AccountId: 011433970860
ContactId: 384c70b8-76a6-4731-897d-dcf6100839eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1477890 ms
Total Talk Time (AGENT): 956509 ms
Total Talk Time (CUSTOMER): 490674 ms
Interruptions: 8
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/384c70b8-76a6-4731-897d-dcf6100839eb_20250224T14:28_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII]. How are you?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][POSITIVE] I am ready for Friday again.
[CUSTOMER][NEUTRAL] Oh, so I have a lady that she just called several times, [PII], and
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] I think we have everything.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But um, the policy number is 2,326,720.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's data service 122025.
[CUSTOMER][NEUTRAL] Both of the claims on M Tracker for the state of service. So the first piece of information we received, we denied it needing a diagnosis code.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] Second,
[CUSTOMER][NEGATIVE] So she got that and she uploaded it but now we're denied it needing procedure codes.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] And I think that
[CUSTOMER][NEUTRAL] We, I mean we didn't deny it for needing that on the first go around.
[AGENT][NEUTRAL] Yeah, let me.
[CUSTOMER][NEUTRAL] She knows office visits aren't covered, but
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And the second go where we said it wasn't a valid.
[CUSTOMER][NEUTRAL] Procedure code.
[CUSTOMER][NEUTRAL] But we didn't address that the first go around.
[AGENT][POSITIVE] Interesting.
[CUSTOMER][NEUTRAL] So she's confused and I'm kinda confused. It's just my.
[AGENT][NEUTRAL] Yeah. OK. So, no diagnosis codes.
[CUSTOMER][NEUTRAL] But she did come back and get that and that's what was uploaded under the other, the most recent upload that sleep apnea.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But the denial on the other states that it's about invalid.
[CUSTOMER][NEUTRAL] Um, procedure code.
[CUSTOMER][NEGATIVE] But again, because that wasn't addressed the first go around, she's just confused.
[AGENT][NEUTRAL] Yeah, let me
[AGENT][NEGATIVE] I mean what they're saying doesn't even make sense because it's saying please submit with valid ICD9. Nobody uses ICD9 anymore. We use ICD 10.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] So, let me, let me see what's going on here cause that don't make a lot of sense.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] See? Ready for Friday, just ready for Friday.
[AGENT][POSITIVE] I know, [PII], look, I was fine and now you got me this and you know what, I might be right there with you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] We climb aboard. I got here this morning. My system didn't want to let me in. I was like, oh, you've got to be kidding me. You got to be kidding me.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] OK, I see where there aren't procedure codes on the most re no on the first one.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Right. Well, why didn't we address that the first time?
[AGENT][NEUTRAL] That's a valid question. Um.
[CUSTOMER][NEGATIVE] And that's why she's upset because she feels like every time she's told what to get, she's getting that and now we're telling her something different. So.
[AGENT][NEUTRAL] Uh, can't blame her.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] No, I can't blame her at all for being.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] frustrated with that because it definitely should have been something that was noted.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Office visit.
[AGENT][NEUTRAL] OK, so we have a diagnosis, we have a code, but she knows the offices it's not covered.
[CUSTOMER][NEUTRAL] And she knows that.
[CUSTOMER][NEUTRAL] Mhm. So the first go around, we didn't deny it for anything but the diagnosis code and we got, she got that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now we're telling her.
[AGENT][NEUTRAL] That we need that as well, where if she would have been.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, now we're telling her we need valid procedure codes.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I mean, we do, unfortunately, that's, that's not wrong, but.
[AGENT][NEGATIVE] It should have been addressed.
[AGENT][NEUTRAL] First, let me make sure there's not.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] I can't even get that.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] What was I gonna do?
[AGENT][NEUTRAL] My coffee hadn't kicked in. I'm trying to remember what I was about to look for.
[CUSTOMER][NEUTRAL] Girl, I kicked in either.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] I mean, I can't even get on base to.
[CUSTOMER][NEUTRAL] Show me what was initially.
[AGENT][NEGATIVE] Yeah, they didn't put an EOB note or anything on there. They just denied for needing diagnosis codes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] So, I understand her frustration and I'm sorry that it was not addressed. It is true that we need procedure codes.
[AGENT][NEGATIVE] That um remark code doesn't make any sense.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] What is this
[AGENT][NEUTRAL] OK, that says we need an EOB, but we don't we already have that.
[AGENT][NEUTRAL] So
[AGENT][NEGATIVE] I feel like the remark code was wrong.
[AGENT][NEUTRAL] Um, so in order to provide further consideration we will need the procedure code which corresponds with Smi. OK, so it should have been a different, I mean it still gets the point across that procedure codes are needed. It's just the wrong.
[AGENT][NEGATIVE] Remark code was used again, it should have been addressed.
[AGENT][NEUTRAL] The first time.
[AGENT][NEUTRAL] But we do need those so because.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The thing is, is that under these Medlink policies, and this is the only reason we need the actual procedure codes under these Medlink policies if it's disposable, it's not covered.
[CUSTOMER][NEUTRAL] Right. Mhm.
[AGENT][NEUTRAL] So we don't know just by looking at the EOB where it says medical equipment. Is it because my husband has a sleep apnea machine, so I know filters are disposable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You know, sometimes the hoses and stuff you can have those replaced and those are disposable, but the actual machine, the mask, you know, some of that stuff, um, is not necessarily just you may need a replacement, but it's not disposable, you see what I'm saying? So we need the actual codes to determine.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] What's funny is that my husband actually gets it from Lycare as well.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, but
[AGENT][NEGATIVE] We need to know what are they providing what of this is disposable and what of this is actually payable, and we don't know that when it just says medical equipment that should have been addressed on the first claim. I'm so sorry that it wasn't um I'm going to actually ask my supervisor if that's some type of error or something that needs to go to the examiner because it should have been.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEGATIVE] Um, obviously for this reason resulting in our insured being overly frustrated because she provided what we asked for and now we're asking for something else instead of asking for everything at the same time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I will handle that on the auditor side of things um but as much as I wish I didn't have to tell her this or that you or whatever we do need those and I'm so so sorry that it wasn't addressed initially.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Do you, I mean, do you want me to tell her or do you want to tell her?
[AGENT][NEUTRAL] That's up to you if you want me to, I can, um, and I'll explain you exactly the what I've told you like the only reason we need them is that because some stuff being disposable is not covered, so we need to know what exactly was being provided and then, you know, apologize for it not being addressed initially so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then you're gonna find out that this needs to be.
[AGENT][NEUTRAL] Yeah, I'll find out from my supervisor over the auditors if I need to send something to the examiner about not addressing that and the remark code that was used on the second claim, um, but yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So you just tell me, do you want to tell her all of that and what you're gonna do as far as that goes?
[CUSTOMER][NEUTRAL] Or do you want, or do you want me to pass it on? It, it, it, at this point, it doesn't matter to me.
[AGENT][POSITIVE] I can, yeah, I can.
[AGENT][NEGATIVE] I can. I mean, she's gonna be frustrated either way, so you know.
[CUSTOMER][NEUTRAL] Yeah, 3 years.
[AGENT][NEUTRAL] It's, I don't mind, you know, I know that she's frustrated. I get it. I would be too, truthfully.
[CUSTOMER][POSITIVE] Right. Yeah, absolutely.
[AGENT][NEGATIVE] You know, if it was my claim, I'd be frustrated too, so.
[CUSTOMER][NEUTRAL] Absolutely. And I know she's at work, so, yeah, and I know she's at work, so I've been trying to do this, so, yeah. Um.
[AGENT][POSITIVE] I'd be like, seriously, oh God bless her.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you will tell her? And then you're gonna, OK.
[AGENT][NEUTRAL] Yeah, I'll tell her.
[AGENT][NEUTRAL] Yep, and I'll handle everything else on my side. Her name's [PII], right?
[CUSTOMER][POSITIVE] Uh thank you, [PII]. Yes, it is. Yeah, she's nice, but she's, yeah, and she's fully verified. Mhm, she is.
[AGENT][NEUTRAL] OK, and you got everything's been verified I'm assuming.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yep, I got you.
[CUSTOMER][POSITIVE] All right. Well, thank you very much. OK. Talk to you later.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] OK. Ah.
[AGENT][NEUTRAL] All right bye.
[CUSTOMER][NEUTRAL] Yeah, OK, the refund, OK.
[CUSTOMER][NEUTRAL] Like, I don't remember.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Do you want me to jump on any of those projects you said it's all, yeah, that's what I'm asking.
[AGENT][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] OK. Hi, good morning.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hey, are you gonna get her transferred?
[AGENT][NEUTRAL] Or do I need to call her back?
[CUSTOMER][NEUTRAL] I'm on the phone.
[AGENT][NEUTRAL] Yes, this is [PII].
[CUSTOMER][NEUTRAL] Hi, [PII].
[AGENT][NEUTRAL] Hey, is this [PII]?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] This is she, yes.
[AGENT][NEUTRAL] Oh, I'm so sorry. I I thought [PII] was still on the line. I was like, hello.
[CUSTOMER][NEUTRAL] No, that's me.
[AGENT][POSITIVE] OK, I'm so sorry. I'm so sorry. OK. So,
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Um, [PII] explained your situation and I went back and looked and I was just like, OK, hopefully this is not the case because you're 100% correct. It should have been addressed initially if that is what we needed. So I went back and looked, unfortunately we do need those and I want to explain why. So under your policy for any type of durable medical equipment, um, if it's disposable.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][MIXED] Then it's not gonna be covered and the other stuff is so we have to have codes to know exactly what we can cover and what we can't um and with it just say medical equipment on your EOB that doesn't provide us with that information so you're not wrong and I'm, you are completely valid in your frustration because I would be frustrated too um we yeah I definitely would be.
[CUSTOMER][NEUTRAL] Yeah, that you acknowledge that.
[AGENT][NEUTRAL] Yeah of course um I'm gonna handle that particular situation on my end that's not anything that you need to worry with, um, but I do need procedure codes for this claim. I don't know if your provider or.
[AGENT][NEUTRAL] Your insurance could provide you with the codes like sometimes your insurance company can provide you with those codes and they can send you something sometimes your provider can get it to you quicker. I'm not really sure which one's easier for you to get a hold of, um, but if we could get the procedure codes, we then will have what we need. I can assure you because I have an EOB here, I have a diagnosis code, we really do need the procedure codes unfortunately, um.
[CUSTOMER][NEUTRAL] So the procedure code is needed for what?
[AGENT][NEUTRAL] So, the, on your EOB it has 12345 lines that, that indicate medical equipment. Now, this is gonna come from Lincare. So it doesn't look like it's your actual provider, possibly and see if they can.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I need to contact Linca.
[CUSTOMER][NEUTRAL] Yeah, cause I, I
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Uh, I was just gonna say see if they can provide you, we call it an itemized bill with procedure codes, um, just let them know.
[CUSTOMER][NEUTRAL] So I received a bill, sorry to keep interrupting you, [PII]. Um, I received a bill from Lanecare which initiated this whole process. Um, I don't have it with me currently. It's at home, but I will check this evening and I will scan it and upload it hopefully tonight. um, and then I guess I'll wait. But if the procedure codes are not listed on there, like the second document that I provided.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, that's OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, that did have the procedure and the diagnosis code, then you're saying I should call Lyncare, who is the provider of the equipment to get the procedure codes?
[AGENT][NEUTRAL] Yes, they'll ask them for an itemized bill, let them know that you have like a supplemental top policy or whatever, um, that you are trying to just get, you know, reimbursement or whatever and um let them know that you need the procedure codes for the medical equipment that they build your insurance for so that you can submit that for um consideration of benefits and they should be able to provide you with an itemized bill um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I will let you know like I'm here until [PII] central time. I don't know what time zone you're in, um, and I don't know what time you get home. OK, so I'm here until [PII] goodness. OK, I was gonna say if you get home.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Eastern.
[CUSTOMER][NEUTRAL] Not till you're gone, probably.
[AGENT][NEUTRAL] And and then a certain amount of time and before you upload it if you wanted to call and speak with me directly I am here until [PII] and you could ask for me when you get the care team or whatever or customer service team let them know like I spoke with [PII] earlier she told me I could call her back because I have, you know, this document that I want to make sure is correct before I upload anything else um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause once I upload a 3rd document, it's gonna be a 3rd claim number, right?
[AGENT][NEGATIVE] Yes, it would be and um and then if it's not what we need then you're gonna get another EOB that says it's not what we need and that's, you know, that just mounts up to more frustration truthfully I been there totally understand that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Well, hopefully I make it home before [PII] your time, [PII] my time, so I can look at the bill and then, so I would just call the same um [PII] number that I called today and then you said ask for you once I actually speak to a rep like a human representative.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, once you get on the line with a representative, let them know that you spoke with [PII] earlier and like I said, I should still be here because I don't, I don't leave until [PII] and they should be able to get you through, um, just some pointers on that bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what about
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What you're looking for, it's going to be a 5 digit number.
[AGENT][NEUTRAL] It so you I know you saw on your other bill that office code is the 99213 or 4 I can't remember which one it was. It's gonna be something like that it's gonna, it could be alphanumeric, but it's going to be 5 characters, um.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] It's gonna be what?
[AGENT][NEUTRAL] 5 characters so it's either gonna be numbers or letters or it's not gonna be all letters it's gonna be all numbers or numbers and letters. Um, it depends on the type of equipment sometimes it can have letters in it so it could be alphanumeric, it may be all numbers, but it's gonna be 5.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's the procedure codes, right?
[AGENT][NEUTRAL] That should be the procedure code. So if you see, I'm gonna go look at your other bill because if it looks anything like that, I should be able to.
[AGENT][NEUTRAL] Kind of explain what you're looking for.
[CUSTOMER][NEUTRAL] Well, I didn't, I didn't upload bills. I just went on to my uh insurance, my primary insurance provider and downloaded the, the EOBs for for both my doctor visit and then for the equipment.
[AGENT][NEUTRAL] OK, yeah, so for this particular type of policy procedure codes, diagnosis codes and EOBs are gonna be needed with every claim. Just I know this was your first claim and maybe that wasn't explained to you initially or when you got your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Nope. Nope.
[AGENT][NEUTRAL] So, let me let you know now. That is what you're gonna need every single time.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] So every claim will need a procedure code, a diagnosis code, and an EOB.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And the procedure code and the diagnosis code normally come from the provider, like the doctor or the equipment provider.
[AGENT][NEUTRAL] Right, so if you're correct, so if you are getting your equipment, you should have procedure codes, maybe a diagnosis code, but at least procedure codes from them, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For office visits or hospital visits or anything of that nature, you should be able to get procedure codes and diagnosis codes all on the same bill, much like you did with your office visit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But you see, um, or you may not have it with you but on the other bill that you had it said procedure and it says office outpatient established moderate to medium 30 minute visit and then it says 99214 it's likely that your bill that you have may be similar it may have a code and then an explanation of what that code is. That's how you're gonna know if you have a procedure code or not.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I didn't follow that, so I'm looking at the second upload, which is the procedure line item detail and then like followed by let's say 10 numbers. So I see the first line where where it says procedure office outpatient established mod uh MDM 30 minute, and then the code, which is she circled that and said, yeah, that's your procedure code um.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So I, can you repeat what you were saying before cause I didn't follow.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, so if you, if the bill that you already have at home has procedure codes, it's going to likely be, it may not be as detailed as this, but it's gonna be similar where it's gonna have a code and likely have an explanation of what that code is for. So like my husband has a a sleep apnea machine so when we get bills um from Landcare or whatever, a lot of times it'll have like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Disposable hose or filter or you know when he first got everything it was like the machine and the the mask and you know all the things that come with it. So um a lot of times it will have what it is in the code or it'll much like this or it'll have the code first and then it'll explain what that code is. So if you see that then you'll know that you have codes and you likely can go ahead.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you don't see that and you wanna verify with me, I would call them and be like OK I'm not really sure and we'll we'll see if we can figure it out um you can even provide me with some numbers because I can type those in and be like, yep that's the code let's let's move forward or it doesn't seem like you have codes you might need a contact link here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so if for whatever reason I don't get home and get to my paperwork before [PII], [PII] your time, um, can I call back tomorrow and try to do the same thing? Will you be there?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, of course. I, I will be here. I get here at [PII] your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] So I'll be here I'm here [PII] your time, um.
[AGENT][NEUTRAL] 8 to 5 months.
[CUSTOMER][NEUTRAL] OK. Um, and then just to follow up on something that you said, you said nothing disposable is covered. So when it comes to the CPAP machine, like you're familiar with it cause your husband has one, but basically everything provided except for the actual machine eventually is disposed of. So is there like a time frame because some are just changed out every 6 months, some are changed out every year, so how does that work?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So let me go over to your policy so I can look at specifics because usually in the code itself, it will.
[AGENT][NEUTRAL] It will say disposable because like you said, the hose and stuff, it may not need to be changed out weekly, but maybe in 6 months or a year it does. So.
[AGENT][NEUTRAL] Some of those while they may need to be replaced, doesn't necessarily make them considered disposable per the code that is used. So it depends on the code that you're, they're using. Um, let's see, where is your durable medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So first step really is going home, checking that paperwork and making sure that there's a code and calling you if needed.
[AGENT][NEUTRAL] Yes, yes, for sure and then um like I said we can if you do have codes we can go through and I can type in all of the codes and we can say OK this is what looks like um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] May be covered. This is what looks like may not be covered, just so you know what to expect, um, so based on your policy, durable medical equipment is defined as equipment that can withstand repeated use, is not disposable used to serve a medical purpose, obviously, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see, not implantable, which CPAP is not, and then is covered by your other plan which we have an EOB showing that it was, so it's gonna depend on those codes, yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, that I understand that nothing.
[CUSTOMER][NEUTRAL] OK, nothing's covered by APL if it's not covered by my primary insurance.
[AGENT][NEUTRAL] And those hoses.
[AGENT][NEUTRAL] Right, um, and with those hoses and the mask and stuff like that, it is being used repeatedly. It's gonna be stuff like a filter that you have to put in the machine or something like that, like a lot of times.
[CUSTOMER][NEUTRAL] Mhm. But
[CUSTOMER][NEUTRAL] So that's also being used. I mean, they're used like at a, I think it's 2 week intervals, so I have to change it out. So is that all or disposable?
[AGENT][NEUTRAL] You know it's gonna depend on it like I said it's gonna depend on that code they use if they use a code that's that they're providing you with disposable filters, then it, it has the.
[AGENT][NEUTRAL] The probability of not being covered by us um but if it is not if there's not anywhere in there that indicates that it's disposable, that doesn't mean it doesn't have to be replaced, but it's not indicated as being disposable um then there is um a higher probability that we will cover that one so it's just gonna depend on those codes and with not knowing exactly what they billed you for um I can't really I don't really know at the moment, you know.
[CUSTOMER][NEUTRAL] The word
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] What all they've billed and what all we may or may not cover but like I said, if you get home in enough time or tomorrow morning, whichever one, definitely give me a call have that piece of paper with you, and I'll put in all these codes. I, I mean it's, it's just a couple of clicks and I can look these up for you and we'll we'll figure out what is and what isn't that way you kinda have a better idea of what to expect for this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] All right. Thank you so much, [PII], for the time and, and the efforts. Uh, hopefully it all works out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][POSITIVE] No problem at all. I'm so sorry that that information wasn't provided to you in in the beginning, so.
[CUSTOMER][POSITIVE] It's OK. It happens. I mean, hopefully, this is the time and everything else is just the smooth sailing.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I hope so as well.
[CUSTOMER][POSITIVE] All right. Well, thank you and uh maybe talk to you later.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] Yes, ma'am. Yes ma'am. Have a good rest of your day.
[CUSTOMER][POSITIVE] All righty. You too. Bye-bye.
[AGENT][NEUTRAL] OK, bye bye.