AccountId: 011433970860
ContactId: 64f54b85-ad1a-4d31-9202-809ca0bcd72e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1053310 ms
Total Talk Time (AGENT): 378465 ms
Total Talk Time (CUSTOMER): 196388 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/2025/06/12/64f54b85-ad1a-4d31-9202-809ca0bcd72e_20250612T15:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, I received a.
[CUSTOMER][NEUTRAL] Um, text message saying that something about my claim. Are you able to look it up for me, please?
[AGENT][NEUTRAL] Yeah, I can help you with claim status. Um, who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And what's your policy number?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] That I don't know.
[AGENT][NEUTRAL] OK, is it alright if I look it up by your social?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, give me just a moment to look that up for you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And are you the uh the primary insurance holder?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I wasn't able to look you up by your social, um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, I'm so sorry I heard [PII]. I'm really sorry about that.
[AGENT][NEUTRAL] Can I get you to verify your date of birth for me please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And the address that we have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you know which policy it was under? Was it your um.
[CUSTOMER][NEUTRAL] It was the, it just said the claim, it must have been under like the mid link.
[AGENT][NEUTRAL] OK, cause the one for your.
[CUSTOMER][NEUTRAL] And she, cause she had, it was for [PII], it was for a [PII].
[AGENT][NEUTRAL] Oh, OK, give me just a moment.
[CUSTOMER][NEUTRAL] Probably was a couple of them, but
[CUSTOMER][NEUTRAL] Because she had surgery on Friday.
[CUSTOMER][NEUTRAL] So it's the hospital.
[CUSTOMER][NEUTRAL] Position I guess.
[AGENT][NEUTRAL] OK, OK, so it's not for you, it's for your child. OK, one moment.
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not showing it under your med link so give me just a moment.
[AGENT][NEUTRAL] And I'll check all the others.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And it doesn't tell me which one it just says your claim and or additional information has been received. You'll get a text message when your claim review begins.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, because I'm looking up for the 3 of them.
[AGENT][NEGATIVE] I'm not showing anything for her.
[CUSTOMER][NEUTRAL] So, I'm [PII].
[AGENT][NEUTRAL] Um, on your med link I am showing that we received one, it looks like it was submitted.
[AGENT][NEUTRAL] On the [PII] and it's being processed.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] The bottom lock is not locked just with coded.
[CUSTOMER][NEUTRAL] And who's that for?
[AGENT][NEUTRAL] Um, I have it under you, but since it's being processed.
[AGENT][POSITIVE] Yeah I see one for you.
[CUSTOMER][NEUTRAL] It's under me for it's supposed to be for a [PII]. She had surgery on last Friday. She had a tonsillectomy.
[AGENT][NEUTRAL] OK, let me look here and make sure that this is right.
[CUSTOMER][NEUTRAL] So the hospital had her cause she's she was there over 24 hours.
[CUSTOMER][NEUTRAL] And I wasn't sure how badly it works, so.
[CUSTOMER][NEUTRAL] But I gave them the information anyway.
[AGENT][NEUTRAL] Yeah, it typically, um, for Medlink, it will go to your primary first and then we ask for the primary insurance um explanation of benefits to show um what benefits have been paid and the amount, and then this one picks up after it. If it's a covered sur uh if it's a covered service, I apologize.
[AGENT][NEUTRAL] Um, let me see here.
[CUSTOMER][NEUTRAL] OK. OK, so do you guys pay?
[AGENT][NEUTRAL] OK, I am seeing it. So it must be that we're processing that one now.
[CUSTOMER][NEUTRAL] OK, so is there within that um.
[CUSTOMER][NEUTRAL] Oh, so I guess you guys would look at all the policies to see what is able to be paid out. Is that how that works?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And it looks like it's going to your Medlink right now.
[AGENT][NEUTRAL] So that's the only one that I see for her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause she had um.
[CUSTOMER][NEUTRAL] So you'll get all the information, but she had a tonsillectomy and adenoids that was last Friday. And she was admitted to the hospital.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I didn't know how that would work with Bed link and then I wasn't sure if you guys went through each policy I had to see what benefits she would qualify for.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, and since it's being processed, it might not have shown up, um, it might not have shown up on the others yet. It's according to your Medlink policy right now though.
[CUSTOMER][NEUTRAL] For payout.
[AGENT][NEUTRAL] I do see the um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I do see the codes and everything, so it's being processed right now.
[CUSTOMER][NEUTRAL] But you said it's only being processed through the med link, not the other policies?
[AGENT][NEUTRAL] Um, just right now.
[AGENT][NEGATIVE] I won't, I won't be able to see it on.
[CUSTOMER][NEUTRAL] Oh, but that doesn't mean it's not being processed through the other ones.
[AGENT][NEUTRAL] Right, I'm not going to be able to see that until it's until it's um completed right.
[CUSTOMER][NEUTRAL] Oh because it's processing.
[CUSTOMER][NEUTRAL] OK, the other question I have is for my cancer insurance.
[CUSTOMER][NEUTRAL] Um, my son [PII] is on that policy.
[AGENT][NEUTRAL] I mean what.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, give me one moment, let me look.
[AGENT][NEUTRAL] Let me get into that policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and what is his date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what questions did you have for that?
[CUSTOMER][NEUTRAL] So how does that work? He was um just recently diagnosed with um skin cancer, stage 2.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So how does that, how does that work?
[AGENT][NEUTRAL] Let me pull up your policy and look. Let me pull up that policy and look.
[CUSTOMER][NEUTRAL] The cancer policy
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right. I've got it pulled up. Let me go down to the benefits just real quick.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So I'll know exactly what I need to submit, you know, submit or.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And are you wanting to know if skin cancer is covered or are you just wanting to know some basic benefits?
[CUSTOMER][NEUTRAL] Uh, a little bit of both.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I would think any cancer should qualify for cancer and cancer.
[CUSTOMER][NEUTRAL] Little
[AGENT][NEUTRAL] All right. Let me get here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like skin cancer is on your policy. Um, it's considered a specified disease. Let me see, what else?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let's get.
[AGENT][NEUTRAL] It looks like there are some benefits related to the skin cancer diagnosis.
[AGENT][NEUTRAL] Um, he does have a hospital confinement benefit of up to $200 per day for the 1st 90 days, $200 a day thereafter. Um, and I will say that this is just a verification of benefits, not a guarantee of payment.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It does show in your policy that the surgical benefit and the 2nd and 3rd surgical benefit option are not um covered for skin cancer, and the anesthesia benefit is not covered for skin cancer.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but there is an attending physician benefit of $400 per day or I'm sorry, $40 per day while confined in a hospital.
[AGENT][NEUTRAL] There's a blood plasma and platelets benefit that's up to $200 per day with a maximum of $10,000 per calendar year.
[AGENT][NEUTRAL] Um, any radiation therapy, chemotherapy, or immunotherapy, you get up to $1000 per calendar month of treatment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see what else there might be.
[AGENT][NEUTRAL] You have a hormone therapy benefit of $50 per treatment with a maximum of 12 treatments per year.
[AGENT][NEUTRAL] And let me see. Same with the experimental treatment benefit. It's paid under the same manner and same maximum as the other treatments.
[AGENT][NEUTRAL] You do have transportation and outpatient lodging benefits. Um, your transportation benefit is um 40 cents per mile, with a maximum of 1000 miles per round trip.
[AGENT][NEUTRAL] And you are paid up to 12 round trips per calendar year.
[AGENT][NEUTRAL] Um, if should you need to go to lodging for outpatient services, you have an outpatient lodging benefit of $50 per day and up to $50 or up to 50 days per calendar year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that is the same with family member transportation and lodging.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Is there anything else you'd like me to go over for that one?
[CUSTOMER][NEUTRAL] No, so what I would need from the physician is what?
[AGENT][NEUTRAL] You will want
[CUSTOMER][NEUTRAL] What I would need to upload.
[AGENT][NEUTRAL] You'll want an itemized bill um with procedure codes.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You will also want, uh, again the primary EOB if your primary is paying first, um, you'll want to send that in.
[AGENT][NEUTRAL] You'll want the uh physician's report stating the diagnosis of cancer.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Let me see what else you might need.
[AGENT][NEUTRAL] Uh, any pathology report, report, um, that's, has the initial diagnosis of cancer and a new, um, any surgeries that includes biopsies you'll want to send in.
[AGENT][NEUTRAL] Um, I believe I said the itemized receipt or invoice already. Um, if you are doing your travel and lodging expenses, you will want to include receipts for that as well.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] And you'll want the addresses of where you had, of where the hospital was and where you are uh currently residing, and they'll do the mileage for you uh for that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, if he does anything such as hospitalization, surgery, chemo, uh, or any type of radiation therapy or anything like that, you'll want the itemized bill.
[AGENT][NEUTRAL] And then, um, yeah, the, the explanation of benefits from your primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, and should I wait till Monday to look back into uh [PII]'s plan?
[AGENT][NEUTRAL] Uh, yeah, you'll want to give it 7 to 10 business days to process, um, claims. However, if you are signed up for the text messages like it sounds like you are, uh, you should be able to get a text message when it's ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] No ma'am, thank you so much.
[AGENT][POSITIVE] Great, thank you for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Right bye.