AccountId: 011433970860
ContactId: 125a1f22-6264-4231-89b9-84ee2476627a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400529 ms
Total Talk Time (AGENT): 209253 ms
Total Talk Time (CUSTOMER): 140406 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/125a1f22-6264-4231-89b9-84ee2476627a_20250331T16:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes, I received um a note in the mail.
[CUSTOMER][NEUTRAL] That said, um,
[CUSTOMER][NEUTRAL] Basically they need some more documentation. I'm a little confused about what um they need so I have the reference number, so maybe you can help me with that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, I can help you. And the, the letter that
[AGENT][NEUTRAL] A minute.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, can you hear me?
[CUSTOMER][NEUTRAL] I'm sorry, your phone cut out for just a moment.
[AGENT][NEUTRAL] Uh, the letter that you received in the mail, can you hear me?
[CUSTOMER][NEUTRAL] Yes, hello?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the letter that that you received in the mail was it for a claim you submitted?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] OK, and can I please get your name and your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] OK, my number is [PII] and my number is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your policy number?
[CUSTOMER][NEUTRAL] Policy number is 02485390.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] Mine is [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Uh, the address should be [PII].
[CUSTOMER][NEUTRAL] Um, what else did you ask?
[AGENT][NEUTRAL] Mail address and um the phone number that we have on the policy.
[CUSTOMER][NEUTRAL] Oh, phone number [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Your your email address please?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] [PII], I appreciate you verifying your policy for me, OK, and then what is the claim number that's on the letter?
[CUSTOMER][NEUTRAL] 357-933-1
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK, so, um.
[AGENT][NEUTRAL] Let's go back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What the remarks mean that's on the letter that you received?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] The primary explanation of benefits which came from your primary insurance.
[AGENT][NEUTRAL] Um, does not list the amounts applied to the deductibles because this, this policy that you have with us, uh, helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, uh-huh.
[AGENT][NEUTRAL] So the explanation of benefits did not list the amounts applied to the deductible co-pay or co-insurance. So they're asking that you resubmit an EOB with the explanation of benefits that shows that those amounts, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We paid
[AGENT][NEUTRAL] So it says please submit a more detailed explanation of benefits that shows these amounts.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK, so I contacted my primary insurance company and they're like, well, that's on the thing. I mean, we didn't pay like $1900.16 dollars and some odd cents because that is the deductible.
[CUSTOMER][NEUTRAL] And and they said that was on there so that's why I was confused I thought I was like I'm not understanding maybe they need something more.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, OK.
[AGENT][NEUTRAL] Yes, that's, that's what they're requesting is, is it for it to be detailed that shows that they paid something towards the deductible co-pay or co-insurance.
[AGENT][NEUTRAL] And then the second remark.
[CUSTOMER][NEUTRAL] OK, OK, so they, no.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So they have to have paid to the deductible or they had they left that for me to pay?
[AGENT][NEUTRAL] OK, so this is what it says need a detailed EOB. We have received the primary explanation of benefits that was submitted with your claim. However, the explanation of benefits received does not list the amounts applied to the deductible copay or co-insurance. Please submit a more detailed explanation of benefits.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK, that makes sense. OK, I will.
[CUSTOMER][NEUTRAL] Alright, I'll contact the hospital and the insurance and get that, OK.
[AGENT][NEUTRAL] OK. And then the second um remark that's on the claim is there are no benefits payable for chemotherapy, radiation therapy when administered in a physician's office or in an outpatient facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So the chemo radiation therapy for it to help with deductible, co-pay or co-insurance cannot be administered in a physician's office or an outpatient facility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, this hospital has a specific this hospital that they do all their chemotherapy at.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But it's still part of the hospital but it's a separate I mean it's a separate facility.
[CUSTOMER][NEUTRAL] But that's where all of their chemotherapy is done for [PII] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So does that not count?
[AGENT][NEUTRAL] Well, it's the
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Hello, are you still there?
[AGENT][NEUTRAL] Let me see, I'm, I'm here. Yes ma'am. I'm just looking at I'm here, OK, so, um.
[CUSTOMER][NEUTRAL] Oh, there you go. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's, uh, it's going by what the hospital submitted on their EOB.
[CUSTOMER][NEUTRAL] OK, I'll talk to him then and see if we can get it.
[AGENT][NEUTRAL] So the. OK. OK.
[CUSTOMER][POSITIVE] Change. OK. All right, thank you.
[AGENT][NEUTRAL] Uh, OK. Well, you're very welcome. Is there anything else that I can help you with, Ms. [PII], before we go?
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] OK. Well, you have a wonderful day and thank you for calling APL. Mhm. Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you bye bye.