AccountId: 011433970860
ContactId: 9fcfbc88-190c-4e8d-b449-fb9a439face0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 439420 ms
Total Talk Time (AGENT): 229091 ms
Total Talk Time (CUSTOMER): 208920 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/9fcfbc88-190c-4e8d-b449-fb9a439face0_20250513T15:06_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, could you tell me your name again? I'm sorry.
[AGENT][NEUTRAL] That's OK. [PII]
[CUSTOMER][NEUTRAL] OK, um, I am calling because we submitted a new claim, a new cancer claim, and it's just kind of sitting there and I can't see what else you might need. um, I, I don't think that it's been, you know, I, I think you must be waiting on something.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure, OK.
[AGENT][NEUTRAL] OK, I can definitely check on that status and see where that's at. Um, what was your name, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK. And then [PII], can I get a good
[CUSTOMER][NEUTRAL] Um, but this is for my dad.
[AGENT][NEUTRAL] I'm sorry. No, no, you're fine.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] This is for my dad. I'm an authorized um person that you can speak to there.
[AGENT][NEUTRAL] Sure, what was his name, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Got it. OK. And then can I get a good call back number from you, [PII], uh, in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thank you. Do you have that policy number?
[CUSTOMER][POSITIVE] Yes, um, I do.
[CUSTOMER][NEUTRAL] 445,110
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, uh, do you see you as an authorized user I appreciate you letting me know that then, uh, if you would, can you verify, um, [PII]'s date of birth please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then uh can you verify the uh mailing address we've got on file please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Awesome, thank you for verifying that. OK, so I do see one claim for [PII] that we received [PII], and it is currently being processed. So the reason you're not really seeing anything is because it is still being processed. It can take about 7 to 10 business days for claim information to complete processing, so I'd imagine it should be done here pretty soon.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and then you will also of course get um well you can view the status on the website, um, but you're more than welcome to give us a call as well, but I imagine it should be completed shortly.
[CUSTOMER][NEUTRAL] OK, that's fine. I, I didn't put any, so he had surgery and um.
[CUSTOMER][NEUTRAL] Uh, it includes some radiation, some mileage, like it includes a few things, um, and, and I didn't include anything from his primary health insurance, so that's, I wasn't sure if I'm, well they just message us if we're missing something they need like I never saw where they actually needed that, but I did send the statements from the hospital with the uh diagnosis and treatment codes so I was wondering, you know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Ah, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Absolutely. So, mhm.
[AGENT][NEUTRAL] Perfect. Yes. Absolutely. OK. So generally, that's all we're going to need except when it comes to uh chemo radiation or immunotherapy, we will need the primary EOB uh for those treatments. Um, so if you'd like, you can go ahead and submit that. Um, or if for just good measure, if you wanted to wait till it's completed, just in case there might be additional information that we're missing, uh, you can do that as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So would I just um let's see just upload a new file um just say upload files and I don't have to associate it with that particular claim or anything OK.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Right, right, we'll be able to associate that, of course it could still take that 7 to 10 business days for it to process, um, but I, it's that's always a ballpark as well. It very well may not take quite that long but just so that you are aware.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, he only had, so he's still undergoing radiation. He had 6 weeks of radiation and he only had, I could only get one statement from the hospital at the time that I requested it because he had only had one that that they had processed so that's I kind of, we've got more to go. Um, my, my next question to you is his policy reads that he gets up to $500 per day for the radiation.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh, that's fine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that based off of, I, I mean, you know, the hospital has a cost and then the insurance negotiates it down is that based off of the insurance negotiated amount?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, so it will be um from actual charges up to that limit um you bear with me just a moment I'm gonna get that pulled up just to make sure that we're looking at the same thing um but that's generally how that goes, OK, yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So this is a bit of an older policy. Let's take a look.
[CUSTOMER][NEUTRAL] Yeah, yeah, he's had it a while.
[AGENT][POSITIVE] That that's good.
[AGENT][NEUTRAL] OK. And while I am finding this, just so that I, I'm sorry if this is repeated information if you're already aware, but um as far as, you know, like you said, he's still undergoing radiation treatment, um.
[AGENT][NEUTRAL] There's no uh specific time frame that you have to get that to us so I don't want you to feel a lot of people think that there's a rush that they have to get that information to us as quickly as possible. Obviously you want that reimbursement um but just so that you know there's no, you don't have to feel like there's a time frame to get that to us. uh, it's whenever it's convenient for y'all. OK, chemo radiation per day, yes, $500 and so as we do need that, uh, primary EOB that will be based on the actual charges.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Now, my next question to you is, he's in a little bit of a unique situation and their, um their treatment plan is 1 day a week of those 6 weeks, he's actually getting 2 radiation treatments that are like, they have to be 6 hours apart. Is that still based off of the $500 per day, or do you make an exception if they have 2 treatments in one day?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, um, as this chart, this particular policy is very explicit with daily, uh, maximum.
[CUSTOMER][NEUTRAL] OK, OK, so it doesn't matter, OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And mileage you guys I mean I put it in the original we put it in the original claim statement where there's uh you know where it asks for mileage but you automatically just calculate that OK.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Absolutely, based off of this home address, um, and then of course, we'll see the address, uh, on the statement, so we'll be able to do the math that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, OK, all right, I think that's all the questions I had. I just wanted to make sure all the correspondences go into his phone so I wanted to make sure that um you know I wasn't missing something.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Absolutely, yes, and that's where you know of course the website is um utilizing that's going to be very handy because all of that information will be there you can check that at your convenience.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[CUSTOMER][POSITIVE] OK thank you I appreciate it.
[AGENT][NEUTRAL] Of course. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Um, no, I think that's it.
[AGENT][POSITIVE] Alrighty well thanks for giving us a call [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Sure you too bye bye.
[AGENT][POSITIVE] Thanks. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm