AccountId: 011433970860
ContactId: a02c065e-c68a-4204-ad6e-d00a48b1312d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1927479 ms
Total Talk Time (AGENT): 880733 ms
Total Talk Time (CUSTOMER): 731134 ms
Interruptions: 9
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/a02c065e-c68a-4204-ad6e-d00a48b1312d_20250116T20:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, uh, [PII]. My name is [PII] and I previously had a plan with you guys, but you know how you have to update your plan, your annual uh benefits in November.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And I have not received anything, so if I give you my policy number, could you let me know if I'm still active or.
[AGENT][POSITIVE] Certainly I'd be happy to look at that information, Miss [PII]. Can I have your call back number first in case we get disconnected and I can call you back.
[CUSTOMER][NEUTRAL] What I need to do. OK.
[CUSTOMER][NEUTRAL] Sure, my callback number is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's that policy number, please?
[CUSTOMER][NEGATIVE] I have, I have several with you guys. I have cancer uh hospital and density, and then, then I can never take this flight.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Indemnity, uh huh, got you.
[CUSTOMER][NEUTRAL] Indemnity program and life insurance. So the indemnity uh policy number is 18.
[CUSTOMER][NEUTRAL] 35786 because I'm assuming the number don't change, right?
[AGENT][NEUTRAL] Not usually, um.
[AGENT][NEUTRAL] If you start and stop coverage, um, sometimes that might, you know, give you a new policy number, but um.
[AGENT][NEUTRAL] It should remain the same. Yeah. OK.
[CUSTOMER][POSITIVE] No, I never stopped. I just wanted, yeah, I just did my renewal, yeah, and I just wanna make sure that my employer, well, for one, our HR person is no longer with us. So I wanted to just follow up to make sure I'm still active and everything is good.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, certainly I can help you with that. So go ahead and um I'll have you verify some information, verify your date of birth please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and then that last piece of verification, your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, thank you for verifying that. OK, so let's take a look here and see, so you're just wanting to make sure that your policies are still all active, is that right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am, and I have some claims to submit, and I wanted to ask about those cause I had to do physical therapy and they just gave me a list of the dates, but I'll go into that once you check to see if everything is still good.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do show the policies are active. I show you have 4 policies with us, um, and you also have a disability policy. Um, and I do show that those policies are all currently active.
[AGENT][NEUTRAL] Um, and right
[CUSTOMER][NEUTRAL] Oh, so the disability, I upgraded that. So it's supposed to, instead of having to wait like 14 days or something like that, I think I uh.
[CUSTOMER][NEUTRAL] I think I updated that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need me to check on that?
[CUSTOMER][POSITIVE] Yes please and thank you so much. I really do appreciate it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Certainly, OK, so let me.
[CUSTOMER][POSITIVE] I, I'm just making sure I have everything.
[AGENT][NEUTRAL] I got you. I understand.
[AGENT][NEUTRAL] OK, so I'm looking at that disability policy now, so bear with me for a.
[CUSTOMER][NEUTRAL] Can I get the number too? The number for the disability policy? OK.
[AGENT][POSITIVE] Sure, absolutely.
[AGENT][NEUTRAL] Yeah, let me just pull that up here, um, and just let you know it is a verification of your coverage, not a guarantee of payment, so I do show that you have that, uh, disability policy. I'm showing that it's elimination period of 14 days, is that what you're saying you switched to?
[CUSTOMER][NEUTRAL] No, I updated it to the other plan. I thought, like, where you don't have to wait for 14 days.
[AGENT][NEUTRAL] Yeah, that's what this is the elimination period's 14 days, meaning that if you have to, um, if you are, uh, have to file a claim and you file a claim with us, it's eligible after you meet that 14 day elimination, meaning that you have to be out for 14 days and then your, your benefits would, uh, your, your benefits would be active after that 14 days.
[CUSTOMER][NEUTRAL] Right. I thought.
[CUSTOMER][NEUTRAL] Right, I understand, but I thought I had switched that policy. I thought I had switched because we did everything online. I wasn't really feeling real good about this. We did everything online, but I, I wanted it where it went into effect. I wanna say day one, I'm not for sure. There's another policy that you guys offer and it's not the 14 day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, I do show that it's not.
[AGENT][NEUTRAL] If it did update.
[AGENT][NEGATIVE] I'm showing it in the system it's still saying the 14 days so if you applied for a different or if you upgraded it, I'm not showing that here and you said that would have been at the beginning of this year?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, no, we did our renewal in November. Hold just a moment please.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you for holding.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so I do show that um this policy went into effect. It's [PII], so I don't show that it changed as of [PII] if you did change the plan.
[AGENT][NEUTRAL] Um, you may need to reach back out to human resources and, and let them know that you thought you changed the plan, so there's nothing I can do unfortunately for that, um, on my end, but you wanna definitely give your human resources contact, um, get in contact with them and be sure that you're signed up for the correct plan and that you're paying for the correct plan.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] OK, because we're not, we don't have a human resource person, so I'll follow up with them to see um what else do I have. So for the disability policy number, what is that policy number?
[AGENT][NEUTRAL] For the disability that policy number is gonna be 02.
[AGENT][NEUTRAL] 45
[AGENT][NEUTRAL] 54
[AGENT][NEUTRAL] 62.
[CUSTOMER][NEUTRAL] So that's 02455462, is that correct?
[AGENT][NEUTRAL] That's right, mhm, 245-546-2, the 0 in front, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you check my uh cancer plans to see if that changed or if that's still the same?
[AGENT][NEUTRAL] I don't see any changes on any of your policies.
[CUSTOMER][NEUTRAL] Ha.
[AGENT][NEUTRAL] Um, let me check that to be sure, though. Just bear with me for one moment. I'm gonna go into each plan.
[CUSTOMER][NEUTRAL] Oh, that.
[CUSTOMER][NEUTRAL] OK, maybe they left everything the same. I don't know.
[AGENT][NEUTRAL] It appears that way. I don't see that anything was changed, um.
[CUSTOMER][NEUTRAL] And um what
[AGENT][NEUTRAL] And do you, do you know which plan you signed up for or you try to change to?
[CUSTOMER][NEUTRAL] I'm gonna try to look online and try to contact the insurance people that's over our our insurance coverage and see if they can help me. I wasn't feeling real good about it because for one, we did everything online and we didn't get an email stating what we had, so I didn't feel real good about that, but at least I still have the policies in place. And my other question was, um, if
[CUSTOMER][NEGATIVE] My husband is a current cancer. Uh, he was diagnosed with cancer last year.
[CUSTOMER][NEUTRAL] Does his benefits start over? Like, you get a certain amount of money when you go to, does it start over every year or if it's just a one time, once you use it, that you can no longer use it?
[AGENT][NEUTRAL] I believe it's based on that diagnosis. So if there's a an additional diagnosis for cancer, um.
[CUSTOMER][NEUTRAL] Not additional. It's the same diagnosis. Yeah, so they pay you, they pay you so much for chemo. Does that start over?
[AGENT][NEUTRAL] It's the same, yeah. So I don't believe.
[CUSTOMER][NEUTRAL] Is it quarterly or annually? Cause I know it's like, I think it's once, I thought it was once a year.
[AGENT][NEUTRAL] OK, let me take a look here.
[CUSTOMER][NEUTRAL] Cause once you meet, once you meet the max benefits, that's it for that year. My question is, does it start over for the following year?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so I know the diagnostic and the prevention benefit does um and as far as that cancer screening, that does um start over from the next plan year. um.
[AGENT][NEUTRAL] Now as far as the.
[AGENT][NEUTRAL] Treatment. Let me just take a look here.
[AGENT][NEUTRAL] OK, and as far as the uh radiation and chemotherapy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It does say it is payable during that 12 month period that you're receiving the radiation, chemo, or immunotherapy. A 12-month period begins on the first day the covered person receives that radiation therapy, chemotherapy, or immunotherapy.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so that means that it starts over then I guess if you need to, cause I think that's.
[CUSTOMER][NEUTRAL] Yeah, I think I submitted his claim.
[CUSTOMER][NEUTRAL] Mm April. So I guess it starts over cause his chemo started in April.
[CUSTOMER][NEUTRAL] I don't think he has to take it anymore, but I was just, I just wanted to do a follow up to see exactly what, you know what I mean? I don't think he has to do chemo, but I just wanted to make sure cause
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I just needed to know how much I'm paying a month for everything starting from my [PII] benefits.
[AGENT][NEUTRAL] And that's for each plan you're inquiring about? For each policy?
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Just, well, you know what? You could do each policy if that would be easier to say how much I'm paying for each policy.
[AGENT][NEUTRAL] Sure, I can give you that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], you you, [PII], right? I don't wanna mess up.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] You said you're very helpful and I really do appreciate this. It's just that they implement in a new way.
[CUSTOMER][NEUTRAL] And it seems like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for each, um, policy, and I'm gonna give you the premium amount for that hospital indemnity.
[AGENT][NEUTRAL] And you have that policy number correct? That that's the first number you provided me, the 183-578-6?
[CUSTOMER][NEUTRAL] Uh-huh, yes.
[AGENT][NEUTRAL] OK, so that premium is 22238 cents.
[CUSTOMER][NEUTRAL] And this is a month, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and that, like I said, that's 22222 38, and that's the hospital indemnity.
[AGENT][NEUTRAL] OK, and then for the um well, I just went off that screen. Bear with me for just a second while I go back to that.
[CUSTOMER][NEUTRAL] You're fine. So there's the [PII] right here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], is your name [PII]?
[AGENT][NEUTRAL] I use [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And just give me one moment to pull up this plan.
[AGENT][NEUTRAL] OK, so for that life, uh, that life plan, the life insurance plan.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] On that premium it's 108 and 50 cents.
[CUSTOMER][NEUTRAL] And that's um the coverage for myself 100,000, right?
[AGENT][POSITIVE] Yeah, I show it actually as a family type of a family plan.
[CUSTOMER][NEUTRAL] Oh, OK, and it doesn't tell you the individual amounts?
[AGENT][NEUTRAL] Um, I can look at that.
[AGENT][NEUTRAL] I just have to pull up each one individually, so I apologize.
[CUSTOMER][POSITIVE] Oh no. Oh no, that's OK. I, I appreciate it.
[AGENT][NEUTRAL] Yes, I see the benefit amount is $100,000.
[CUSTOMER][NEUTRAL] And then my husband is 50,000, right? And then my son is 10,000.
[AGENT][NEUTRAL] 150.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] 10, I believe.
[AGENT][NEUTRAL] Yes, I believe so. I'm looking for that in the policy.
[CUSTOMER][NEUTRAL] I don't know if this stuff gonna change. I don't know cause I don't even think he gave me an option to do 100,000 this year, but I, I'll take it if it's still in the system.
[AGENT][NEUTRAL] I just see you and your spouse, so I'm looking for the dependent.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My son, [PII].
[AGENT][NEUTRAL] I see the spouse writer.
[AGENT][NEUTRAL] I don't see the dependent though.
[CUSTOMER][NEUTRAL] Yeah, my son is supposed to be on there.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Let me look at a different spot here.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Dependent is 10,000 yeah.
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] So it's 150 and then 10 just like you thought it was.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and so.
[CUSTOMER][NEGATIVE] But this so I got to cancel the disability plan.
[AGENT][NEUTRAL] Yes, so the cancer plan that premium is $78.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then your disability is $60.84 for that premium.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Cause I get 400222.
[CUSTOMER][NEUTRAL] 38.
[CUSTOMER][NEUTRAL] 108
[CUSTOMER][NEUTRAL] OK, so it comes out to 469. OK.
[AGENT][NEUTRAL] Yeah, 4 69 72 is what I got mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because my employer gave me $450 so I guess I just have to pay the difference.
[CUSTOMER][NEUTRAL] So that's what I'm thinking that my plan changed. So, cause my disability plan should have changed cause I, I upgraded.
[CUSTOMER][NEUTRAL] I don't know. I will, I don't know who I need to follow up with, but.
[CUSTOMER][NEUTRAL] I want to make sure at least it was uh.
[CUSTOMER][POSITIVE] Active with you guys.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I have some plants.
[CUSTOMER][NEUTRAL] And when I fall for the therapy, I have a list of all the days cause oh I, I owe them a lot of money, but I know for therapy, you only get like, is it like $40 some dollars for therapy and you get like
[AGENT][NEUTRAL] Yeah, let me pull that up, and that's under the hospital indemnity. Just bear with me for one moment while I pull up those benefits.
[AGENT][NEUTRAL] Yes, it's a $45 a day benefit and you're allowed up to 5 days per calendar year per covered person for the physical, uh, speech or occupational therapy.
[CUSTOMER][NEUTRAL] Yeah, $45. OK, so you're up to 5, OK.
[CUSTOMER][NEUTRAL] So I guess I can just fax over.
[CUSTOMER][NEUTRAL] Um, the sheet that did all the therapies, I could fax that over.
[CUSTOMER][NEUTRAL] And I did have an X-ray on my leg, but I don't know. Um, it's been challenging cause I went to the urgent care, so it's been challenging to try to get the documentation. I could just forward over the after visit form to see if that could help.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So these are all up under my hospital indemnity plan, right?
[AGENT][NEUTRAL] Yes, if you were right. Now, the X-ray, unfortunately would not be covered under your hospital indemnity, um, but the urgent care visit and physician office visit, you're allowed one of, one visit each for urgent care and physician's office. So if you went to that urgent care, you can go ahead and submit that for reimbursement.
[CUSTOMER][NEUTRAL] Oh, I thought
[CUSTOMER][NEUTRAL] You know what, I think I submitted an urgent care for 24 already. I'm not for sure.
[AGENT][POSITIVE] Oh you did OK.
[AGENT][NEUTRAL] I can check. Let's see.
[AGENT][NEUTRAL] Let me see what we paid out here.
[AGENT][NEUTRAL] Yeah, I show you have one urgent care visit in [PII].
[CUSTOMER][NEUTRAL] And you only get one, right?
[AGENT][POSITIVE] That's right, yes, only one.
[CUSTOMER][NEUTRAL] What about when I'm going to see the specialist like.
[CUSTOMER][NEUTRAL] Um, cause I had a mammogram. Well, you only get one well visit. So I had the mammogram and my regular Pap smear. So I have to just submit that under the well visit, right?
[AGENT][NEUTRAL] Yeah, now that I believe it would be under your cancer policy for the mammogram, uh huh.
[AGENT][NEUTRAL] Cause under your hospital indemnity that does not have that wellness benefit built into it. I don't believe, let me double check, but I don't believe it has reimbursement for wellness or screening benefits. Um, but let me double check that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, um,
[CUSTOMER][NEUTRAL] So the wellness benefit is counsel.
[AGENT][NEUTRAL] Yeah. It's under the cancer for the, the cancer screening cause it's kind of like um it's a cancer screening, uh, procedure if they're just, you know, screening like that would be reimbursable under that cancer screening under your cancer plan. Now, um, as far as uh hospital indemnity, that does not appear to have any wellness.
[AGENT][NEUTRAL] Um, but you do have that one visit, that's reimbursement for a physician's office. So that would be like your specialist offices that you were speaking of. You are allowed one of those per calendar year as well. So if you do have a visit to the physicians, yeah, you'd submit that uh billing for us with that procedure, diagnosis code and data service, and then we could, um, you know, process it under that physician's office visit.
[CUSTOMER][NEUTRAL] OK, so I need to submit that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so that is under the hospital and the dentisty plan, right?
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I get so confused on which ones I need to claim.
[AGENT][NEUTRAL] Right, well, usually if you do just so you're aware if you are on our portal, do you have, you have access to the portal is that correct? It looks like you submitted claim. OK, so when you um submit on that um portal if you submit that wellness claim it's gonna go to the correct policy so what happens when you submit a wellness claim like you were speaking up for that mammogram?
[CUSTOMER][NEGATIVE] So I don't get
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Once you file that wellness uh claim in the system, it will automatically kind of push it to all your policies and what we'll do is just review to make sure if there's payable benefits we'll pay those benefits under that plan and unfortunately if there's not a payable benefit we'll still process that claim and let you know that so just so you're aware of that feature.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And I just always get confused on which documents to fill out. So do I still have to fill out the, the stuff for the wellness, I know you just submit that information and any documents you may have because they sent me.
[CUSTOMER][NEUTRAL] It doesn't have any diagnostic calls on there. They just sent me saying that everything was clear and I had my mammogram and everything looked good.
[AGENT][NEUTRAL] OK, and that's
[CUSTOMER][NEUTRAL] It doesn't have that.
[AGENT][NEUTRAL] Yeah, you don't have to if you're just submitting that wellness portion so like for instance it's a cancer screening under that cancer policy I would go into the portal and on that dashboard when you choose that uh feature that it asks you if you want to file a wellness claim and you would just go ahead and click that you answer those four questions you don't have to send in documentation for that wellness visit.
[AGENT][NEUTRAL] Basically what you're gonna answer it's gonna have the patient information then it's gonna have a little box that's there's a bunch of tests listed there so you could go under that mammogram and just put your data service there.
[AGENT][NEUTRAL] And then uh sign the claim form and submit it that way. It's like 4 questions you answer and it will automatically just go ahead and push it through the system and like I said, what will happen is the way we have it set up for those wellness claims it it will push it to each of your policies in our system on our end internally so that we can check to make sure if there's a payable wellness benefit under any of your policies we'll go ahead and process that claim that same claim information under that.
[AGENT][NEUTRAL] Um, each plan that is eligible for that service and we'll go ahead and uh reimburse you if there's any payable benefit but for like for instance this hospital indemnity, it doesn't have wellness, but it would still push that claim information to your to your plan and we would go ahead and process and let you know this plan doesn't have those benefits, but it would be processed under the cla um plans that you do. In other words, in this situation that cancer plan that allows that screening.
[CUSTOMER][NEUTRAL] OK, so that's that. And then I also, I do have one, a couple of visits with my physician, so I need to submit those claims. I think that's like $150 or $100 or something like that, I think, a claim when you go see the doctor. I'm trying to do all my claims because I owe a bill of $1400.
[AGENT][NEUTRAL] Yeah, so you're trying to get some reimbursement. I understand.
[CUSTOMER][NEUTRAL] With um
[CUSTOMER][NEGATIVE] Yeah, I owe them $1400 because I hadn't met my deductible and I didn't realize that I was gonna be billed that amount of money.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I'm trying to get all my claims um in and submitted.
[CUSTOMER][NEUTRAL] Um, but I know you guys will reject it if it's not done correctly. So the office visit, that's the hospital and indemnity plan as well.
[CUSTOMER][NEUTRAL] Um, and I have to fill out a form that the howdemnity form along with the uh claim, right? Or no?
[AGENT][NEUTRAL] That one for just the office visit you don't necessarily need that um we encourage you to to complete those claim forms, but a lot of times um it's not necessary if it's a simple procedure and we have all the information. So in other words if you have that um itemization of charges from your physician visit.
[AGENT][NEUTRAL] And it lists, you know, the patient information which is your name, data service and then procedure and diagnosis codes you can just submit that information you don't have to necessarily submit that claim form.
[AGENT][NEUTRAL] Just for reimbursement for that office visit. We just need some sort of documentation that verifies that you saw this doctor on this date and this procedure code and the reason for it would be the diagnosis code. So in other words, like I said, if you're doing a follow up for, you know, maybe a cholesterol check or whatever the situation may be, that's gonna be the procedure code, that office visit, and then the diagnosis code is the reason why you're seeing the doctor. So, and then we just need that, like I said, is that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, it kind of puts the claim all together so we see the whole picture we'll process it through each, um, and then under that hospital indemnity plan for each date that you submit. Now that physician office again is only a one day reimbursement as well, but it is a $100 benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the world is, I think the count, that's 90, and then I get 45 per.
[CUSTOMER][NEUTRAL] Um, my, um, therapy and that's up under the hospital indemnity plan as well. And also, I know, I know what I was getting some food.
[AGENT][NEUTRAL] Yes, and you, you'll just need that itemization for that yeah.
[CUSTOMER][NEUTRAL] I think while I was getting confused is that I got an X-ray and I thought that I had X-rays. I know X-rays is up under the cancer plan, but I don't know if you have to have X-rays for cancer or they cover X-rays. I don't know. But I had to get X-rays on my knee. So you said that's not covered.
[AGENT][NEUTRAL] Um, not under, no, not under your hospital indemnity. Um, and I don't think it would be payable under any of your other plans as well. So yeah, those outpatient, uh, laboratory and diagnostic. Um, I don't see any coverage for those.
[CUSTOMER][NEUTRAL] Uh, on the cancer plan, it has to be related to cancer.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's what I, I didn't know. So I don't even have to submit that one. OK, so I got the urgent care. I already got paid. So the doctor visits I need to submit and my therapy visits and also my well check, my mammogram.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, sounds good, and I'm glad to know that my policy is active. Now if I'm no longer with my employer, can I still keep these plans?
[AGENT][NEUTRAL] Now some of them might have that we call that portability that you may have the option to port um I know some of them do. I believe your um the hospital indemnity has that um option to port um it's just it goes by which plans are allowed um to portability just means that you're allowed to carry them with you in the event you would separate from your employer. So what happens is once we receive that information that you've separated, usually a letter will go out to you asking you if you want.
[AGENT][NEUTRAL] To keep your coverage and then you just respond to that letter by saying yes and then they can let you know you know what it's um when that letter comes it will kind of break it down for you as much as which plans are portable and how much that premium will be to continue that coverage.
[AGENT][NEUTRAL] But you'll need to respond to that or they usually give you uh a few weeks to respond to it. So then you would just go ahead and, and you can either call us, I believe you can call us and but we'd need that form back just, you know, letting you know that you selected to go ahead and put your coverage and you wanna continue it.
[CUSTOMER][POSITIVE] OK, thank you, you've been very helpful, [PII], so much. Thank you so much. So I just, at least I do have, at least I can submit um my 5 visits uh for $45 for therapy. What about seeing a specialist? I did go see the uh.
[CUSTOMER][NEUTRAL] That, what do you call it for your knee, uh, or not or.
[AGENT][NEUTRAL] Orthopedic.
[AGENT][NEUTRAL] Orthopedic? Yeah.
[CUSTOMER][NEUTRAL] Yeah, orthopedics, yeah. I did go see the specialist.
[AGENT][NEUTRAL] Now, um, just keep, just keep in mind that you have that one visit available under the hospital indemnity and that's for the physician office, so it doesn't matter if it's your primary care doctor or a specialist. You could submit for um either one of those, but you only have the one benefit per calendar year. So, was that in this calendar year yet or was it still in [PII]?
[CUSTOMER][NEUTRAL] And, and he
[CUSTOMER][NEUTRAL] It was in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah, you can um
[CUSTOMER][NEUTRAL] OK, so I'll just
[AGENT][NEUTRAL] You can submit either one of those and you know it doesn't hurt you can go ahead and submit what you think you know just so and it's probably better for your records too if you wanna just submit all of them that way you'll you'll get reimbursed for what we're we can reimburse you for and at least you'll know if there's not reimbursable why it's not and then you'll have that information for your records so that you know that you've sent it to us kind of, you know.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Cause I, I, right, cause I think I got some claims that haven't been paid and I guess I just need to follow up. I'm just so exhausted because it's just like it should be an easier process.
[AGENT][NEUTRAL] Yeah, I understand.
[CUSTOMER][POSITIVE] Um, luckily I had a great team with the cancer, so when I got my cancer plan, they were really amazing and that was kind of like easy, honestly, and that was my biggest, uh, one. But of course, as you know, the bills for cancer is outrageous. Yeah. So, yeah, OK, well, [PII], thank you so much. I'm getting ready for a meeting.
[AGENT][POSITIVE] Absolutely, yeah.
[AGENT][POSITIVE] OK, well I'm glad I was able to help you straighten out some of that and if you have any additional questions feel free to give us a call.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. I hope you have a great rest of your day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK