AccountId: 011433970860
ContactId: 727bff30-2ef5-4168-8cac-63691ae6baec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 949669 ms
Total Talk Time (AGENT): 286388 ms
Total Talk Time (CUSTOMER): 323934 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/727bff30-2ef5-4168-8cac-63691ae6baec_20250325T20:54_UTC.wav
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[CUSTOMER][NEUTRAL] You're
[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Yes, well, I was calling to see. I've had some, you all have done some of my claims, but I got 2 more claims and I just wonder if they're covered before I try sending them in.
[AGENT][NEUTRAL] OK, sure, I can check your benefits.
[CUSTOMER][NEUTRAL] So I got uh
[CUSTOMER][NEGATIVE] Yeah, I got 22 bills that I've gotten that I've paid. One was for $250.01 is 171, and it says my insurance, my other insurance paid everything but this, so I owe.
[CUSTOMER][NEUTRAL] What was left.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. The 250 is um for what type of procedure or service?
[CUSTOMER][NEUTRAL] Uh, 250 was for.
[CUSTOMER][NEUTRAL] I'm going to take radiation.
[AGENT][NEUTRAL] Radiation.
[CUSTOMER][NEUTRAL] And my insurance paid for most of it except for $2 I mean $2 250 dollars.
[AGENT][NEUTRAL] OK, and what's the 71?
[CUSTOMER][NEUTRAL] And the one I had today.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the one for 171.
[CUSTOMER][NEUTRAL] said that was the last portion that I had to pay before I met my complete deductible from my other insurance. So both of them are from
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Insurance that
[CUSTOMER][NEUTRAL] That I hadn't finished me my deductible.
[AGENT][NEUTRAL] So they're both for radiation?
[CUSTOMER][NEUTRAL] Yeah, they're both from, they both came from uh radiation.
[AGENT][NEUTRAL] OK. Uh, what's the policy number so I can look at the product you have with us?
[CUSTOMER][NEUTRAL] OK, the policy number is 709252.
[AGENT][NEUTRAL] OK. And may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][NEUTRAL] OK, thank you, Miss [PII]. And may I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] OK, [PII] [PII] and email is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Mm, let's see.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me pull the policy itself for one moment.
[AGENT][NEUTRAL] Yeah, I'm waiting on the documents to upload, OK? One moment.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Go
[AGENT][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like for, let's see, for radiation, chemotherapy, immunotherapy, you have $500 per calendar month. So it's um this is a monthly benefit for radiation.
[CUSTOMER][NEUTRAL] setting up.
[CUSTOMER][NEUTRAL] Just
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see, we have.
[CUSTOMER][NEUTRAL] OK, but um.
[CUSTOMER][NEUTRAL] On that, on that radiation. So these two were for radiation.
[CUSTOMER][NEUTRAL] But then I have, I did my first radiation today. I have 15 more to go.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. So we paid $500 a month. So it's every month we pay $500 and this is not a guarantee of payment, just a verification of coverage, but that is your benefit. So I'm not sure if you're gonna have um more than one each week or is it gonna be like.
[AGENT][NEUTRAL] Like a couple of them in a month.
[CUSTOMER][NEUTRAL] I'm having, well, she, I have, I'm having uh
[CUSTOMER][NEUTRAL] 16 days.
[CUSTOMER][NEUTRAL] Of uh radiation treatment.
[AGENT][NEUTRAL] If
[AGENT][NEUTRAL] Is it gonna be back to back or is there?
[CUSTOMER][NEUTRAL] So I started today.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, it goes for like a week at a time. So I go this, all this week, all next week, all the next week. Then she told me I'll be through on [PII].
[AGENT][NEUTRAL] OK. So basically, if they're gonna do it back to back, um, we only pay monthly. So it's $500 monthly. So you will get like $500 for this month of March and then um
[AGENT][NEUTRAL] After that, we're gonna count um the 30 days and then you get another 500. So you, let's say you did the one today, so that's [PII] and then you get another one on [PII] on [PII], another 500.
[CUSTOMER][NEUTRAL] Oh yeah, I, I mean, I would.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I would do it, but I didn't know.
[CUSTOMER][NEUTRAL] This is new to me so I didn't know if you pay, if my other insurance paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Oh, yes. Um, this one is separate from your other insurance. It does pay actual charges, so we do need a copy of the explanation of benefits, um, so we can pay the correct amount and we don't underpay or overpay. Um, but, um, you just need to send in the explanation of benefits from the primary insurance, OK?
[CUSTOMER][NEUTRAL] And make sure I do what now?
[AGENT][NEUTRAL] But this is separate.
[AGENT][NEUTRAL] Send in the copy of the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now, I, I don't.
[CUSTOMER][NEUTRAL] I don't know. I mean, I guess I'm gonna get an explanation of benefits, but they gave me a bill that told everything that was due.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] How much they paid out and then they told me how much the insurance paid out and then it told me what I had, what was left was what I had to pay.
[AGENT][NEUTRAL] OK. Um, you can send that information that you have and let us look at it, but if it's missing the explanation of benefits, we will ask for it because it's something that is needed to process the claim. So, um, if you want to just go ahead and send what you have, you can. If you want to wait for the explanation of benefits from your primary insurance, then you can go ahead and wait for that and then send the whole thing in.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. Well, I, I'll try to see if, if they, they send me an explanation of benefits. I think they do, but it's like on the like I.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Some kind of health thing, but I, I can wait on that. I was just wondering cause I, I'm getting all these bills, but
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yes, I understand.
[CUSTOMER][NEUTRAL] I just didn't know, yeah, yeah, yeah, I don't, I didn't know, this is my first time. I don't know what I'm going, what I'm doing with them or what.
[AGENT][POSITIVE] Yeah, you can.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] I understand. Do you have the claim form or you need me to send you a copy to your email?
[CUSTOMER][NEUTRAL] Well, send me a copy to my email.
[AGENT][NEUTRAL] OK, let me go ahead and do that and it's gonna have the instructions.
[CUSTOMER][NEUTRAL] And then when I get them all, I think.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I, when I get them all, all instead of sending one this time and then one the next time and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I just try to send them all in at the same time.
[AGENT][NEUTRAL] That's fine. Whichever is easier for you, you can send it at once or you can just wait or whichever is easier for you, OK? So let me go ahead and send the, the copy of the claim form so you have it. The first page is gonna give you instructions. So you're gonna have the instructions of what you're gonna need to send in, OK? Um, do you mind holding for me so I can send this out to you right now while I got you on the line?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, no, I'll hold. I'll hold.
[AGENT][NEUTRAL] OK. All right, thank you. One moment.
[CUSTOMER][NEUTRAL] Oh, uh-huh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Going to get him food.
[AGENT][POSITIVE] Thank you for holding, Miss Miss [PII], thank you for holding.
[CUSTOMER][NEGATIVE] Well you just gonna drop me off and then I don't know what you want me to do.
[CUSTOMER][NEUTRAL] Drop you off and then go get the food, yeah, because I have to say that.
[CUSTOMER][NEUTRAL] And then you gonna come back there.
[CUSTOMER][POSITIVE] And what do you want? Uh, it's a pleasure.
[AGENT][POSITIVE] Thank you for holding, Ms. [PII].
[CUSTOMER][NEUTRAL] What? Just lettuce and tomatoes, I mean, uh, oh yes.
[AGENT][NEUTRAL] OK. Uh, I went ahead and sent that email. Do you want to check and see if you got it?
[CUSTOMER][NEUTRAL] Uh, yes, hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] TJ, yes, OK, so y'all are getting food. Yeah.
[CUSTOMER][NEUTRAL] Where are you at? I'm at school. Oh, you're at school.
[CUSTOMER][POSITIVE] OK, yeah, OK, cool.
[CUSTOMER][NEUTRAL] I'm in the car with him. Oh, OK, so you're getting into those, yes.
[CUSTOMER][NEUTRAL] And she said, she said yes.
[CUSTOMER][NEUTRAL] Oh, OK, I'm still at school. OK. All right, bye.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It hasn't come in yet.
[CUSTOMER][NEUTRAL] To open the shop.
[AGENT][NEUTRAL] OK, um, it should be there shortly. If you don't get it within 15 minutes, you can give us a call back or you can go to our website at [PII] and you can get one, but it should be there soon, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I may help you with?
[CUSTOMER][NEUTRAL] That's what I say, it usually comes in. I've had it before.
[CUSTOMER][NEUTRAL] So they usually come in.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, right now it's taking a little bit longer to get there for some reason. Um, so just give it a couple more minutes and it should be there. I did send it to the email on file, the same one that I verified earlier, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Is there anything else, Ms. [PII]?
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] That would be all. I appreciate you. Thank you.
[AGENT][POSITIVE] Mm. You're welcome and thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.