AccountId: 011433970860
ContactId: edcb850e-9215-4ef6-bd9e-974bd16d7b7c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 768349 ms
Total Talk Time (AGENT): 401364 ms
Total Talk Time (CUSTOMER): 255963 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/edcb850e-9215-4ef6-bd9e-974bd16d7b7c_20250103T17:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello [PII]. My name is [PII] and um I am a um insured employee uh through Medlink but when I tried to um create an online account last night, it kept saying that they couldn't find me in the system.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes, so the information does have to match what we have in our system, [PII], so we can go through and verify all of that. uh, first, if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have your policy number?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 144.
[CUSTOMER][NEUTRAL] 6442
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] All right. [PII], just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. Last thing I need is the email address that we've got on file for you. uh, looks like it is for uh through your employer.
[CUSTOMER][NEUTRAL] OK, and I will tell you now that I bet it's an old one because our system changed, um, it may be [PII].
[AGENT][NEUTRAL] No, um, it's [PII], go ahead, sorry.
[CUSTOMER][NEGATIVE] It shouldn't be
[CUSTOMER][NEUTRAL] It should be.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It should be [PII].
[AGENT][NEUTRAL] That is correct. That is what we've got. OK, so when you went in to create the account, is that the email that you were using?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK, so that's going to be the hiccup there um now if you'd like I can change this email, um, or whenever you go to create the account you could just use this one.
[CUSTOMER][NEUTRAL] No, there was no.
[CUSTOMER][NEUTRAL] OK, I'll just use that one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Email work OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And also, um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I, OK, um,
[CUSTOMER][NEUTRAL] I was diagnosed with um.
[CUSTOMER][NEUTRAL] Uh, invasive ductal carcinoma in July or in, in August. And um,
[CUSTOMER][NEUTRAL] I have been collected, I mean, I've been through 4 surgical procedures and uh treatments, um.
[CUSTOMER][NEUTRAL] And um I wanted to file claims.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but I wanna make sure that I filed them correctly.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't know. I don't even know what questions I need to ask, to be honest.
[AGENT][NEUTRAL] I can give you a brief rundown um of the necessary information we would need to file claims [PII] um if you've got a pen and paper, uh let me know when you're ready.
[CUSTOMER][NEUTRAL] I do
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so we would need an itemized statement.
[CUSTOMER][NEUTRAL] OK, now do I need an itemized.
[CUSTOMER][NEUTRAL] Statement
[CUSTOMER][NEUTRAL] For each procedure.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the itemized statement and it would have to show diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK, so it needs diagnostic code.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Diagnosis and procedure codes.
[AGENT][NEUTRAL] Yes. And then the other big thing we would need is the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Yes, the ELB from Blue Cross Blue.
[AGENT][NEUTRAL] Yes, essentially showing what they've paid and you can get all of that information from whatever provider you went to for treatment. They will have all of that information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I have a binder with all my ELBs um that I.
[AGENT][POSITIVE] Oh awesome.
[CUSTOMER][NEUTRAL] that I have received, but the automatic statements, um.
[CUSTOMER][NEUTRAL] I don't think I have those except for one.
[CUSTOMER][NEUTRAL] 2 procedures and I've had 4 so I will have to get those but.
[AGENT][NEUTRAL] Yeah, depending on the providers sometimes they would just give you more or less a bill um but the itemized statement that shows those codes sometimes you would have to ask for those, but they will have that information.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] OK, so, uh, um, uh, are those the only two things that I will need?
[AGENT][NEUTRAL] Yes, and then of course uh the claim form you would fill out a claim form you can those will be on our website though.
[AGENT][NEUTRAL] And there's a spot you'll see a button that says upload documents and now if if you have more than one claim you need to file or more than one procedure you don't have to do them each individually you can send them all at once um I will say though some our website does have a limit on how much can be uploaded at a time.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, a size limit, you know, like so many megabytes, so you might have to break them up that way, but you don't have to do it for, you know, each of them separately if that makes sense.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, so do I only get one claim form?
[AGENT][NEUTRAL] You can, you can do a single claim form is perfectly fine, um, and then I will say, um, I'm sorry if this is repeated information if you've heard this or not but just while you're on the phone with me, um, are you gonna be using a laptop or a desktop computer?
[CUSTOMER][NEUTRAL] Or do I need to do it? OK.
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] Perfect. OK, yes, [PII]o the reason I ask is our website, um, does not have support for mobile devices like phones or tablets, so it would have to be uploaded uh through a computer, an actual computer.
[CUSTOMER][NEUTRAL] OK, uh, and, and, um, so I can use one claim form for all my procedures and my treatments or would it be better if I broke each one of them up?
[AGENT][NEUTRAL] You know that's completely that's gonna be your preference um so it would be it would come to us if you say you had 3 procedures you sent all of that information to us at once to us that would be one claim but of course with multiple items on it. So if you would prefer them to be kind of separated um that's completely up to you.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, OK, thank you, that, that makes that clear.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Um, now, um, do you have access to my actual plan?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, yes, um, your policy?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][POSITIVE] Absolutely, give me one moment, let me get that pulled up.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, and if you'd like [PII], if you don't have a copy yourself, um, I can send you one so that you've got it for your records. It's very easy to read, it's not just a bunch of jargon, I promise, um, but it does go through what is and is not covered dollar amounts, frequencies, things like that.
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][POSITIVE] Oh, I would love that.
[AGENT][NEUTRAL] OK, absolutely, um, did you want me to send it to the email that we have your work email or did you have a different one you'd prefer?
[CUSTOMER][NEUTRAL] Yes, that would be.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that would be perfectly fine.
[AGENT][POSITIVE] OK. I will get that sent to you right now.
[AGENT][NEUTRAL] Did you have any specific questions you wanted me to look at for you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I, I
[CUSTOMER][NEUTRAL] I never stayed overnight in the hospital, but I had, like, I, I had.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, 2 biopsies, a lumpectomy, and then, um, a, a radiation delivery device inputted and I had radiation treatment and
[CUSTOMER][NEUTRAL] I, even though I was never hospitalized, this policy does still apply, right?
[AGENT][NEUTRAL] It can. It absolutely can. So uh hospitalizer staying overnight, um, that would be considered more inpatient, but you do have some outpatient benefits as well, which would be, you know, essentially just you leaving the same day for simplicity's sake. Let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, bear with me just a moment. I can get you those.
[AGENT][NEUTRAL] Dollar amount.
[AGENT][NEUTRAL] And now, um, for the radiation and such, um, was that at an actual cancer treatment facility, do you know?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am, Texas oncology.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so to put it simply, your outpatient benefit for this plan is on a per occurrence basis and this can get a little bit confusing. It's not necessarily per day. Per occurrence would simply mean for the same thing. So, for example, if you had um broken your wrist.
[AGENT][NEUTRAL] And you had to receive multiple treatments on it, it would pay up to $500 for that specific occurrence. So if you then broke your leg, that would be a separate occurrence. Does that make sense?
[CUSTOMER][NEUTRAL] Yes, so like the, all of the things that I just listed for you, the, uh, the two biopsies, the lumpectomy, the savvy device, and then each of the radiation treatments were all for the same cancer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If it was for the same cancer, that's, uh, that's a good question. I would think, yes, that would be considered the same occurrence, but
[AGENT][NEUTRAL] I can get clarification on that. Let's see, and frankly, I'm not quite sure.
[AGENT][NEUTRAL] Radiation is going to be a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But as far as the biopsies are concerned, that it is an actual surgery.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So that should be.
[AGENT][NEUTRAL] But I don't see
[AGENT][NEUTRAL] Radiation as a covered benefit.
[AGENT][NEUTRAL] OK. Yeah. I, I think it would just be for the biopsies regarding that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, and I did email this to you um just so that you are aware I think what I like to tell everybody um the page that says schedule of benefits, um, it's I think it's gonna be kind of somewhere in the middle, um, that's gonna be the easiest clear cut.
[AGENT][NEUTRAL] Here's what's covered. Here's the dollar amounts. Here's the frequencies, um, the rest of the pages are all going to be more definitions, um, so if there's something you're like, well, you know what, what would we define that as, that's what that would be. But if you do have any other questions about anything more specific or you're not quite sure what it means, definitely give us a call and we'll do what we can to help you figure it out.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it is the you said that was scheduled benefits.
[AGENT][NEUTRAL] That page, yes, it says schedule of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I have received it. I have opened it and I'm going to print it.
[AGENT][POSITIVE] OK, [PII]e. All right, sounds good. Did you have any other questions for me, [PII]?
[CUSTOMER][NEUTRAL] Um, not at this time. I think that you've that I know to ask at this point.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Awesome, yeah, I completely understand that it is very confusing. So if you have any other questions feel free to give us a call back. Now I hope you have a great rest of your day, [PII]. Thank you for giving us a call.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you. Thank you. Bye-bye.
[AGENT][POSITIVE] All right thank you bye bye.