AccountId: 011433970860
ContactId: ed08ae76-1758-4976-84a5-6b5842ad2bbd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 686520 ms
Total Talk Time (AGENT): 425876 ms
Total Talk Time (CUSTOMER): 286290 ms
Interruptions: 11
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/ed08ae76-1758-4976-84a5-6b5842ad2bbd_20250509T17:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], my name is [PII]. We sent in a um a claim for my husband, [PII] Senior. I think, and I was, we were just making sure that y'all got it.
[AGENT][NEUTRAL] OK, yeah, I can check to see if that we received that claim. Absolutely, um, how was that claim submitted to us, [PII]? Did you do it through our online or was that mailed?
[CUSTOMER][NEUTRAL] I can give you a social.
[CUSTOMER][NEUTRAL] We excuse me, we did a fax and we also sent it a hard copy we did both.
[AGENT][NEUTRAL] That, OK, yeah, I could definitely check to see if that has been received. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes. [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you and uh you said you had his social?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yes ma'am. You want his birthday?
[AGENT][NEUTRAL] Uh, one moment, let me get his policy pulled up first.
[CUSTOMER][NEUTRAL] OK, honey.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Uh, yes, I'll go ahead and take his date of birth, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK and then are you able to verify the uh mailing address we've got on file?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII].
[AGENT][NEUTRAL] Perfect thank you so much for verifying all of that. OK, so I do see that we have received a couple pieces of claim information we've got one that was received [PII] and another that was received [PII] and both of those are currently.
[CUSTOMER][NEUTRAL] Sure, fine.
[CUSTOMER][NEUTRAL] Those are the same thing.
[AGENT][NEUTRAL] OK, so both of those are currently being processed right now. Uh, typically it could take about 7 to 10 business days for claim information to complete processing.
[CUSTOMER][NEUTRAL] OK, OK, are we.
[AGENT][NEGATIVE] But they have been received.
[CUSTOMER][NEUTRAL] OK, we would just, you know, we didn't know that we, if he was gonna be um eligible for any type of benefits or not, and we would, you know, we were just checking you don't have any way of knowing that, do you?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Oh absolutely not based off of I, I'm unable to view what was received, um, but what you're doing is perfect. um, it's always best I'd say to just go ahead and submit what you have worst case scenario we say that that's not a covered benefit best case, you know, you get some money so.
[CUSTOMER][NEUTRAL] Right, OK, OK, yes, we send everything from the doctor's office, but is there anybody that can tell us, you know, just based on our policy, if, if you are, he is eligible, I hold on one second. I'm asking him now. It's OK. Wait, wait, I told him, I'm asking her now. It's OK. All right. Yes, ma'am. Go ahead.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure. OK. So let, let's, um, no, no, you're fine. Um, so was this in regards to a positive diagnosis of cancer, [PII]?
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yes, ma'am, and he had 12 treatments of radiation.
[AGENT][NEUTRAL] Got it. OK, so have you sent us that original pathology report already? or is that included with this information?
[CUSTOMER][NEUTRAL] Everything, yes, ma'am. It's all included in that packet with the dates for each radiation treatment and everything else.
[AGENT][POSITIVE] Awesome.
[AGENT][NEUTRAL] Got it. OK, so I will say, uh, that's first and foremost thing that we would need would be that pathology report. Everything after that, um, it would have to be uh the itemized statements that show any diagnosis and procedure codes also for.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] radiation or immunotherapy, that would also have to include uh the explanation of benefits from the primary insurance. So we do have to see what they contributed to that treatment as well. But that would just be for the chemo radiation and immunotherapy.
[CUSTOMER][NEUTRAL] OK, I mean, so it, it, in other words, I mean, well, we, we, I don't know what our, you know, our, our primary care pay, this is a supplemental policy that I've had that we've had for 20 years and I was.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure you can get that information from the provider or facility wherever he went for treatment. You can ask them for that information and they'll be able to get that to you.
[CUSTOMER][NEUTRAL] You know, I mean,
[CUSTOMER][NEUTRAL] What what information is that that I'm asking them for?
[AGENT][POSITIVE] Sure, the explanation of benefits from your primary insurance. Oh, awesome. OK, then.
[CUSTOMER][NEUTRAL] Oh, it's all there.
[CUSTOMER][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] OK, yes, so just so that you are aware, no, it is confusing, trust me, I, it is, especially because, you know, everything else we basically just need the itemized statement that shows those codes, um, chemo, radiation, immunotherapy, that's where we need that little bit of extra, um, but I can, let me get that policy pulled up real quick and I can kinda give you an idea. I'm sorry?
[CUSTOMER][NEGATIVE] I'm just we just so confused.
[CUSTOMER][NEGATIVE] Well, I'm OK, thank you. We're just, he's just pitiful, you know, just, you know, he's just.
[CUSTOMER][NEGATIVE] No, no, it's pitiful. It's it's old. I mean, we just, you know, we're not, I'm, I'm not, he's older than I am, but he just, he just gets kind of upset and nervous, whatever, so.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure. Yeah, perfectly understandable. All right. Give me just now. Let me get this pulled up here and we'll take a look.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, so y'all do have that first occurrence benefit. So that first occurrence benefit um is $5000 and that is, of course, you know, once we receive the pathology report, that's just simply that benefit. Uh, as for radiation and chemo, that benefit pays, it is.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Up to $10,000 per 12 month period and that 12 month period would begin, of course, at the first time that he received treatment. So, you know, hopefully it'll, it won't go that long um but worst case scenario if it has to be, you know, longer than 12 months, it will replenish, uh, back to that 10,000 after that 12 month mark.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Yes ma'am, yes.
[CUSTOMER][NEUTRAL] I got you. OK, yeah, I mean he did it, you know, it was over a 3 or 4 month period, you know, that he did it, but you don't know if we'll, if we qualify for those benefits or is that part of our, our policy?
[AGENT][POSITIVE] That is on your policy. This is, I'm, I'm reading all of this from, yes, absolutely.
[CUSTOMER][POSITIVE] OK. Thank you. Listen.
[CUSTOMER][NEUTRAL] I, I, I, we just don't know, you know, I mean, it's just, no, we submitted it.
[AGENT][NEUTRAL] Oh, trust, I understand.
[AGENT][NEUTRAL] Yes, um,
[CUSTOMER][POSITIVE] Well, honey, listen, I told the lady that helped us before. Y'all need somebody needs to tell everybody in the country how wonderful you are. Most people won't even talk, won't even talk to us. It kind of gets upsetting, but um we appreciate it and he said, he's sitting right here smiling, so we appreciate it and I guess in about two weeks we'll hear something.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] It's absolutely.
[AGENT][POSITIVE] Good. That is what it's about, yes. Oh, I'm so glad to hear that. And yes, we, trust me, it's not just me, as you probably experienced, we take a lot of pleasure in not just helping give y'all information, but we know how hard it is. Oh, and then, you know, top insurance on top of that, and it gets so overwhelming and confusing. So if I can provide any kind of relief for that, then, you know, that is 100% my pleasure.
[CUSTOMER][NEUTRAL] You think in about 2 weeks?
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Well, we both, we both appreciate he just got it went wrong to get back in bed for a little while, but that's OK. But, uh, we, we just wanted to be, you know, to see if there was any chance that we would possibly, you know, to get any benefits from the, from the policy.
[AGENT][NEUTRAL] Oh, yes. Absolutely. Yes. Now, if you would like, I would also like to offer, uh, just in case you don't have it already, uh, [PII], I can send you a copy of this policy, so you gonna have it for your own record. Um, it it's, yes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Well, you know, we, we, we, we, we have, they said, but we, I don't, you don't need to do, we read it, we just weren't sure, you know, you just, you just don't, you know, you don't do this kind of stuff all the time and I, I didn't, I, you helped me just now with what you said. So I guess we'll just wait to see if it does pay. I guess that's our thing, is it gonna pay or, or is it, you know, with something that we've had that we paid on, you know, we just.
[AGENT][POSITIVE] Oh, yes, absolutely.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] But yes, oh trust me I know, um, so yeah, fortunately not a clear answer until we've got everything, um, I would say worst case uh the only reason it may deny is if we were possibly missing information, but from what you've said it certainly sounds like you've covered all bases and sent everything to us.
[CUSTOMER][NEUTRAL] OK, honey.
[CUSTOMER][NEUTRAL] OK, and I guess too uh we were trying to find like he said see if they have everything, but you know we'll just have to wait and see if they notify us if you know.
[AGENT][NEUTRAL] Yeah, unfortunately, I'm not able to view it as it's currently being processed, but it shouldn't take too much longer. Um, I would also like to, um, just in case you weren't aware, um, well, actually, let me check real quick. Give me just a moment. OK. So if you want to, uh, it is possible to set up direct deposit, uh, for these, uh, benefits to pay.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] OK, sweet.
[AGENT][NEUTRAL] Uh, otherwise we would send a paper check in the mail. So for these claims, um, it depends on how soon, um, I think you've still got a bit of time if you wanted to go ahead and do that, um, but you know these claims it might be kinda on the line so it if they get too close to being processed before we get that, it would just send us a paper check but if that's something you're interested in, you would definitely get that money so much quicker.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, what do I need to do?
[AGENT][NEUTRAL] Sure, OK, so do you, you have a couple of different options um we do have it on our online portal if you use that if not I can just simply send you that form um I can send it to you via email so you can get it very quick you just fill that out and then send it right back to us via email so it would be a very quick process is that what you would prefer?
[CUSTOMER][NEUTRAL] We don't
[CUSTOMER][NEGATIVE] I, I, I, I don't, I, well, I don't have a place to get an email when I, when I sent the information, I sent it from the ups place and we don't do email but that's how pitiful we are. We just, you know, we've just never got, I mean, we get little things, but, you know, but we don't do any business I guess is what I'm, you know, we're pitiful, we're pitiful.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] No, it's not pitiful, trust me, it is not.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure, yeah, not a big deal at all. Um, no, I, it's not pitiful, trust me, it is, if I could get away from it, my gosh.
[AGENT][NEUTRAL] But um so we I can also, so of course I can just mail it to you um or I can fax it to you as well or you know if you had a computer or something it is also on our website.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] And you can print it, mail it, whatever you prefer to do.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, maybe I can go up to my my son's office or something and somebody can help me but I'm I think I'm just gonna leave. I don't wanna do anything different. I'll just wait, we get a check, we get a check. If we don't, we don't.
[AGENT][NEUTRAL] Sure
[AGENT][POSITIVE] OK, yeah, just know that that's an option for you.
[CUSTOMER][POSITIVE] OK, all right, well, I, I thank you very much. Thank you. What was your name?
[AGENT][NEUTRAL] You're welcome. I know that was uh [PII] I know that was information overload. Did you have any other questions for me at the moment?
[CUSTOMER][NEUTRAL] G
[CUSTOMER][POSITIVE] No, ma'am, no ma'am. Thank you so very much. Thank you.
[AGENT][POSITIVE] All right. You are very welcome. Don't hesitate if y'all need anything else, OK?
[CUSTOMER][POSITIVE] Thanks care. Thank you. Bye-bye.
[AGENT][POSITIVE] Yes ma'am thank you have a great day.