies in this situation.
[CUSTOMER][NEUTRAL] Cause they go, cause, cause they
[CUSTOMER][NEUTRAL] They picked him up from home, and transported him to one hospital and then they transported him to, so he had 3 different
[CUSTOMER][NEUTRAL] Yeah, they picked him up.
[AGENT][NEUTRAL] Yeah, so, so from home to [PII]?
[CUSTOMER][NEUTRAL] Right, and then for every.
[AGENT][NEUTRAL] And from [PII] to [PII]?
[CUSTOMER][NEUTRAL] The [PII] and then from [PII], he got on the helicopter to [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] And so we'll need to receive each one of those itemized bills from each hospital that he went to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Plus we'll need a bill from the ambulance service.
[CUSTOMER][NEUTRAL] So what we have to send that in or uh when he present?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Usually, um, and this is a conversation that you can have with each hospital. Usually they'll submit the claims to American Public Life on the patient's behalf.
[AGENT][NEUTRAL] But it's gonna be a matter of you communicating with each of the 3 hospitals.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, and then if you know who the ambulance service is, maybe contacting them to submit a bill.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So that there's no loopholes or anything like that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, if you or he, um, decides to send the claims in, then there's you, we pretty much need the same documentation, but it's, it's a lot of leg work if you do it if he does it or you do it, you know, so I would reach out to the hospitals and see their billing department and see if they would, you know, submit the bills to American Public Life on his behalf.
[AGENT][NEUTRAL] And the information that I'm giving you, it's not, you know, uh, protected information it's just basically the policy benefits because of, you know, he's not able to do it at this time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Under the rehabilitation benefit, it says that we will pay the rehabilitation benefit for each day a covered person is receiving rehab care.
[AGENT][NEUTRAL] Services while confined in a rehab unit or skilled nursing facility immediately after a covered period of confinement. So he's going to go to the rehab.
[AGENT][NEUTRAL] Facility immediately, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] They do, yeah.
[AGENT][NEUTRAL] OK, so that's what it says. Immediately after a covered person of period of confinement due to an injury or covered sickness.
[AGENT][POSITIVE] Um, so that's a benefit rehab benefit.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So is he, after the rehab, uh, will he be able to do physical therapy after the rehab and be covered?
[AGENT][NEUTRAL] Let me see if physical therapy is covered. Give me a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does he not get PT in rehab?
[CUSTOMER][NEUTRAL] Yeah, he gonna get PT in rehab, but he gonna have to learn how to uh walk and stuff over again. He can't um he can't control his body.
[AGENT][NEUTRAL] Uh-huh. OK. I don't show a physical therapy, a separate physical therapy benefit outside of the rehab benefit in his policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So you said that they was only gonna pay $100 per day while he was in ICU?
[AGENT][NEUTRAL] Uh, let me go back to that benefit. So yeah, the, the intensive care unit benefit is $100 per day for a maximum of 20 days. So the policy will cover up to 20 days. You said he was, uh, he went, he admitted on the [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so it pays a maximum of 20 days per calendar year per covered person for ICU at 100 per day.
[AGENT][NEUTRAL] Did he have any kind of surgeries or anything like that?
[CUSTOMER][NEUTRAL] Uh, he had a procedure done on his heart where they had to um check the valves in the back of his heart. That's the only procedure he had, but he was on a ventilator for like 9 days.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, cause there's also a benefit for uh surgery as a result of the sickness or an accident under the policy as well. And it's 500 per day, uh, one time per calendar year.
[AGENT][NEUTRAL] So that's what I'm showing under the policy.
[CUSTOMER][NEUTRAL] OK. So how do he go by paying his policy since he's no longer working?
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] That is a question that is for his employer, is this like a temporary service?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah, so that's a question that's gonna be for his employer because his premiums, you know, more than likely, um, uh, are they come, you know, they're submitted to APL by his employer, so that's a that's a conversation for the employer of course they know that he's out, of course.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Is his insurance still active as of today?
[AGENT][NEUTRAL] It is, it is. It is.
[CUSTOMER][NEUTRAL] OK, OK, so I need to call his employee and see how do we go about paying while he uh.
[CUSTOMER][NEUTRAL] Continue to get way up, right?
[AGENT][NEUTRAL] Yeah, well, he's in rehab and all of that.
[CUSTOMER][NEUTRAL] Well, he's still in the hospital as of now.
[AGENT][NEUTRAL] I know it, but even after that, he'll have to go through rehab. Yeah. Mhm.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Well, let me see, can I, uh.
[CUSTOMER][NEUTRAL] Get the employee number and call them and see how.
[CUSTOMER][NEUTRAL] We pay cause uh I, I don't know.
[AGENT][NEUTRAL] Are they aware of what's happened?
[CUSTOMER][NEUTRAL] Yes, I think his supervisor is aware.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, so you may wanna reach out to his supervisor and let that person be maybe the lead in talking to HR or something like that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, cause I think he got paid biweekly, so biweekly would be insurance was taken, no, he get paid weekly.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So insurance would be taken out weekly.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Oh, I sure hope he gets to feeling better and doing better.
[CUSTOMER][NEUTRAL] Uh, would, would you, would you, would you have the number to Hamilton record, the uh temp service he was working through?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] I'm showing a 502.
[AGENT][NEUTRAL] 456.
[CUSTOMER][NEUTRAL] No, I think the area code is supposed to be 662.
[AGENT][NEUTRAL] OK then you may need to uh then I'm not for sure um and this looks like it could be for HR so if you have the supervisor number that might be the route to go and let them get you know kinda navigate.
[CUSTOMER][POSITIVE] Just better.
[AGENT][NEUTRAL] For you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But his insurance do cover.
[CUSTOMER][NEUTRAL] We have.
[AGENT][NEUTRAL] You know, when he's, you know, when he goes to rehab immediately after an inpatient stay only physical therapy isn't after that isn't covered. I don't show that under the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Well, I think you uh that I need to be answered and I thank you.
[AGENT][NEUTRAL] Oh, you're welcome, [PII]. Any other questions I can answer for you?
[CUSTOMER][NEUTRAL] Uh, no, ma'am, not right now.
[AGENT][POSITIVE] OK. And anytime we provide a benefit.
[AGENT][NEUTRAL] We do have to let you know that the information provided is verification, not a guarantee of payment until we get all of the documentation, the claim documentation.
[AGENT][NEUTRAL] Um, so you may wanna have a conversation with the hospital as far as submitting his, um, uh, his charges to APL.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. OK, I will, I will.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because, um,
[CUSTOMER][NEUTRAL] Um, when the doctor came in yesterday, that, um, I think his insurance follow him when he presented it at the one hospital, they follow him to the rest of the hospital.
[CUSTOMER][NEUTRAL] But I will make a, have a talk with them to make sure.
[CUSTOMER][NEUTRAL] That they, they do, they do.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And this is this this is each hospital, [PII], and then [PII].
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All righty. Anything else?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] Alrighty well have a good day. I hope he, um, you know, is doing fine and will continue to progress.
[AGENT][POSITIVE] In a positive way.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Yes, ma'am, and I thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely my pleasure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] Alrighty, thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Uh bye-bye.