AccountId: 011433970860
ContactId: f74096ae-7276-4f29-89bc-756d478f8dd7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 784210 ms
Total Talk Time (AGENT): 441463 ms
Total Talk Time (CUSTOMER): 226782 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/f74096ae-7276-4f29-89bc-756d478f8dd7_20250523T14:27_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Yes, uh,
[CUSTOMER][NEUTRAL] I just got this policy. I didn't even realize that I signed up for it and um.
[CUSTOMER][NEUTRAL] In March, and I've just received the booklet uh about 3 weeks ago.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I see, I, I was hospitalized, um.
[CUSTOMER][NEUTRAL] On the [PII].
[CUSTOMER][NEUTRAL] And I see I have a I can file a claim for that.
[AGENT][NEUTRAL] OK. Um, well, I can help you with your coverage and let you know, um.
[AGENT][NEUTRAL] How to file and everything so you can um get that in and processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have your name and a good contact number just in case we disconnected?
[CUSTOMER][NEUTRAL] Yes, it's, uh, my contact number is gonna be [PII].
[CUSTOMER][NEUTRAL] And my name is [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and Ms. [PII], may I have your um policy number?
[CUSTOMER][NEUTRAL] Would that be on the front of the book?
[AGENT][NEUTRAL] um, have you received any cards or just the book?
[CUSTOMER][NEGATIVE] No, I just got the book and I got, like I said, uh, it, it had been sitting on at my job for a while cause it didn't come to my house.
[CUSTOMER][NEUTRAL] Cause I, I was out and when I finally saw it, uh.
[AGENT][NEUTRAL] Well, I can look the policy up with your social if you like.
[CUSTOMER][NEUTRAL] Uh, no, no, I think I have two things on here. One says group issue.
[AGENT][NEUTRAL] Group issue.
[CUSTOMER][NEUTRAL] And then the number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, and the other one is.
[AGENT][POSITIVE] OK, that sounds right.
[CUSTOMER][NEUTRAL] The same but it's got [PII].
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Yep, that puts you right up. And can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII]. My email is [PII].
[AGENT][NEUTRAL] And your mailing address?
[CUSTOMER][NEUTRAL] Well, they, they have my job. That's not my mailing address and.
[CUSTOMER][NEUTRAL] But it's down as [PII].
[AGENT][NEUTRAL] OK, so that one, so the [PII], that's your work address?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's correct. That's why I didn't get the, the thing until I return back to work.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You want me to update this to your personal address?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, um, and what is that whenever you're ready?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alive.
[AGENT][NEUTRAL] It's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, I was right. OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I've updated your mailing address on file. So, um, you have a group accident policy with us, the medical policy, which is a hospital indemnity policy, and then you also have the short-term disability policy with us. Um, and you said you were hospitalized on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh let me see first the Friday after the [PII].
[CUSTOMER][NEUTRAL] Hold, hold on a second there, I think it's the [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me look at the calendar real quick.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Uh, Saturday.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, the [PII], and I was discharged on the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just waiting for your benefits to populate here so I can see what all your um you can file for and all the information provided is a verification of benefits, not a guarantee of payment. So your policy has a hospital admission benefit, um, one day per calendar year. So we'll pay up to, it will pay $2000 per day um for that first day that you you were admitted.
[AGENT][NEUTRAL] And then every day after that, it'll pay $100 per day, um, with a max of 30 days per calendar year.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, did you, did you have any surgery or anything or it was just like a hospital stay?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it was a hospital stay.
[AGENT][NEUTRAL] OK, um, if they did any, just I'm just looking through the benefits to see what all I can tell you. If they did any diagnostic testing or like imaging, um, there is a benefit here. They did, OK. So there's a benefit there, $100 per day, um, they'll pay towards the imaging.
[CUSTOMER][NEUTRAL] They did.
[AGENT][NEUTRAL] With the max of 1
[CUSTOMER][NEUTRAL] So we're talking like uh [PII].
[CUSTOMER][NEGATIVE] That's considered image incorrect.
[AGENT][NEUTRAL] Let me um see if this policy specifies or if it's just anything diagnostic. Hold on one second.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they took a look at the images of my heart while I was there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Diagnostic testing.
[AGENT][NEUTRAL] OK, so this one, this policy is specified. So, um, MRIs, CAT scans,
[AGENT][NEUTRAL] Um, the radioactive iodine test for thyroid is on here, um, CT scans and PET scans, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, those are the, so this one specifies it, but you can um take advantage of the hospital admission and the hospital confinement benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so to file a claim, you have two options. If you want to let the provider, uh, you know, the hospital that you want to know, hey, I have this insurance, here's my policy number, and just, um, give them our phone number if they need to verify anything, so they can bill.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Well, but then when they build the money going to them.
[AGENT][NEUTRAL] Um, it depends. If something is still owed to them, it could go to them. If it has already been paid.
[CUSTOMER][NEGATIVE] Oh, come on, I wish I'd have known that. I would have never got this policy.
[AGENT][NEUTRAL] So that we can pay your bills?
[CUSTOMER][NEUTRAL] What's the
[CUSTOMER][NEUTRAL] Yeah, I need the money. Oh, I have the um.
[CUSTOMER][NEGATIVE] I need the money to, uh, cause I'm, I'm out of work. I was out of work all that time.
[AGENT][NEUTRAL] So are you, are you looking for your disability policy?
[CUSTOMER][POSITIVE] I want everything I got.
[AGENT][NEUTRAL] Your short-term disability is what pays you, your short term disability is what pays like your pays you for while you're out of work. This that I'm telling you now is just so that we can try to get your hospital bills paid. Do you want me to pay your short-term disability benefits too, that goes straight to you.
[CUSTOMER][NEUTRAL] Disability.
[CUSTOMER][NEUTRAL] Yeah, both of
[AGENT][NEUTRAL] OK, hold on one moment. So, um, so I was saying for this policy for your hospital indemnity policy for your hospital bills, either the hospital can file it or you can file it. Um, so that $2000 and all the other benefits, if there's something that's still owed to the hospital that can go to them, if you've already or if you have other insurance and there's no balance, then that will go to you as well. Um.
[AGENT][NEUTRAL] You can mail the claim, you can fax it, or you can send it electronically. And let me see what your short-term disability policy is. Hold on one second.
[AGENT][NEUTRAL] I'm just waiting for it all to come up. Hold on one moment.
[CUSTOMER][NEUTRAL] OK, cause I, I had another policy and it and it came to me, the hospital.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] What they pay for you going into being admitted that to me yeah.
[AGENT][NEUTRAL] The medical.
[AGENT][POSITIVE] Mhm. Like with the admission and everything that goes, that goes towards your hospital bills, but now this disability that I'm pulling up, this is for you.
[AGENT][NEUTRAL] To help while you're out of work.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so your disability benefit is $2900 per month.
[AGENT][NEUTRAL] Um, so, to file for your disability.
[AGENT][NEUTRAL] You, it might be, did you want me to I can email you the claim forms.
[AGENT][NEUTRAL] Would that be easier for you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'll email you the short-term disability claim form and your hospital indemnity claim form, and then in
[CUSTOMER][POSITIVE] I'll, I'll just send that to you. How about, wait, I, I'm just gonna go ahead and give them that information and let them file since they get it. I don't have to, I have to be worried about it.
[AGENT][NEUTRAL] Oh, who, the doctor?
[CUSTOMER][NEUTRAL] In the hospital.
[AGENT][NEUTRAL] You can give them the hospital indemnity, but the short-term disability, that's for you.
[CUSTOMER][NEUTRAL] I understand
[AGENT][NEUTRAL] So, on the short-term disability claim form, you'll see three sections. It's a section for you to fill out, a section for the doctor to fill out to say when you're out of work, you know, how long you'll be returning or when you're returning, so we know how long to pay you. Um, that first time that you file your claim, you'll need all three, but um, you
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Depending on how long you're out, you will have to send in the continuation form each month, so we can pay you for the next month. So, like, for example, if you send it in today and you go ahead and get paid, I would just go ahead and send that continuation and so we can start for June. The only time you'll need your doctor or your employer to fill out the forms again for your disability is if, like if your doctor extends you or something, we'll need to know the new date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well I'm back at work already. I just want to go ahead and file for when I was out.
[AGENT][NEUTRAL] Oh, OK. Um, so I'll go ahead and and send the claim form to you. I don't know if you're on the online service center, so you can file electronically. If not in the email, there's a link to it, so you can sign up and file your claims electronically. Now, for your disability, there is an elimination period. Every disability policy has an elimination period. It's they can range from 7 days to 90. Yours is 7, thankfully. So,
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] So that first payout is going to be missing 7 days of pay, so it's not going to be the full 2900.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then it depends on how many days you were out of work. So I'll go ahead and send that to you now, so you'll have the breakdown and everything. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] So I just have to give them the policy number, the name of the company and the policy number to the hospital, right? And then they can file it.
[AGENT][NEUTRAL] Mhm. I give them my phone number if they need to verify benefits or anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then just
[CUSTOMER][POSITIVE] Well thank you so much I appreciate it.
[AGENT][NEUTRAL] You're welcome. I know we went over the email, but just because I'm getting ready to send you an email, I just want to make sure. So it's [PII]?
[CUSTOMER][POSITIVE] That's right.
[AGENT][POSITIVE] OK, so I'm getting ready to send both of the forms to you now.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No ma'am, thank you so much I appreciate it.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great weekend.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Oh, I'll wait, wait, wait a minute.
[AGENT][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] The hospital confinement, that goes to them too?
[AGENT][NEUTRAL] Mhm. Everything.
[CUSTOMER][NEUTRAL] $100 a day.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Damn it.
[AGENT][NEUTRAL] It depends on what the billing shows.
[CUSTOMER][NEUTRAL] Well, at least that'll be one less thing.
[CUSTOMER][NEUTRAL] What do you mean?
[AGENT][NEUTRAL] So if we get the bills and do you have any other insurance or this is your only medical insurance?
[CUSTOMER][NEUTRAL] Uh, I have all the insurance.
[AGENT][NEUTRAL] Yeah, so when we get the bills, depending on what's already been paid, what's left, if there's anything left over, right, if there's nothing left over, then this will go to you.
[CUSTOMER][NEUTRAL] Oh, the, the difference. OK. All right.
[CUSTOMER][POSITIVE] OK, thank you so much, sir.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.