AccountId: 011433970860
ContactId: 9f74585f-5f6b-422e-857d-ff2b0529d6f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 577700 ms
Total Talk Time (AGENT): 290587 ms
Total Talk Time (CUSTOMER): 229050 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/9f74585f-5f6b-422e-857d-ff2b0529d6f5_20250106T22:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I have a question um.
[CUSTOMER][NEUTRAL] I had some skin cancer removed, so I did the most surgery, but I didn't think about this policy that I took out with y'all if that covers that at all, does it?
[AGENT][NEUTRAL] I can take a look at that. Can I have your name?
[CUSTOMER][NEUTRAL] Is it OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and what's a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what's your policy number?
[CUSTOMER][NEUTRAL] 7896
[CUSTOMER][NEUTRAL] Oh that's the group number sorry.
[CUSTOMER][NEUTRAL] Uh, I don't know my policy. Is that what you need the group number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, I would need that policy. It should say a policy number or certificate number.
[CUSTOMER][NEUTRAL] And where would that be? I don't I don't have any information. I got the group number from my HR department.
[AGENT][NEUTRAL] OK, I can search by your social.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK, thank you, verify your address and date of birth.
[CUSTOMER][NEUTRAL] Do they
[CUSTOMER][NEUTRAL] Sure, it's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] All right, thanks, [PII] and you're calling uh in regards to your benefits, right? Is skin cancer is covered?
[CUSTOMER][NEUTRAL] Yes, do they normally mail you some packets or information so you have all the policy number?
[AGENT][NEUTRAL] Yeah, you, um,
[CUSTOMER][NEUTRAL] Just one
[AGENT][NEUTRAL] At the time of the policy becoming effective, you should have received a policy certificate with a breakdown of your benefits and policy information, and that's also available online on our website at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, if you haven't already um registered for an account you'll just walk walk through the steps as uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] A new user and it'll ask for your basic information. Once you're logged in, you'll see your policy information there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and let's see.
[CUSTOMER][NEUTRAL] I guess I just missed it in the mail. I don't know. Like I said, I couldn't find anything, so I called my HR department to ask them.
[AGENT][NEUTRAL] Got it. If you like I can send a hard copy to the mailing address on file.
[CUSTOMER][POSITIVE] That would be great, yes.
[AGENT][NEUTRAL] OK, sure, and also uh verify your email address.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right. And this is a verification of coverage. It doesn't guarantee the payment of a claim. Uh, this policy would cover a um skin cancer diagnosis. So under that benefit, the surgery for uh the skin cancer removal will be considered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you'll just send in, uh, go ahead.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Oh, OK, yeah, I've never done this, so I've, I had it done on [PII] and then I believe they emailed me, um.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] I'm going blank. It's Monday. Um.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Like a bill, like uh my my portion.
[AGENT][NEUTRAL] OK. Yeah. So you want to send in a copy of the itemized bill for the surgery, um, and be sure that that bill is from the surgeon because there's two separate billings. One is from the facility and one is from the surgeon, and the surgeon's bill will have those codes that we need to process your claim.
[AGENT][NEUTRAL] And um also you want us to.
[CUSTOMER][NEUTRAL] Oh OK then I guess mine is just from the facility.
[AGENT][NEUTRAL] Yeah, there's, sometimes the facility bill will have those procedure codes, but a lot of times they don't. So we specify the surgeon's bill.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My, I don't know.
[CUSTOMER][NEUTRAL] It just says it has the procedure.
[CUSTOMER][NEUTRAL] Mos one stage.
[CUSTOMER][NEUTRAL] H N H F slash G but that's not a code that you need, correct?
[AGENT][NEUTRAL] That's correct. It's typically a five-digit code, um, somewhere procedure code or CPT code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and this must be just the facility, OK.
[CUSTOMER][NEUTRAL] I'll have to call this.
[AGENT][NEUTRAL] And you also wanna obtain the pathology report that diagnose the cancer and send that over as well.
[CUSTOMER][NEUTRAL] pathology report? OK.
[CUSTOMER][POSITIVE] I believe that's online as well in my portal so I can I can get that.
[CUSTOMER][NEUTRAL] That's how I found out I had it no one called me.
[AGENT][NEUTRAL] Oh, understood, yeah, uh, so yeah, you.
[CUSTOMER][NEGATIVE] Unfortunately.
[CUSTOMER][NEUTRAL] So, um
[AGENT][NEUTRAL] You would send that over the pathology report to itemize the bill and um.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Send it over to to where? I'm sorry.
[AGENT][POSITIVE] You no no problem you can submit that by fax, by mail or you can upload the documents via the online portal that web address I gave earlier you can submit them very electronically.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh perfect OK I'll create an account then and do that.
[CUSTOMER][NEUTRAL] Do, um, so y'all don't do anything with the facility bill.
[CUSTOMER][NEUTRAL] Then cover as far as coverage.
[CUSTOMER][NEUTRAL] Just the one from the surgeon?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Not for a skin cancer diagnosis. If it's internal cancer, then uh benefits for the facility on the date of the surgery would be considered, but for a skin cancer, the only, if it's not internal, and that's determined um based on the information on a pathology report.
[AGENT][NEUTRAL] So if that pathology report shows a skin cancer that's not internal, then the only benefit would be for the surgery itself.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't know what you mean internal like.
[CUSTOMER][NEUTRAL] Other than like it was on my face. So I guess, I mean, obviously it was.
[CUSTOMER][NEUTRAL] You're talking about like on my organs or something like that.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Got you. OK.
[CUSTOMER][NEUTRAL] OK, well I haven't gotten the itemized thing but I'll need to call them OK.
[AGENT][NEUTRAL] In the meantime, you can send over what you have if you wanna just get the ball rolling. And if it's not uh enough of information, then we'll just request that surgeon's bill. But if you wanna start, um, just in case it's possible that those codes are there, um, while you're waiting to get the surgeon's bill, you can absolutely submit what you have.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, yeah, I don't see any codes on here just.
[CUSTOMER][NEUTRAL] The date of the surgery and then the doctor's name.
[AGENT][NEUTRAL] Got it. OK, yep, so we'll need those codes. That's how the benefit amount is determined.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, OK, I will work on getting that and creating an account and then submit all that and then.
[CUSTOMER][NEUTRAL] Um, how long does it take to hear back so that way I don't get in trouble with the bill with them.
[AGENT][NEUTRAL] Yeah, understood, um, it's typically 7 to 10 business days from the date of receipt for the claim to be reviewed and a claim decision to be made. Um, let's see, yeah, so, uh, yeah, as soon as you get that in, it'll be 7 to 10 business days from the date that it has been submitted.
[CUSTOMER][NEUTRAL] Got you. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and on the website you also have the option to uh sign up for text alerts so it'll let you know that we received it and then you'll receive a text when we start processing and then when the claim decision is made so that'll keep you updated on what's going on.
[CUSTOMER][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] OK go ahead.
[CUSTOMER][POSITIVE] Oh, OK, perfect. OK, well I guess I will make a few phone calls and sign up on this online portal thing to get that started as well.
[AGENT][POSITIVE] OK, good deal, um, and also I can give you your policy number, do you have a pen and paper?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK. Yes, ma'am, I do.
[AGENT][NEUTRAL] OK, so your policy number is 024.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] 40
[AGENT][NEUTRAL] 404.
[CUSTOMER][NEGATIVE] Not for.
[AGENT][NEUTRAL] Yes, it is
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wow, OK. 02440404.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Well, I appreciate your help in this and I will.
[CUSTOMER][NEUTRAL] Do my, my work on my end.
[AGENT][POSITIVE] All right, good deal. Well, is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] Alright, well thank you for calling APL have a great day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thanks bye bye.
[CUSTOMER][NEUTRAL] Bye bye.