AccountId: 011433970860
ContactId: f04013ff-1533-4318-a558-ba03f4e64f37
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 653049 ms
Total Talk Time (AGENT): 380314 ms
Total Talk Time (CUSTOMER): 277925 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/f04013ff-1533-4318-a558-ba03f4e64f37_20250409T14:39_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], this is [PII]. I need to ask some questions on whether I can file a claim that I had, uh, I had procedures done.
[AGENT][NEUTRAL] OK, so we're just needing to see if those procedures were covered under your policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Absolutely. OK, I can check that for you. Uh, [PII], can I first get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, it is 02515176.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] All right. [PII] I'm just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. The last thing I need is the email address we've got on file for you. Uh, looks like it might be [PII]'s, it's a Yahoo account.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, uh
[CUSTOMER][NEUTRAL] I, I know my, I, I don't know, I think you might have both of ours. It's [PII]. That one's mine.
[CUSTOMER][NEUTRAL] And his is [PII] or something like that.
[AGENT][NEUTRAL] OK, no, it's not either of those, um, it is a Yahoo account, but I, I do believe it is [PII].
[CUSTOMER][NEUTRAL] It might be his
[AGENT][POSITIVE] That's OK, that's all right.
[CUSTOMER][NEUTRAL] OK, yeah, well that's his and then yeah.
[AGENT][NEUTRAL] That's OK. We can look at coverages. Let's see. OK. So, I'm so sorry. Did you say you already have this procedure or you will be having this procedure?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I had the procedures done and I don't know if these are covered or whether I should submit in a claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, on, uh, I had a loop recorder and plan it.
[CUSTOMER][NEUTRAL] Do y'all cover that or is that on my plan?
[AGENT][POSITIVE] What was it called again? I'm so sorry.
[CUSTOMER][NEUTRAL] It's called a loop recorder.
[CUSTOMER][NEUTRAL] That's implanted underneath on my chest.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and that, I know this is gonna sound funny, but that did require a surgery, correct?
[CUSTOMER][NEUTRAL] Uh, well, well, they consider it a surgery.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They had to, they had to cut me and then slip this thing underneath my skin and then kind of sew a stitch or two, and that was it.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's take a look. Give me just a moment.
[CUSTOMER][NEUTRAL] To monitor my heart.
[AGENT][NEUTRAL] Oh, got it. OK.
[AGENT][NEUTRAL] All [PII]. Bear with me just a moment. Let me take a look. Mhm.
[CUSTOMER][NEUTRAL] To monitor my heart rhythm, to see if I'm going in afib or whatever.
[AGENT][NEUTRAL] Sure, OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Were you confined in the hospital or was it more of an outpatient? Like did you have to stay overnight?
[CUSTOMER][NEUTRAL] No, it's outpatient.
[AGENT][NEUTRAL] It was outpatient. OK. Got it. Alright, thank you for that. So this policy can be a little bit um specific as to those kinds of things, uh why I ask, so I appreciate that. Give me just a moment. Let me take a look here.
[CUSTOMER][NEUTRAL] No, it was outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Now I, I can ask you real quick, do you, do every time I have a procedure, do I just send in a claim and whether y'all deny me or not or, or we get, you know.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes. Sure.
[AGENT][NEUTRAL] You know, I, I would.
[CUSTOMER][NEUTRAL] You know that we could file it or whatever.
[AGENT][NEUTRAL] Sure, I would always recommend doing that anyway, especially with this kind of surgery, uh, or excuse me, with this kind of policy, um, again, as they can be a bit specific and a little bit difficult to understand specifics as to what is and is not.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Covered, um, so but, you know, the worst we're going to say is no, this isn't covered. Um, but of course, best case scenario, we would pay that benefit. Um, so I will say that you do have a surgical benefit under this policy. It does state that it's in regard to accident or sickness. So I'd imagine needing that, that would be in regard to a sickness if they're having to monitor your heart like that. Um, so surgery in a
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Hospital outpatient, excuse me, outpatient facility, free-standing outpatient surgery center or in a physician's office that pays $1000 per day for surgeries.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, like I said it was an outpatient and then, OK, well, let's put it this way, I, I'm trying to get the itemized bill. I'm waiting for somebody to call me on that and if I just send in all the information I'll just take a chance if I get approved, OK, no good.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Absolutely, um.
[CUSTOMER][NEUTRAL] And then let me ask you, I had, I had another procedure done which is called a T.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] A TEE where they had to go in.
[CUSTOMER][NEUTRAL] And look at the back of my heart and that's a separate that's another separate day. I want a week later. I'm, I'm assuming I send that one in too, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK, OK, because that was outpatient also.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yes, OK, so, and I will say as well, yes, go ahead.
[CUSTOMER][NEUTRAL] All right, now,
[CUSTOMER][NEUTRAL] Which form do I fill out?
[AGENT][NEUTRAL] OK, so it would be this plan is called hospital indemnity, so it would be that claim form um and let me ask you really quick, can, do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, have you created an account on our online portal before?
[CUSTOMER][NEUTRAL] I think I did, but I don't know how to send it that way.
[AGENT][POSITIVE] Um, I can check. Uh, the reason I ask is that's going to be typically the quickest and easiest way to get claim information to us. We get it very quickly, um, guaranteed to get to us, you know, as opposed to if you were to mail it or something like that, um.
[AGENT][NEUTRAL] So I do recommend doing it that way uh let's see so I'm not showing that you have created an account online before with us or [PII] has not.
[CUSTOMER][NEUTRAL] Oh, OK. Oh, I know what I did. I had to go on there and I had to print out the forms. That's what I did.
[AGENT][NEUTRAL] So I, whenever you're
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that that website we do have a public website our online portal is a different web address and that's going to be of course your actual account where you can um upload claims you can view their status, uh you can get, you know ID cards um oh it's more personalized to your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So whenever you're ready I can give you that web address, yeah.
[CUSTOMER][NEUTRAL] The thing is,
[CUSTOMER][POSITIVE] OK, I'm ready I'm ready, uh huh go ahead.
[AGENT][NEUTRAL] Sure, OK, so it's the word [PII].
[CUSTOMER][POSITIVE] [PII]. OK, I got it.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then the word [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I, I do remember, I remember seeing that. That has to be. I don't know, I have to check. I'm gonna tell you.
[AGENT][NEUTRAL] It might be on your um ID card, yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, let me see, let me see, I got my ID card right in front of me. This it is [PII], yes.
[AGENT][NEUTRAL] It's secured. [PII] that secured has to be in front without it that's just our public website like you were talking about where you can get the claim forms and such, yes with the secured in front of it that's your actual online portal and so to create an account.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Oh, I got you.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] You would use all of the information that we just verified so it would have to be the same uh email address that we've got um so I would get with uh [PII] to find out um this Yahoo account. I'm sorry?
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I was gonna say it would have to go on any [PII]'s account so I have to let him do it.
[AGENT][NEUTRAL] Correct because it does have to match what we have in our system.
[CUSTOMER][NEUTRAL] Right, OK.
[AGENT][POSITIVE] Yes, and then from there it's very easy you'll see uh a spot right on the main page where you can upload claim information so that's where you would send us that um itemized statement that shows uh diagnosis and procedure codes and then of course the all of the claim forms are right there as well so just that correct claim form the hospital indemnity upload that we get it very quick.
[AGENT][NEUTRAL] And then from there it can take about 7 to 10 business days for claim information to process. It may not take quite that long, but that's, you know, probably a safe yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Um, now I, we already filed a claim. I don't know, maybe 1 month, 2 months ago, whatever, so you know we've been through this already. The thing is the reason why I do it this way is because.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] I wait for my grandson to come in because he kind of helps me kind of teaching me on this computer stuff. So that's why I fax it in.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Oh no I mean whatever is easier for you no that's perfectly fine if you prefer doing it that is perfectly fine. I just always like giving this option to others and even if you prefer sending it via fax you can still uh create the account and you can view the claim status uh from the website as well so however you prefer to do it, that is perfectly fine.
[CUSTOMER][NEUTRAL] That's why I factored in.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of course. Right, right.
[CUSTOMER][NEUTRAL] OK, cause that's the way I have to do it because otherwise they get all screwed up.
[AGENT][POSITIVE] Sure, no, no, that's fine. Again, I just like presenting that option to people and you know facts is probably, you know, gonna be the next best way I would definitely say.
[CUSTOMER][NEGATIVE] I hate to say that.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Right, well, once my grandson comes in from college, he usually sets everything up on my computer and I just have to press a button and then I can go right in it. So I need to wait for him to come in so he, I'll let him do this.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] I understand. I completely understand and if you need to when he's here y'all can give us a call and you know if we need to walk you through it we absolutely can.
[CUSTOMER][NEUTRAL] Right, but I just needed to know what form so it's the hospital. I actually I made copies, so I know that has to go with everything else to be sent in.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, yes. So this one is the hospital indemnity claim form. Yes, ma'am.
[CUSTOMER][NEUTRAL] And that'll be on both of them correct?
[CUSTOMER][NEUTRAL] OK, so that would be the, the, the two procedures that I had done. OK, well then, then we got it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] All right. Well, thank you so much, [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] You did good, girl.
[AGENT][POSITIVE] Alright, thank you. I'm happy to hear it. Well, I hope you have a great rest of your day. Thanks for giving us a call.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] You too, thank you, hon. bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.