AccountId: 011433970860
ContactId: 977583bf-83ee-4531-a4d1-b690c5bfcf73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2489199 ms
Total Talk Time (AGENT): 968097 ms
Total Talk Time (CUSTOMER): 1048247 ms
Interruptions: 15
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/977583bf-83ee-4531-a4d1-b690c5bfcf73_20250602T12:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good morning [PII]. How are you?
[AGENT][POSITIVE] I'm good and yourself?
[CUSTOMER][NEUTRAL] Good, can I give you my policy number? I have 2 questions for you.
[AGENT][NEUTRAL] OK, first off, who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Is the uh landline number [PII]. You guys have both.
[AGENT][NEUTRAL] What's the last number again? [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And you said that you have questions on your policy, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, Miss [PII], I can help you with that. And what is your policy number?
[CUSTOMER][NEUTRAL] 253
[CUSTOMER][NEUTRAL] 1373.
[AGENT][NEUTRAL] OK, thank you. Give me a couple of moments please to get your information pulled up and then I will have to verify several things with you first for security, so one moment.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And again, Ms. [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. If you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file are the two numbers, both are the same as the one you gave me, so those are the numbers that we should have for you, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and lastly your email address?
[CUSTOMER][NEUTRAL] Um, it was changed to [PII].
[AGENT][POSITIVE] OK, thank you very much. So now, how can I help you today exactly?
[CUSTOMER][NEUTRAL] OK, um, I believe that you guys changed systems, so is that correct?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] When you say change systems, are you referring to the online service center?
[CUSTOMER][POSITIVE] Uh huh yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am. There were some updates made to it.
[CUSTOMER][NEUTRAL] OK, because I had I was each time that I was signing in for a little bit I was seeing something that it would prompt you to.
[CUSTOMER][NEUTRAL] I guess help with
[CUSTOMER][NEUTRAL] You signing on to the new look of it or whatever I don't know uh anyway the last time that I signed on was.
[CUSTOMER][NEUTRAL] I don't know it's like the [PII] I think it was, um, and it didn't prompt me so I just pushed OK but it says it was the last day will be the [PII]. So sure enough, long story short is I can't get in now because it's not recognizing that I have an account. So can you help me with that part because you guys finished the claim and it told me to sign on, so can you help me with that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so is it asking you to set up like a new profile?
[CUSTOMER][NEGATIVE] And I don't know what he's asking me because he didn't let me.
[AGENT][NEUTRAL] OK, so give me just a moment because it appears that there must have been something that occurred over the weekend. Give me just one moment, OK?
[CUSTOMER][NEUTRAL] the what?
[AGENT][NEUTRAL] Give me a moment to look at a few things because I believe you're going to need, need to re-register, Ms. [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] All right, so let's see, with the changes, I believe that you're gonna have to re-register, so give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It might be because they didn't recognize me and they did say that it said something I wouldn't be able to log in if it wasn't created.
[AGENT][NEUTRAL] OK, so try and see if you can just create your account again.
[AGENT][NEUTRAL] While we're on the phone, if you're able to do that, do you have time to do that while we're on the phone? OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Yeah, I could do that, but um just to let you know, I tried that like 50 times.
[AGENT][NEUTRAL] Just create an entire new profile, not put in your username and not put in your password, but to actually set up an entirely new profile. You tried that 50 times?
[CUSTOMER][NEUTRAL] And it wouldn't, but.
[CUSTOMER][NEUTRAL] In your
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, I did, I did, but anyway, I'm there with you. Let me, let me, let me, uh, try to, um, sign on. Let me, I mean, you know, get to you, to your thing.
[AGENT][NEUTRAL] Sure. OK.
[CUSTOMER][NEGATIVE] Uh come on.
[CUSTOMER][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] We'll try to walk through this together since it's going to be.
[CUSTOMER][POSITIVE] I appreciate you helping me. I, I do.
[AGENT][POSITIVE] You're very, absolutely, you're very welcome.
[AGENT][POSITIVE] We're gonna learn something new this morning.
[CUSTOMER][NEUTRAL] OK, so I'm there.
[CUSTOMER][NEUTRAL] OK, so it says create your OSC account, that's it, right?
[AGENT][NEUTRAL] Yeah, uh, yes, ma'am. It should be. Uh-huh.
[CUSTOMER][NEUTRAL] OK, so I'm gonna hit there and then it's wanting me to select which role best describe you agency group, huh, provider.
[AGENT][NEUTRAL] I think so.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Does it say new user?
[AGENT][NEUTRAL] Or I'm an individual. Does it say I'm an individual?
[CUSTOMER][NEUTRAL] Uh uh.
[CUSTOMER][NEUTRAL] Uh uh, no, it has provider, it has insured, it has agent or broker.
[AGENT][POSITIVE] Insured. OK, so you're the insured. So they changed the verbiage a little bit. That's why I said I'm, this was rolled out, I mean, just the other day, so we're gonna have we're gonna learn something together.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, that's what I did.
[CUSTOMER][NEUTRAL] Yeah, OK, so I did hit that one. I'm gonna hit next.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And then it'll take me to create um put in my last time and I think once before they told me that the caps are small letters didn't matter, right? So I just type it in.
[AGENT][NEUTRAL] It, no, ma'am, and I do, yes, I, it did not before, so I don't think that it's.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] I, I don't think that still matters.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Oh goodness dang it.
[CUSTOMER][NEUTRAL] Check in again, OK, um, the birthday part.
[AGENT][NEUTRAL] And then you will use your updated email, your SBCG or global email.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 63.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It's not liking this.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, finally, OK and then um my social security, right?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK, and then my email, the one that I just gave you.
[AGENT][NEUTRAL] Uh-huh, yes, ma'am. Correct. Uh-huh.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I just verify it because like I said I, I did this and it didn't work.
[CUSTOMER][NEUTRAL] OK, so I'm there I'm gonna hit next.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then, um, complete your account set up, hit continue.
[AGENT][NEUTRAL] Uh-huh. Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK, and then it's asking me to log in.
[AGENT][NEUTRAL] Yeah, there you go. So you should be able to log in now.
[CUSTOMER][NEUTRAL] Uh, OK, OK, and what about do I use the same password that I created, uh, on the old system?
[AGENT][NEGATIVE] You're, you're setting up, no, you were gonna, I mean, you're just, it's gonna be like you would never set up your profile before.
[CUSTOMER][NEUTRAL] OK, yeah
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] So I'm gonna suggest because it's giving me a prompt it says uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm gonna have to choose a new one because it didn't say new, it just says password.
[AGENT][NEUTRAL] You can try your other password. I don't know if that's, if it will accept it or not.
[AGENT][NEUTRAL] Because I think it's, I think you have to create an entirely new profile.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll just create something similar.
[CUSTOMER][NEUTRAL] OK, sign in.
[AGENT][NEUTRAL] It's allowing you to do that. OK.
[CUSTOMER][NEGATIVE] No, it says we can't seem to find your account that's what they told me last time.
[AGENT][NEUTRAL] OK, so and that's with you using a new password and a new username?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Mhm, and now it gives me a prompt where it has my email and it has, I guess that's you guys, is that [PII], is that your is that.
[CUSTOMER][NEUTRAL] You guys email or location?
[AGENT][NEUTRAL] It's not a, say that all again.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's like a key like a security where I put you guys information and I'm gonna, I'm gonna click on that because.
[CUSTOMER][NEUTRAL] But when I click on that it's.
[AGENT][NEUTRAL] It should have, is it asking you to enter a code like a security key or that it should have sent to you?
[CUSTOMER][NEUTRAL] But yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] No, it hasn't sent anything to me yet.
[CUSTOMER][NEUTRAL] I don't know. No, that's not it either.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No, no, I, I try always.
[CUSTOMER][NEUTRAL] Uh, let me see, recently filled in again.
[CUSTOMER][NEUTRAL] Other password.
[CUSTOMER][NEUTRAL] OK, uh, password is, uh, that's to my system. I need to unlock.
[CUSTOMER][NEGATIVE] It it needs to be reset that's what's wrong.
[AGENT][NEUTRAL] OK, so just
[AGENT][NEUTRAL] Try my set it, see what happens.
[CUSTOMER][NEUTRAL] OK, let me see if it doesn't.
[CUSTOMER][NEUTRAL] No, it's not recognizing it.
[AGENT][NEUTRAL] OK, so what I'm gonna need to do is it's just not letting you, it's not letting you enter your SBCG or SBC that email, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, I put it in there, but which one should I put in? Should I put in my job? Is, is I, OK.
[AGENT][NEGATIVE] No, ma'am. No, ma'am, because that's not what's on file and it won't, for security purposes, it will definitely reject that one.
[CUSTOMER][NEUTRAL] No, that's what it was.
[AGENT][MIXED] Correct, but that's not what it is, yeah, but it's not that anymore.
[CUSTOMER][NEUTRAL] It was that one.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK, right.
[CUSTOMER][NEGATIVE] So you guys having problems with not just me but other people as well since she's uh.
[AGENT][NEUTRAL] Um, well, we just opened for business, so I'm not sure yet if this, if this is an issue throughout. So, what I will.
[CUSTOMER][NEUTRAL] OK, well, can you help me with the other part? What, OK, go ahead.
[AGENT][POSITIVE] Hello ma'am. Uh, let me look into this and I'll be happy to call you back since you're not able to set it up at all and it's giving you an error message when you are entering your information.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I did well, it just says that we cannot, uh, let me, let me go back into it let me see.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, can you help me with the other part? You guys made a decision on my claim, so what was it?
[CUSTOMER][NEUTRAL] Cause that's how I knew something was going on. I was trying to sign in to see what the decision was.
[AGENT][NEUTRAL] OK, so I do see that there was a claim processed for you on the [PII] and there was a benefit paid on that claim, um, Ms. [PII] in the amount of $669.87.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What was it?
[AGENT][NEUTRAL] 669.87.
[CUSTOMER][NEUTRAL] OK, and when was that done?
[AGENT][NEUTRAL] On the [PII].
[CUSTOMER][NEUTRAL] On the [PII] that was Saturday.
[AGENT][NEUTRAL] No, ma'am. I believe that Friday was the [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes ma'am, Friday was the [PII], so it went through our overnight processing Friday night.
[AGENT][NEUTRAL] And I can see, let's.
[CUSTOMER][NEUTRAL] OK, so it's not gonna process for a few more days. OK, so, um, question to you, which claim was was paid out that couldn't have been for all the invoices.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] There was a previous claim processed on [PII].
[CUSTOMER][NEUTRAL] No, I'm not talking about that one.
[CUSTOMER][NEUTRAL] This was on the last uh few that they were working. Was it any of them that was rejected? Are they pending for more information?
[AGENT][NEUTRAL] OK, so there was, there was an app.
[CUSTOMER][NEUTRAL] Cause I sent over a biopsy, a mammogram. Go ahead.
[AGENT][NEUTRAL] So on the [PII], there were multiple things on this claim.
[AGENT][NEUTRAL] Uh, the there was a preventative service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] That was denied. Give me just a moment to get that in.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] The preventative was not on that claim.
[AGENT][NEUTRAL] On the [PII], there were several things uploaded for multiple dates of service from March through May.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for a [PII] data service for Texas Health Resources.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that one should have been. That was a preventative.
[AGENT][NEGATIVE] Yes, ma'am. And that one was denied. Right. That one was denied. The diagnostic and prevention benefit has been exhausted for this calendar year. So there were no further benefits available for this screening.
[CUSTOMER][NEUTRAL] But not the other ones.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then on if for data service [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was imaging done in which there was a $500 benefit paid.
[AGENT][NEUTRAL] And the calendar, your maximum for this benefit has been exhausted with the payment of this claim.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEGATIVE] There was also another test on [PII] which was denied because this claim appears to be a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it didn't have the codes on there, and, um, let me, let me just try to explain to you. I, um, on the [PII] I went for my annual mammogram, OK, so that's, that would, would have been the preventative, OK, from that point on it when, excuse me, is when they started to, uh, tell me that I needed to, um.
[CUSTOMER][NEUTRAL] I need an additional test, OK, so that's where a second mammogram came in, which was the digital.
[CUSTOMER][NEUTRAL] With the ultrasound. So that, that's not a duplicate. That's the second mammogram. That's is when they started seeing something that was the cancer.
[CUSTOMER][NEUTRAL] So when they did that is when they verified that it was a mass. From that point is when they did another doctor's appointment for the biopsy, OK? So that was done on.
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] OK, from there is when they um.
[AGENT][NEUTRAL] And we paid on those two.
[CUSTOMER][NEUTRAL] Ordered uh uh.
[CUSTOMER][NEUTRAL] You $500. How much did you pay on that?
[AGENT][NEUTRAL] Well, we had not gotten that far.
[AGENT][NEUTRAL] I have not given you that information yet, Ms. [PII], because we hadn't gotten that far. You had stopped me on the other one. So for the 420, because the 425 data service, there was a benefit paid.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh, uh.
[AGENT][NEUTRAL] On that, um, of
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] For 425, there was a benefit paid in the amount of $135.90.
[AGENT][NEUTRAL] And also $33.90. 97 cents, I'm sorry. So 135.90 and 33.97 for data service 425.
[CUSTOMER][NEUTRAL] Hm?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there was another one that was.
[CUSTOMER][NEUTRAL] So that would have been the biopsy.
[AGENT][NEUTRAL] Mhm. And then there was another one that was for 425 that was denied as a duplicate as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's nothing on 2425 is a duplicate.
[AGENT][NEUTRAL] OK, so what I can do now, I'll be.
[CUSTOMER][NEUTRAL] As far as service.
[AGENT][NEUTRAL] Would I be happy?
[CUSTOMER][NEUTRAL] As far as service.
[CUSTOMER][NEUTRAL] I, I'm, I'm really not understanding. OK, so, OK, and then after [PII], uh, there's the MRI.
[CUSTOMER][NEUTRAL] So if anything.
[CUSTOMER][NEUTRAL] I sent over.
[CUSTOMER][NEUTRAL] Uh, invoices and then.
[CUSTOMER][NEUTRAL] As you have mentioned, there was another claim that was paid on [PII]. I sent all those over really all at one time. However, those were pending status because they wanted the codes, you understand what I'm saying? So, uh, uh, that's the reason why I reuploaded those again with further details with the codes.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So you understand what I'm saying, so maybe that's the reason why there seem to be like duplicates because I would never send over duplicates.
[AGENT][NEUTRAL] OK, cause I can see that there were on the previous claim it was processed with the $50,050 payment.
[AGENT][NEUTRAL] Earlier
[CUSTOMER][NEUTRAL] Yeah, it was only $50 that was processed in the right it was only $50. The other was a whole different assurance that that one time $5000 has nothing to do with invoicing.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so what I.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Well, that's your first occurrence benefit, it appears. Right.
[CUSTOMER][NEUTRAL] Exactly so right, so that isn't right, so the other invoices don't have anything to do with that. So what you guys did is you did pay for I think it was uh.
[CUSTOMER][NEGATIVE] Anesthesia or something, you guys pay $50 for that.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So the rest of this stuff was pending because you needed uh codes.
[CUSTOMER][NEUTRAL] You needed codes in order to see what type of service was rendered. So that's the reason why I had them to do rebilling and then they sent me over uh the itemized statements with the codings on it and then that would have been.
[AGENT][NEUTRAL] Right, so
[CUSTOMER][NEUTRAL] Uh, the one that was like uh $13,000 and they gave all the codings.
[CUSTOMER][NEUTRAL] And then uh the other one, same thing.
[AGENT][NEUTRAL] So I can say that on that initial claim, one of the charges that had been denied, it appears that it was paid on this one that was um processed on Friday for 5/14.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can see that and the other was still showing us tonight as a duplicate. Now, I will be happy to connect you with one of the examiners who can look at both of these claims with you, Ms. [PII], to break them down on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The that you know that are were denied as a duplicate but that you're saying are not actually a duplicate.
[CUSTOMER][NEUTRAL] Do you see that it's a duplicate?
[AGENT][NEUTRAL] I can't see all of that. No, ma'am. I can't, I can just see the remarks on the code. Mhm. I can, I can just see the remarks on the claims.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEGATIVE] Yeah, because I'm trying to see what was duplicate. I'm like, God, I didn't send anything to. I'm still waiting for you guys to find it because I still have more to go.
[AGENT][NEUTRAL] Sure. Sure. So, yes, so to break this claim down since it was multiple dates of service submitted, um, I will be happy to do that for you. When I do connect you though, you're not gonna have to re-verify your information. I'm gonna give them your policy number. Let them know that that has been done. Now,
[AGENT][NEUTRAL] Can we go back before I do that and just one more time on your online service center profile?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And see if we can look at that one more time.
[CUSTOMER][NEUTRAL] OK, I'm still in it. What do you want me to do?
[AGENT][NEUTRAL] OK, so give me just a second. Alright, so you did create your OSC account. I'm just trying to walk through some steps so that I'll know what we need to try to troubleshoot.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's what you did, correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then you selected the.
[AGENT][NEUTRAL] Insured, new insured or whatever, how it was worded.
[AGENT][NEUTRAL] Does it, does it have your social in there?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I did.
[AGENT][NEUTRAL] All right, take, take that out. Let's try to take that out.
[CUSTOMER][NEUTRAL] Take that out.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you're saying don't put it in there.
[AGENT][NEGATIVE] Yeah, don't, don't have your social in there.
[CUSTOMER][POSITIVE] OK, I don't think it's gonna go without that.
[AGENT][NEUTRAL] Um, it may not. Like I said, I'm just trying to troubleshoot some things.
[AGENT][NEUTRAL] So then I'll know exactly what we're needing to.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I know when you enter your your.
[CUSTOMER][NEUTRAL] Date of uh your birthday is
[CUSTOMER][NEGATIVE] Gives you a problem, you gotta redo it.
[AGENT][NEUTRAL] It's giving you a problem on your date of birth.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] No, I mean the system. I don't know. I had to redo it like 3 times.
[CUSTOMER][NEGATIVE] It's not user friendly right there.
[CUSTOMER][NEUTRAL] OK, so I'm gonna try to do it without the social.
[CUSTOMER][NEUTRAL] Oh yeah, it, it took it without the social.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I didn't recognize it. I know.
[CUSTOMER][NEUTRAL] Let me just do this call one more time.
[AGENT][NEUTRAL] No, you're fine. Like I said, I appreciate you trying to help me with this part, Ms. [PII], since it's new and I'm just trying to, again, troubleshoot so that I'll know what to look into. So we're using the last name, you use your zip code, the email, your date of birth. Date of birth is [PII]. I know we've already verified it, but that is correct.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so
[AGENT][NEUTRAL] Try put, try using, OK, try adding, I'm trying to talk to someone while we're kind of walking through this.
[CUSTOMER][NEUTRAL] No, it's it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Try with your special one more time and then if not, we'll look into it and call you back.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] And thank you for helping. I really, really appreciate it.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, OK, let me go back here.
[CUSTOMER][NEUTRAL] I also sent them an email. I don't know if they had got it.
[AGENT][POSITIVE] I'm so sorry. Say that again, Ms. [PII].
[CUSTOMER][NEUTRAL] I have sent them an email over the weekend as well telling them it needed to be reset.
[AGENT][NEUTRAL] About the
[AGENT][NEUTRAL] About the issue you were having with the portal. OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It would be what care team?
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, yeah, that's what I sent it to.
[CUSTOMER][NEUTRAL] What time is it? I have to get dressed. I have a doctor's appointment.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh I really appreciate that.
[CUSTOMER][NEUTRAL] I think it's the email thing in in all honesty.
[AGENT][NEUTRAL] And I'm gonna get back over.
[CUSTOMER][NEGATIVE] It's probably stuck. It probably didn't transfer over.
[AGENT][NEUTRAL] Because we're showing in the system [PII] [PII] Correct. [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's it.
[CUSTOMER][NEUTRAL] OK, so I, um, redid it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, complete your account set up. I hit continue.
[CUSTOMER][NEUTRAL] And then I'm gonna try to log in again.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Is it giving you like a successfully created message or anything like that, Ms. [PII], or just
[AGENT][NEUTRAL] You get to the point where it says complete your setup.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] It, it, yeah, it says complete your set up and then.
[CUSTOMER][NEUTRAL] Uh, and then it comes over, welcome.
[CUSTOMER][NEUTRAL] A welcome page comes up for you to log in.
[CUSTOMER][NEUTRAL] Last time
[CUSTOMER][NEUTRAL] This happened is at the initial time of me uh trying to set up the original one and it was because it was showing that I was inactive so did it go back to that where I'm inactive? do you still show me active?
[AGENT][NEUTRAL] No. No, ma'am. No, your policy is active. Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So when you get to complete your set up message, then it takes you.
[AGENT][NEUTRAL] To the log in page right? for you to enter your username and password.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] No, it says we can't seem to find your account.
[AGENT][NEUTRAL] Alright, hold on, yeah.
[AGENT][NEUTRAL] Alright, what is that message again exactly?
[CUSTOMER][NEGATIVE] We can't, we can't.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Seem to find your account.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. So we will look into this for you and someone will call you back, um, Ms. [PII].
[CUSTOMER][NEGATIVE] Can they just send me an email because I or either they could call me on my cell line today because I'm, I have a doctor's appointment. I'm gonna be away all day.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, ma'am, because it's gonna, yes, I may even, hopefully, it will be today. It's possible, it could be tomorrow, but I will put that, you know, your cell number is gonna be the best number to reach you on, and that is the [PII] number, correct?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah, and if that team uh person can reach out to me as well because I want to know what she's saying that was a duplicate because none of those were duplicates it was a duplicates because of uh.
[CUSTOMER][NEUTRAL] You know the originals didn't have the the code on it, you know what I'm saying?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So you would like for me to send a request to have someone to call you uh since you have to go to your doctor's appointment about that as well?
[CUSTOMER][NEGATIVE] Yeah, yeah, OK, yeah, and then one other question to you is everything on that board closed now because see I can't see it because it was something else that was uploaded after that fact that has nothing to do with those that we're talking about.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] I only see two claims on file for you. The one that was the information, there were like 34, there were 4 separate uploads on [PII] and then I see 2 uploads from [PII] and that's the last information that I see uploaded.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So everything is closed.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Everything to date that you have uploaded, yes ma'am, has been reviewed is that.
[AGENT][NEUTRAL] When you say closed.
[CUSTOMER][NEUTRAL] OK, because that last one.
[CUSTOMER][NEGATIVE] That last one had nothing to do. Those are like doctor visits, so you guys don't satisfy those.
[AGENT][NEUTRAL] The doc uh, let's say, I did see a remark. We didn't get to go over all of your remarks, but it, there was one that says that office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] I mean that's just great information.
[CUSTOMER][NEUTRAL] I guess because I'm learning, you know what I'm saying? I don't know what to submit and whatnot, so, huh?
[AGENT][POSITIVE] Sure. Yes, ma'am. Uh, absolutely.
[AGENT][NEUTRAL] Uh, I mean, no, ma'am, I understand. That's, that's a very good question. So yes, office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] I mean because they said that this is a cancer policy and it's supposed to help me with my outstandings and so far.
[CUSTOMER][NEGATIVE] But $700 compared to what is paid into this claim already, you know, it's not really a big help.
[AGENT][POSITIVE] Yes ma'am, I do understand firsthand that this is a lot.
[CUSTOMER][NEUTRAL] No, I'm just saying I'm not trying to be, I mean, every little bit helps. I mean, I appreciate it, but I'm just saying when you have lump sum bills coming in and you have a second supplement that's supposed to help you and they're making the decisions on what could be paid and what can't, I mean, you know.
[AGENT][NEUTRAL] And when you're able.
[CUSTOMER][NEUTRAL] You have a $13,000 bill and you guys are only gonna pay $500 of it at what uh at like what percentage is being paid?
[CUSTOMER][POSITIVE] It's probably a good question.
[AGENT][NEUTRAL] And it's not percentages. Your, your benefits are based on dollar amount on this policy, Ms. [PII], and in your policy.
[CUSTOMER][NEUTRAL] That's what I thought, but
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right. For covered services. I mean, some things have a percentage like anesthesia and surgical up to, you know, your benefit max. But you do, you know, you have, are you going to be receiving chemo and radiation? Are you gonna have to take any treatments like that? OK. So that's a separate benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so, um.
[AGENT][NEUTRAL] For that benefit, you have 15.
[AGENT][NEUTRAL] The benefit amount is $15,000 per 12-month period. It's not a calendar year benefit. So that starts.
[CUSTOMER][NEUTRAL] Yeah, but see that's just what, uh, right, so this is a good question because, oh, I gotta get dressed, OK, so, uh, um, with the chemo, the chemo is every time I walk in it's it's an appointment so like you said you guys don't cover uh office visits, but.
[CUSTOMER][NEUTRAL] It's considered as an office visit.
[CUSTOMER][NEGATIVE] You see what I'm saying? So you book an appointment, let's just say I go every Monday, they're gonna charge me $85.
[CUSTOMER][NEUTRAL] Um, for the co-payment and then they're gonna do the chemo.
[CUSTOMER][NEUTRAL] So how would you process that?
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] The chemotherapy itself, those treatments are reviewed under your $15,000 benefit.
[AGENT][NEUTRAL] And it would be dependent upon how they're billing you. If they bill you for an office visit and for your chemotherapy treatment, the office visit portion of it would not be covered under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, as long as it shows chemo on there with that invoice it needs to show that.
[AGENT][NEUTRAL] But we would review for the therapy. Yes, we would review for the therapy.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, OK, and then, um, I'm scheduled to go for surgery. Uh, you guys are supposed to help out with that portion as well, right?
[AGENT][NEUTRAL] Again, the on this benefit, the maximum per operation for the surgical benefit is $3000.
[AGENT][NEUTRAL] And then the, the anesthesia.
[CUSTOMER][NEUTRAL] OK, I don't know what it is, but I'm just saying you guys.
[AGENT][NEUTRAL] No, I'm, I'm letting you know that that would be the maximum that this policy would pay if approved.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Why wouldn't it be approved?
[AGENT][NEUTRAL] We can't pay claims over the phone, Ms. [PII]. We have to receive all of the medical documentation that's required for a claim to be reviewed and processed.
[CUSTOMER][NEUTRAL] No, no, no, no, I, I get it.
[AGENT][NEUTRAL] We can provide benefits. Yeah, I can provide you what your benefits state on your policy, but I also, I gave you the disclaimer that I cannot guarantee payments. So that's, I'm just letting you know what your benefit is on this policy for surgery.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][POSITIVE] OK, I appreciate your time.
[AGENT][NEUTRAL] Absolutely, you're very welcome. So, um, we will be back in touch with you. It would be two different uh areas that I'll be contacting you back regarding the portal and then someone to go over these claims more with you on that.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, and they should and they should be able to resolve it right hopefully.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] They would just be able to explain to you what your, you know, how it was reviewed since you sent two different sets of information.
[CUSTOMER][NEUTRAL] No, no, no, I mean the IT part, the IT part.
[AGENT][POSITIVE] Oh, hopefully, yes, ma'am. Hopefully so, yes, ma'am, because we definitely need to see what is going on with that as to why you cannot uh set up your profile.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, well thank you so much so if not, if I don't hear nothing, what time do you guys close toda[PII]?
[AGENT][NEUTRAL] Uh, you're welcome, Ms. [PII].
[AGENT][NEUTRAL] [PII] central time.
[CUSTOMER][NEUTRAL] OK, so if I don't hear back by half a day, then I'll call you guys back and see what's going on, at least with this set up.
[AGENT][NEUTRAL] It would probably be tomorrow, typically a yes ma'am, with, yeah, usually it's a 24 to 48 hour turnaround time on callbacks when we have to do that. So, and I just can't um tell you exactly what the phone number will look like when it comes up because we have a lot of different phone numbers for outgoing and I know we all get a lot of robo and spam calls. So, you know, unfortunately, you know, I can't, I can't tell you what to look for.
[CUSTOMER][NEUTRAL] Oh tomorrow OK.
[CUSTOMER][POSITIVE] OK. OK, that's great. OK.
[CUSTOMER][NEUTRAL] No, you're fine. I've been answering the phone.
[AGENT][NEUTRAL] So, OK. Well, can I help you with anything else?
[CUSTOMER][NEUTRAL] OK, no, you're fine.
[CUSTOMER][NEUTRAL] I don't really believe in the caller ID. I answer the phone, so it doesn't matter.
[AGENT][NEUTRAL] Oh, OK, then. Well, that's good to know. Well, can I help you with anything else this morning or try to anyway?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, you're fine. OK, so I'll, uh, I'll look for that, um, the dollar amount that you, you told me, um, I, I guess that should happen in a couple of days or so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][POSITIVE] Well, you're very welcome. I hope you have a very nice day too, Miss [PII] and thank you again for calling APL.
[CUSTOMER][POSITIVE] You have a great day.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][NEUTRAL] All right, bye-bye.