AccountId: 011433970860
ContactId: 89bb6758-b54d-443e-aca1-b2d423d55ad7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294140 ms
Total Talk Time (AGENT): 222541 ms
Total Talk Time (CUSTOMER): 51083 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/89bb6758-b54d-443e-aca1-b2d423d55ad7_20250501T13:30_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi good morning how are you?
[AGENT][NEUTRAL] I'm fine how are you?
[CUSTOMER][NEUTRAL] Good, good. Um, I need to file a gap insurance, uh, claim.
[AGENT][NEUTRAL] OK, and this is for your policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, well, let's look that up. What is your policy number, please?
[CUSTOMER][NEUTRAL] Um, policy number and hospital. OK, I think it's 018.
[CUSTOMER][NEUTRAL] 55
[CUSTOMER][NEUTRAL] 234.
[CUSTOMER][NEUTRAL] M as in Mary L 7.
[AGENT][NEUTRAL] I appreciate that. If I could just get, uh, if I could just verify your name, uh date of birth and the phone number, please. I just want to make sure I have the right policy.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] And my, uh, you said telephone number?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] I appreciate that. Thank you. And the um claim that you're wanting to file, uh, do you, is this for something that's coming up or that uh you already receiving a bill for or?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] Receiving a bill for.
[AGENT][NEUTRAL] OK, and, and what is the service that, uh, that it was for?
[CUSTOMER][NEUTRAL] It was appendicitis.
[CUSTOMER][NEUTRAL] In the hospital?
[AGENT][NEUTRAL] Oh, OK. Oh bless your heart. Um, OK, [PII], so what we'd end up doing on this is with your, um, gap insurance, we'll pick up the deductible, co-payment or co-insurance is $2500. Now, to file the claim, uh, there's several different ways to do it, but the, first of all, the paperwork, what we will need is an explanation of benefits from your major medical. Now, they would have filed it through Anthem first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and you will get that EOB in the mail or they also have uh an online service center that you can uh get that off of.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And then for the hospital.
[AGENT][NEUTRAL] They will have they will have a bill that they will, it will be an itemized bill.
[AGENT][NEUTRAL] And it will tell us uh the dates that you were in the, or the date that you were in the hospital as well as the uh the things that were done in the charges. But the third thing that we need is the diagnosis code and that is the, the appendicitis that you went in for that. And that will either be on the hospital bill, but that is, uh, you know, that that was what the surgery was for was for appendicitis, um, or your doctor who, uh, that you saw.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, they will have, they will have, uh, what are called walkout papers or, or the notes that they will have stating that this is why that, that, uh, service was done. Now, once you have those three things, the, uh, explanation of benefits from your major medical, the itemized bill from the hospital, and then the, that information from the, from your provider, um, why you had that surgery, there are a couple of different ways that you can file this claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now you can mail it to us, you can fax it to us, but probably the fastest way to do it is to go on to our online service center. Now, on your card, you will see where it has a website and that website is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I see that.
[AGENT][NEUTRAL] And when you get to that site.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It will say, uh, it will say ATL and it's a blue and green site and it says workforce benefits that work for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You'll go to on the right hand side it says sign in. Now, if you've never felt uh filed a claim yourself.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] You'll be a new user and all you have to do is just put your information in. You're going to create a user ID and a password, you know, as we always have to do, and then you, it will, it will show um uh file a new claim and there's a little red, uh, you know, once you're in the system, it says file a new claim. You can also uh print out new cards. You can track the, the process of the claim, you know, after we receive it, but that's probably the fastest way to do it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, uh, once we do that, it takes us um 8 to 10 business days to process. Uh, but, um, but that is what we will be needing, um, is that, that information from the hospital that, uh, the itemized bill, uh, the, um, explanation of benefits from Anthem, and then the diagnosis code letting us know uh what um what the surgery was for.
[CUSTOMER][NEUTRAL] OK, that makes sense.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK awesome thank you so much, very very helpful I'll be doing that shortly.
[AGENT][NEUTRAL] Is there anything, anything else at all that I may help with?
[CUSTOMER][POSITIVE] No, no, no, you've been great thanks again.
[AGENT][POSITIVE] Mhm thanks for contacting ATO.