AccountId: 011433970860
ContactId: 0911223c-31a8-4f7c-b8ee-0e250c9a057d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 468260 ms
Total Talk Time (AGENT): 149141 ms
Total Talk Time (CUSTOMER): 274668 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/0911223c-31a8-4f7c-b8ee-0e250c9a057d_20250128T15:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was wondering if you could look up a claim for me.
[AGENT][POSITIVE] Sure, I can help you with that. Can I have your name?
[CUSTOMER][NEUTRAL] Sure, [PII]
[AGENT][POSITIVE] Thank you. What's a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and what's the policy number?
[CUSTOMER][POSITIVE] Oh goodness, I'm so sorry. I'll have to pull that up. I don't know what I was thinking.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] If you're the policy holder, I can search by your social.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Oh, OK, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright and verify your address and date of birth.
[CUSTOMER][NEUTRAL] [PII]. My date of birth is [PII].
[AGENT][NEUTRAL] Alright thanks [PII] and also verify your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that information and you're calling for claim status?
[CUSTOMER][NEGATIVE] Yes, I've already spoken with one of your representatives, and I mean it's already been the 10 days now that was filed on the [PII]. I know it's business days, but the claim still hasn't been processed, 4 of them and they're.
[CUSTOMER][NEGATIVE] Pretty important claims to me. And I'm trying to find out what's going on, if there's lacking information, why this time it's not being processed. Now, I got the one in the mail for the other one, and I know those were lacking information, and I'm working on that, but the new ones that that say the [PII] on there, those shouldn't be lacking anything.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And I'm trying to find out if you can find out what's going on, why those are not being processed in a timely manner, because they told me they only get 10 days to process those. And it was, it was sent in on the [PII]. And I know that, you know, you can't count the weekends or whatever, but
[AGENT][NEUTRAL] OK, yep, and I do see that we have some claim submissions received on the [PII]. Uh, those are in line to be processed. Um, we're still within this is day 8 from um the time of submission. Uh, so it'll be any day now, but as of now they haven't been reviewed or processed.
[CUSTOMER][NEUTRAL] And what is today? What day?
[AGENT][NEUTRAL] Today's, um, that would be the [PII] day.
[CUSTOMER][NEUTRAL] And you only have 10 days, legally to get it, right, to get it done.
[AGENT][POSITIVE] Yeah, that's correct.
[CUSTOMER][NEUTRAL] OK, so it should be tomorrow or the next day for sure that I should have some kind of claim showing there.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Well, thank you for looking then. And then the other claims that you see that are under that, uh, I think it was under them. I got something in the mail about some claims that have been denied because they were lacking information. One was lack of address, I believe, for the facility I was going to, and then the other one might have been lack of explanation of benefits, I'm not sure. Can you look that up as well?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure. Yeah, I do see we requested an explanation of benefits for uh chemo in January, I'm sorry, in [PII].
[AGENT][NEUTRAL] And we're also requesting, go ahead.
[CUSTOMER][NEUTRAL] Uh, but
[CUSTOMER][NEUTRAL] Oh, what I was gonna say is on the [PII], when the young lady from your department, she was great, she got on the phone with me and she stayed for like an hour, 1 hour and a half, and she went through and she got a hold of Blue Cross and got a hold of everything. And they, that particular day on the [PII], they claimed they gave her, and she said, they gave me an explanation of benefit and everything. That's what, that's what we were on hold for so long for.
[CUSTOMER][NEUTRAL] Because she wasn't giving up until we got it. So that should be there now, unless it's a separate claim.
[AGENT][NEUTRAL] Yeah, so that could be the information that was received on the [PII] that hasn't been processed just yet.
[CUSTOMER][NEUTRAL] Oh, OK, so one of it was for address and then one of it was for.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I'm sorry, [PII]. Was there anything else missing?
[AGENT][NEUTRAL] And that's all I show on the most recent completed claim.
[CUSTOMER][NEUTRAL] OK, and on those claims, were they, uh, were any of those paid for then, probably not because of that.
[AGENT][NEUTRAL] That is correct. I will, um, once that information is received, then the benefit will be processed.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and then the ones that are waiting could possibly be duplicates of those, right?
[AGENT][NEUTRAL] Yeah, it's, it's a possibility if we receive the same information more than once. I show 4 submissions in total received on [PII]. Um, once those are reviewed and processed, if it is duplicates, then it'll just be noted as such, um, but as of now, yeah, those claims haven't been processed. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And on the address that I'm needing for that facility, for it's for my travel, um, it's what it's for.
[CUSTOMER][NEUTRAL] I'm not exactly sure what y'all need, because UT Southwestern, where I go for my treatments, they wouldn't, it's so weird, but their paperwork doesn't have an actual address on it. When you send it in and I thought, well, this is crazy. So how do I, how do I prove to you where I was?
[CUSTOMER][NEUTRAL] What do I send you exactly for that address?
[AGENT][NEUTRAL] You can put the address on page one of the claim form under the transportation section um with the dates of service, yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And there were so many dates of service, I know it only covers like 12 a year. And so I don't know exactly. I have to fish through and see what my dates of service were. And on those dates of service, does it matter which you went for? Everything I went for was cancer-related, but it wasn't all chemotherapy.
[CUSTOMER][NEUTRAL] Some of it was PT, some of it was chemotherapy, some of it was radiation, some of it was, you know, like that, and immunotherapy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah. So the transportation benefit would only cover on days there was chemo, radiation therapy, immunotherapy, or a covered surgery.
[CUSTOMER][NEUTRAL] Oh, OK. So I can follow at least on those days, if I can, excuse me, if I can find the dates of service. OK. And then I've had the policy since [PII], and the way my doctor put it to me is that there's no, there's
[CUSTOMER][NEUTRAL] I can basically claim the once a year scans that I did not claim from [PII] on. They called it the wellness benefit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So is it, it's not too late to find those from the [PII]?
[AGENT][NEUTRAL] No, you can submit those at any time.
[CUSTOMER][NEUTRAL] Oh, OK. I need to figure out how to do that too then. So that would be more like scans, like my mammograms, my Pap smears, things that were done for wellness.
[AGENT][NEUTRAL] That's correct. There's a wellness claim form where you'll just fill that out and um put the date, the type of test, and the um doctor's name and phone number and you can submit those.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Oh well, thank you for your help and I guess we'll wait a couple more days and see what's going on.
[AGENT][POSITIVE] All right, good deal. Well, is there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No, ma'am you have a good day. Thank you.
[AGENT][POSITIVE] Thank you, thanks for calling