AccountId: 011433970860
ContactId: 68f22088-f40c-4696-bd2e-6bb7d4cb5a98
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2117419 ms
Total Talk Time (AGENT): 817703 ms
Total Talk Time (CUSTOMER): 810370 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/68f22088-f40c-4696-bd2e-6bb7d4cb5a98_20250616T21:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How can I help you?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes ma'am, I was calling to find out status of a claim that I had.
[CUSTOMER][NEUTRAL] Entered
[AGENT][NEUTRAL] OK, a claim for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Do you have your policy number?
[CUSTOMER][NEUTRAL] Um, let me see if I have it.
[CUSTOMER][NEUTRAL] Um, policy number.
[CUSTOMER][NEUTRAL] I think it's 2500.
[AGENT][NEUTRAL] Um, I can look it up by your last name or social.
[CUSTOMER][NEUTRAL] OK 495.
[CUSTOMER][NEUTRAL] 88
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEGATIVE] 2500 is what it says on my benefits plan, but maybe that's wrong.
[AGENT][NEUTRAL] OK, give me one moment. What was your first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then can you verify your date of birth for me please, [PII]?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, and then what is your address and email address?
[CUSTOMER][NEUTRAL] Uh [PII]. Email is [PII].
[AGENT][NEUTRAL] Uh, looks like we might have a work email.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, and then do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what date was that for, for your claim?
[CUSTOMER][NEUTRAL] I'm not sure. I don't, I'm not sure, um.
[CUSTOMER][NEUTRAL] I'm not even sure what.
[CUSTOMER][NEUTRAL] I was communicating back and forth about this and then I got really, really busy with the end of school and and baseball and I just put it on the back burner.
[CUSTOMER][NEUTRAL] I'm coming back to it now, um.
[AGENT][NEUTRAL] OK, um, let me see if I can find some notes on it, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it looks like we
[CUSTOMER][NEUTRAL] I can tell you
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Um, the last call we received was back in March. Um, you just needed to know how to obtain diagnosis codes.
[AGENT][NEUTRAL] I think we had given you information about your benefits.
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm trying to figure what's the where can I go to access all the claims online because I'm having trouble logging in now.
[CUSTOMER][NEUTRAL] Um, to see
[AGENT][NEUTRAL] Um, so you'll go to [PII].
[CUSTOMER][NEUTRAL] Secure OK here we go, um.
[AGENT][NEUTRAL] Uh, [PII], but I've got your email address is [PII]. So do you want to change that to your [PII]?
[CUSTOMER][NEUTRAL] No, that, no, that's it, that's it. I just, it's been so long since.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Since I logged, it's been a month since I logged in, that's why so um.
[AGENT][NEUTRAL] OK, because it's gonna if you create your account, if you go to that [PII], you'll create your OSC account.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And it's gonna, you'll be the insured.
[AGENT][NEUTRAL] Um, it's gonna ask for
[CUSTOMER][NEUTRAL] Did I not create one already?
[AGENT][NEUTRAL] So we updated our website about 2 weeks ago. So if you haven't logged in in 2 weeks, then you'll have to recreate your account.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so, OK, so that's where I went. I went, I entered the.
[CUSTOMER][NEGATIVE] Wrong email.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yeah, and then it's, it's gonna also send you a verification code to that email address.
[AGENT][NEUTRAL] And then we'll ask you to enter the verification code, create their pass create your password.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Once that's done, you'll have to log back in again. It's gonna send another verification code and then you'll be in the system.
[CUSTOMER][NEUTRAL] So, um, I remember it now, um.
[CUSTOMER][NEUTRAL] Asking for the diagnostic codes, um, did I not upload all that stuff?
[AGENT][NEGATIVE] Um, we don't have anything since back in January. We don't have anything new received.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Where, where do I go? Where do I find the diagnostic codes?
[AGENT][NEUTRAL] And so you have to reach out to your healthcare provider, so it's 11 option.
[AGENT][NEUTRAL] Go to the portal for your health care provider.
[AGENT][NEUTRAL] It might contain the diagnosis.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, another option is just to contact them directly and see if they can provide you with an itemization that includes those codes.
[CUSTOMER][NEUTRAL] Can you do, can you tell me which um claims I need to get those for that I would be eligible to receive payment?
[AGENT][NEUTRAL] Um, I can tell you that.
[CUSTOMER][NEUTRAL] Uh, because I, I uploaded this one.
[AGENT][NEUTRAL] OK, um, I can tell you the claims that we've denied for information.
[CUSTOMER][NEUTRAL] OK and this is, does it take a long time to send the um.
[CUSTOMER][NEUTRAL] The the email.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Because I'm not
[AGENT][NEUTRAL] It, it does take a minute, yes. Are you mean the verification code? Is that what you're referring to?
[CUSTOMER][NEUTRAL] OK, yeah, yeah, and it's sending to the email, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We have the [PII] at the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] yeah.
[CUSTOMER][NEUTRAL] OK, yeah, if you could just give me the dates, um, or however you think it would be best and that way I'm, I'm not so, so anything that you've denied for um for that reason I'm, I'm eligible for as long as I get those codes.
[AGENT][NEUTRAL] Um, well, we can't guarantee payment unless we have the diagnosis codes and that lines up with your benefit plan, but yes, as, as long as they
[AGENT][NEUTRAL] As long as
[CUSTOMER][NEUTRAL] OK and then anything that uh.
[CUSTOMER][NEUTRAL] So then the other ones that you what did you do with the other claims are are are there claims that don't fit under that?
[AGENT][NEUTRAL] Um, so we, we've got several claims on here, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was
[AGENT][NEUTRAL] Uh, we got a claim from [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh 1220, [PII], 1118, 2024.
[AGENT][NEUTRAL] So I mean there there's there's several claims on here that we're needing more information um do you, do you want me to send you a list of them or do you wanna get into the system and look at the claims or?
[CUSTOMER][NEUTRAL] You know, yeah, as soon as I can get into the system, um.
[CUSTOMER][NEUTRAL] I guess my question, and I'm sorry, um, that I'm that I'm needing such basic information here, but like, OK, so this, this coverage is you pay out when I go into the hospital at all, is that correct?
[AGENT][NEUTRAL] Yes, so we pay, um, and this is not a guarantee of payment, it's a basic outline. So we pay after your primary processes the claim, um, we'll pick up your deductible co-pay or co-insurance for outpatient hospital services up to, let me get your amount.
[CUSTOMER][NEUTRAL] Sure, right.
[AGENT][NEUTRAL] So it's, it's, we pay a maximum of $500 per occurrence.
[AGENT][NEUTRAL] And so what that's defined as is, say, this is just an example, say you're treated for um knee arthritis in the hospital. Um, so in a 90 day period, that knee arthritis is considered an occurrence. Anything that you're treated for in that 90 day period for knee arthritis is an occurrence, and we'll pay a max of 500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a plan, is there a max plan payout?
[AGENT][NEUTRAL] Uh, no, um, the only max is in relation to your 2500 if you're inpatient, that's per confinement.
[AGENT][NEUTRAL] Um, let me make sure on the per current look it up just real quick. I don't think there's a match.
[AGENT][NEUTRAL] Yeah, the occurrence means treated for the same or related condition unless separated by a period of 90 days. So as long as it's been more than 90 days of the same or related condition, we'll pay out $500 every occurrence.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Can I, can I, can I tell you kind of what happened and you can tell me if like.
[CUSTOMER][NEUTRAL] If these fit
[CUSTOMER][NEGATIVE] If this would fit.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. So, um, on, um, [PII], I had surgery to remove a tumor in my brain. Um, so I went to, um, have that done and I was in the hospital for a week. Does that, does that qualify?
[CUSTOMER][NEGATIVE] At all
[AGENT][POSITIVE] Yes, yeah, absolutely, that would.
[CUSTOMER][NEUTRAL] Or any kind of payout.
[AGENT][NEUTRAL] Yeah, that would qualify underneath the inpatient benefit. So that would qualify for $2500 per confinement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that confinement would be eligible for 2500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then, um, I had developed a blood clot in my leg after surgery, after I was released, um, and, and, and so we're only talking when I've been admitted to the hospital, is that correct?
[AGENT][NEUTRAL] So it would be for admission to the hospital and then outpatient services. So if you went to hospital ER urgent care, you had surgery in the hospital.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] The service
[CUSTOMER][NEUTRAL] OK, so, so then, OK, so then a week later, still in that November month, um, I went to an urgent care to um to get my leg looked at and that's where they diagnosed me with the blood clot. Do you show that claim on there?
[AGENT][NEUTRAL] Um, you said that was in what month?
[CUSTOMER][NEUTRAL] That was in November. That would have been after the [PII]. Do you see the [PII] claim on there?
[AGENT][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] Yes, um, for, uh, the, um, it would have been, um.
[CUSTOMER][NEUTRAL] Stone Oak Methodist Hospital.
[AGENT][NEUTRAL] Uh, yes, it looks like we've got.
[AGENT][NEUTRAL] That one was an outpatient.
[AGENT][NEUTRAL] Um, yes, we've got that claim. Uh, it looked like it was for surgery.
[CUSTOMER][NEUTRAL] Yeah, that should have been an in what's uh because I was there for a week. Is that, is that, would that be an inpatient or?
[AGENT][NEUTRAL] It should be, but we've just got outpatient services. Let me see what we received.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, let's see, this is for.
[AGENT][NEUTRAL] Let me get that pulled up. Give me just a moment.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like, OK, so [PII].
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we received the explanation of benefits um from Blue Cross Blue Shield. We have that on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it doesn't indicate, let me see, I'm not missing anything, um.
[AGENT][NEUTRAL] It doesn't indicate that it was inpatient, so,
[AGENT][NEUTRAL] Really, the probably one thing I could mention um that might be the easiest way is have you created accounts with these healthcare providers like on their portals?
[CUSTOMER][NEUTRAL] Uh, you mean with my neurosurgeon and my ENT?
[AGENT][NEUTRAL] Yeah, and like the hospital that you went to.
[CUSTOMER][NEUTRAL] Uh, no, I don't think so.
[AGENT][NEUTRAL] OK, um, because a lot of the times they'll have patient portals and you can um access like your op report notes, things like that which will show like an itemization of what transpired.
[AGENT][NEUTRAL] You know, the only other way would be to call each healthcare provider and ask them to supply you with like a claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, that they submitted because they submitted a claim to your primary um Blue Cross Blue Shield, you could ask them if they could submit the claims to us as well, um, for payment or submit it to you so you can submit it. Does that make sense?
[CUSTOMER][NEUTRAL] Yes, it does, um.
[CUSTOMER][NEUTRAL] You, so basically you just need to know that I was actually in, in the hospital.
[CUSTOMER][NEUTRAL] For brain surgery and then stayed in there a week after to recover essentially because it look, what does it look like? I just went in for like a day surgery or something. Is that how it looks?
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] Yeah, we just, it doesn't give us a place of service it just says here's the surgery bill charges and then here's what Blue Cross Blue Shield paid so we don't know if that's an inpatient stay or.
[AGENT][NEUTRAL] Um, or what, what it is, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, so, uh.
[CUSTOMER][NEUTRAL] I think when I logged I still haven't gotten that email by the way um but um.
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Um, you might try, uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, what browser are you using? Do you know like Google Chrome or Edge or Safari?
[CUSTOMER][NEUTRAL] Um, I think it's.
[CUSTOMER][NEUTRAL] Uh, chrome.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, it's safari, sorry, it's safari.
[AGENT][NEUTRAL] OK. Um, you should have got the verification code by now. Did you, do you have like a junk folder or anything you can check or a trash folder?
[CUSTOMER][NEUTRAL] Yeah, I have the all folder pulled up and it's.
[CUSTOMER][NEUTRAL] At [PII].
[AGENT][NEUTRAL] Let me, let me
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And that was [PII]. Is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you wanna try changing your email to your personal or you wanna leave it at your work?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean we can sure.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] What's your personal email?
[CUSTOMER][NEUTRAL] Wait, actually, OK, wait, hold on, so this is I went back, well, no, it's just saying um.
[AGENT][NEUTRAL] But did you get?
[CUSTOMER][NEUTRAL] Now I just went back and it says verification that please clicks uh it's asking me for oh that oh wait, hold on, did I not?
[CUSTOMER][POSITIVE] Hold on just a second, I'm so sorry.
[AGENT][NEUTRAL] Oh, you're fine.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Send verification code.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Last time I was at this window, I um I went back to check on my email and I came back it was spinning like um to put in the um verification code like it took away the option to put in the code so I had to open up a new window does that.
[AGENT][NEUTRAL] Oh, OK, yeah.
[CUSTOMER][NEUTRAL] Sound like
[CUSTOMER][NEUTRAL] OK, here it is already. OK, so that's my fault. So [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] verify code.
[CUSTOMER][NEUTRAL] Alright, now it's asking for email.
[CUSTOMER][NEUTRAL] I mean for password.
[CUSTOMER][NEUTRAL] This might help me because then I can see um.
[CUSTOMER][NEUTRAL] What you're looking at too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I've been I've been created. Go to dashboard.
[CUSTOMER][NEUTRAL] Log in
[AGENT][NEUTRAL] OK, yeah, it's gonna ask you to log in again and then it's gonna ask you to send another verification code. It's a two-factor verification.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, it's like I come back to it and it's um trying to log me in.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] So then it makes me generate another uh request for another like I can't leave that page.
[AGENT][NEUTRAL] OK, when you entered your, your email and password, did it ask to send another verification code?
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] Yes, and then I went to check um.
[CUSTOMER][NEUTRAL] That I want to check it and then like when I came back to enter it it it like was spinning um.
[CUSTOMER][NEUTRAL] Like it was trying to log me in.
[CUSTOMER][NEUTRAL] And then it and then it kicks kicks it out and asks me for a new verification code all over again.
[CUSTOMER][NEUTRAL] Do you see what I'm saying?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Um, yeah, if you can just, if you can just, you've created your password and email that should be logged now, so if you can just
[AGENT][NEUTRAL] Get out and then um
[AGENT][NEUTRAL] Try to log back in it should just ask for a verification code once.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Siverification code.
[CUSTOMER][NEUTRAL] OK, I'm just gonna use my phone to check it, um.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Or if I could.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, I'm in perfect. OK, next. OK, so if, if I go to, do I go to my, where do I go to see what, what I've already.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so you'll go to your dashboard.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then from there, yeah, pull this up just real quick.
[CUSTOMER][NEUTRAL] I'm there.
[AGENT][NEUTRAL] OK, on your dashboard, you should be able to see under
[AGENT][NEUTRAL] It should say all uh my details and then claims.
[CUSTOMER][NEUTRAL] And all I see is dashboard. I see my name and then I see, would you like to review the coverage details of your policy, or do you need access to your ID card? And then I see a start your claim.
[AGENT][NEUTRAL] OK, go to my policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then does it say my details and then claims?
[CUSTOMER][POSITIVE] Yes, it does. OK, perfect.
[AGENT][NEUTRAL] OK, so if you click on claims and you will have to give it just a little bit, it'll pull in, it'll probably take a minute or so um to pull in all of the claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it going from um.
[CUSTOMER][NEUTRAL] Mm let's see.
[CUSTOMER][NEUTRAL] It goes from uh
[CUSTOMER][NEUTRAL] Earliest to latest I guess uh as far as the dates are concerned.
[AGENT][NEUTRAL] Uh, well, the dates of service that it goes because it looks like several claims were filed all on the same date.
[AGENT][NEUTRAL] Um, so, yeah, we've got.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Oh, out.
[AGENT][NEUTRAL] About 15 claims or so filed, um, so yeah, it should, should put them in chronological order.
[CUSTOMER][NEUTRAL] So I'm seeing 123456789 10. I see 10. Is there a toggle to go to the next 10 or?
[AGENT][NEUTRAL] Um, let's see, we've actually processed 12345.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Yeah, 10, that's right. I'm sorry.
[CUSTOMER][NEUTRAL] 1010 total.
[AGENT][POSITIVE] In total, yes.
[CUSTOMER][NEUTRAL] For for under all, OK, I'm under all. OK, so, um, alright, so, uh, yes, let's, so, um, if we go to.
[CUSTOMER][NEUTRAL] Date completed. What am I so the service date.
[AGENT][NEUTRAL] Um, so we can just look at like the you have to see the claim number like 355-0559.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Yeah, 3553 so 355-0542.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yeah, that's the um.
[CUSTOMER][NEUTRAL] It says earliest service date it says [PII]. That was the date of my surgery. I'm assuming that's the one that we were just talking about, is that right?
[AGENT][NEUTRAL] Uh, no, I had another one too for that date. Um.
[CUSTOMER][NEUTRAL] Uh, 355-0540, there's a bunch with [PII].
[AGENT][NEUTRAL] Yes, and it looks like these are all requesting that diagnosis code, so.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] How can I diff what's what's the difference? Why are there so many on the the [PII]?
[AGENT][NEUTRAL] So, it looks like they, they billed all the different charges. So you're gonna have a pathology charge, you'll have a surgeon charge, you'll have an anesthesiologist charge, there'll be a facility charge. So it, there's several different charges involved with one date of service.
[AGENT][NEUTRAL] From all the different types of providers.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Yeah, please provide a diagnosis code of the state of service may be obtained from your provider.
[CUSTOMER][NEUTRAL] So I went to I downloaded the um the explanation of benefits.
[CUSTOMER][NEGATIVE] Um, gosh, this is so confusing.
[CUSTOMER][NEUTRAL] This is a lot for uh.
[CUSTOMER][POSITIVE] For somebody, um, thank you for helping me with it, um.
[AGENT][NEUTRAL] Yeah, absolutely. I mean, one option, one option too, if you, you don't wanna mess with it, um, you can call um the provider and give them your Medlink card, and they can file, cause are they sending you bills?
[CUSTOMER][NEUTRAL] Anyway.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, no, I've paid a lot, so the person I spoke with from APL said I could be reimbursed from what I've paid if I was, you know, if it was eligible, yeah.
[AGENT][NEUTRAL] Oh, you have, OK.
[AGENT][NEUTRAL] Can, yeah.
[CUSTOMER][NEUTRAL] Um, I just
[CUSTOMER][NEGATIVE] I'm just so overwhelmed. I don't even know where, where to, where to start. But basically, after, after my surgery, which I was in the hospital for a week.
[CUSTOMER][NEUTRAL] Then I, then I went to uh urgent care, um.
[CUSTOMER][NEUTRAL] They, they diagnosed me with a blood clot.
[CUSTOMER][NEGATIVE] Then they put me on blood thinners and the blood thinners gave me a massive GI bleed and so I went to a new hospital in [PII] near my house, uh Texas Health.
[CUSTOMER][NEUTRAL] Which I was admitted into the hospital for another 5 or 6 days. Um, do you see any claim for that?
[AGENT][NEUTRAL] Um, that would have been towards the end of, uh, November, is that right or?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] It's like almost everything I have says outpatient. Um, let's see.
[AGENT][NEUTRAL] Double check.
[AGENT][NEUTRAL] Yeah, we've got Frisco emergency medicine that was from
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, let's see. Is that where you went for the, um,
[AGENT][NEUTRAL] Blood clot.
[CUSTOMER][NEUTRAL] Frisco Emergency medicine, it was, no, this was um
[CUSTOMER][NEUTRAL] This was in prosper the, the, the little, uh, I think it was um urgent, uh, what was it um.
[CUSTOMER][NEUTRAL] It's an urgent care up the street from me, um.
[CUSTOMER][NEUTRAL] Legacy ER.
[AGENT][NEUTRAL] Oh, OK. Um.
[AGENT][NEUTRAL] Yeah, I don't see that one.
[CUSTOMER][NEUTRAL] OK, um, mm.
[AGENT][NEUTRAL] You want me to
[CUSTOMER][NEUTRAL] That would qualify though, right?
[AGENT][POSITIVE] Yeah, absolutely. Do you want me to do this? I can just make a simple um.
[AGENT][NEUTRAL] I can email you just a simple list of this is the date we have, here's the provider, here's the bill charges, and then maybe you can match it up to.
[AGENT][NEUTRAL] Um, I don't know if that would help or not, so just a simple outline.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah, that that might help. Would it help if I logged into my um Blue Cross Blue Shield portal?
[CUSTOMER][NEUTRAL] And um could.
[CUSTOMER][NEUTRAL] See
[AGENT][NEUTRAL] Yeah, the thing is we've received, we have received all your Blue Cross Blue Shield EOBs, um, so let's see.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] But like I said, the, the problem with the Blue Cross Blue Shield EOBs is that they don't give descriptions. They'll simply just say so XYZ provider, they build this dollar amount and here's what we paid.
[AGENT][NEGATIVE] It doesn't really give us a description of, you know, the specific services that were rendered or the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what do you, what do you recommend I do because so um.
[AGENT][NEUTRAL] I, if you can check.
[CUSTOMER][NEGATIVE] I'm so upside down.
[AGENT][NEUTRAL] If you can check with the, so on the big ones like the inpatient stay, that hospital.
[AGENT][NEUTRAL] Um, each of your inpatient stays, you could start at that point, um.
[AGENT][NEUTRAL] You can see if they have a patient portal that you could create with them because like I said, a lot of the times those patient portals will have the information we need versus you, I mean the other option, the only other option is to call each of them and ask them for the information that we need.
[AGENT][NEUTRAL] Or have them
[CUSTOMER][NEUTRAL] Well, will the, um.
[CUSTOMER][NEUTRAL] Do, do you need an, OK, so is it like for the hospital stay with my surgery, do you need a diagnosis code from every single person like the the anesthesiologist, the ENT, the neurosurgeon, the like.
[CUSTOMER][NEUTRAL] Or is there just like one.
[AGENT][NEUTRAL] There's so
[CUSTOMER][NEUTRAL] Would it just pay out?
[AGENT][NEUTRAL] Yeah, it would just, so for inpatient, for your in-patient stay, it's just gonna pay out that $2500 per confinement. So all we really need is just the hospital bill. We don't, all the rest of that's not gonna matter. It's just strictly your hospital bill and nothing else, um, because again, that's for inpatients, so you're not gonna have any other benefit besides that, um, for your in-patient stays.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so if I can log on to those two hospitals because I had, I had two, inpatient stays of like a few days, the one down in [PII] and then the one up here in [PII], um, what should I do? So, um, where should I send that?
[AGENT][NEUTRAL] Um, so you'll
[CUSTOMER][NEUTRAL] If I can get a copy.
[AGENT][NEUTRAL] You can upload that to the portal, um, and so the account you just created, you would do start a new claim and then it'd be a traditional claim and then you can upload the documents.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so it would basically nullify any of those other claims from before.
[AGENT][NEUTRAL] Well, we would just we would match the records that you're submitting with what we've received and then see if we can process off of that so.
[CUSTOMER][NEUTRAL] And just
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So those two main hospital stays would be 2 big ones that would qualify.
[CUSTOMER][NEUTRAL] Would the urgent, the uh legacy ER urgent care be something worth filing?
[AGENT][NEUTRAL] Yes, so you do have um urgent care. Let's see, it is.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Just making sure it states and it it was an actual facility too, was it? It wasn't like a walk-in clinic, is that right?
[CUSTOMER][NEUTRAL] No, it was, it was like one of those dock in a box places.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so, under your benefit, it says urgent care facility. Um, so that, that should qualify. And again, that's gonna be that, um,
[AGENT][NEUTRAL] That's gonna be the $500. Now,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you went to the ER at a hospital, that's
[AGENT][NEUTRAL] That has a $100 deductible you have to pay out first and then we pay the remainder of the $500. But if this was urgent care,
[AGENT][NEUTRAL] Then it would be the 500 per occurrence. So just keep in mind again that per occurrence like if, if the
[AGENT][NEUTRAL] tumor caused the blood clot, then that's all related. So you only have the max of that 500.
[AGENT][NEUTRAL] That makes sense.
[CUSTOMER][NEUTRAL] Yes, but, but, OK, but then, um.
[CUSTOMER][NEUTRAL] What happened was, so that the GI bleed occurred. I had to go to the hospital here and then they found um.
[CUSTOMER][NEUTRAL] You know, they found a polyp in my colon that turned out to be cancerous. And so, would that still be
[CUSTOMER][NEUTRAL] Would that be a new thing, um, because I've had several.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know, visits or or doctor's appointments and and whatnot that that.
[CUSTOMER][NEUTRAL] Have to do with that
[AGENT][NEUTRAL] Yeah, so that would be, it's unrelated on a different part of the body, so it shouldn't be considered the same, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but the blood clot would, would, would be associated with tumor because it kind of was fall out from that.
[AGENT][POSITIVE] Right, exactly, right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, is there any way that um is it kind of luck of the draw who I get when I call this number? Is there any way I can continue to work with you if I like.
[CUSTOMER][NEUTRAL] Do you have a
[CUSTOMER][NEUTRAL] Like a an um extension or OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure, and if I'm not available, I can give you a call back. My name is [PII], and my first initial is [PII].
[CUSTOMER][POSITIVE] Definitely.
[AGENT][NEUTRAL] My last name is
[CUSTOMER][NEUTRAL] [PII],
[AGENT][NEUTRAL] Yes
[CUSTOMER][POSITIVE] OK perfect OK.
[CUSTOMER][NEUTRAL] And so when I uh is there an extension I should um use or um.
[AGENT][POSITIVE] Um, no, I don't have an extension. Um, yeah, I just call and all of our colleagues are really awesome though, so if, if I'm not available and you feel comfortable, absolutely you can speak to anybody, but I'm happy to help you if you just want to speak to me.
[CUSTOMER][NEUTRAL] Just call and
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, yeah, I just because it just got to uh to start all over sometimes, but I guess they would catch on quickly. um, OK, so I'm gonna, um, let you go. I really appreciate your patience and I'm gonna go try to log on to these two portals, grab the hospital bills, and then just upload that entire thing starting a new claim, um, and then try to do the same with the urgent care as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, yeah, that sounds good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, all right, perfect, thank you, [PII] so much, and um let me get this done and I guess maybe I'll talk to you later and if not then thank you so much for your help.
[AGENT][POSITIVE] OK, well, thank you, [PII]. I hope you have a good evening and thanks for calling APL.
[CUSTOMER][POSITIVE] All right, thank you so much. Bye bye.