AccountId: 011433970860
ContactId: 1118fa15-f0b1-40a5-9d50-fc0915891d8e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414390 ms
Total Talk Time (AGENT): 176488 ms
Total Talk Time (CUSTOMER): 195155 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/1118fa15-f0b1-40a5-9d50-fc0915891d8e_20250207T16:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, ma'am. I'm calling to find out how far back can you go back and file on a claim that you, you didn't file years ago but you, you need, it was for a hospital confinement benefit.
[CUSTOMER][NEUTRAL] And it, and it was uh two different times. I stayed in the hospital in [PII]. I had two stem cell transplants. And is there any way if I've got the itemized bill that I can file for that claim now?
[AGENT][NEUTRAL] Let me take a look at the policy. Can I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what's the policy number?
[CUSTOMER][NEUTRAL] 1239457
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And verify your address and date of birth.
[CUSTOMER][NEUTRAL] It's [PII], and my date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you, Ms. [PII], and also verify your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that information and you're calling about uh filing claims for previous years, right?
[CUSTOMER][NEGATIVE] Yes, it's in [PII]. I was very sick in the hospital and I don't think I ever filed for a hospital confinement benefit.
[AGENT][NEUTRAL] OK, yeah, there is no uh time limit as long as the policy was active for the dates of service, you can submit those claims at any time.
[CUSTOMER][NEUTRAL] Oh, well, that's good to know. Um, yes, I'll call the hospital. It's UAMS in [PII], where I stayed in. I'm sure they can get me the itemized bills, uh, for the, the time I stayed there. I know each one was at least around 30 days each.
[AGENT][NEUTRAL] OK, yeah, so you wanna make sure those are itemized bills and send them over to us. You can submit it by fax, by mail or online.
[CUSTOMER][NEUTRAL] OK, I'll probably do it by fax and I think um I had to stem cell transplants and I don't, I think that I
[CUSTOMER][NEUTRAL] Already submitted for those, but I'm not sure about the stem cell.
[CUSTOMER][NEUTRAL] If if um.
[AGENT][NEUTRAL] Let's take a look.
[AGENT][NEUTRAL] And you said that was in [PII]?
[CUSTOMER][NEUTRAL] [PII] yes, ma'am. See, one was in um late March to early April and the other one was in [PII].
[CUSTOMER][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] Yeah, so I do show where we requested the itemized bills for the hospital consignments and.
[AGENT][NEUTRAL] May and oh no that's, let's see it looks like March.
[AGENT][NEUTRAL] Yeah. So I show that we have a date range of [PII] where we, we requested the itemized bill for the hospital stay, but we have not received that.
[CUSTOMER][NEUTRAL] OK, thank you. All right. So, and the other one was in September. Yes. OK. Well, I will, um, now the stem cell transplant, will that be a different bill than the hospital confinement benefit where I had the two stem cell transplants?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, depending on um the claim will be processed based on the information on the itemized bill. If additional information is needed, we will request it, but if that if you receive the actual itemized bill, it's not a claim uh detailed list or it's itemized bill from the hospital that should have everything we need.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the stem cell on there too, that would that be a different claim, the stem cell?
[AGENT][NEUTRAL] It's possible that it would be um under the surgery benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if so, then we would need the itemized bill from the surgeon.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] OK. OK, from the surgeon, OK. There's two different times.
[AGENT][NEUTRAL] Yeah. So the hospital and the surgeon.
[CUSTOMER][NEUTRAL] The hospital and the surgeon. OK. Uh, the, the stem cell will go under the uh surgery benefit, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] I see a bone marrow and stem, stem cell transplant benefit.
[AGENT][NEUTRAL] Let me pull that up.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I see that on here.
[AGENT][NEUTRAL] Give me just a moment, I'm pulling up your actual policy certificate so I can see those benefits as well.
[AGENT][NEUTRAL] Yeah. Yeah, that is correct. So you do have the bone marrow stem cell transplant benefit. So that would be paid under that benefit, not the surgery benefit. Let me see if
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that information should be on the itemized hospital bill.
[CUSTOMER][NEUTRAL] That should be on one bill that all of the hospital consignment bill?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] It should show my stem cell. OK. All right. Do I need to write on there when I fax it in you, do I need to write hospital confinement and bone marrow and stem cell transplant plant benefit?
[AGENT][POSITIVE] You, you can, but, uh, the more information, the better, uh, of the chances of us to process it in that one go without requesting additional information. And sometimes those bills just are kind of hard to put the whole story together. So yeah, you could absolutely add that information and it'll help us in the processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yes ma'am, thank you so much for your help and I'll be sending those to you as soon as I can.
[AGENT][NEUTRAL] All right, good deal, Ms. [PII]. Well, is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am. Thank you.
[AGENT][POSITIVE] No problem, thank you for calling ATO have a great day.
[CUSTOMER][POSITIVE] Thank you.