AccountId: 011433970860
ContactId: 39ecd739-b6f8-44c0-b08e-3f81703d56e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1511069 ms
Total Talk Time (AGENT): 898347 ms
Total Talk Time (CUSTOMER): 559817 ms
Interruptions: 18
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/39ecd739-b6f8-44c0-b08e-3f81703d56e8_20250403T14:36_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, [PII]. How are you? Good morning.
[AGENT][NEUTRAL] How are you?
[CUSTOMER][POSITIVE] I'm good. I'm here.
[AGENT][NEUTRAL] I know, right?
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's like today, I don't know what's wrong with today.
[AGENT][NEUTRAL] I don't know either. I feel like it's been the longest, like 2 weeks of my life.
[CUSTOMER][NEUTRAL] It feels like Monday. Yes, I'm like, oh, is it?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, but I have a member, well, I have the wife of a member on the line. She is authorized, but she, we do have the authorization paperwork for her. Um, but it looks like, um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, she has some question about two policies. One is the disability and one is the HI. And there are two claims, one, well, there's two claims on the HI and one on the disability. Uh, for the disability, she's just confused, uh, and she wants to know why we're asking for, uh, medical records from the VA.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um for the HI she wants to know why we still asking for the itemized bill when she sent all this information in to us. So let me give you, which one you want first. I'm sorry.
[AGENT][NEUTRAL] It doesn't matter. It's OK it's OK just whichever one, just let me know which one's which one you're telling me.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. So let me give you the disability first since that's the one she was asking about the VA medical records. Um, but that is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I had to guess it's probably like.
[AGENT][NEUTRAL] Preexisting.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] I'm not sure. I mean, um, [PII] just put that she asked for the medical records and what she asked for and then for what time range, but that's all, that's what I was telling her like, you, uh, because she said, but why? I'm like, oh well.
[CUSTOMER][NEUTRAL] All I see here is that they asked for it.
[AGENT][NEUTRAL] Right, it's like, um, hang on.
[CUSTOMER][NEUTRAL] Yeah, I feel like I always give you the craziest call, [PII].
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] You know, I'm gonna start screening y'all or something. No, I'm just kidding.
[CUSTOMER][POSITIVE] You're gonna be like, oh it's so nice.
[AGENT][NEGATIVE] Right, hang on, why are you calling? Nope, just kidding. I'm not busy or I'm too busy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They be like let me breathe before I answer.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Oh, goodness. OK, let's see. Thank you.
[AGENT][POSITIVE] OK, they've not had it. It was just effective.
[AGENT][NEUTRAL] Yeah, so.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] In their policy.
[AGENT][NEUTRAL] Let's see, I'm trying to remember the exact verbiage, so I'm just gonna pull it up.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm, well, it may not be if it's disability.
[AGENT][NEUTRAL] Let me see what they submitted.
[AGENT][NEUTRAL] Because
[AGENT][NEGATIVE] I have received your request, uh, not correct.
[AGENT][NEUTRAL] Yeah it is
[AGENT][NEUTRAL] So they've requested medical records to just verify that it's not the result of a preexisting condition, um, under that claim 358-0229 that DD 201, that is.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] That remark code that is exactly what it says we've received your request for benefits before we can consider it, we have to obtain records to make sure it's not due to preexisting we'll contact you again, um.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] You know with needing names and addresses or whatever if we need it um and then if you have questions or concerns you know we can.
[CUSTOMER][NEUTRAL] Uh, so that's that means.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] We can let you know, but that's what it is. They were just effective on [PII] and um let's see when he's claiming that this started.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] It's so cloudy here at my house today and I'm just like, this is sleeping with. This is like.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] This is lay down and relax with her.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, this is a, a hot chocolate moment.
[AGENT][NEUTRAL] Yes, like, I mean, it's, it may be nearly 80 degrees outside, but I feel like it should be like, you know, I should be cozying up to a warm fire or something.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] Are you in [PII] or in [PII]?
[AGENT][NEUTRAL] I'm actually in [PII].
[AGENT][NEUTRAL] So I'm not too terribly far away, um, from [PII] at least. [PII] is a drive, but.
[CUSTOMER][NEUTRAL] Oh, you're in [PII]. Oh yeah, almost, yeah.
[CUSTOMER][NEUTRAL] Oh, yeah. Because I saw outside, I'm like, yeah, it looks like that a little bit here.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it does. It's very overcast, but hot.
[CUSTOMER][NEUTRAL] Yeah. Yeah, it's hard. Mhm.
[AGENT][NEUTRAL] So, um,
[AGENT][NEGATIVE] Very hot, humid, and pollen everywhere.
[CUSTOMER][NEUTRAL] Mhm. Yeah. Yup, yup, yup.
[AGENT][NEUTRAL] Um, OK, so they were effective on [PII] and he's saying that he last worked his job on [PII].
[AGENT][POSITIVE] So he became effective.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And he has degenerative disc disorder.
[AGENT][NEUTRAL] So, if it were like he was working and then on.
[AGENT][NEUTRAL] You know, the next day or whatever, he had an injury that occurred at work or something like that. It may be a little different, but, um, I mean.
[AGENT][NEUTRAL] I have degenerated disc. So he was having surgery basically um for a disc herniation and acute on chronic low back pain.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mm, OK. So yeah, she just want to know why, um, all that was asked for. And then on the HI, um, she just wants to know like uh why we need the documents because she believes she sent everything we needed. So I don't know if you want to look into those two and let her know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, let me, yeah, I need to see what we got so I can better explain that for sure. Um, what is the policy number for that one?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me go back to one moment.
[CUSTOMER][NEUTRAL] I was finishing a note on another one.
[CUSTOMER][NEUTRAL] Uh, OK, uh, how are you?
[CUSTOMER][NEUTRAL] Alright, I like to. OK, all right, OK.
[CUSTOMER][NEUTRAL] And the HI is 2333.
[CUSTOMER][NEUTRAL] 213.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] No diagnosis code.
[AGENT][NEUTRAL] That DM 400 on those two claims that were recently processed yesterday.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] It states no diagnosis code.
[CUSTOMER][NEUTRAL] Mm, mhm. Yeah, that's it.
[AGENT][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Oh, OK. All right.
[AGENT][NEUTRAL] In order to provide further consideration.
[AGENT][NEUTRAL] Supporting documentation so it says that it's it may include but is not limited to an itemized bill so.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's really just that we don't have a diagnosis code because it says itemized bills with diagnosis codes, super bills office notes, hospital admission and discharge summaries or diagnostic testing results.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see and they submitted for.
[CUSTOMER][NEUTRAL] Let me know when you're ready for her.
[AGENT][NEUTRAL] Fine.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Just gonna verify really quick that we don't have.
[AGENT][NEUTRAL] Anything
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then that way I can.
[AGENT][NEUTRAL] I can be confident saying well I reviewed your documents and yes we did receive the bill, however, there is no diagnosis provider.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I mean this examiner is usually pretty good about that. I don't doubt that, but just.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You know, [PII], um, just kidding. There are diagnosis codes.
[CUSTOMER][NEUTRAL] Yeah, I guess.
[AGENT][NEUTRAL] At the very end.
[AGENT][NEUTRAL] So I can send that back um on that one but this one's a different.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Let me check this one because there were 2 different ones.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Oh goodness, I'm glad I checked because that examiner is usually pretty good. I'm gonna point that out to her and be like, really? And she's gonna be like, oh my God.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Oh my God, I can't believe I did that.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Yeah, me either.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Get it together.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] No wonder she's like, I don't understand because it's, it is there um let me see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, and that's why she's like, I submitted everything. What else do you want?
[AGENT][NEUTRAL] Yeah, I, I can understand why I'd probably be the same way. um, let's see now it looks like now one of them it looks like we we truly don't, um, let's see.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we did for the one they were listed at the end.
[AGENT][NEUTRAL] But this one.
[AGENT][NEUTRAL] It looks like we have all of the charges and everything.
[AGENT][NEUTRAL] And the admission date, but they did not include a diagnosis code. So one did and one didn't. Um, so that's really where we're at with that. I don't think we have anything else in history.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, Miss, I'll have to put her in because it's been 10 minutes.
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] Yeah, yeah, yeah, go ahead. I, I think I have everything I need now, so you're good you're good.
[CUSTOMER][NEUTRAL] Uh, yeah, OK.
[CUSTOMER][NEUTRAL] OK, alright, alright, thank you, and I fully verify her the callback number is the same in the system. OK, alright.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome. Thank you for holding and being patient for me. I got miss [PII] on the line. She's gonna assist you with that information. Thank you so much for your help. You're welcome.
[AGENT][NEUTRAL] Hey Miss [PII], how are you?
[CUSTOMER][POSITIVE] I'm doing well how are you?
[AGENT][POSITIVE] I'm doing well, um.
[CUSTOMER][NEGATIVE] Just a little confused with some of this process.
[AGENT][NEUTRAL] Yes, and and that is perfectly normal um you were not the only one I promise um OK so I'm gonna start with your HR because I have it pulled up currently and I know um I've looked at everything that's why it took us a bit to a little bit to get back to you, um, so for one of the claims that we processed yesterday.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I do see the diagnosis codes, so I'm gonna send that one back for processing. However, the other one where he.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what I didn't understand. uh-huh.
[AGENT][NEUTRAL] Yeah, I know. I looked at it and I was like, hang on a second, they're right here. No wonder she's confused.
[CUSTOMER][POSITIVE] I said everything and I, I, because we've done it before, I, I made sure to have the right document.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right. Yeah, so that one, that one I can definitely understand. Now, I will say the admission for the hospital stay from 32 to 37, that document did not include diagnosis codes. It has procedure codes, it has service dates, it has, you know, all of that, the charge amounts, but it did not include diagnosis codes. Um, I went.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that you said 32. OK, so I'll request it again because it's the same I requested it from the same people, but OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so that one.
[AGENT][NEUTRAL] Got you, yeah, I don't know why because I was like, oh this looks the same. I bet it's on this last page like the other one and I went to the last page and I was like, well, maybe not so.
[CUSTOMER][NEUTRAL] Because it was the same thing. The, the, the two, both of them are the same state. It's the same, not the same state, but the same situation. He had, he had to have back surgery twice.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Oh, God bless his heart.
[CUSTOMER][NEUTRAL] It's exactly, but it was at two different hospitals. So he went to the first one, they did the surgery and then when he was healing, there was a complication and had to be rushed back in.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Oh my goodness, bless his heart.
[CUSTOMER][NEUTRAL] And the ambulance would not take him as far to the other hospital, the original hospital. They took him to the 2nd, to a hospital that was closer, which is why they're two different thing, but it's the exact same.
[AGENT][NEUTRAL] Gotcha. OK.
[CUSTOMER][NEUTRAL] Procedure almost.
[CUSTOMER][NEUTRAL] The first one, the 2 to the 2nd to the 7th 7th, um, had a little bit was a little bit more expensive, and then the second one was to repair.
[AGENT][NEUTRAL] Oh my word.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] My goodness. Bless his heart. That is, that is a mess. Poor guy. I cannot even imagine. I mean, one surgery on your back is something else, but two, within just a little bit of each other. Oh my goodness.
[CUSTOMER][NEUTRAL] OK, yes, it is.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, so.
[CUSTOMER][NEUTRAL] OK, so I'll go back and ask them again for that. I'm just trying to deal, I mean because.
[AGENT][NEUTRAL] Yeah, that one.
[AGENT][NEUTRAL] Yeah, because the one was from [PII], so the second one where he had to go in, that's the one we actually have, but because it's two different hospitals, I would say, oh, OK, you know, it's the same whatever if it were the same hospital, like maybe they just included it, but since it's two different hospitals, um, yeah, it's just the diagnosis code that's all we need.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll go back and request it again.
[AGENT][NEUTRAL] Yeah, um, and then for.
[CUSTOMER][NEUTRAL] OK, but then it starts the process over again, right?
[AGENT][NEUTRAL] It won't start it over again necessarily um because we have everything that we need once we get that we'll basically go in with the documents that we have and just process what we already have so once we get it's literally just the diagnosis codes so um I don't know if you have like an admin discharge summary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, cause I thought that I thought I saw it on there cause it's.
[AGENT][NEUTRAL] Yeah, I did. I've gone through.
[CUSTOMER][NEUTRAL] Um, well, it doesn't have that, it doesn't have on there.
[AGENT][NEUTRAL] Oh, it doesn't have what he was treated for on that?
[CUSTOMER][NEUTRAL] I just I don't think it shows a diagnosis code. I have the discharge summary.
[CUSTOMER][NEUTRAL] But it wouldn't have diagnosis codes on it. There's no back in there. Just sit on the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What does the discharge summary say?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Give me a second to get to my party and some glasses for my bed.
[AGENT][NEUTRAL] Feel that
[AGENT][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Oh, in my back pocket.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Discharge let me log in.
[CUSTOMER][NEUTRAL] So I gotta get to it.
[AGENT][POSITIVE] No, that's OK. No rush at all.
[CUSTOMER][NEUTRAL] I see 6 hospital much.
[CUSTOMER][NEUTRAL] Um, it talks about the doctors. It says you were admitted, for hospitalization. It just, uh,
[CUSTOMER][NEUTRAL] Um, discharge, it just has the discharge instructions.
[AGENT][NEUTRAL] Mm. So it doesn't say anything like you were treated for and then like list something out like complications due to, you know, surgery or what, it doesn't say anything like that.
[CUSTOMER][NEUTRAL] Uh, postoperative.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's it just shows the neurological pickup medication so we can see schedule an appointment mm mm.
[AGENT][NEUTRAL] Weird. OK.
[CUSTOMER][NEGATIVE] Nowhere on there.
[AGENT][NEUTRAL] Well, that is unusual, but OK, I was gonna say if you have, since you have access to that, you could just upload that but um let's see.
[CUSTOMER][NEGATIVE] I don't think I can find it.
[CUSTOMER][NEGATIVE] I'll go through it and see it just says postoperative instructions, but I don't see anywhere where it says it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yeah, if you have access to anything even if it's just the records.
[AGENT][NEUTRAL] From that day so that you're not having to wait on them, um, because the records will tell us what he was treated for. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] About
[CUSTOMER][NEUTRAL] OK, I'll see if I can.
[CUSTOMER][NEUTRAL] Um, find that.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] I get that and they would, if I call them, they'll email me because we waited for a good while to get the dish, the, the.
[CUSTOMER][NEUTRAL] Um, thing that they sent me the itemization that they sent me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, if they, if they will respond quickly for you so that y'all are not having to continue to wait then yeah I would I would just contact them and be like hey the itemization that you sent is missing diagnosis codes like can those be added and you resend it or you know can I get something?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's it like because I've gotten them from them before, so I know that that's possible.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Perfect. OK. Yeah, so that's really all that's needed for that hospitalization. Like I said, I'll send the other one back where there were diagnosis codes and we'll go ahead and get that one processed, um, because those are there. Um, as far as his disability.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the disability is um they're having to request records because the policy has a preexisting clause and so what they have to do just it's normal procedure that if your disability begins within, I believe it's the 1st 12 months um of the policy then they automatically check for pre-existing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It doesn't mean that the claim is going to be denied they just have to double check so that's just part of that process for the disability product um once they get the records and they verify what they need to verify then they'll move forward with processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The, my only concern with that is for this particular issue, he's never been seen. Uh, she said that he was they needed records from the [PII]. He's never been seen at the [PII] for this particular process and it takes months to get records from the [PII].
[AGENT][NEUTRAL] Yeah, my dad's with the [PII] too, so they're slow, um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Would it be appropriate for me to just go how far do they need the records to go back?
[AGENT][NEUTRAL] Let's see, let me pull up the letter.
[CUSTOMER][NEUTRAL] Because I may be able to go on to the VA's website and uh and to log into his portal and.
[AGENT][NEUTRAL] And pull what you need.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yeah, let me.
[AGENT][NEUTRAL] Let me get over there to that letter and see how far back she requested.
[CUSTOMER][NEUTRAL] But that's like a 3000 page document.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] I believe it. It's funny that they have like all these records, yeah, that they have all these records, but.
[CUSTOMER][NEUTRAL] Well, because it's gonna go all the way back to his military service.
[AGENT][NEGATIVE] They're so slow about doing things.
[AGENT][NEUTRAL] Oh man. OK, let's see.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] See how far back she went.
[AGENT][NEUTRAL] So her request to the [PII] states from [PII] to [PII], so it's the last year, so yeah, so when it's within the first year of your effective today, they go back a year to verify that you know, treatment was not received or anything like that prior to uh your disability.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or that the, yeah.
[CUSTOMER][NEUTRAL] So I need to go and pull.
[CUSTOMER][NEUTRAL] His particular, so they just need all of his medical records from the [PII] from for the last year.
[AGENT][NEUTRAL] Mhm, from [PII].
[CUSTOMER][NEGATIVE] They kind of see invasive for whatever else is going on with them.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Has he, has he seen anyone else regarding this? Like, has this been something he's been treated for? No.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It wasn't an ongoing issue. Mm mm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] They took him into surgery as an emergency.
[AGENT][NEUTRAL] Oh dang.
[CUSTOMER][NEUTRAL] It had never been seen for anybody else, seen by anybody else before for this issue.
[AGENT][NEUTRAL] Wow, it just like got bad real fast and he just had to have it right then. Wow.
[CUSTOMER][NEUTRAL] Mhm. He went in for some, uh, a little bit of a problem and it was not getting better with the hospital stay, and the neurological surgeon said, let's take it.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] Man, that's wild. Does he have a high pain tolerance.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I was fixing to say because for him to just go from like 0 to 100 that fast like Mr. [PII], I'm, I'm gonna need you to pay attention, sir. I know you've been hurting.
[CUSTOMER][NEUTRAL] Which, yeah.
[CUSTOMER][NEUTRAL] I know, I needed to as well.
[AGENT][NEUTRAL] OK, um, oh gosh, I wish there was a way around that because I can understand because, you know, like I said, my dad's with the VA as well and you know it's not just one thing that he may or may not have issues with, you know, there's, there's several things um that he deals with as well so.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, I mean, he's a kidney transplant patient so a kidney transplant recipient, so.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, there's just a lot of other medical information on there and it has nothing to do with this particular thing and we are also like, we're a whole month now without any income.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Got you. Well, like I said, let me, the HR one with the diagnosis codes that one can be reprocessed today and you're signed up for direct deposit. So, um, so you know, as long as I, I don't foresee that being an issue, um, I would allow 24 to 48 hours for any, any type of payment to come through, um, and then so that should be completed today.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so.
[CUSTOMER][NEUTRAL] She
[AGENT][NEUTRAL] Um, and then as far as the records.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the
[AGENT][NEUTRAL] I don't know. I wish I could give you like reassurance that there was uh something else that we could do, but I don't think that there is. The only reassurance I can give you is that you know your, your information is protected by HIPAA laws we do not share we do you know what I'm saying like that's not information it's strictly for the purpose of your claim and I realized that he doesn't have.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Issues related to this in those records, that's all they're doing though is skimming through it and being like, OK, has he been treated has, you know, do we see anything that would cause us to believe this was preexisting? If not, um, that's, that's literally it, you know, it's not held against you, it's not, it's not used to negatively affect you in any way it's strictly for the purpose of the preexisting for this claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So that's really the only reassurance I can give you. I, I hope that helped a little bit. Um, but, and then with the other HR as soon as you get those, uh, diagnosis codes, we'll, we'll get that, um, turned around as quick as we can as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so I will get those sent in um.
[CUSTOMER][NEUTRAL] This afternoon I'm going to be taken to a doctor's appointment right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, and then, OK, so I'll work on both of those.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That sounds great. If you need anything else or have any more questions, just give us a call OK?
[CUSTOMER][NEUTRAL] Oh, OK, alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. All right. Have a great day. You, my name is [PII].
[CUSTOMER][POSITIVE] Alright, thank you so much. I'm sorry, what is your name?
[CUSTOMER][POSITIVE] Hey [PII], thank you so much for your help.
[AGENT][POSITIVE] You're very welcome y'all have a great day.
[CUSTOMER][POSITIVE] Yeah you too.
[AGENT][POSITIVE] Thank you. Bye bye.