AccountId: 011433970860
ContactId: 6ade69f3-e878-49a1-bcf9-6648768a1064
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1845339 ms
Total Talk Time (AGENT): 660660 ms
Total Talk Time (CUSTOMER): 774189 ms
Interruptions: 14
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/6ade69f3-e878-49a1-bcf9-6648768a1064_20250321T15:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Uh, I'm Pearle online, and I understand that my job place does not have y'all for insurance anymore.
[AGENT][NEGATIVE] Oh no, [PII].
[CUSTOMER][NEUTRAL] But what I need.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] What are we gonna do without you? I do.
[CUSTOMER][NEUTRAL] You recognize me?
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] How are you doing?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Oh my gosh. OK, so I'm sorry. I was just excited to talk to you again. OK.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEGATIVE] Uh yes, yes, and I'm so sad that we don't have y'all anymore cause I have gotten used to all y'all.
[AGENT][POSITIVE] Yes, ma'am. We, and we've enjoyed taking care of you too.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] I know, I know. What's your name now?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Yes, I remember you so well, [PII].
[AGENT][POSITIVE] Oh thank you. Are you doing OK?
[CUSTOMER][NEUTRAL] So here's my question.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] When did they stop?
[AGENT][NEUTRAL] Let me get your policy pulled up.
[CUSTOMER][NEUTRAL] Can you give me that date?
[AGENT][NEUTRAL] I can. And I just need to verify your date of birth and current mailing address and a callback number.
[CUSTOMER][NEUTRAL] OK, the day the call back number is area code [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And mailing address.
[CUSTOMER][NEUTRAL] And my phone my
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And date of birth.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Thank you. You know, we just have to do that to protect your information. Make sure you're you.
[CUSTOMER][NEUTRAL] Oh yeah, I know.
[AGENT][NEUTRAL] Oh, we know you're you, but we, we just have to do that. It looks like your last date of service or of coverage was [PII].
[CUSTOMER][NEUTRAL] I remember
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So, I can send you things.
[CUSTOMER][NEUTRAL] I could file claims with you all before [PII].
[AGENT][NEUTRAL] Yes, [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, the [PII], before [PII]. I'm writing this down.
[CUSTOMER][NEUTRAL] You remember my husband [PII]?
[AGENT][NEUTRAL] I do.
[CUSTOMER][NEGATIVE] Yeah, he passed away.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Miss [PII], I am so sorry. I know that's got to be so hard.
[CUSTOMER][NEGATIVE] Yeah, I lost my [PII].
[CUSTOMER][NEUTRAL] Yeah, I, I'm too.
[CUSTOMER][NEGATIVE] It is. That's why I'm having to do all this by myself. And I'm so confused. I didn't know the district had changed and I was getting ready to send some papers in.
[CUSTOMER][NEUTRAL] Some planes into your all, and I didn't know it had changed.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I am too. Yeah, just.
[CUSTOMER][NEGATIVE] He got sick and uh.
[CUSTOMER][NEUTRAL] You know, he couldn't fight it.
[AGENT][POSITIVE] Yeah. I just know that, I just know that y'all are gonna be together, you know, again one day and it's gonna be a beautiful reunion.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Yes it is. I thank you for telling me that because it will, you're so right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] It, it's so hard to lose a loved one.
[CUSTOMER][NEUTRAL] I don't wanna get too emotional on me.
[AGENT][NEUTRAL] Yeah, I hear you. I, I'm getting emotional too.
[CUSTOMER][NEUTRAL] Yeah, it is uh-huh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I know, I know.
[AGENT][NEUTRAL] But yeah, it's, it's.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] But I am so sorry to hear that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Now let me.
[AGENT][POSITIVE] And just know that you'll be in my heart and prayers.
[CUSTOMER][POSITIVE] Yes, thank you, thank you. Now what I wanna know, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Let me get on to it before I get too emotional here. OK.
[AGENT][NEUTRAL] OK, yes, ma'am.
[CUSTOMER][NEUTRAL] I have some, I have some uh.
[CUSTOMER][NEUTRAL] I want to ask you this. I have some papers that was [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's the skilled nurse. When the nurse came out.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I wanna, I don't think I ever got paid for that, so, can you check and see, did I get paid for that?
[AGENT][NEUTRAL] And that was for you?
[CUSTOMER][NEUTRAL] R
[CUSTOMER][NEUTRAL] Yeah, it was for me.
[CUSTOMER][NEUTRAL] And it's back in [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. I have all these papers in front of me, but before I send them to you all.
[AGENT][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] I wanted to know.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What I get paid for.
[AGENT][NEUTRAL] Let me pull this claim up. Looks like, and you said that was from [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me check this real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Jefferson County Home Health.
[CUSTOMER][NEUTRAL] Yeah, that's what it is.
[AGENT][NEUTRAL] And was that for your cancer diagnosis or specified disease diagnosis?
[AGENT][NEGATIVE] Because they denied that claim.
[CUSTOMER][NEGATIVE] I think it's for the cancer.
[AGENT][NEUTRAL] They said that the policy provides benefits for the treatment of cancer and specified disease only.
[AGENT][NEUTRAL] Benefits are not payable for any other disease is what they have on that claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we do have the claim on file.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For the SCA nursing.
[AGENT][NEUTRAL] Yes, ma'am. For um Jefferson County Home Health.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] I'm trying to get more information pulled up bear, bear with me just one moment. And of course my computer is just kind of going crazy, but that's OK. I'm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I, we're gonna get it looked up. Hang on just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me. I'm just checking one thing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, that was for like a tumor maybe in your liver or something?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, I had cancer on the liver.
[AGENT][NEUTRAL] 30. OK.
[AGENT][POSITIVE] You sound like you're doing good.
[CUSTOMER][POSITIVE] Yeah, I'm doing so much better. I got a liver transplant.
[AGENT][NEUTRAL] Did you
[CUSTOMER][NEUTRAL] I don't know if you remember that. Yes, and they got rid of the cancer. Huh?
[AGENT][NEUTRAL] I didn't remember that.
[AGENT][NEUTRAL] I, I didn't remember that.
[AGENT][NEUTRAL] And I tell you what I can do is I can get you to one of our adjusters to discuss this claim.
[CUSTOMER][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] And see why it's not why it's not payable. Would you like for me to do that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, but hold on a second before I get you off, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any other stuff.
[CUSTOMER][NEUTRAL] That I have like in August, July, and all that I could send that.
[AGENT][NEUTRAL] You can.
[CUSTOMER][NEUTRAL] Cause I know they, yeah. Do y'all still pay for therapy?
[AGENT][NEUTRAL] Let me see if I can get your policy pulled up.
[AGENT][NEUTRAL] I'm gonna pull up your policy certificate. It was that, was that after [PII]?
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] When was that? Let me look.
[CUSTOMER][NEUTRAL] Yeah, it was after the liver transplant. And then I had had an accident. I had an accident and I had to have therapy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that was not too long ago. That was uh, I'm trying to find the dates on here. They got everything but the date.
[AGENT][NEUTRAL] Hang on just a second. I'm looking.
[CUSTOMER][NEUTRAL] The they, I, I had it through Jefferson Home Healthcare too. I had my therapist through there too.
[AGENT][NEUTRAL] Is that for physical therapy or is that gonna be a chemo or immunotherapy?
[AGENT][NEUTRAL] Radiation.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No, wouldn't radiation.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It was a therapy, um, what's the other therapy, uh,
[AGENT][NEUTRAL] Immunotherapy or chemotherapy?
[CUSTOMER][NEUTRAL] No, um,
[AGENT][NEUTRAL] Hormone therapy?
[CUSTOMER][NEUTRAL] Physical therapy, physical therapy.
[AGENT][NEUTRAL] Physical therapy?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know y'all paid for it because y'all paid for it before.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm just pulling that up in the policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, physical, um, occupational speech or audio therapy is covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Physical and audio therapy.
[AGENT][NEUTRAL] It's physical.
[CUSTOMER][NEUTRAL] What you say now?
[AGENT][NEUTRAL] You have physical therapy, occupational therapy?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Speech therapy.
[AGENT][NEUTRAL] Audio therapy or psychotherapy is covered under your plan.
[CUSTOMER][NEUTRAL] OK. Psycho.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I know I have speech therapy.
[AGENT][NEUTRAL] So that is covered as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, I got to find those papers on there. I might have already gotten paid for it. I don't know. But I know I haven't gotten paid for this therapy, so I'm gonna send this in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] I know y'all don't pay for lab work, right?
[AGENT][NEUTRAL] Not unless it's like for the biopsy.
[AGENT][NEUTRAL] A biopsy uh for the pathology.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But you're right.
[CUSTOMER][NEUTRAL] What about injections?
[AGENT][NEUTRAL] You know what, that's a good question. Um, is it for the chemotherapy or or any type of treatment?
[CUSTOMER][NEUTRAL] No, it's like a treatment for for not cancer, for kidney.
[CUSTOMER][NEUTRAL] AC injection for the blood.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we, when, when, when I get you to that adjuster, I'm gonna ask her that question for you.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Alright, alright, now let me ask this before you transfer me over.
[AGENT][POSITIVE] And she can help you with that as well.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] When I do send in a claim, I already got my
[CUSTOMER][NEUTRAL] It's already on the computer and uh our email, but it's.
[CUSTOMER][NEUTRAL] My username.
[CUSTOMER][NEUTRAL] And password and everything. I put all that in and then I send that to you all.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm. That's right.
[CUSTOMER][NEUTRAL] But I sent it to y'all email, right?
[AGENT][NEUTRAL] You send it through that portal through that online service center where it says upload files that's where you'll upload the claim documents.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] OK, so when I send my send my password and everything, it will have that, right?
[AGENT][NEUTRAL] On your portal.
[AGENT][NEUTRAL] Yes ma'am, once you enter that username and password on our website, then you'll go down to where it says upload.
[AGENT][NEUTRAL] Files or file a claim, that's where you'll click on that and upload your documents.
[CUSTOMER][NEUTRAL] But I have to put in you[PII] website first, right?
[AGENT][NEUTRAL] Yes, ma'am. You would go to [PII].
[CUSTOMER][NEUTRAL] Oh, wait, wait a minute, wait a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, wait a minute, let me write that down.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Secure
[AGENT][NEUTRAL] Right, SEC.
[CUSTOMER][NEUTRAL] What is it?
[AGENT][NEUTRAL] You are ED secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I put that in, see, my husband used to do all this. I put that in and then, is he gonna ask me my username?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, once you pull that up it's gonna ask you for your username and your password.
[CUSTOMER][NEUTRAL] OK, OK, now I'll just secure [PII].
[AGENT][POSITIVE] Mhm. It's [PII] [PII], secured.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, I'll definitely.
[AGENT][NEUTRAL] Mhm. Go ahead.
[CUSTOMER][NEUTRAL] Secure. [PII].
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] It it's secure. [PII]. So it's [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, wait a minute. Let me, let me write that.
[AGENT][POSITIVE] OK, take your time
[CUSTOMER][NEUTRAL] Let me write that again. OK, start again.
[AGENT][NEUTRAL] Yes ma'am. It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. So it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] What else? That's it, secured [PII].
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Well, let's do it one more time. So it's.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] You
[AGENT][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. I got it.
[AGENT][NEUTRAL] Got it. Now, mhm.
[CUSTOMER][NEUTRAL] Secure [PII].
[AGENT][POSITIVE] Right, but it's secured.
[CUSTOMER][NEUTRAL] OK. I'm a little slow cause of all the medication.
[AGENT][POSITIVE] You are fine. You don't worry about that at all. You're fine.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII], and make sure that you put a [PII] in between the words secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And AM public, so secured. [PII].
[CUSTOMER][NEUTRAL] I got it.
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEUTRAL] And if it's easier for you, you can also fax those to our claims department if you have access to a fax machine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, let me have this back.
[AGENT][NEUTRAL] Our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] 877-365
[CUSTOMER][NEUTRAL] [PII] 3.
[AGENT][NEUTRAL] Yes, ma'am. That's for if you want to fax the claims to us.
[CUSTOMER][NEUTRAL] OK. OK. My friend is helping me, so she gonna scan them to you all.
[AGENT][POSITIVE] Oh, well, that would be nice. And that does go directly on your policy, so that's good.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] Yeah, yeah. It's faster if it's, if it's, if you send a client if you scan it, right?
[AGENT][POSITIVE] Yes, ma'am. It does get on your policy quicker.
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] Um, because, and you'll get a confirmation that it was uploaded successfully.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so all I have to do is look for the speech, occupation, physical.
[CUSTOMER][NEUTRAL] And audio, you do you have any way of checking to see what I already paid for this?
[AGENT][NEUTRAL] I tell you what, when we get you to that claims adjuster, she can check to see if those physical therapy benefits have been, she sure can.
[CUSTOMER][NEUTRAL] Oh, she can check, OK.
[AGENT][NEUTRAL] She can check all that with your claims.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, sounds good.
[AGENT][NEUTRAL] Now, before I transfer you, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] I think that's it. I think everything else she's got to help me with.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] As long as I got
[CUSTOMER][NEUTRAL] I have to give all this to my friend, how she got to load it up and everything and all that.
[AGENT][NEUTRAL] And I do see some claims that we.
[CUSTOMER][NEUTRAL] And so and he
[AGENT][POSITIVE] I'm so glad you've got somebody to help you. But I was just checking in your history. I do see some therapy that was covered in [PII].
[AGENT][NEUTRAL] Some physical therapy claims were covered.
[CUSTOMER][NEUTRAL] OK, OK. See, OK, so these I have is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I don't think I got paid for those.
[AGENT][NEUTRAL] I don't see anything for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So I don't think I got paid for those.
[AGENT][NEUTRAL] I don't think so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But we need to check on this home help for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yes, that's what I'm gonna get them when you switch me over. I'm gonna ask them about that and then um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think that's it. I just needed the
[CUSTOMER][NEUTRAL] Email
[CUSTOMER][POSITIVE] And everything so she could do this for me.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I think that's all I need.
[AGENT][POSITIVE] Well, it's been such a joy to speak with you again, Miss [PII]. And if you'll hold just one moment, I'll get an adjuster. And listen, you take one day at a time.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And everything's gonna be OK.
[CUSTOMER][NEUTRAL] OK, I will.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yes, yes, I'm trying, and look, I still have my son, you know, and uh, yeah, we have a.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] Oh good. There you go, and friends.
[CUSTOMER][NEUTRAL] Uh yes, yes.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And you've got us too.
[CUSTOMER][POSITIVE] And I I have a good church home. Yeah.
[AGENT][POSITIVE] You can't do without that church home now. You gotta keep that going.
[CUSTOMER][NEGATIVE] Oh no, you can't.
[AGENT][POSITIVE] Yeah I couldn't do it without it.
[CUSTOMER][NEUTRAL] Gotta keep it going, yeah, yeah.
[AGENT][POSITIVE] So for sure.
[CUSTOMER][POSITIVE] Yes, I can't neither. They were very, very good for me and still is.
[CUSTOMER][NEUTRAL] OK, at, uh, now.
[CUSTOMER][NEUTRAL] My last and final thing, everything before [PII] would be good for me to send in, right?
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][POSITIVE] OK. All righty.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right, if you'll hold just one moment, I'll get a representative to assist you with that claim information. And again, it's been lovely, lovely to speak to you again and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] OK, I thank you so much. I hope you have a wonderful day too. OK, alrighty, bye bye.
[AGENT][POSITIVE] Thank you, Mrs. My pleasure.
[AGENT][POSITIVE] Thank you. One moment, please. Bye-bye.
[CUSTOMER][NEUTRAL] Welcome, bye bye.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][POSITIVE] Hey, [PII], it's [PII]. How are you doing? Happy Friday.
[CUSTOMER][POSITIVE] I'm good, yes, ma'am. How are you [PII]?
[AGENT][NEUTRAL] I'm doing good, thank you. I need, um, I have an insured on the line and we were looking at a claim that was denied and not sure why it was denied, if you can assist us. Policy number 121.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] 1009.
[AGENT][NEUTRAL] I have Ms. [PII] our line on the line. I don't know, she's been with us forever and
[AGENT][NEUTRAL] I don't know if you recognize the name.
[CUSTOMER][NEUTRAL] I don't, but I might recognize once I get over there.
[AGENT][NEUTRAL] Yeah. Now, it's a cancer claim, but this is a home health and it is covered under her policy. And I looked at that diagnosis code, it looked, I mean, to me, it appears to be a cancer diagnosis.
[CUSTOMER][NEUTRAL] Oh yeah, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm not sure on this and if you can look at her. Well, wouldn't that help? I'm sorry.
[CUSTOMER][NEUTRAL] OK, which claim are we looking at?
[CUSTOMER][POSITIVE] Yeah it's OK.
[AGENT][NEUTRAL] It's 337.
[AGENT][NEUTRAL] 0727.
[AGENT][NEUTRAL] From [PII], [PII] Home County Home Health.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And if you can help her, she's very disappointed cause she just learned the school district is no longer with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] And if you can just kind of help her with that.
[CUSTOMER][NEUTRAL] Condition other than cancer.
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I'm a little confused about that as well.
[CUSTOMER][NEUTRAL] I mean, they even put a cancer diagnosis.
[CUSTOMER][NEUTRAL] Let me look it up just to confirm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He hepatoblastoma hepatoblastoma, I'm not really sure.
[AGENT][NEUTRAL] And it's due to her, she had liver cancer.
[CUSTOMER][NEUTRAL] Uh, how to say that
[AGENT][NEUTRAL] And it's like a tumor on the liver.
[CUSTOMER][NEUTRAL] Yeah, it's a rare malignant liver tumor.
[CUSTOMER][NEUTRAL] Most common in children, so it's definitely rare for her.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] [PII] County Home Health.
[CUSTOMER][NEUTRAL] Physical therapy and skilled nursing admission.
[CUSTOMER][NEUTRAL] Post concussional syndrome.
[CUSTOMER][NEUTRAL] Anemia.
[CUSTOMER][NEUTRAL] So on her.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I kidney disease on her, her billing statement.
[CUSTOMER][NEUTRAL] For.
[CUSTOMER][NEUTRAL] The health care, the skilled nursing.
[CUSTOMER][NEUTRAL] The cancer diagnosis is not listed.
[AGENT][NEUTRAL] So why would it be on the plane? I'm sorry.
[CUSTOMER][NEUTRAL] It's state
[CUSTOMER][NEUTRAL] No, yeah, no, that's a valid question. um, so the very first diagnosis and the admission diagnosis state post-concussional syndrome like she's.
[AGENT][NEUTRAL] Fallen
[CUSTOMER][NEUTRAL] Fallen maybe and got a concussion, um.
[CUSTOMER][NEUTRAL] That's also listed like her cancer diagnosis is not why they listed it on there. I don't know they shouldn't have they should have listed the actual diagnosis codes provided.
[CUSTOMER][NEUTRAL] Um, because that is why. So if she has medical records that indicate that she was there for cancer-related services, we're going to need those because that is not indicated in her diagnosis codes. It says that she has a history of liver cancer, but it is not indicating treatment for her cancer or care because she's in, you know, the ending stages where her life.
[CUSTOMER][NEGATIVE] You know, unfortunately is being affected to the point she can't take care of herself because of it. That is not indicated anywhere. It just says she has a history, but she's there for post-concussional treatment.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Can you
[CUSTOMER][NEUTRAL] Which is more accident related.
[AGENT][NEUTRAL] Yeah, can you discuss that with Miss [PII]? She'll um
[AGENT][NEUTRAL] That way, cause I don't know if this was post-transplant or pre-transplant.
[AGENT][NEUTRAL] I don't know how that affects anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It, uh, does that, do you know if that does affect anything? I mean,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, so if they go into a skilled nursing or something like that after they've been admitted, um.
[CUSTOMER][NEUTRAL] And it's because they're recovering, yes, however, the diagnosis codes would indicate that a concussion is not going to have anything to do, to my knowledge again, unless her medical records from her admission into the skilled nursing facility state.
[CUSTOMER][NEUTRAL] That this is kind of all the result of whatever um but as as indicated it's strictly for a concussion.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Well, if you.
[CUSTOMER][NEUTRAL] That she's just needing the additional care.
[AGENT][NEUTRAL] OK, if you don't mind discussing that with her that way if she has any further questions.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Would that be OK? I appreciate it, [PII]. Let me, let me get her on the line and I verified all of her information.
[CUSTOMER][POSITIVE] Yeah, that's fine, no problem.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], thank you. I was, uh, we have [PII] on the line with you and she's going to assist you further. I was letting her know, um, regarding that claim that we were wondering why that was denied and you needed further information, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Thank you, ma'am.
[CUSTOMER][NEUTRAL] OK, so she's gonna talk to me?
[AGENT][POSITIVE] She is gonna talk to you, yes. Yes, ma'am.
[CUSTOMER][NEUTRAL] Ma'am, she's gonna talk to.
[CUSTOMER][NEUTRAL] I just need to stay on the line.
[AGENT][NEUTRAL] Yes, ma'am. She's on the line with us now. I was just explaining what you were needing.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Oh, OK. Listen, I thank you so so much. OK. OK.
[AGENT][POSITIVE] Such a pleasure to talk to you again, Ms. [PII], and you have a lovely afternoon.
[CUSTOMER][POSITIVE] It's a pleasure talking to you too and thank you so much for everything and you have a good day, the rest of the day.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] You too. Thank you, [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, alrighty, bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Hi, Miss [PII], how are you? OK, how about you?
[CUSTOMER][NEUTRAL] I'm doing well. My name is [PII]. I'm with the claims department, um, and so I was taking a look at your claim and I see that they denied it as, um, they put your cancer diagnosis but they denied it as the service is not being cancer related so I went to the documents that we received because that was a little confusing.
[CUSTOMER][NEUTRAL] Um, and it looks like the treatment, all the bills that we received indicate that it was treatment for a concussion that you were admitted due to post-concussional care.
[CUSTOMER][NEUTRAL] Oh no, that's the
[CUSTOMER][NEUTRAL] That was when I fell. When was that?
[CUSTOMER][NEUTRAL] Um, this looks like it was July through.