AccountId: 011433970860
ContactId: 987c776c-3878-401e-b53f-7034672433e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1632719 ms
Total Talk Time (AGENT): 642197 ms
Total Talk Time (CUSTOMER): 1071845 ms
Interruptions: 26
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/987c776c-3878-401e-b53f-7034672433e3_20250507T21:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hi [PII], um, this is [PII]. Um, I have the power of attorney for my son who has coverage with you guys. Um, I just found out today that he had this coverage through his HR person at work. I tried to register him through the website and it's not finding him, um, so it's just call.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] Yes, so the information that's entered, it does have to match what we have in our system. Um, 9 times out of 10 it's uh email they're using like a different email or something like that, uh, but we can go ahead and get that pulled up and just verify that what we have is correct, um, [PII], before we go any further, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Thank you. Do you have that policy number?
[CUSTOMER][NEUTRAL] I do. It is.
[CUSTOMER][NEUTRAL] 02589516
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] I was asking her for a breakdown because he's on leave from work of his um how you know how his insurance premium is working and that's how I found out that I was like, what is, what is this? I didn't even know he had this. He's been critically ill since January. He's had a liver transplant and he is going to need a kidney transplant. He's on the list for a kid, yeah, and so I just found this out and I'm like.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][POSITIVE] Definitely. OK.
[CUSTOMER][NEUTRAL] I was like, OK, we might have some additional help here that I didn't know we had.
[AGENT][POSITIVE] No kidding.
[AGENT][NEUTRAL] OK, um, [PII], I'm sorry, I think I might have misheard that policy number. Would you mind repeating that for me?
[CUSTOMER][NEUTRAL] Sure it's 02589516 and also have the group and the payer ID if you need that if that will help you.
[AGENT][NEUTRAL] OK, um, what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Um, it's [PII], [PII].
[AGENT][NEUTRAL] OK, so this policy number that you gave me is giving me someone else entirely, so it's a completely different number. Um, let's see, uh, I can search using his social if that's easier.
[CUSTOMER][NEUTRAL] I wonder if she, I I wonder if she gets.
[CUSTOMER][NEUTRAL] Yeah, it's um [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I wonder if she must she typed this to me in an email if she got the wrong. I wonder if she hit the wrong key.
[AGENT][NEUTRAL] It might have just been something.
[AGENT][NEUTRAL] Yeah, let's take a look here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh what did you say his date of birth was? I'm sorry.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, OK, I did find it, um, let's see, looks like.
[AGENT][NEUTRAL] It is
[AGENT][NEUTRAL] [PII]. OK, so the last digit, the [PII] is supposed to be a 7.
[CUSTOMER][POSITIVE] [PII]. OK, got you, thank you.
[AGENT][NEUTRAL] Yes, it's usually something small like that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] So I understand that you are power of attorney [PII] however we don't have any information regarding that so unfortunately I won't be able to go into any specifics regarding the policy um let me see.
[AGENT][NEUTRAL] Oops
[CUSTOMER][POSITIVE] Am I able to send you guys that information so that you, I mean, he can talk to you. He's available. He's, he's on dialysis 3 days a week, so basically he's either at dial or not feeling well, um, so I usually handle this stuff for him. I'm happy to I've got it to you.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEGATIVE] Uh, poor guy.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Um, I just wanted to see because she was, because I, she said, I said, well, can you explain to me how it works? And she goes, well, she goes, you're supposed to present it with their card. I was like, well, we haven't been doing that, um, and she said, based on what I've seen, they don't pay much. She goes, she's had a lot of health issues herself, I guess this year that was just, she goes, but here's the number and you can call. I was like, OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I will say
[AGENT][NEUTRAL] Yes, uh, we have these secondary medical policies. They are all very different, so some people might have a benefit of, you know, up to $1000 a year, some have benefits up to $1000 a day, um, so they are all very, very different as to how they work and how much is covered. um, I will say without, you know, of course disclosing anything, um, that when you go to create the account first of all, uh, the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Spot that mentions a member ID or a social you would put in his social um the member ID is not the policy number um is this policy doesn't have a member ID, so that would be the social there um I'll also say that the email address 9 times out of 10 is who their employer like through their employer.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To do that.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Oh, OK, got you. I'll have to ask him because I've only got his personal one. I don't know if he has one unless it's some Commonwealth restoration specialist is who he works for, but um.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Um, anyway, the, the paper that I have about once she told me that they had it, I went back and dug through employee benefits, you know, thing, and he says, and I, I'm not great at interpreting these things, but his says 2000.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Outpatient
[CUSTOMER][NEUTRAL] Under deductibles and then 2000 inpatient and then family 2X co-insurance, 2000 outpatient, 2000 inpatient. Um, same for out of pocket limit and then um.
[CUSTOMER][NEUTRAL] Something it's really basically every blank, every, every block that has like lab imaging emergency room, it all says that same thing of outpatient. So would that be 2000 outpatient per year and 2000 inpatient per year? Is that how I should interpret that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I, yes, most likely, um, I've only ever seen a few policies that are have the per day, um, this one is most likely per calendar year and as it is just again I'm sorry if this is repeat information but just so that you are aware um how this policy works is as it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Secondary medical it is first and foremost very dependent on his primary medical, so this policy cannot pay unless his primary does, and then from there it is designed to help with co-pay, deductible and co-insurance after primary pays.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh yeah, they've been billed about $1.6 million this year from what I can tell.
[AGENT][POSITIVE] Well yeah well I hope they pay a good chunk of that um I will also say um for you know anything in the past, uh, there's no timely filing limit for getting claim information to us. So while of course I understand you want bills paid, um, you don't have to worry about getting anything to us really quickly or within a specific time frame you could do it at at your convenience.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To like
[CUSTOMER][NEUTRAL] Got you. OK, so if I wanted to send you the power of attorney so that you can discuss it with me, how would I, who would I send that to?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So I've got an email address, fax number, and a mailing address I can give you.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Email would probably be best. I can just shoot it right over.
[AGENT][NEUTRAL] Yeah, that would be pretty quick um OK let me know when you're ready for that.
[CUSTOMER][NEUTRAL] Let me, let me put this in here, um.
[CUSTOMER][NEUTRAL] And should I reference his um his the number that you gave me that ends in 7?
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] OK, just so I know how you can find out who who we're talking to.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK, what's the email address?
[AGENT][NEUTRAL] OK, so that is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], so [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] Alternately, because I'm not, I'm gonna be completely honest with you, [PII], I'm not quite sure with power of attorney, I know that does have to go to a like legal review. I don't.
[CUSTOMER][NEUTRAL] Uh where's
[AGENT][NEUTRAL] Imagine it would take very long, but I also know that there is um if uh [PII] is up to it there's a form that he can fill out it's not very long at all and it's essentially a third party authorization form so if he completes that with your information, same thing, you can just email it right to that email then we'll have your information on the policy and we'll be able to disclose anything and everything with you without need for his permission.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. So should I, OK, let's see.
[CUSTOMER][NEUTRAL] I have to ask him if he has a work email address. Um, are you seeing something that looks like a work email address in the system? Like he, he works for, um, it should say some.
[AGENT][NEUTRAL] I can't disclose that, Ms. [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] Um, I understand there's a lot of rules and regulations because his um.
[CUSTOMER][NEUTRAL] His benefits lady sent me uh where is it?
[CUSTOMER][NEUTRAL] I don't even remember hers. I always have to look it up. Telegram. Let's see [PII], where are you?
[CUSTOMER][NEUTRAL] Silly, let's see, she's got, I, you know, it's so, yeah, they're [PII]. So but I don't know, he may not even know if he has, if it is, I would think it's just his name, so I'll, I'll probably see if it works.
[AGENT][NEUTRAL] I understand. I'm sorry it's frustrating. Um, if you could get that that form to us soon or if there's an opportunity where, um, email could give just like verbal consent over the phone, it would only be good for that single phone call, um, but we can then, you know, of course verify his info and then ask if it's OK to talk with you then we can for the duration of that call.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] And he's also ah.
[CUSTOMER][NEUTRAL] He must because it let me in. OK, I'll figure it out. OK, I'll, I'll talk to him more about it and I'll set up.
[AGENT][POSITIVE] Good awesome.
[CUSTOMER][NEUTRAL] Uh, so can we get um
[CUSTOMER][NEUTRAL] So by registering him in here, um, is there, because we don't have a word for this. they Centerra Healthcare is Centera Health Systems or whatever is in their primary. So that was sent and he, he went into the emergency room on [PII] and have had a renal failure. He was a critical condition. And I did not.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That the company had changed insurances and so he had been under medical care since like October. The company told him just hey, just keep using your old card, which was a different company so you get your new card. Well, you wouldn't believe what kind of horrible that cause because here you.
[AGENT][NEUTRAL] Oh, I can't imagine.
[CUSTOMER][NEUTRAL] you know, he, he's, you know, had emergency, he had dialysis within hours of being admitted. His kidneys were completely shut down. So, so, so they, the hos I was out of the country. He's not married, so they used the insurance information they had on file in in the HCA health system already because that's where he was in October. He was sick so.
[AGENT][POSITIVE] Wow. Oh my gosh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I didn't find out. In fact, everything including his transplant was filed with healthkeepers, and they weren't even his insurance anymore. Now, mind you, all the.
[AGENT][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] You know what that's like, so he's in the hospital. He's in the ICU. This was moved to another hospital, the transplant center, um, and but they're in constant communicate, you know, you can't just have somebody in the hospital and not communicate commating with insurance, you know, everything.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Especially a liver transplant, OK? Just even put him on the right? I have got EOBs, I mean like 3 inches worth of where healthkeepers said they were.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEGATIVE] And then they took it back and then it had to be refiled with the new carrier and then today I found out he has this other little gap I'm like oh my gosh but you know this is what happens when you know I had all of his we had to move him out of his place he moved moved him just had to move him out while he was in the hospital because he was not gonna be able to go back to his his apartment.
[CUSTOMER][NEUTRAL] And when he got out of the hospital in March, he moved in with us and will be with us until he's able to live on his own. So I mean I've had all forwarded here so I'm getting things and a few weeks into his hospitalization, finally I was like, son, I got this thing out of your mail and it's your insurance. It says that I'm like you have ants on healthkeepers, he goes, oh that must be the new one. I'm like, what new insurance? So I was like, oh you, I mean.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] I will say in his defense, I in his defense, I will say we get a number I mean you would be surprised at how many calls we'll get of people that will have active insurance with us for years and they'll say they've never even realized that they had this and you know my only thing is maybe the employers just aren't communicating that very well, but.
[CUSTOMER][NEUTRAL] But he was literally.
[CUSTOMER][NEUTRAL] To tell anybody
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Really?
[AGENT][NEUTRAL] It certainly happens quite a bit.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] The lady who she is a lovely person, but I think um.
[CUSTOMER][NEUTRAL] You know this is a this is a crew of guys who do restoration and moving and stuff right so if you have a fire or a flood in your house, that kind of stuff, so I think.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, yeah.
[CUSTOMER][NEUTRAL] Is that this little gal.
[CUSTOMER][NEUTRAL] She didn't understand much about it, admittedly and so I think they had somebody come from, you know, the a benefits, um, ambassador type person [PII] from the company, right? They.
[AGENT][NEUTRAL] Mhm, yeah, yes.
[CUSTOMER][POSITIVE] He was there. And then you got all these young men who are probably between 20 and 40. And then my son was really sick and figures, you know how they are, it's like, hey, you guys gotta come in early, like 45 minutes early today, we're gonna have the benefits will come.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] He heard that and then uh he actually wasn't well when that person was there and then proceeded to go into the hospital shortly and I think he like all these kids are probably thinking they're gonna send me this stuff in the mail so I'm gonna get it. I don't really need to really understand it and also being like like all this stuff he's never been sick in his life. The the first surgery he had was a liver transplant, you know, he's never been.
[AGENT][POSITIVE] Right, yes, exactly.
[AGENT][NEGATIVE] Oh, that's awful.
[CUSTOMER][NEUTRAL] So you know, I know he was probably sitting there going, OK, well I'll either ask my mom or you know when the stuff comes because I usually will help him pick out his benefits, you know, if it anything changes every year enrollment he's like what should I pick, you know, because that's, um, he was a healthy guy, uh, or so we thought, um, and so, you know, I know he probably just it didn't even register with him that he needed.
[AGENT][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Sir,
[CUSTOMER][POSITIVE] To understand this stuff and now, so here we are. So it doesn't look like it's probably gonna be a ton, but any, every little bit will help. So.
[AGENT][POSITIVE] Yeah, absolutely.
[AGENT][NEUTRAL] Absolutely. Yes, definitely. That is for sure. Um, I'm trying to think anything else. I mean, obviously, you know, with, it's already a terrible and stressful situation and, you know, tacking on confusing insurance and hospitals and stuff on top of that. That's just uh the house on fire. Um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Really, so that's what we'll definitely do whatever we can to help, um, oh there was something else I was gonna tell you while you're on the phone. Oh, just so that you are aware as well, um, while I've got you, um, on the website if you were to submit claim information there which I do recommend that's gonna be the quickest and easiest way to get claim information to us, um.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It it would have to be done on a desktop or a laptop computer uh it does not have at this time our website doesn't have support for mobile devices just so that you know.
[CUSTOMER][NEUTRAL] Um, yeah, we have, we're, we're good on that front. One question, so you have him in there under his business email. Am I able to change that to his personal email when I create the account?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I don't, mm, I don't think so. I think it would have to be he would have to call us and change it, um, because again that information matches what we have in our system, so I don't think that's something that can be edited on that end.
[CUSTOMER][POSITIVE] OK, before I set it up this way, I need to ask him with because we ended up giving them his work phone and his tablet just because he's on leave and we're not sure when he's gonna be able, he's, you know, gonna be able to come back. They have been wonderful. They love him. They're like, your job is here when, when you want, you know, in fact, he went by there last Friday and had a little visit on his way to dialysis, but um.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh, that's, that makes a huge difference.
[AGENT][NEUTRAL] Ah
[CUSTOMER][MIXED] So yeah they've been terrific but um I don't know if he got to that email without his company devices so I'm gonna wait till he he's sleeping yeah so I.
[AGENT][POSITIVE] That's awesome.
[AGENT][NEUTRAL] Oh, I see that is perfectly fine, yes, and that's always something that can be changed later but yeah definitely uh no rush um if you were to, of course you know send us that power of attorney information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you go on our it's it's not the portal it's uh our public website so it's just [PII], not the secured in front there's a spot that has all of our different forms and right up at the top it'll say authorization form and again that's something he could fill out with your information, send that to us that that will I'm guessing it will probably process much quicker than the power of attorney information just so that we can discuss this information with you freely without having to bother him.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got you. So is it, let me make sure it's I've got the right, so I put in AM public. This is the first name was [PII] Public Life, is that it? [PII]?
[AGENT][POSITIVE] That's it, yes ma'am.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Got you. OK, I'll print and then tomorrow he doesn't have dialysis, so we'll, um, we'll work on this when he's because he had dialysis today and he's kind of like taking a nap. So, um, we'll, we'll work on, um, tomorrow and, um, to see if we can because I mean he's got, I mean you can only imagine, I mean even we got an I got an ambulance bill for him.
[AGENT][NEUTRAL] Sure.
[AGENT][NEGATIVE] I bet, poor guy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] They literally moved him from one hospital to the next. It was at [PII]. I was there when they packed him up, so he had to be monitored because he was in the ICU at that time. Um.
[CUSTOMER][NEUTRAL] It was about
[CUSTOMER][NEGATIVE] Not even 10 miles. I think it was 8 or 9 miles possible hospital.
[AGENT][NEUTRAL] Oh gosh.
[CUSTOMER][NEUTRAL] It was like over $2000 and I'm like I get it.
[AGENT][NEUTRAL] Wow. Seriously?
[CUSTOMER][NEUTRAL] Fi
[CUSTOMER][NEUTRAL] Yeah, we had that, you know, skilled paramedics because he was, you know, he had multiple lines. He had a central line in his neck. He had peripheral IVs, he had to be monitored the whole.
[AGENT][NEUTRAL] Well, sure, and it's definitely worth the risk, but man, that's a pretty penny.
[CUSTOMER][NEUTRAL] Yeah, but
[CUSTOMER][NEUTRAL] It's like
[CUSTOMER][NEUTRAL] Yeah, it was like $2200.
[AGENT][NEUTRAL] Yikes.
[CUSTOMER][NEUTRAL] And I don't even know honestly.
[CUSTOMER][NEGATIVE] and I said, Hey, here's his insurance and they said we'll refile it. It'll be because it was filed, you know, they didn't have the correct insurance. They said everything I do that 30 days, 30 to 45 days. So I don't even know what they're gonna pay. I mean, it's, I'm getting a lot of this has been resubmitted or the provider's been told that they basically did it wrong and they're having to redo it.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] Yeah, I get a lot of denied this was covered under the global transplant fee. So I mean how this is gonna shake out at the day I don't know because I guess when you have a transplant, there's agreed upon fee for all of the everything that goes along with it I guess with, with the carrier. So I'm waiting for the final, the real bills to like shake out, you know, because um.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Uh,
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] It's, it's such a mess, especially because a lot of stuff got filed.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Absolutely and then like you said it's all these separate bills for these different little things and.
[CUSTOMER][MIXED] OK, but I can't imagine that.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I say little, but you know.
[CUSTOMER][NEUTRAL] Yeah, oh, in the end the group, yeah, the user group, the gastroenterologist, the nephrologist, the hepatology group, intensive medicine, so many players, it's, it's, it's crazy, but the, the really
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] boggles my mind is.
[CUSTOMER][NEUTRAL] Before he could be put on the transplant list, insurance had to approve it. The minute they called and gave his member ID for Anthem.
[CUSTOMER][NEGATIVE] I cannot believe they didn't say he's not active, but they didn't and they approved.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I didn't find out that his insurance was not what I thought it was until he got discharged home on the [PII] or or maybe it was the [PII] right at the end of February.
[CUSTOMER][NEGATIVE] We were only home 2 days. We had to go back to the hospital. When we went back in, the nurse called and said, Nope, his blood work is off the charts. You gotta bring him back. I was like, Oh my God, you're kidding. We've been in the hospital for 2 months. You could come to the emergency room. I was like, Oh, you're killing me here, lady. 7 o'clock at night in a level front center.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Oh yeah
[CUSTOMER][NEUTRAL] So when we got to the emergency room and they they went and they were registering him.
[CUSTOMER][NEGATIVE] They are the ones who figured out that they had the wrong insurance information after 2 months. How does that happen? How does the answer?
[AGENT][NEUTRAL] That is insane, yeah, that's right. I mean that's the first thing I mean you know if we if somebody calls about a policy we see a big old A for active or a big old L for lapsed, you know, it's like it's right there so I don't big company like them that is very shocking.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] My sister-in-law works she worked for Anthem for 20 some years, and I told her what she's like, I don't understand how that could happen. I said, well, yeah, not only that, but the fact that there I've seen all the research contacts to healthkeepers because I got the, yeah, we've recertified you for 5 additional days, 3 additional days, 2 additional, you know, all those that they do, they, they were recertifying him.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] As eligible, so I don't know what it's a mess, but I, she just said I would just.
[AGENT][NEGATIVE] 00, that is a huge mess. I am so sorry.
[CUSTOMER][NEGATIVE] Well she just said, you know what? I said, what would you do? She goes, frankly, I'd stay out of it and let the hospital and the two insurances until they ask for your help or reach out to you because clearly they're working on it because then I started to get EOBs from his new company.
[AGENT][NEUTRAL] That's true, yeah.
[CUSTOMER][NEUTRAL] She said, she said, I would stay out of it until they reach out to you and say, hey, X, Y and Z. She goes, otherwise, she goes, it helps [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] [PII] is probably gonna have to reimburse them.
[AGENT][POSITIVE] Yeah, and that's that's a good plan because that's a lot less stress on you. I know you're probably still stressed as I'll get out, but that's a lot less for you to have to worry about and obviously the hospital is gonna be on top of that because you know, they want their money, so you can trust them to get get their money.
[CUSTOMER][NEUTRAL] But you know there's uh.
[CUSTOMER][NEUTRAL] Oh [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Can you imagine being the housekeepers' associate that approved a liver transplant for um a patient that's no longer active in with your policy and then what happens when when [PII] says um excuse me, we didn't approve this $1.3 million surgery.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, I
[AGENT][POSITIVE] Exactly, like that is not a small thing, like at all, that is huge.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] My goodness.
[CUSTOMER][NEUTRAL] Yeah, so I don't know what what all happened.
[CUSTOMER][NEUTRAL] But he is completely, you know, now he's an end stage renal disease so that automatically qualifies him for like Medicare, which I don't even know how that all works out, but um.
[AGENT][POSITIVE] Oh, that's wonderful.
[CUSTOMER][NEGATIVE] Yeah, so I don't know how that happens, how that coordinates with your regular insurance when you have employer insurance, but that, that's a do not pass.
[AGENT][NEUTRAL] I think it goes, uh, yeah, I, I, from my understanding it's like 3rd on the totem pole, so he's got his major, then he's got this one, the secondary, and then after that I believe is uh gonna be the Medicare.
[CUSTOMER][NEUTRAL] Like supplemental or
[AGENT][POSITIVE] So that should help quite a bit.
[CUSTOMER][POSITIVE] Yeah, so they literally, yeah, so they just changed the status to end stage renal disease. So, um, that changed the social worker called me today and she goes, yeah, this changes everything. She goes, we will help you. It's complicated, uh, you know, like, OK, I'm gonna need your help because.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right now my head is is pretty much spinning.
[AGENT][MIXED] Complicated is the about the nicest word I'm sure for what this whole mess is.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] We're very lucky that we've had.
[CUSTOMER][POSITIVE] Such kind
[CUSTOMER][NEUTRAL] Everyone providers, um, social workers for transplant for the dialysis center, I mean, you name.
[AGENT][POSITIVE] Yeah, well, and like you said, his employers, um, I mean that, that alone makes a world of difference, just having that, you know, obviously they really care about him, that, that means a lot. I'm sure it means the world to him.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] They came and visited him in the hospital and I mean, he had all kinds of
[AGENT][POSITIVE] Oh, that's so sweet.
[CUSTOMER][NEUTRAL] Yeah, they were calling me that um.
[CUSTOMER][POSITIVE] The owner of the company and his wife came to visit some of his coworkers. I mean, I mean we were just blown away by how much emotional support he had from from his work.
[AGENT][POSITIVE] Oh, I love that, yes.
[CUSTOMER][POSITIVE] You know, so and they, I had not met, you know, he's an adult, so I had not met any of his work people, you know, so I, I, when I finally did, they were like, oh, we just love [PII] we're, you know, his job is here when he can come back and so he's very blessed to have the support with this job.
[AGENT][POSITIVE] That's wonderful.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Oh, that's so, I love that, yes, absolutely.
[CUSTOMER][POSITIVE] Yeah, so many, so many places are just kind of like, OK, well, good luck to you, yeah, they won't work like this, so we're, we're very lucky. Well, I don't wanna hold you up, but I really appreciate your help, and when he's up and out tomorrow, we'll, we'll get on and work on this and get him all registered.
[AGENT][POSITIVE] Yeah, exactly.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] You are perfectly fine.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Absolutely. I sure hope he gets to feeling better soon and it's just gets to smooth sailing for y'all.
[CUSTOMER][POSITIVE] You, I appreciate it. You have a good night.
[AGENT][POSITIVE] Yes sir, you too, [PII]. Thank you. Bye bye.
[CUSTOMER][POSITIVE] All right take care bye bye.