AccountId: 011433970860
ContactId: 8e170ba4-0c91-4c23-9946-54419c1e0641
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 961320 ms
Total Talk Time (AGENT): 648813 ms
Total Talk Time (CUSTOMER): 210467 ms
Interruptions: 6
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/8e170ba4-0c91-4c23-9946-54419c1e0641_20250612T15:26_UTC.wav
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[AGENT][NEUTRAL] For calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, can you tell me, um, first of all, what different, uh, policies I have with your company?
[AGENT][NEUTRAL] Sure I can get all that pulled up and let you know kind of policies you have um what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK and then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's uh [PII].
[AGENT][NEUTRAL] Thank you. Do you have a policy number?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK, um, I can start using your social.
[CUSTOMER][NEUTRAL] Sure. It's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, and you did say [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you believe I found you, um, just gonna verify some information really quick. Can I get your date of birth please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. The last thing I need is the email address we've got on file for you. Looks like it might be through your employer.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Awesome, thank you so much for verifying that. OK, so you've got 3 policies with us, [PII]. You've got a cancer policy, an intensive care policy, and a hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK, you said um.
[CUSTOMER][NEUTRAL] Cancer
[CUSTOMER][NEUTRAL] Hospital in [PII], what was the other one?
[AGENT][NEUTRAL] Intensive care.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you tell me, um.
[CUSTOMER][NEUTRAL] What each policy um
[CUSTOMER][NEUTRAL] The specifics of um of the policies, what they actually pay on.
[CUSTOMER][NEUTRAL] Or what they actually um what what are the benefits of each policy that's what I'm asking.
[AGENT][NEUTRAL] OK, sure. Give me just a moment. Let me get that pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, so I'm getting the cancer policy pulled up because I believe that's going to be the most um.
[AGENT][NEUTRAL] In depth, um, the intensive care I can tell you provides benefits, of course, if you were in, uh, it's intensive care or coronary care. So that's going to be that flat, that's what that covers. Um, cancer, let me get that pulled up. That one can be a bit more.
[CUSTOMER][NEUTRAL] OK, so that's only Corne.
[AGENT][NEUTRAL] I'm sorry, yeah, uh,
[CUSTOMER][NEUTRAL] OK, that's only coronary related?
[AGENT][NEUTRAL] Uh, intensive care and coronary care. Yes, ma'am. Um, let's see. The cancer policies, of course, are usually, you know, specific to cancer, but some of them do offer other benefits as well. So let me get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if you, I'm just asking why you put, if you were in intensive care for other reasons other than coronary, that won't apply to that policy?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] I can get that pulled up and we can see um for sure. I do believe it's uh intensive care or coronary care so if you were in intensive care for any reason. Right, yes, um, but I can get that pulled up and we can look at that specifically. OK, so I do see just in general your cancer policy you've also got a critical illness writer, um, so specific critical illnesses could be covered as well as benefits for a heart attack or stroke.
[CUSTOMER][NEUTRAL] Oh, it's or corn in there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me get that up and we'll look a little bit more specifically.
[AGENT][NEUTRAL] OK. So this, again, these benefits are going to be specific for um cancer treatment if uh you had a positive diagnosis of cancer. So there are quite a bit of benefits, um, hospital confinement, drugs and medicine, surgical benefits, um, 2nd and 3rd opinion benefits, outpatient hospital, ambulatory surgical center, anesthesia, um, inpatient special nursing services, excuse me.
[AGENT][NEUTRAL] Prosthesis
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Blood plasma and platelets, uh, radiation, chemo, immunotherapy, lab work, hormone therapy.
[AGENT][NEUTRAL] Blood marrow stem cell transplant, experimental treatment, dread disease.
[AGENT][NEUTRAL] Donor benefits, uh, ambulance, uh, ground or air, and then transportation and lodging as well, uh, hospice, diagnosis and prevention.
[AGENT][POSITIVE] And now this one, that's where I'm looking is that diagnosis and prevention because that is going to be a benefit that you would have regardless. That's, you know, you don't have to have a positive diagnosis of cancer to get that benefit. That's again going to be more along the lines of um.
[AGENT][NEUTRAL] Preventative. So typically, and again, I can look at more specifics, but typically, that's going to be things like um mammograms, colonoscopies, uh Pap smears, things like that that can um preventative screenings like looking for cancer.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm, let me ask you something when you're, if you have to file for any of these, do you, can you, do you have to file specifically for each um incident or I mean not incident or um the different benefits that you're naming or can you just file everything and the, the you guys find out where it falls as far as if it's covered.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Sure, OK, yes, that's perfectly fine. So first off, [PII], I can send you a copy of this policy just so you have it for your records and you can, you know, of course reference that if you'd like to see if something is covered. What I tell everyone.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Whatever kind of treatment that you receive, go ahead and just send that information to us if there's any you know you know I wonder if this is covered and you're not quite sure um you can of course give us a call but go ahead and send it to us you know the worst we're gonna say is that's not covered best thing we're gonna say is you know you get a benefit for that so um and yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can absolutely send multiple um things at once if you'd like uh some people prefer to do it that way, others prefer to do it separate um it's completely up to you um there's also no timely filing limit so I will say this policy, for example, the effective date was [PII]. So if you've had anything um since then.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] That you didn't file you can definitely go back and file that and we would give you that benefit.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And would this be filed like only under
[CUSTOMER][NEUTRAL] Like if it was cancer, or what about the hospital endemicity, would it, would I get benefits from both?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Sure I can get that one pulled up as well.
[AGENT][POSITIVE] Yes, uh, they do, right.
[CUSTOMER][NEUTRAL] Or is that that's what would I have to file that separately under a separate.
[AGENT][NEUTRAL] Um, so it would be, yes, I absolutely do. So, um, you know, and I, I apologize if it's confusing, but they do, um, what's the right word, stack I guess is the right way to say it, um, so you can file multiple claims if it's applicable, of course, um, for your hospital indemnity and then also for your cancer or again your um intensive care as well, uh, you can absolutely get multiple benefits they would have to be filed separately.
[CUSTOMER][NEUTRAL] You see what I'm saying?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so, you know, for anything that's, um, yes, so one would be, you know, submit it for the hospital indemnity and then you could submit it again for the cancer, for example.
[CUSTOMER][NEUTRAL] OK, that's what I was asking, OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So I guess I need to know.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How do I do something like that? How do I, um.
[AGENT][NEUTRAL] Sure, how to file claims?
[CUSTOMER][NEUTRAL] Do I just get records from the um medical centers and have them to submit like all of their records that they have for me or?
[AGENT][NEUTRAL] Whatever is easier for you sure OK so I will say for just general across the board any kinds of claims what we would need is the itemized statement.
[CUSTOMER][NEUTRAL] How does it work?
[AGENT][NEUTRAL] That shows diagnosis and procedure codes, so any kind of treatment that was received, you could get a hold of that provider or facility wherever it was that you received treatment, um, and uh just request that itemized statement that shows diagnosis and procedure codes and then once you have that you there's multiple ways to file claims as well um whenever you're ready we can kinda get into all that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so um.
[CUSTOMER][NEUTRAL] So I need a statement showing diagnosis and procedure codes and what else?
[AGENT][NEUTRAL] Yes ma'am, uh, the autoized statement that shows those codes, that's generally going to be all that we need, [PII]. The only thing time that we would need anything additional is, um, I will say if you're receiving, um, chemo, radiation or immunotherapy.
[AGENT][NEUTRAL] We would also need the explanation of benefits um from a primary insurance so showing if anything else has been received towards that treatment but that's really going to be the only time that we would need anything additional um so as far as getting these filed I will say generally the quickest and easiest way is going to be through our online portal. Do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Not right this minute, I, I can do it a little later. Oh yes, ma'am, I do. Yes, ma'am, I do.
[AGENT][NEUTRAL] Oh no, no, no, it doesn't have to be right this second. I just meant in general, no, it does not have to be right now. OK, awesome, yes, uh, the reason I ask is our online portal is, um, it doesn't really have much support for mobile devices at this time, uh, so it does work better on a desktop or a laptop, um, so what I can do is I can send you copies of these policies so you do have it for your record you can see what is and isn't covered, uh, dollar amounts, frequencies, things like that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I can also include a link to our online portal um and so all you would do to set up that account is enter all of the information that we had previously verified uh it does have to match what we have so you would enter that same email address the one through your employer um that's there's usually some confusion regarding that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and then from there you'll see where you can file claims, uh, through the portal you would select of course what kind so and then it will walk you through all of that filling out the appropriate claim form and then where you can upload documents.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, now let me ask you this you mentioned um.
[CUSTOMER][NEUTRAL] Items that they were covered under my general insurance so your insurance doesn't pay if um.
[CUSTOMER][NEUTRAL] I thought it was in addition to the general insurance. How does, how does that work?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes. OK. Well, I guess there might be a bit of confusion with that. Um, do you have any other medical um insurance besides the one that you have with us?
[CUSTOMER][NEUTRAL] Does yours pay
[AGENT][NEUTRAL] Anything like um
[CUSTOMER][NEUTRAL] Yes, I have general medical insurance.
[AGENT][NEUTRAL] You do OK so that would that would be what that's considered um and again that's just going to be for um if chemo or radiation or anything like that was received we would need that explanation of benefits that's all we would need but yes you can still file these claims additionally to get that um uh those additional benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does that make sense? I'm sorry, I know it's a bit confusing.
[CUSTOMER][NEUTRAL] So, um, yes it.
[CUSTOMER][NEUTRAL] It does. I'm just making sure I have everything. Um, so you need diagnosis and procedure codes showing itemized statements and for.
[AGENT][POSITIVE] No, you're fine, absolutely.
[AGENT][NEUTRAL] Yes, ma'am, with that itemized statement, yes.
[CUSTOMER][NEUTRAL] And for radiation and chemo.
[AGENT][NEUTRAL] The explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] You need um.
[CUSTOMER][NEUTRAL] Explanation of benefits.
[AGENT][POSITIVE] And all of that information can be, yes you can get all of that from again wherever treatment was received and also just again there is a timely filing limit so you don't have to be you know stressing about you know I need to have this at a specific time whenever is convenient for you you can go ahead and get that information uploaded.
[CUSTOMER][NEUTRAL] From Primary Insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what is the website again?
[AGENT][NEUTRAL] Um, so I will include that, uh, link, but I can go ahead and give it to you. Just let me know whenever you're ready.
[CUSTOMER][NEUTRAL] In the email, OK.
[AGENT][NEUTRAL] Did you want me to go ahead and give it to you now?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] Sure, OK, so it's the word [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, and if you have any, uh, if you need any help with that or anything, definitely give us a call back and um we'll walk you through all of that. It can be a little bit confusing. OK, so as for these policies, [PII], would you like me to send you all three?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK and then do you want me to just send it to this email address that we've got on file for you or is there a different one you'd like me to send that to?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Is it uh the [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, alright, um, OK, so you will receive 3 separate emails, um, with all of that and you know if you get them, you have any questions or anything, uh, give us a call back and we'll help you out. Did you have any questions for me at the moment? I know that was quite a bit of information.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] Um, just making sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you kinda tell me again what hospital indemnity is?
[AGENT][NEUTRAL] Yes, yeah, we didn't really go over that one very much so, um, with you having the, you know, like you said a general um actual primary insurance, the hospital indemnity would be more um supplemental. So indemnity simply means that it's, um, would pay a set dollar amount per covered procedure or office visit.
[AGENT][NEUTRAL] Um, in addition to, of course, whatever you would get from your, uh, major medical now with the hospital indemnity you can see if the providers would file those claims for you. Uh, there are some cases where they would do that. Um, unfortunately it is going to be up to them. Each provider's office is very different. Some don't like messing with any kind of supplemental or anything like that, in which case you can still file those claims yourself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, ma'am, I think that's it.
[AGENT][POSITIVE] Alright, well, be on the lookout. You will be getting 3 separate emails from me, um, and again, you have any other questions definitely give us a call we can help uh clear up any confusion. Um, did you have anything else to ask me at the moment?
[CUSTOMER][NEUTRAL] No, ma'am, not at this time.
[AGENT][POSITIVE] All right well thanks for giving us a call and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too. Bye.
[AGENT][POSITIVE] Alright thank you bye bye.