AccountId: 011433970860
ContactId: 01371b09-16ec-4352-989e-b06d0fb0767a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 797039 ms
Total Talk Time (AGENT): 361617 ms
Total Talk Time (CUSTOMER): 416607 ms
Interruptions: 6
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/01371b09-16ec-4352-989e-b06d0fb0767a_20250501T17:59_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, um, my name is [PII]. I was calling, um, see if I can get some information on how I submit a claim on my gap insurance.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with your claim information. Uh, can I please get your callback number, ma'am just in case our call is disconnected I'll be able to call you right back.
[CUSTOMER][NEUTRAL] Sure it is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your policy number?
[CUSTOMER][NEUTRAL] Policy number is 0244.
[CUSTOMER][NEUTRAL] 262 9
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, Ms. [PII], can I please um get your date of birth?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you. And then also your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] It would be [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, phone number is the one I just gave you [PII]. My email address is my first name [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. I appreciate you verifying your policy for me.
[AGENT][NEUTRAL] OK, um, I got a quick question for you. Are you signed up for the online service center?
[CUSTOMER][NEUTRAL] I do not think so.
[AGENT][NEUTRAL] OK, I can check and see if you are, um, that's the easiest.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, I, I mean, I don't think I've done anything on this.
[AGENT][NEUTRAL] OK. OK. That's fine. I'll help you through it all. Um, let me go and let me just make sure that you haven't signed up at any point in time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, you're correct you have never signed up for it so um what you're gonna need to do first is you're gonna go to our website it's secured, it's SE.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, is there a way you can send me a link to that?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah, I can send you an email.
[CUSTOMER][NEUTRAL] Um, actually, let me look and see what do I have on here, um, oh yeah, it's on the back of the card.
[AGENT][NEUTRAL] Um, and
[AGENT][NEUTRAL] Good, good deal. OK, so once you sign up for the online service center, um, the first option is you're gonna choose that you're a new user and then the second option you're going to choose is you're an individual with an APL policy. Once you get in there, you're gonna click on claims and forms.
[AGENT][NEUTRAL] And you're gonna choose the, the med link. It's M E D L I N K Medlink claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And cause that matches your policy.
[CUSTOMER][POSITIVE] Alright thanks.
[AGENT][NEUTRAL] And then, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll, you'll have to um send in your explanation of benefits from your primary insurance carrier.
[AGENT][NEUTRAL] And your itemized statement from the provider's office along with your claim form so you can uh download those forms and then upload them in the online service center and then push submit your claim.
[AGENT][NEUTRAL] And it'll send to us and you'll get a confirmation number back showing that we received it.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] OK, so of course nobody wants to send me anything. Nobody will mail me anything. So I, it's, it's a fight. I have breast cancer and it's a fight to get anything. All they want is their money. They don't want to send me an EOB. They don't want to send me anything. So just tell me exactly again. I need my EOB. So basically it's $5000. So to my understanding, I have gap insurance that's supposed to cover $500. So.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Bless your heart.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I don't know it's gonna be a lot of different rejection forms or it's just because I have not met my deductible so um is that part of this program?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, this policy helps with, uh, and this is just to verify your benefits. It's not a guarantee of payment, but yes, your policy helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] OK, so I need my EOB.
[AGENT][NEUTRAL] You have, you have an in.
[AGENT][NEUTRAL] Yes, you need your EOB and your itemized statement. The EOB comes from the primary insurance and the itemized statement comes from the facility that you went to the office that you went to.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, well I have that because there I have to make payments of $400 a month for the next I don't know 8-9 months, um, so is that feasible to send um, obviously I've got to try to log into Blue Cross Blue Shield and uh what uh you know what I mean because there's so many, it it's not just one bill.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's several bills. It's from the mammogram to the diagnostic mammogram to the surgery to the radiation to the uh all of that. So what do you just need the, the biggest one? What, what is it that you are requiring?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, we require that you fill out the claim form and you can fill out one claim form on our, on our end and for every day of service that you had, you'll need the the EOB to cover the date of services and you'll need the itemized statement to cover the the date of services that you went.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so if you guys are willing to reimburse me $500 and my first bill is $5000 and you still want every other bill after that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, once you've reached your benefit maximum for the calendar year then then it won't, um, you won't get it back again until January.
[CUSTOMER][NEUTRAL] Well, that's what I, that's why I'm trying to understand because that's still a lot of work I've got to figure out how I'm gonna print all this stuff to get it to you. So before I go and, you know, do all of these visits, all of my radiation visits, all of my oncology visits, you just need me to get to what amount?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And if you went inpatient, if you had if you had to stay in the hospital for 18 hours or more, OK. OK.
[CUSTOMER][NEUTRAL] No, no, no, I never, no, I, I had a lumpectomy that was all out. Everything is outpatient, um, but I can tell you strictly along with the mammogram that all of that, that's already got me well over $5000. So currently I'm already past.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] What I will ever owe, but now the fact is is I've got to pay almost a whole check every month to these to the health care providers. So to my understanding through my work that it was, uh, hopefully giving me a reprieve of, you know, 1 or $500 or something of that sort. So I just, I'm, I wanted to be clear on what it is that you need all of it or just up to.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right, and you get.
[AGENT][NEUTRAL] On your policy, you have an outpatient benefit amount per calendar day of $500.
[AGENT][NEUTRAL] So each day, yeah, so each day.
[CUSTOMER][NEUTRAL] OK, OK, well, that, OK.
[AGENT][NEUTRAL] And it has to be, you know, within a 24 hour period next day each day you get $500.
[CUSTOMER][NEUTRAL] I, I don't know that that would work since I had surgery. I had, you know what I mean? Nothing happened consecutively, you know, it was 1 day, then 2 weeks later, then a week later, then 6 weeks later, then radiation, every other. So, uh let me just see what I can, how I'm gonna be able to pull these EOBs, um, and.
[AGENT][NEUTRAL] That's fine.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, I guess, I don't know. I've got 10 online portals. Uh, do you want who did the surgery, it's just I have 5 different doctors, so I'm like trying to figure out how the heck I'm gonna even try to figure it out because nobody wants to mail anything to me. They want to do everything online. They don't want to waste stamps, nothing. Um, so I got hospital, surge, surgeon, um, oncologist, radiologist.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then let's see what I can find as far as EOBs um and then.
[CUSTOMER][NEUTRAL] I guess it's the hospital bill that I'm paying right now which is $6000.
[CUSTOMER][NEUTRAL] So I, I don't know.
[AGENT][NEUTRAL] Right and just
[CUSTOMER][NEGATIVE] I don't feel like I'm fully comprehending what it is that that I, I have to get to you.
[AGENT][NEUTRAL] If you
[AGENT][NEUTRAL] If you
[AGENT][NEUTRAL] If you see on your EOBs where you pay a deductible, co-pay, or co-insurance, that's what this policy covers.
[AGENT][NEUTRAL] So if you look on your EOB and you see it, and that'll probably help minimize some of it for you, that if you pay the deductible, a co-pay, or a co-insurance, then you're gonna want to send that in.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got you OK well I mean even if I start with some things and then I'm, it's blurred on what else I'm sure you'll reach out to me and say no we're gonna need this, this and this or.
[AGENT][NEUTRAL] Right, if there's any information additional information that we need, we'll send you something through the online service center you'll see that the claim was denied and then it'll tell you why.
[AGENT][NEUTRAL] and usually it's because more additional information is needed or it'll say paid and it'll tell you, you know, it'll tell you what was paid on it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, and then that payment goes directly to the hospital, which is the ones that are hounding me right now. Every, all the little ones have paid. I've paid the surgeon $1000. I'm done with them. Um, the oncologists I've never had to pay any of them. It's the hospital that is coming.
[CUSTOMER][NEUTRAL] And, and, and, you know, saying you need to pay this, you need to pay this, you need to pay this, so um I will uh.
[AGENT][NEUTRAL] So if, if you
[AGENT][NEUTRAL] If you are the one filing the claim, then you will get the payment which you can turn around and give to the hospital.
[CUSTOMER][NEGATIVE] OK, yeah, because I mean that's easier for me. I, I don't wanna keep that money. I'd rather use it to help pay, you know, pay this monthly bill that's killing me right now, um, OK, OK, um, I, I will look on obviously when I get home and I have access to a computer, um, and, and download these things and see now can I attach the downloads then to your website so that I don't have to print all this stuff out?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, yes, you could just upload it.
[CUSTOMER][POSITIVE] Or does things have to be fat? Oh, perfect, upload it. OK, cool.
[AGENT][NEUTRAL] Yeah, you could just upload it from your computer if you already have it and it also gives you an option to put your um if you want your payment direct deposited it gives you an option to do that too to put your bank information in then we could just send it by direct deposit and you could turn around and pay the the facility.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect awesome alright well I truly appreciate your help I will download that um app and then hopefully that'll help guide me and I can see a little more information other than talking on the phone and then uh if I have additional questions at least I'll have what I need and then um I appreciate your help thank you so much.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. And if you get stuck at any time or you um feel like you have another question that you couldn't think of now, just pick up the phone and we'll help you all we can, OK?
[CUSTOMER][POSITIVE] OK perfect I truly appreciate it thank you so much.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright well you take care and thanks for calling APL you're welcome.
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] Oh, OK, bye bye.
[AGENT][NEUTRAL] Mm bye bye.