AccountId: 011433970860
ContactId: 1ee50a7a-2a97-4ec4-82ec-f0999e240ab5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 977940 ms
Total Talk Time (AGENT): 577885 ms
Total Talk Time (CUSTOMER): 217866 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/1ee50a7a-2a97-4ec4-82ec-f0999e240ab5_20250110T17:22_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling ATL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, hi, uh, I'm wondering uh if you guys received my, uh, documentation.
[CUSTOMER][NEUTRAL] Because uh I am, I'm looking at the uh
[CUSTOMER][NEGATIVE] And my app and it showed yesterday that I was there, but now it doesn't show that it's, it's even that I sent it.
[AGENT][POSITIVE] OK, yeah, I can definitely take a look at that for you. Do you mind if I have that policy number real quick?
[CUSTOMER][NEUTRAL] Uh, yeah, it's uh 237-044-0.
[AGENT][POSITIVE] Thank you, and give me one moment to get that all pulled up.
[AGENT][NEUTRAL] And then do you mind if I get your first name, your last name, and your date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Perfect thank you and.
[AGENT][NEUTRAL] Um, may I also get a good call back number as well, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then could you verify for me please your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect and then just lastly if you could verify for me your um your email address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII] perfect and.
[AGENT][NEUTRAL] It looks like you said that you uploaded it yesterday, is that correct?
[CUSTOMER][NEUTRAL] Yeah, I, I did it twice. Yesterday and like last week I think.
[AGENT][NEUTRAL] OK. I do show something that was updated. It looks like we received a document on the [PII].
[AGENT][NEUTRAL] Um, which would have been early.
[AGENT][NEUTRAL] This week on Monday.
[CUSTOMER][NEUTRAL] Oh, OK, OK. I, I, I, I think I see it.
[CUSTOMER][NEUTRAL] No, no, that's, oh yeah, yeah.
[AGENT][NEUTRAL] It looks like it was a visit from 2 visits in July and a visit in August. Does that sound right?
[CUSTOMER][NEUTRAL] OK, OK. Yeah.
[CUSTOMER][NEUTRAL] Yeah, 2 of them, yeah.
[AGENT][NEUTRAL] All right and then it looks like.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] Let me see, I'm so sorry. I just wanna.
[AGENT][NEUTRAL] And then it looks like we received.
[AGENT][NEGATIVE] I'm not sure if we received it twice.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I think that's what I'm looking at. We received something on the [PII] and then again on the [PII], and it looks like.
[CUSTOMER][POSITIVE] Yeah, it, it was proud.
[AGENT][NEUTRAL] They were put under the same same number?
[CUSTOMER][NEUTRAL] Yeah, yeah, it was probably me because uh I, I thought when I was looking at the list in my app, it uh
[CUSTOMER][NEUTRAL] It was on uh on uh
[CUSTOMER][NEUTRAL] Um, this daily, and I guess it's not.
[CUSTOMER][NEUTRAL] Uh, the dates are not, uh.
[CUSTOMER][NEUTRAL] I listed
[CUSTOMER][NEUTRAL] accurate. So, when I went down the page, I saw that it was uh
[CUSTOMER][NEUTRAL] That I send it
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] On the, on the [PII] and uh and also on the [PII]. I was looking at this on the top.
[CUSTOMER][NEUTRAL] And on the top it says my last one that I sent was on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] You know what I mean? Uh, yeah, yeah. OK.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Perfect, yeah, so it looks like they put them all under that same claim number there, the 079, and then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I am seeing.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] It looks like on the [PII] it's saying that office visits aren't covered for the September or not September, I can't talk. I'm sorry, [PII], it says the policy doesn't provide benefits for injections or administrations objections or I'm so sorry, my words are not coming out right.
[AGENT][NEUTRAL] And then it looks like it says the same thing on the [PII] as well.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, so it's not, it's not covered?
[AGENT][NEUTRAL] Yeah, it looks like they're just not, um, there's no, there's no coverage under your policy for those particular procedures, codes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. I, oh.
[CUSTOMER][NEUTRAL] I got the impression that it was, it was covered.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] But no, none of them are covered then, not of uh.
[CUSTOMER][NEUTRAL] Those visits and all that, no?
[AGENT][NEUTRAL] It looks like the way they processed it, no, it's not, um.
[AGENT][NEUTRAL] It does, it does show them as not covered charges, and I'm trying to see if there is
[AGENT][NEUTRAL] Any
[AGENT][NEUTRAL] Other notes.
[AGENT][NEUTRAL] Listed for it.
[CUSTOMER][NEUTRAL] How about, uh, how about, uh, MRI, MRI on uh
[CUSTOMER][NEUTRAL] On my brain, and my neck.
[CUSTOMER][NEUTRAL] Anything of those cover?
[AGENT][NEUTRAL] So I can't like guarantee like payment of anything over the phone. It really depends on the diagnosis code and the procedure code um and how that claim form is submitted, where, what happened, like where the location, like were you in an ER or hospital, a doctor's office, and so that's where it's like kind of hard to give.
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] narrow down coverage over the phone, um.
[AGENT][NEUTRAL] It does look like for this policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And you're wanting to submit these under your critical illness policy, right? Like, I didn't even look to see if you had another policy.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, accidental too, but.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. It doesn't look like any of it was processed under your accident policy. They just processed it under your critical illness policy.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] But it looks like the benefits here.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Pay if you are diagnosed with one of the listed critical illnesses, so you have that. Um, you also have
[AGENT][NEUTRAL] A wellness benefit on here. I'm not sure as far as you're saying like your neck and your head, like I'm not sure like what you had done. I suppose I don't process claims, so like when I'm looking at the pages, I don't know what those codes mean.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So there is another uh
[CUSTOMER][NEUTRAL] There is another uh
[CUSTOMER][NEUTRAL] Uh, procedure that I have, which is uh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, MRI on, on my neck, and my neck.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, I, I haven't sent it, but you know, I just, uh, uh, wanna find out if that covers and uh.
[AGENT][NEUTRAL] So it doesn't look like you have any diagnostic coverage as far as your critical illness policy goes. Um, that one's really just like a wellness benefit, and then it seems like it has some lump sum payments if you were to be diagnosed with one of those critical illnesses. Let me pull up some benefit information on your accident policy. Um, I will say if you are going to file an accident policy claim, you do have to fill out that um.
[AGENT][NEUTRAL] That accident policy claim form and I can email a copy of it to you, um, but they're gonna need like more information than just um
[AGENT][NEUTRAL] Like they they're gonna ask like, what happened, and I think
[AGENT][NEUTRAL] They need something filled out from your doctor. I can pull it up and double check that. But if you do want to try to file the claim under accident instead, we would need that filled out.
[CUSTOMER][NEUTRAL] But, but what
[CUSTOMER][NEUTRAL] Yeah, but it wasn't an accident.
[AGENT][NEUTRAL] Oh, yeah, so then your critical illness.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't see diagnostic coverage as far as your critical illness goes.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Like you have a, let me, I'm gonna pull up the policy documents so I can um like read it over with you.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] What I'm seeing here on this is
[AGENT][NEUTRAL] You have under your benefits.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Section 4. So you are entitled to like um a critical illness benefit if you're if you get advanced Alzheimer's, Parkinson's, ALS, benign brain tumor, bone marrow transplant, uh, bone marrow transplant, loss of sight, complete loss of speech, complete loss of hearing, sorry, and it was complete loss of sight.
[AGENT][NEUTRAL] Coronary artery disease, coronary artery disease with the bypass surgery, cystic fibrosis, end stage renal failure, heart attack, heart valve surgery, invasive cancer, major organ failure, multiple sclerosis, non-invasive cancer, pulmonary embolism, pulmonary fibrosis, skin cancer, stroke, sudden cardiac arrest. And so those all have different benefit amounts. If you're diagnosed with one of those illnesses, you have a benefit you can receive.
[AGENT][NEUTRAL] You also do have a health screening benefit, um, and that can pay up to $50 and that is, I can look more into that. And then if you were to receive a mammography, you could be paid up to $200 on that benefit. um.
[AGENT][NEUTRAL] If you have, let me see, let me read more about the additional benefits. It says we will pay the applicable, critical illness benefit amount shown in the schedule of benefits for the first time a person is diagnosed with any one of the critical illnesses after the covered person's effective date, um.
[AGENT][NEUTRAL] And then there is no limit to the number of additional critical illnesses payable, but um you can only be paid for one once.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Your wellness benefit is the total number of claims payable as a wellness benefit in any one plan you're subject to the maximum number of wellness benefits shown um for that health screening.
[AGENT][NEUTRAL] Um, it says that we will pay health screening benefit for the amount shown for each day a covered person receives one or more of the following tests on an outpatient basis, a wellness test, a routine physical exam, or any additional general generally medical accepted screening test received as an outpatient.
[AGENT][NEUTRAL] And then the mammography, we will pay the mammography benefit um shown in the scheduled benefits for each day a covered person receives a breast ultrasound or mammogram if the service has been rendered by a physician on an outpatient basis, this benefit is payable once every 2 years. And so those are your like the total of your benefits for this critical illness policy. Um, so there's as far as like diagnostic testing, like there isn't any benefits for that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, uh, will you send me an email of, uh.
[AGENT][NEUTRAL] I can email this to you, like this document to you so that way you can read through it.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, please, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, cause I, I, I remember.
[CUSTOMER][NEUTRAL] I remember when, what about?
[CUSTOMER][NEUTRAL] If I go to an emergency room.
[CUSTOMER][NEUTRAL] Do, do they cover that?
[AGENT][NEUTRAL] So that's not on here. It might be like there might be like coverage if.
[AGENT][NEUTRAL] On your accident policy as far as your like accidents go, but not on this critical illness policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So where, where, where the physical therapy is under?
[AGENT][NEUTRAL] Uh, there's no physical therapy covered under this policy, so I'm not sure.
[CUSTOMER][NEUTRAL] So it's the other one then because I used to pay, I used to get paid for each physical therapy that I
[CUSTOMER][NEUTRAL] Uh, went.
[AGENT][NEUTRAL] Um, I can take a look at your, I can pull up your accident policy information if you'd like. Um, let me get this email sent out to you real fast. It's just gonna say APL policy documents.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm hitting send on that right now for you. It should be coming your way. And let me go into the accident policy and see if I can get more information on that one for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And it looks like it was your accident policy that had paid for physical therapy benefits for you in the past. Um, so it looks like whatever happened, you had an accident and it caused you to need physical therapy. So it fell under the purview of that policy, but I am looking at your last paid claim and it was under the accident policy.
[CUSTOMER][NEUTRAL] Oh, I know.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then
[CUSTOMER][NEUTRAL] All
[AGENT][NEUTRAL] This one, if you want, I can go ahead and I can just send you um the documents for the accident policy too, so that way you have them if you'd like.
[CUSTOMER][NEUTRAL] OK. Yeah, please.
[AGENT][POSITIVE] Perfect. I'm gonna send it to that same email address and.
[AGENT][NEGATIVE] Hang tight.
[AGENT][POSITIVE] But this one does, it does have a little more coverage um in case of.
[AGENT][NEUTRAL] Um, it looks like a couple of different types of accidents on here.
[AGENT][NEUTRAL] Alright, and I am hitting send on that 2nd email, so they should both be coming to you to your email and you can look over your benefits on those.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, all right, and then what else can I help you with today, my friend?
[CUSTOMER][POSITIVE] I, I think that that that'll be all. Yeah, thank you for your information.
[AGENT][POSITIVE] Yeah, absolutely. And [PII], if there's any more information we can give you any help you need or you, you're reading through it and you're not sure you understand, um, you're always welcome to give us a call and we'll do our best to help you out, OK?
[CUSTOMER][POSITIVE] OK. OK. Thank you so much.
[AGENT][POSITIVE] My pleasure. You take care.
[CUSTOMER][POSITIVE] OK, you too, thanks.