AccountId: 011433970860
ContactId: 492dae8d-63c9-49cf-8a8b-753b2de5f038
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1059140 ms
Total Talk Time (AGENT): 355649 ms
Total Talk Time (CUSTOMER): 556382 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/492dae8d-63c9-49cf-8a8b-753b2de5f038_20250522T17:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII], and I have a policy, um, with y'all, and I was wanting to know a little bit about some benefits.
[AGENT][POSITIVE] I can help you with benefits. um, [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, um, [PII].
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] I do not.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is it all right if I look you up by your social?
[CUSTOMER][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] OK, and what is it?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] And last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your mailing address and phone number that we have on file?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And then the phone number that we have on file?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm not seeing that one. Give me just a moment.
[AGENT][NEUTRAL] Would it be under a different phone number?
[CUSTOMER][NEUTRAL] Um, not unless it's under my husband's. It's, uh, [PII].
[CUSTOMER][NEUTRAL] But I've had this number for a long, maybe not since I had the policy which was in 07. I might, it might have changed, but.
[AGENT][NEUTRAL] Yeah, because I have a different phone number.
[AGENT][NEUTRAL] For you. Um, do you need me to update that phone number?
[CUSTOMER][NEUTRAL] Please
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the number? Is it this one that is it your callback number ending in [PII]?
[CUSTOMER][NEUTRAL] Yes. Yes, ma'am. Mhm.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] And what questions did you have regarding your.
[CUSTOMER][NEUTRAL] Tell me what your name is again.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], I'm going to let you talk with my husband, um, and he'll explain um what we need to know, OK? I give him, I give you permission to talk to him. His name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hey [PII].
[AGENT][NEUTRAL] Hi, what questions do we have on the insurance?
[CUSTOMER][NEUTRAL] OK, um, [PII]'s had this policy for quite a while. We're, we're a bit familiar with it. Um, we, um, we don't have the copy before us. We're, we're on a little trip. [PII] has been diagnosed with breast cancer and, um.
[CUSTOMER][NEUTRAL] Uh, we have surgery scheduled for next Friday. Um, the providers we've talked, we've talked with well said they do not file on cancer insurance, so I guess we just need to get the, the, you know, the procedures for filing, um, on, on every point where we can.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, if they won't file, you can file on.
[AGENT][NEUTRAL] Um, your own behalf, do you all have an online service center account with us?
[CUSTOMER][NEUTRAL] Probably
[CUSTOMER][NEUTRAL] [PII] think she has set that up, but she's not sure.
[AGENT][NEUTRAL] All right, let me, let me double check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can double check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, because on, on that service center you can upload anything, any documents that you need, and you can file a claim online.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I'm showing that she doesn't have an account, so it looks like she'll need to set up an account with the email that she has with us on file.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, we'll we'll go to um y'all's website and um there'll be a link for that I'm sure, right?
[AGENT][NEUTRAL] Um, you'll go to [PII].
[CUSTOMER][NEUTRAL] OK, um, write this down, [PII].
[CUSTOMER][NEUTRAL] Oh, OK, I'll, I'll get that for you while she's getting something to write with, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, um, let me just kind of.
[CUSTOMER][NEUTRAL] Uh, you can tell me what, what we're looking at here, um.
[CUSTOMER][NEUTRAL] Mileage uh going and coming from, well, let me get that she's ready to write down so the the the link is what now?
[AGENT][NEUTRAL] Secured SEC, yes, [PII].
[CUSTOMER][POSITIVE] Secure
[CUSTOMER][POSITIVE] [PII]
[CUSTOMER][NEUTRAL] OK, we got that a.m. you say?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] As in [PII].
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, we got that. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, alright, um, [PII], just thank you for being patient with us. This, this new territory for us, so, um, then we can, we can claim mileage.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] From our home to um for doctor visits or otherwise, right?
[AGENT][NEUTRAL] Right, it shows round round trip coach fare or travel by car, uh, you get up to 50 cents per mile up to a maximum of $1500 per round trip.
[AGENT][NEUTRAL] Um, the benefits are for transportation are paid up to 12 round trips per calendar year, so you can file it 12 times. Um, I do want to give the disclaimer real quick that this is just a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you also have outpatient lodging of up to $60 per day and up to 90 days per calendar year.
[CUSTOMER][NEUTRAL] OK, um, I, at this point we don't see, uh, for the needing the lodging, but, um.
[CUSTOMER][NEUTRAL] Yeah, we, we do, we live about 50 miles from our providers, so. OK, um, we are keeping a record um since we started after her diagnosis so um we can with, with each of these claims we'll go to this link that's set up and and then just file a claim per um per covered um event right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, you can file a claim um through that online portal and also through that online portal it will have your policy certificate um so you can read all of the benefits it will be on the page schedule of benefits so that you can see the dollar amounts and all of that will be right there on the website as well so you, you're able to see it um 24/7.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah and we uh we talked to someone a while back, um, and, and yes we have that on file at home um we we're my wife just wanted to have a little getaway, so we're we're we're on that, um, a little beach trip so um.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That's great.
[CUSTOMER][NEUTRAL] Yeah, yeah, just the surgery next week, so, um.
[CUSTOMER][NEUTRAL] We did find out that she can go back with regards to mammogram, so we went to providers and I think we were able to go back to [PII] so um we were told earlier that we just, we could, we, we did, she didn't realize she could file on those um and uh but uh that would be another area we would want to address so um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, that, that, that's something that might be available to us, correct?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Right, so we don't have timely filing, so as long as the claim you're submitting for was within the er the effective date of your policy, which the policy is active currently to date, um, as long as it's within that policy time period, you can file a claim at any time. So any back files or any any other claims that you might have, um, from the effective date, you should be able to file.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, we have some of those and we'll, we'll exhaust that search and, and that will be a claim too, OK, um, doc doctor's visits, um, we, we will get documentation for that, um, I, I think, I think we can look at our explanation of benefits I guess the, the real question we have, um, unfortunately we had to, uh, we changed insurance.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, coverage from my work, um, just to bridge a couple of years for [PII] so she's on Medicare.
[CUSTOMER][NEUTRAL] Um, and it's not the policy we were hoping for, so, um, that's OK. We, we will deal with that. It's a limited, so we're kind of leaning on what we have with you guys to help make up some, some difference anyway. What will y'all, um, what will y'all cover, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On outpatient surgery.
[AGENT][NEUTRAL] OK, let me look at your benefits.
[CUSTOMER][NEUTRAL] At, um,
[CUSTOMER][NEUTRAL] Yeah, it's, it's gonna be at Forest General Hospital um in [PII], uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It looks like you have a surgical benefit amount of
[AGENT][NEUTRAL] Up to $30 per surgical unit with a maximum of $3000.
[AGENT][NEUTRAL] You have an outpatient hospital or ambulatory surgical center benefit of up to $400 per day surgery is performed.
[AGENT][NEUTRAL] There's also an anesthesia benefit of 25% of the amount paid for the covered surgery.
[CUSTOMER][NEUTRAL] So basically
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] 25% of the amount paid. What, what, what interprets, I mean, what is that, um, or is that gonna just pay 25% of of the of the bill?
[AGENT][NEUTRAL] So how
[AGENT][NEUTRAL] It's 25% of the amount paid for the surgery. So, however much was paid from the surgery, it'll be 25% of that.
[AGENT][NEUTRAL] For the anesthesia benefit.
[CUSTOMER][NEUTRAL] It's paid on our part you're talking about on our behalf in other words, or just what the bill is OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Well, no, no, no, I'm sorry, what the bill would be given to you.
[CUSTOMER][NEUTRAL] Oh, OK, OK, 25%. OK, that, that, uh, OK, so basically we're just looking at $400 for outpatient surgery is all y'all pay, correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, you do have more depending on what it is because you have the surgical benefit. It just depends on the surgical unit that they use. So when you file your claim, you'll want to ask for itemized bills with procedure codes because we go based off of the numbers on the procedure code.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, OK, yeah, I mean, uh, not disclosing personal, but it'll be a, a mastectomy and, uh, same time, uh, the surgeon will start the reconstruction process, so.
[CUSTOMER][NEUTRAL] OK. Um, and the maximum.
[AGENT][NEUTRAL] OK. And I am showing that you have a surgical implantation. Um,
[AGENT][NEUTRAL] Benefit which may, depending on what they decide to do, you may be eligible for that if they're doing, if they're inserting something um of up to $1500 per device.
[CUSTOMER][NEUTRAL] OK, well, that's good. OK. All right. Yes, um, we understand that, that, that will be a multi-step process from what the plastic surgeon has told us. Yeah, OK. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So what is, what is the maximum benefit on the for yearly for the outpatient surgery up to?
[CUSTOMER][NEUTRAL] 3000, is that what you said?
[AGENT][NEUTRAL] Uh, let me get back to it.
[AGENT][NEUTRAL] You have an outpatient hospital or surgical center benefit of $400 up to $400 per day of surgery.
[AGENT][NEUTRAL] And then the surgical benefit, depending on the amount, uh, depending on their surgical unit numbers, up to $3000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3000. OK, alright, um, OK, well that that'll help some without a doubt, OK, um, and then we, we're just, you know, we're hoping that, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I, I, I think there's a.
[CUSTOMER][NEUTRAL] Uh, afterwards, uh, we just hope it hasn't spread, the cancer has not spread, and maybe, uh, the possibility of chemotherapy, and I think, you know, we understood that to be 15,000 a year on that. Is that correct?
[AGENT][NEUTRAL] For chemo, the actual charges up to $5000 for 12-month period.
[CUSTOMER][NEUTRAL] 0 $5000. OK, OK.
[AGENT][NEUTRAL] $15,000.
[CUSTOMER][NEUTRAL] Oh, which would be 15 per year, OK, OK.
[AGENT][NEUTRAL] Yeah, for 12 month period, yes.
[CUSTOMER][POSITIVE] OK, OK, well that would be helpful if maybe not needed, but OK, well, [PII], we appreciate it. It kind of gives us a little bit of insight and we'll, we'll pull that paperwork up and get that, um.
[CUSTOMER][POSITIVE] And uh her logged in to the portal or the you know the site so we can start the process of of claims so thank you very much means a lot.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome, you're welcome and like I said, um, just to be safe and anything that you think is relevant we check every document that you send in on a claim, so even if you don't know if it's covered, go ahead and send it in, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and anything you think is relevant to the to the claim, just go ahead and send it cause we review all of it.
[CUSTOMER][NEUTRAL] Yeah, so even, even if we have paid because obviously these days and um they, they make you pay up front so even if we pay, uh, if we paid on uh a claim y'all will still come behind and pay on that and I guess would just reimburse us directly or does it go to the provider?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's going to be whoever files the claim first so if you file the claim first it will go back to you if they file the claim first it'll go to them and then you would contact them to see if they credit your account or refund you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, and it appears that
[AGENT][NEGATIVE] Or reimburse you.
[CUSTOMER][POSITIVE] Yeah, it appears we'll be doing the filing [PII], so OK, alright, good.
[AGENT][NEUTRAL] OK. Then it'll go to you.
[CUSTOMER][POSITIVE] Yeah, OK, great, great. Well, thank you, um, many blessings and appreciate your your time with us, OK?
[AGENT][POSITIVE] Great thank you so much for calling APL have a very fun trip, OK?
[CUSTOMER][POSITIVE] OK thank you alright bye bye and [PII].
[AGENT][NEUTRAL] Alright bye.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] Alright, bye.
[CUSTOMER][NEUTRAL] Right. I know.
[CUSTOMER][NEUTRAL] Oh, wow, I thought you, it's your phone.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] What's gonna