AccountId: 011433970860
ContactId: 4ec1c596-9dbc-4b8c-80c4-cb08154b78db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 440920 ms
Total Talk Time (AGENT): 157079 ms
Total Talk Time (CUSTOMER): 224537 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/4ec1c596-9dbc-4b8c-80c4-cb08154b78db_20250501T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling um about a cancer cancer claim form I'm trying to get filed for my mother. Um, she passed away in October and so, um, I'm trying to get her cancer claim filed but I'm not exactly sure how to go about it here. I've got the form in front of me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, yes sir.
[CUSTOMER][NEUTRAL] And like
[CUSTOMER][NEUTRAL] Um, it's got, you know, the insured about the insured which is her, and then about the patient which is her, but I'm just wondering since she's deceased, would that need to be in as her estate or how would that need to be filled, filled out?
[AGENT][NEUTRAL] Right, um, yes, you would have to fill it out as the estate because we wouldn't be able to deposit into her account, um, since she's no longer with us.
[CUSTOMER][NEUTRAL] Right, yeah, that's what I was thinking.
[CUSTOMER][NEUTRAL] Yeah, so on like name like first name on first name do I put like or where like where do I indicate that it's her estate?
[AGENT][POSITIVE] Right, yes, you're correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can um let me look at the claim form and [PII] I'm also gonna pull up her policy real quick can I get your call back number sir? Just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you sir and then what is her policy number?
[CUSTOMER][NEUTRAL] 0013.
[CUSTOMER][NEUTRAL] 0974.
[AGENT][NEUTRAL] OK, let me look her up.
[AGENT][NEUTRAL] OK, and what is your mom's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what was her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you sir I appreciate that. I wanna make sure I have the right one pulled up OK, um, and then I'm gonna look at the cancer form with you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] I had meant to get this done earlier, but just too many irons in the fire with everything else.
[AGENT][NEUTRAL] Yes, I understand it's a lot, OK so.
[AGENT][NEUTRAL] I do see that it's a section A and section B, um, if you wanted to.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Write in or even add a separate sheet of paper at the bottom please make check payable to the estate of.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can do that.
[CUSTOMER][NEUTRAL] OK, so just like down here underneath the signature and stuff just say please make check payable to the estate of.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is that where you're talking about putting it?
[AGENT][NEUTRAL] You can do that.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] OK, and so it looks like looking through this, the only thing she's going to be eligible for is the one time benefit and um she had a few rounds of chemotherapy.
[CUSTOMER][NEUTRAL] Um, and I was looking on the thing and it said.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] An itemized bill from the medical provider and then an explanation of benefits from the medical carrier.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] So to get reimbursed for those, you gonna have both of those two things.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes sir and then all her pathology report.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, yes, yes, yes, I'm, I'm gonna send the pathology report, um, to cover the one time benefit, but um.
[CUSTOMER][NEUTRAL] OK, I'm trying to figure out how I get the explanation. I guess I have to call Medicare to get that, um.
[CUSTOMER][NEUTRAL] And then she had a supplement um do I need to get the EOB from her supplement also?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Or just from Medicare.
[AGENT][NEUTRAL] Any I would get EOB from any pro any provider that um.
[AGENT][NEUTRAL] That claims may have been filed with.
[CUSTOMER][NEUTRAL] OK, so is she just gonna get the difference of what it costs versus what was paid because if that's the case then I won't even fool with it because her supplement and everything paid for everything.
[AGENT][NEUTRAL] Right, um.
[AGENT][NEUTRAL] If you have it you can send it in. I mean her, her benefits I'm not sure I'm not in the claims department. I'm not a specialist, but you know that her, her benefit, um, for that first occurrence.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] With that um diagnosis from the um
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Pathology report will be paid.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] I mean that's up to you if you wanna send everything in or not or just send the information that you have.
[CUSTOMER][NEUTRAL] I'm just kind of yeah.
[CUSTOMER][NEUTRAL] Yeah, because I'm just trying to figure out if it's even worth trying to get the EOB from Medicare and her supplement if I'm if it's, I don't because I'm looking on her thing it says.
[CUSTOMER][NEUTRAL] Um, let me pull her thing thing up here.
[CUSTOMER][NEUTRAL] It says um policy schedule radiation and chemotherapy benefits $100 daily but then down here it says um on the actual benefits schedule it says actual charges not to exceed the amount shown in policy in the policy schedule which is $100 a day so um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $100 right.
[CUSTOMER][NEUTRAL] Yeah, so she would get $100. It sounds like at at least, is that correct?
[AGENT][NEUTRAL] Right, that's the way the policy is reading.
[CUSTOMER][NEUTRAL] OK, but to do that we gotta have a copy of the EOB from Medicare.
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] Well, the EOB if you have an EOB from her primary, you can send it, but you definitely need to send an itemized bill, uh, with the diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then the explanation of benefit right to show what's been done.
[CUSTOMER][NEUTRAL] OK, right, yes, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well that's what I needed to know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] Yes, [PII], is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, ma'am, uh that's it.
[AGENT][POSITIVE] Alright well you have a wonderful day and thank you for calling AL sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][POSITIVE] OK thank you bye.
[AGENT][POSITIVE] Bye-bye. You're welcome.
[CUSTOMER][POSITIVE] You're welcome.