AccountId: 011433970860
ContactId: 441de2a9-c008-4d0d-b92a-5c33d2255efc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342739 ms
Total Talk Time (AGENT): 146215 ms
Total Talk Time (CUSTOMER): 141527 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/441de2a9-c008-4d0d-b92a-5c33d2255efc_20250411T13:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. I'm uh trying to get benefits, uh, for, um, uh, one of your insured members and also if you received a claim for him so.
[AGENT][NEUTRAL] OK, and sure, I can assist you with claims or benefit information. May I have your name?
[CUSTOMER][NEUTRAL] Yeah, my name's [PII].
[AGENT][NEUTRAL] OK, and you're calling from provider's office?
[CUSTOMER][NEUTRAL] Yeah, skin cancer treatment center.
[AGENT][NEUTRAL] OK. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] All right, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, the number that I had was 01659252 and then M like Mary L Larry 8.
[AGENT][NEUTRAL] All right, what's the name and date of birth?
[CUSTOMER][NEUTRAL] And this is again going back to [PII]. It says name is [PII].
[AGENT][NEUTRAL] OK, and what's his date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII]'s date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] All right. And what is the date of service?
[CUSTOMER][NEUTRAL] Uh, his service was [PII].
[AGENT][NEUTRAL] OK, how much was the total?
[CUSTOMER][NEUTRAL] And the build amount was 10 145 even.
[AGENT][NEUTRAL] Yeah, OK, alright, let me see if I can find that claim.
[CUSTOMER][NEUTRAL] As we switched to a new system in July and I don't know if you got it number one and you know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm searching it looks like um.
[AGENT][NEUTRAL] Maybe a different policy number.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It doesn't look like we have it. Um, let me check in the old policy again, OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure, because on our system that it didn't even, it didn't have like a time or date stamp sometimes most of the time it'll it'll say, OK, this went out on this date and I, I just kind of going through some of the unpaid claims and I didn't see that on this one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah, it doesn't look like um we have received it, not in the old one or the new one. And um let me go ahead and give you the updated policy number.
[CUSTOMER][NEUTRAL] OK, can I use that for a 2024 policy though? Is that OK?
[AGENT][NEUTRAL] Mhm. Yes, the, the effective date is.
[CUSTOMER][NEUTRAL] Or for for a data service I mean OK.
[AGENT][NEUTRAL] Yes, OK. The date of service on this one is [PII].
[CUSTOMER][NEUTRAL] OK, yeah, what's the ID number then?
[AGENT][NEUTRAL] Alright, the ID number is 0198.
[AGENT][NEUTRAL] 2113.
[CUSTOMER][NEUTRAL] OK, I'll go and.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Update that on his um uh account here with us um let me ask a question as far as benefits uh [PII] just came in for an office visit on [PII]. It was a, I don't, I don't know what APL covers I guess he, he didn't know either when he came in. Do, do you, can you tell me what's covered under this plan?
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] OK, yes, I can. Uh, let me go ahead and pull his benefits and before I give you benefits, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And this is his secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Right, OK, that's what we have too yeah.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, so, um, what we do is we help with the co-payments, co-insurance and deductibles from the major medical. Now, he does have an additional rider for cancer outpatient treatment.
[AGENT][NEUTRAL] So we do cover uh cancer outpatient treatments for this member. It's subject to the outpatient maximum, which is 7900.
[AGENT][NEUTRAL] The calendar year.
[CUSTOMER][NEUTRAL] OK, and, but as, but as far as like the office visits and stuff like that, is that covered also or not?
[AGENT][NEUTRAL] If it's related to cancer, yes. If it's not related to cancer, um, then no, it's just gonna be office treatments and procedures only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK, because, yeah, this is, uh, you know, this is a, I mean, we're a cancer facility, you know, it's not, we're not like an outpatient or skin cancer treatment center that's what we kind of do, but, um, you know, I guess basically I should just send the claim into you guys maybe by paper. Do you have like a fax number I could send it to?
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, we do. Yes, the fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, um, I appreciate your time thanks a lot.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, have a good day take care.
[AGENT][POSITIVE] You as well and thank you for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Alrighty bye.