AccountId: 011433970860
ContactId: f29fdfab-3691-49d9-bab6-1fd6bf6f215f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 893549 ms
Total Talk Time (AGENT): 301178 ms
Total Talk Time (CUSTOMER): 373702 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/f29fdfab-3691-49d9-bab6-1fd6bf6f215f_20250404T18:07_UTC.wav
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[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, can you hear me?
[CUSTOMER][NEUTRAL] Oh hey Miss [PII], it's [PII]. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] I, I can hear you now. I could not hear you at first. Um, can you help me with something because I don't wanna transfer this gentleman, but I've never had a call with this [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy number that he's calling on is um.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Well, hold on, because it's one of those BWA ones.
[CUSTOMER][NEUTRAL] The policy certificate is 248.
[CUSTOMER][NEUTRAL] 984 6
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, he's been fully verified. He's asking me how to file a claim for the accidental death and dismemberment.
[CUSTOMER][NEUTRAL] First off, I don't, I mean, I see that policy language in the cert, but I don't see benefit information on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Maybe I'm just don't understand what I'm looking at.
[CUSTOMER][NEUTRAL] And the next question is, is what claim form? Yes, how would he go about filing? I've never received one of these type calls.
[AGENT][NEUTRAL] OK, give me one second.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] X
[CUSTOMER][NEUTRAL] Way out.
[AGENT][NEUTRAL] Give me 1 2nd to see if I can find it.
[CUSTOMER][NEUTRAL] Oh no, you're fine. Yeah, I'm uh I'm just uh again I've never had one of these calls and I'm trying to just help him without having to have, you know, someone to call him back or transfer him.
[CUSTOMER][NEUTRAL] Trying to learn something.
[AGENT][POSITIVE] OK, you're good.
[CUSTOMER][NEUTRAL] But I mean like
[CUSTOMER][NEUTRAL] I don't, I don't
[AGENT][NEUTRAL] See hospital emergency accident.
[CUSTOMER][NEUTRAL] I and sickness.
[CUSTOMER][NEUTRAL] Surgery, dental anesthesia.
[AGENT][NEUTRAL] Look here.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] And he has a benefit, OK.
[AGENT][NEUTRAL] Accidental accident health.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK, so for an accidental death or dismemberment, I mean.
[AGENT][NEUTRAL] I don't, I'm not seeing that.
[CUSTOMER][NEUTRAL] I see them in the policy certificate it talks about.
[CUSTOMER][NEUTRAL] And I just
[CUSTOMER][NEUTRAL] On page 31 of 38 of the thing, it does talk about accident, accident and health, life, you know.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] That's for each insolvent company, the association will pay a person's claims.
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] Yeah how you particularly if your life is my health insurance company fails.
[CUSTOMER][NEGATIVE] I cannot stand these BWA calls [PII].
[AGENT][NEUTRAL] I've never heard about this one.
[AGENT][NEUTRAL] Cause I've never taken one of these either.
[AGENT][NEUTRAL] You can send them over and I'll see if I can um I'm gonna have to find out myself about it.
[CUSTOMER][POSITIVE] Oh good. I know.
[CUSTOMER][NEUTRAL] Um, well, I didn't tell him that I was gonna connect him, so do you mind, um, letting me try to join him in and just introducing you? Is it possible I can stay on the line or do I need to hang up? I mean, are you gonna have to call him back?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's fine.
[AGENT][NEGATIVE] I'm gonna have to call them back because I've never had this one myself.
[AGENT][NEUTRAL] I've never, I've never heard of this.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Well, let me try and me either me either, so um thank you very much for your help with this one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me see if I can join him in with us and just introduce you um and then turn I'll I'll just leave the call OK but he's fully verified and he is already on the OSC so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Thank you, [PII]. All right.
[AGENT][POSITIVE] Alright, no problem.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi this is [PII], and I have one of our claims, um, examiners on the line with us. Her name is [PII].
[CUSTOMER][NEUTRAL] And I am going to [PII] is going to be further assisting you with your question today on your policy. [PII], are you able to hear Mr. [PII]?
[AGENT][NEUTRAL] I am.
[CUSTOMER][NEUTRAL] OK, so Mr. [PII], is there any, is there anything else that I can help you with today before I
[CUSTOMER][NEUTRAL] Just release you to [PII]?
[CUSTOMER][NEUTRAL] Yes, um, the, the member ID I gave you was that the right one or do I have a different one?
[CUSTOMER][NEUTRAL] Now I can also give you a specific policy number we can pull your information up with the number, your member ID that you gave me but in your portal with APL you'll also see this number that I'm about to give you. It's 02.
[CUSTOMER][NEUTRAL] 48.
[CUSTOMER][NEUTRAL] Mhm. 48.
[CUSTOMER][NEUTRAL] 98.
[CUSTOMER][NEUTRAL] 46.
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][NEUTRAL] And that's the APL number?
[CUSTOMER][NEUTRAL] Yes sir, that you will see in your portal for APL mhm. All right, thank you. Well, you're very welcome and I.
[AGENT][NEUTRAL] Hi, did he, did he give you another?
[AGENT][NEUTRAL] Did he give you another number? Did he give you another number at the beginning of the call?
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] [PII], he gave me, he did, he gave me the member ID number that's in the system. It's 682.
[CUSTOMER][NEUTRAL] 380
[CUSTOMER][NEUTRAL] 466.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He's with um this is through his association with the Business Workers of America, so on their ID cards they do have a different number.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK alright thank you.
[CUSTOMER][NEUTRAL] Yeah right, OK, well, again, Mr. [PII], before I leave the call, is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, that's all thank you very much, [PII]. Well, well, you're very welcome and thank you again for calling APL. I hope you have a very nice weekend.
[CUSTOMER][NEUTRAL] Too bye bye. OK, bye bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Hi, how are you?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm good. Is it [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, [PII], OK.
[AGENT][NEUTRAL] Yes, yes, OK, so she said you were calling trying to get uh to see how to file a claim for the accidental death and dismemberment, is that correct?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so.
[AGENT][NEUTRAL] And so, uh, you don't mind me asking, did someone pass away?
[AGENT][NEUTRAL] Do an accidental death.
[CUSTOMER][NEUTRAL] Um, yes, my son.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] M[PII] son passed away in January.
[AGENT][POSITIVE] OK, I'm sorry to hear that.
[AGENT][NEUTRAL] OK, so we, um, how did it happen? so I can try to see if we, I can make sure you send in everything that we're needing.
[CUSTOMER][NEUTRAL] Um, so, in, um, [PII], um, he was admitted into, uh, the ER.
[CUSTOMER][NEUTRAL] And come to find out after testing, he was diagnosed with uh leukemia.
[CUSTOMER][NEUTRAL] And uh he was in ICU for over 5 weeks.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um,
[CUSTOMER][NEUTRAL] Uh, he was put under a life support machine.
[CUSTOMER][NEUTRAL] And he also had um a piece of his skull removed due to um pressure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But he finally passed away in January.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. OK, so it wasn't due to an accident.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, so the, the accidental death and dismember benefit would probably it would be, you know, if there was, if he died due to an accident, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Maybe like he was in a car accident and he passed away, then that would be considered an accidental death for that benefit but at this time was he in in, I'm sure he was in the intensive care unit, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so under your policy you have an intensive care benefit, uh, that would pay up to $1500 per day.
[AGENT][NEUTRAL] And that it'll pay that benefit a maximum of one day per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, for inpatient surgery, it, uh, because of course he did have surgery, uh, the benefit would pay up to $500 per day, uh, maximum of 1 day per calendar year for that also, and for the anesthesia, it'll pay up to $125 per day.
[AGENT][NEUTRAL] Uh, so it looks like that's gonna be.
[AGENT][NEUTRAL] The bulk of your benefits.
[AGENT][NEUTRAL] Under this policy.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, let's see, now you do have the hospital admission benefits.
[AGENT][NEUTRAL] Which that would pay up to $75,750 per day, a maximum of one day, and there's a $200 1st time occurrence.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A maximum of 1 hospital consignment benefit that's payable 200 per day.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] For each day he's confined to the hospital up to 30 days. So to claim that benefit, we would need the itemized billing from the hospital.
[AGENT][NEUTRAL] With the diagnosis code and so, so that we can see how long he was confined to the hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And other
[CUSTOMER][NEUTRAL] Do I need to request an itemized statement.
[AGENT][NEUTRAL] Mhm. Yes, so we can see how long he was in the hospital.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so for the inpatient.
[CUSTOMER][NEUTRAL] OK, uh, I.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I guess the itemized statement would tell you guys everything for you guys to look everything up.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. And so just make sure that it has the diagnosis code on it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which is the reason why he was in the hospital.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um, can I, can I email it to you when I get it, or?
[AGENT][NEUTRAL] Uh, you can upload it, uh, on the through the OSC. Are you, have you already signed up for our online service center?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, uh, then if you wanna email, uh, actually the claims, uh, email is not, uh.
[AGENT][NEUTRAL] Email is not a secure way to to send in your claims so usually they ask that you can fax it in or upload it through the online service center or either mail it in to our office.
[CUSTOMER][NEUTRAL] OK, um, so what's the best way of getting it to you?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The best way is uploading it on the OSC, uh, create an account and upload it on the OSC, but if you don't wanna do that, then the next way is gonna be faxing it in to us.
[CUSTOMER][NEUTRAL] OK, I can try and upload it. Um, can you give me the link to the website?
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] I can open an account.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] U R E D
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then you would just need your uh your policy number.
[AGENT][NEUTRAL] And I wanna say your social security number.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In order to um create an account.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So it's secure [PII].
[AGENT][NEUTRAL] Uh, secured with a [PII].
[AGENT][NEUTRAL] U R E D
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Oh, [PII] [PII].
[AGENT][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Mm. Oh, so it's just an email I can send it over?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is that an email address?
[AGENT][NEUTRAL] No, that should, uh.
[AGENT][NEUTRAL] Go to our uh online service center.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] The cure at like AT not like an email address.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, OK, so it's uh [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh. [PII], OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, alright, let me, let me get everything rolling. I'll come to the hospital and get the statement and then I'll get it going.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII]. Mhm.
[AGENT][POSITIVE] Alright, thank you for calling ATL and have a great rest of your day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye bye.