AccountId: 011433970860
ContactId: fb0bab16-81d5-476c-b9b4-317628948946
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466290 ms
Total Talk Time (AGENT): 83914 ms
Total Talk Time (CUSTOMER): 360792 ms
Interruptions: 2
Overall Sentiment: AGENT=1.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/fb0bab16-81d5-476c-b9b4-317628948946_20250110T18:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][POSITIVE] Hey, [PII]. Yes, ma'am. Uh, my husband had a a serious melanoma in the fall and I sent in some bills and things, and we got two checks that I thought were, you know, very generous and I was very excited to get them. Um, but I was sitting here paying bills and going through paperwork and I found on one of the explanation of benefits.
[CUSTOMER][NEUTRAL] Uh, a line that led me to believe that if I submitted uh an itemized surgery bill that there might be another payment.
[CUSTOMER][NEGATIVE] And I don't know if I'm reading it right, so can, can I give you my information or something where you can look at this with me? Because if there is, then I mean, I'll call the doctor and get what this says, but if, if I'm reading it wrong, then I don't, I don't want to inconvenience the doctor's office and all and, and you all if you know this, I've already gotten the maximum um that I'm gonna get.
[AGENT][POSITIVE] OK, sure I can help you with that. Can I have your name?
[CUSTOMER][NEUTRAL] Yes, uh, [PII]
[AGENT][POSITIVE] Thank you and what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what's the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the.
[CUSTOMER][NEUTRAL] Policy number is 00708155.
[AGENT][NEUTRAL] OK, thank you and verify your address and date of birth.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, my date of birth is [PII] and my address is [PII].
[AGENT][NEUTRAL] OK, thank you and also verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you for verifying your information and you are calling in regards to um additional information for a claim for Mr. [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes, I'm looking at and I don't know if you can see this particular thing that I'm reading, but on the check, you know how it has the tear off portion, um, on the check that was sent on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It was check number 2012209.
[CUSTOMER][NEUTRAL] And it had on here, in order to give consideration to your claim, we will need a fully itemized surgery bill that includes the procedure code and the diagnosis diagnosis code. Please submit this information at your earliest convenience.
[CUSTOMER][NEUTRAL] And I'm just now seeing this and I thought, oh my gosh, well, so this came with a check. So when I got this check.
[CUSTOMER][NEUTRAL] I thought that I had already gotten it and if you look over on the other side.
[CUSTOMER][NEGATIVE] I don't know, again, I don't know if you can see exactly what I'm seeing. If you look over on the side, you know, they paid me 4258. It made me cry actually when I opened it in the mail cause I didn't, I didn't really know if it would pay anything since it was skin related. And you know, that was an exclusion on my pol uh it says it won't do just skin cancer, but the, the person I talked to said, well, cause it was melanoma and it was that bad, that's why they did it. But
[CUSTOMER][NEUTRAL] If you look on that list, it says I got a surgery benefit. Like it says surgery benefit 1550 surgery benefit 1036. So I was confused.
[CUSTOMER][NEGATIVE] On why it was saying it needed that when it looked like to me what I sent in they saw that and gave me money for that. Does that make sense?
[AGENT][NEUTRAL] Yes, it does. Um, do you have the claim number?
[CUSTOMER][NEUTRAL] Um, yes, I do actually, uh, well, I say that, yeah, I do, I do, I do. Here it is 352.
[AGENT][NEUTRAL] OK. What is it?
[CUSTOMER][NEUTRAL] 675-5
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, yup. So it looks like uh surgery on [PII].
[CUSTOMER][NEUTRAL] Uh, um, this says on this it says dates of service is [PII].
[CUSTOMER][NEUTRAL] And that was the day of the surgery.
[CUSTOMER][NEUTRAL] The July date was when we went.
[CUSTOMER][NEGATIVE] That was when he was in the dermatologist's office and they just cut the mole out thinking, you know, this doesn't look good.
[CUSTOMER][NEUTRAL] And then they sent, OK, so maybe that's the issue then um they're wanting more information from that that that technically, I don't know if that's gonna count for anything because that, that was just seeing a dermatologist who was like, yeah, oh that's, this doesn't look good. Let's just take a sample up. Let's just get it off and see what happens and then it came back melanoma.
[CUSTOMER][NEUTRAL] Then they sent us to a surgeon, surgeon, a cancer surgeon in in uh [PII] that was the Doctor [PII], and that was the one they paid on, the [PII] 1. So, technically, the [PII] was just an in-office visit to a dermatologist. So would that even get any payment?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, from the looks of it that [PII], there was a biopsy performed. If that, if that comes back positive, then that procedure is considered a, a surgery.
[CUSTOMER][NEUTRAL] There was
[CUSTOMER][NEUTRAL] Oh, OK, well then I'll call them. I will call Green Clinic right now because that's what, but I don't know, I don't know it. I guess it would be considered a biopsy. I mean, I took it out and sent it off, so.
[AGENT][NEUTRAL] Yeah. That's why we requested it. If we received the pathology report, um, and it's a positive diagnosis, then we request the surgery codes for that date of service.
[CUSTOMER][NEUTRAL] Perfect. OK, well I'll send it and see now would I use the same form? Would I need to go back to the original cancer form I sent or would I just take that bill and maybe put it in with this copy of this uh.
[CUSTOMER][NEUTRAL] Stuff that came with the check and would that be enough or do I need to start over and do another little application thing?
[AGENT][NEUTRAL] No, you can just submit the itemized bill.
[CUSTOMER][NEUTRAL] OK. Perfect. I'm so glad I called you because I was thinking, well, I think we've already got our benefit for the surgery, but the surgery in [PII] was way, way more serious, you know, and so that, that's the one we got the money for, and I thought, well, I mean, are they gonna pay more for that surgery? I wasn't looking at the dermatologist.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Appointment as considered as a quote surgery. So, OK, well I'll call Green Clinic then and and get that bill and thank you so much for for clarifying that, OK? All right, all right.
[AGENT][POSITIVE] No problem.
[AGENT][POSITIVE] Alright, no problem, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] That is all that is all. Thank you.
[AGENT][POSITIVE] OK, thanks for calling ATL. Have a great day.
[CUSTOMER][NEUTRAL] OK, you too, bye bye.
[AGENT][NEUTRAL] Mm bye.