AccountId: 011433970860
ContactId: f32b122b-809a-4d19-b501-a1092d8cba30
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1038229 ms
Total Talk Time (AGENT): 424207 ms
Total Talk Time (CUSTOMER): 460769 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/f32b122b-809a-4d19-b501-a1092d8cba30_20250102T21:13_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I have your insurance. I have some questions about a, uh, a claim, um, for some medical services that I that I performed this year or last year I should say.
[AGENT][POSITIVE] OK, well, I can definitely help you with your claims um questions. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] 8649093009
[AGENT][POSITIVE] Thank you for that and then your policy number whenever you're ready.
[CUSTOMER][NEUTRAL] 0234
[CUSTOMER][NEUTRAL] 1054
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have you here and I just need you to verify your date of birth, your mailing and email address.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my email address is [PII].
[AGENT][NEUTRAL] OK, it looks like for this one we have [PII]. Should I update that?
[CUSTOMER][NEUTRAL] Yes, please do because I'm having a hard time reading that one on my phone.
[AGENT][NEUTRAL] OK, hold on one moment. And um can you repeat the new email address?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And um that was [PII]?
[CUSTOMER][NEUTRAL] I think we got a little um let me just repeat again.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I got it. Thank you. Hold on one moment.
[AGENT][NEUTRAL] And then um what questions did you have about your claims?
[CUSTOMER][NEUTRAL] OK, so I, uh, was referred to my primary doctor to go to Mayo Clinic to be evaluated.
[CUSTOMER][NEUTRAL] Uh, for a, uh.
[CUSTOMER][NEUTRAL] Hemochromatosis, which I did do that. So it was out of, out of date, number one, so I wanted to know what coverage do I have available to me to cover not only the medical expenses that uh Blue Cross and Blue Shield did not pick up, but then also the uh.
[CUSTOMER][NEUTRAL] The travel expenses.
[AGENT][NEUTRAL] OK, let me pull up all your policy benefits. Hold on one moment. And all the information provided is a verification of benefits, not a guarantee of payment. So I'm just waiting for the policy documents to populate. Hold on one moment.
[AGENT][NEUTRAL] So in terms of like transportation or mileage, um, your secondary insurance, we don't have any coverage for that. um, but in terms of the services, it really depends on the type of facility. Um, so for example, your policy with APL is broken down into like in hospitals, like if you're admitted and then outpatient, um, so depending on what it is considered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Um, you have benefits for each.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so I can answer that was all outpatient. I spent 3 days there had, uh, several different types of uh.
[CUSTOMER][NEUTRAL] Uh, tests done and then also lab work.
[CUSTOMER][NEUTRAL] I, I believe, 6 different events at the hospital, and it took about 3 days overall. Um, so, most of them were, uh, were test related and then there was 1 lab related.
[AGENT][NEUTRAL] OK, so the, the benefit is up to $3000 per calendar year. There's no um deductible or like co-pay or anything, um, but it does have coverage for diagnostic testing in a hospital outpatient facility or MRI facility, and then, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You also have the office treatment rider, so any, if something is considered an office, if it's treatment, it could be covered up to that $3000.
[CUSTOMER][NEUTRAL] Yes, OK, so you brought up a good point. So I had a, I had a doctor's appointment visit, and then I, I, then like I said, I had 3 procedures done, medical tests done, and 1 lab.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, done. So the question then is it's always hard for me to understand how to file a claim. I tried to go online and I was unable with the information I have on my card to be able to access my account to be able to file a claim, so I'm assuming I could go on Mayo Clinic, get the uh get the um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the billing or with the bills and then submit them that way, is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Like through Mayo Clinic?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Or just go to them, OK.
[CUSTOMER][NEUTRAL] I've already asked.
[CUSTOMER][NEUTRAL] I'm, I'm gonna do it myself. I'm gonna put the claim in myself. I'd like to do it online through your website if possible or is there another way to do it? I would, I would have to gather the uh all the uh bills that the hospital uh provided me and, um, and exclamation of benefits, um, and then how do I how do I start the process I guess is what I'm really asking.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] There's 23 things, OK, so you can file a claim, you can um mail a claim. I file a claim, I meant to say fax. You can fax a claim, you can mail a claim. Now, in terms of the online service center.
[AGENT][NEUTRAL] Let me see. Hold on one moment.
[AGENT][NEUTRAL] Because this policy.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] This particular policy number that you um
[AGENT][NEUTRAL] Gave me, I'm flipping through screens. Hold on one moment, for it is no longer active as of [PII], but you, um.
[AGENT][NEUTRAL] Yeah, as of [PII], your Medlink policy is no longer active, so that may be why it's giving you a hard time on the online service center because that it's linked with our system, but you can still fax or mail um any claims that you have from [PII].
[CUSTOMER][NEUTRAL] OK, but I, I have coverage past that because we're in our new, uh, cycle.
[CUSTOMER][NEUTRAL] Um, and I paid for the additional.
[CUSTOMER][NEUTRAL] APL services in my new handout book, uh, accident or accident insurance and also the Cancer plus critical.
[AGENT][NEUTRAL] Cancer
[CUSTOMER][NEUTRAL] illness insurance.
[AGENT][NEUTRAL] OK, so that was gonna be my next question because I do see your cancer policy is active and now that policy may offer the transportation and the mileage. Now that's different than the Medlink policy. So let me go into that um policy and pull up.
[CUSTOMER][POSITIVE] Right, so you're correct, so.
[CUSTOMER][NEUTRAL] Yeah, I'm sorry, I didn't mean to interrupt you. You're correct. Uh, uh, [PII], my old policy expired and they came up with new policies for us to to look. So my new policy that's in effect right now should have been from [PII].
[AGENT][NEUTRAL] Oh no, you're fine.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK. Well, it's, it's active as of [PII]. There is no termination date.
[CUSTOMER][NEUTRAL] Yes, in
[CUSTOMER][NEUTRAL] And which is that, uh, [PII] correct.
[AGENT][POSITIVE] So you're good to go.
[AGENT][NEUTRAL] And so for the, for the cancer policy now, yes, you do have um transportation benefits, hold on, I'm going to it now.
[AGENT][NEUTRAL] OK, so for transportation, would it be bus, plane, train, or car?
[CUSTOMER][NEUTRAL] We, we drove by, uh, so what we did is we drove so basically whatever expenses that would, we did stay in a hotel, uh, for 4 days while we went through the test, um, um, you know, and then
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know what else would be covered. So we have, uh, uh, we have travel expenses using our personal vehicle. We have hotel expenses and I don't know if food expenses are included or not, but those are the three expenses we have as far as travel goes, um, and I.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] So for transport, oh, I'm sorry.
[CUSTOMER][NEGATIVE] I'm sorry, and I also had to take 3 days off from work to do this.
[AGENT][NEUTRAL] OK, so for transportation, the cancer policy would pay um the car is 75 cents per mile.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With a max of 12 trips per calendar year.
[CUSTOMER][NEUTRAL] OK, so this was one trip, OK.
[AGENT][NEUTRAL] And now this is for you, this is for you, and you also have coverage for family transportation. So if someone went with you, you can, you can, um,
[AGENT][NEUTRAL] It'll be for both.
[AGENT][NEUTRAL] Um, and then for lodging, the policy would pay.
[AGENT][NEUTRAL] $100 per day with a max of 100 days per calendar year and that's the same for if someone was lodging with you also.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, so we did the transportation, the lodging, and I don't, but now for the food, I don't see the food expense.
[CUSTOMER][NEUTRAL] OK. OK. Well, those are the three expenses as far as traveling goes. So, so I have uh uh travel expenses, um, so I could uh use uh be able to figure out the mileage by just from our house to their facility or to the hotel and, you know, that kind of stuff. Um, and then I do have the bill for the, uh, hotel, uh, expenses. So that's that part. Um, so what I, um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] What about the medical part? Um, the, uh, you know, the doctor visit, the, uh, and all the testing, the 6 tests I had done while I was at the facility.
[AGENT][NEUTRAL] Now, for that, um,
[AGENT][NEUTRAL] That's kind of hard to say over the phone because it we'll have to examine it and look at the codes and everything and how it was sent in. Your cancer policy though covers more so like your treatment. Um, you do have a
[AGENT][NEUTRAL] Let me find the diagnostic testing.
[AGENT][NEUTRAL] There's a diagnostic testing benefit on here, um, $100 up to 1 test per calendar year. So typically for that one, whichever one is the most expensive, the 100 would be applied to that. Um, but it's one test per calendar year and then if a follow-up test was needed, that will be another $100 and then if there, hopefully there's not, but if there is a positive diagnosis then and and more imaging is needed.
[AGENT][NEUTRAL] Then it will go up to $500 per two tests.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] So what, so what's it, so the, OK, so you said the best way to do it by mail or by uh or by fax correct? or could I do this online?
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEGATIVE] No, I can't do this online.
[AGENT][NEUTRAL] Um, if you want to try, l[PII] if you're around a computer, we can try together. I just know cause that the Medlink policy, your medical policy is no longer active, but your cancer is, so it still might work. Um, we can try it together if you like.
[CUSTOMER][NEUTRAL] OK, let me go, um, so it says here.
[CUSTOMER][NEUTRAL] Is this secured?
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is that the the uh the website?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, uh, let me, let me just go there real quick. Let me type this in.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] I mean it'd be a lot easier for me if I could just download everything.
[CUSTOMER][NEUTRAL] Then they have to uh.
[AGENT][NEUTRAL] Try to gather everything and mail it right.
[CUSTOMER][NEUTRAL] Mail it
[CUSTOMER][NEUTRAL] And hope it gets there.
[AGENT][NEUTRAL] And then just for the call again, all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And then let me know when you get on the website you're gonna click on new user.
[CUSTOMER][NEUTRAL] OK, I'm here click on new user OK.
[AGENT][NEUTRAL] OK, so you clicked on new user?
[CUSTOMER][NEUTRAL] Yes, and then they have to give me an options here.
[AGENT][NEUTRAL] Yes, and then you'll click on I'm an individual.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then um click next and then your last name, your full social, zip code and email address that we just updated.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And then it should let you get to step 3. we're just trying to get to the part where you can create your username and password and then you know you're, you're good.
[CUSTOMER][NEUTRAL] Make sure I entered all the information correct here, my last name, my social security number.
[CUSTOMER][NEUTRAL] My zip code's in there, my new email address in there, my birth date of birth.
[CUSTOMER][POSITIVE] Alrighty, I think that's correct.
[CUSTOMER][NEUTRAL] OK, now it's asking for user name, OK.
[AGENT][POSITIVE] Yeah, OK, so you're good.
[CUSTOMER][NEUTRAL] So I could uh I don't have to use the password I could create my own password, right?
[AGENT][NEUTRAL] Yes, um, you're going to create your own username and password and then you're gonna get a um text message asking you to verify, um, and then it'll go ahead and let you in the system and everything will populate. But as long as you got to the create a username and password, you're through.
[CUSTOMER][NEUTRAL] OK, so I could just go through this and then where do I go from here to I'm assuming when I get in there then it'll tell me how to how to submit a claim is that what it basically would say?
[AGENT][NEUTRAL] Oh, yes, sir. Once you, once everything populates in your in your dashboard, it's gonna be like a button. Um, it's gonna say, it might say file document or upload documents, but you'll click on that and then it'll take you through the uploading process.
[CUSTOMER][NEUTRAL] OK. OK, um,
[CUSTOMER][NEUTRAL] The question I have, let me get back if I can to the medical. So, uh, I have a primary insurance company which is Blue Cross Blue Shield, and they pay for, you know, so should I, when I submit for the claim, should I include, uh, uh, the, uh, the bill from the hospital and then also the, um, uh, Blue Cross and Blue Shields portion that they paid or does not that does that not matter?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I would send it just to be on the safe side, um, because sometimes they do deny asking for it, so I would just send it.
[CUSTOMER][NEUTRAL] OK, I guess what I was saying is that exclamation of benefits, um, OK, so I'll do that. I'll go through here and I'll send both of those plus, uh, the vehicle expense or travel expense and a hotel expense then.
[AGENT][NEUTRAL] Cause sometimes they don't need it.
[AGENT][POSITIVE] Mhm. I just rather be on the safe side and don't, I don't want you to have to wait and you know, get denied or anything. So if they don't need it, they have it and if they have it or they need it, it's there too.
[CUSTOMER][POSITIVE] OK, I got it. Sounds good I appreciate your help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that would be it. Thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and I hope you have a great day and happy New Year.
[CUSTOMER][NEUTRAL] You too. Same to you. Bye.
[AGENT][NEUTRAL] You're welcome, [PII]. Bye bye.