AccountId: 011433970860
ContactId: a0fb6c34-ac64-44ef-8625-0b0b57516708
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2492439 ms
Total Talk Time (AGENT): 733634 ms
Total Talk Time (CUSTOMER): 1382291 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/a0fb6c34-ac64-44ef-8625-0b0b57516708_20250430T18:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I was calling with a few questions, um, some specific and some just general about filing a claim.
[AGENT][POSITIVE] OK, I'm happy to help. Uh, do you have a, you're an insured, Do you have a policy with us?
[CUSTOMER][POSITIVE] Yes, I am insured and I have a policy with you.
[AGENT][NEUTRAL] OK. Um, do you have your policy number? I can pull that up.
[CUSTOMER][NEUTRAL] I do not. Can I give you some identifying information about me that can help you to link to that?
[AGENT][NEUTRAL] Sure, I can look you up by name or social, whichever you would prefer giving me.
[CUSTOMER][NEUTRAL] Let's, let's try name and if you need the social after that, I'll, I'll try, but it's [PII]
[AGENT][NEUTRAL] All right, [PII], let me take a look here.
[CUSTOMER][NEUTRAL] Can you tell me my account because I, I bet I have to put it on a claim form.
[AGENT][POSITIVE] Yeah, I can give that to you for sure.
[AGENT][NEUTRAL] Uh, what's your date of birth?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then lastly just to verify the profile, I need your uh physical address and email address, please.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][POSITIVE] Perfect. Thank you so much. OK. So here is the policy number. Let me know when you're ready to copy this down.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] You go right ahead. Thank you very much.
[AGENT][NEUTRAL] Mhm. It's gonna be 01.
[AGENT][NEUTRAL] 38
[AGENT][NEUTRAL] 6480.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] Not a problem.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] My first question for you.
[CUSTOMER][NEUTRAL] Is can you tell me because I.
[CUSTOMER][NEUTRAL] I had a
[CUSTOMER][MIXED] Had a busy and exciting year and and not necessarily a good way last year and I've gotten way behind on um had some surgery to remove one cancer and they found another cancer um and I'm just now trying to I I started a couple other times but I sort of got overwhelmed trying to figure out how to do the claims. Could you tell me though when when was the last time that I filed.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A claim because I did notice that.
[CUSTOMER][NEUTRAL] Like I can get some reimbursement for diagnostic testing each year on a calendar year basis, is that correct?
[AGENT][NEUTRAL] Mhm, yeah, it looks like there is, let me go down to your schedule benefits here.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK. So, yeah, it looks like the plan does have for cancer screening, um, one diagnostic test per calendar year. It pays a $50 benefit for that. And then it looks like follow-up diagnostic testing, it allows a maximum of 1 per covered person per year and that pays at 100.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All right, and the follow up just means like meeting with the doctor to discuss the diagnosis or, or what does that mean?
[AGENT][NEUTRAL] So that means when a covered person receives an abnormal result from a screening test, so if you had um a, you know, there's all these different, like a PSA test, a blood test, colonoscopy, uh, chest X-ray. If you had any of these come back abnormal, and then you had to receive an additional test, then it, we would pay that amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] On the topic of diagnostic testing, I have had like regular PSA test multiple times a year for multiple years. um, can, can you tell me when was the last time that I filed for a claim because I don't even know like how far I know that I'm gonna have a lot of stuff to file a claim for last year because of the surgery and everything related to it but I think I'm even behind.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Before that, because I, I can't not remember the last time that I filed a claim even for my, my my PSA diagnostic tests.
[AGENT][NEUTRAL] Yeah, so it looks like the last claims I see here that paid were from the date of service was [PII].
[CUSTOMER][NEUTRAL] OK, and it's not too late.
[CUSTOMER][NEUTRAL] To go back and can you tell me, did that claim have any PSA test for the year [PII] in it as part of it?
[AGENT][NEUTRAL] Uh, let's see here.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I don't see any on here. No. It looks like it was mostly um
[AGENT][NEUTRAL] There was some lab. It looks like there was a clinic, but I don't see anything for the PSA testing. No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's not too late to go back even as far as that to if as long as I have something that shows that I had the PSA test done back then.
[AGENT][NEUTRAL] Yeah, no, um, so we don't have like a time limit in which claims have to be filed by, so yeah, you can definitely still go back and and do that for sure.
[CUSTOMER][POSITIVE] Thank you. On the, the topic of um things like a colonoscopy and blood work.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] If I had
[CUSTOMER][NEUTRAL] Like, um, last year.
[CUSTOMER][NEUTRAL] My, the PSA test that I had done.
[CUSTOMER][NEGATIVE] On a regular recurring basis shot way up.
[CUSTOMER][NEUTRAL] And then they also have done.
[CUSTOMER][NEUTRAL] Like once a year.
[CUSTOMER][NEUTRAL] Some type of biopsy test on my prostate and, and monitoring it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, both of those things got, were, were way up last year and so they decided that they needed to.
[CUSTOMER][NEUTRAL] Have do the surgery to remove my prostate um as a part of that process.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] They did have me do things like a diagnostic scan of my whole body to see if things had spread and they did have me do a colonoscopy um earlier than I normally would as a part of that. How do I know?
[CUSTOMER][NEUTRAL] Or how do you know?
[CUSTOMER][NEUTRAL] If those things.
[CUSTOMER][NEUTRAL] Would even um.
[CUSTOMER][NEUTRAL] Well, actually though you're saying that even if I did have a PSA test and a colonoscopy in the same year I'd still only get $50 as a max for both of them because you can only get $50 for any kind of diagnostic testing.
[AGENT][NEUTRAL] So I would think that with having like the PSA test done, you would get the $50 for that. With your levels coming back abnormal, that would require then that follow-up test, which was then the colonoscopy. Um, so I feel like that would be eligible for the diagnostic testing benefit because the PSA test and the colonoscopy are both listed under diagnostic testing.
[AGENT][NEUTRAL] Um, the only other separate benefit would be, you said you had some scans done. I mean, they do offer a benefit for medical imaging. That would be, I don't know if this applies, like a CT scan, PET scan, MRI. It does pay for that if you then had to have any of that done.
[CUSTOMER][NEUTRAL] And they did do that they they did perform a full body.
[CUSTOMER][NEUTRAL] PET scan. PET scan. PET CT, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, if um.
[CUSTOMER][NEUTRAL] A couple of just sort of general questions because in the past I've never really actually had.
[CUSTOMER][NEUTRAL] Other than the fact that they found it a long time ago um.
[CUSTOMER][NEUTRAL] I haven't had anything.
[CUSTOMER][NEUTRAL] Of a significant nature until this past year, how do people, like I'm a little overwhelmed and trying to go back through all the different stuff that I have.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEGATIVE] Do people just send you like everything and say you go through and find what applies to me or do I need to be because I don't even know on some of these things what they are like the, the medical terminology and the diagnosis on things like that. I don't even know what some of those are on some of the things plus like some of the pages will have like.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You'll have like a whole page full of stuff and I, I don't even know like which one to maybe highlight for you or which one to.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] To single out and it may be that may be multiple things on there or would apply are are you all um.
[CUSTOMER][NEUTRAL] Are, are you all trained in such a way that you figured that out for me or am I supposed to like work closely together with my doctor to figure out somehow which things do apply and, and just.
[CUSTOMER][NEUTRAL] Send those in because I'm not quite sure exact and the other thing about that is this year had so many different things coming from different angles because in the past all I've ever really had to deal with was just my.
[CUSTOMER][NEUTRAL] Cancer doctor but then like this year now I've got big bill from being in the hospital for multiple days with the surgery another bill from anesthesiologist and all sorts of other different types of things like that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] You need some kind of verification what kind of.
[CUSTOMER][NEUTRAL] Thing do I need to send you in regards to each one of those things like do I because I have.
[CUSTOMER][NEUTRAL] A variety of stuff like some things from Blue Cross Blue Shield some things from doctors, some like diagnostic tests and things like that and I'm not exactly sure. I mean it's a big huge thick folder um I don't think you want me to send the whole folder but I'm not exactly sure what I should send.
[AGENT][NEUTRAL] So um the first thing that you'll need any time that you do a claim would be the claim form. um I don't know if you've gotten one of those do you have a claim form?
[CUSTOMER][NEUTRAL] I do have, I believe I printed off let me make sure I have it here.
[AGENT][NEUTRAL] Because the claim form.
[CUSTOMER][NEUTRAL] Yes, well, no, wait a minute, yeah.
[AGENT][NEUTRAL] The first page, OK, because the first page should be just instructions for the insured or patient.
[CUSTOMER][NEUTRAL] I do have it.
[AGENT][NEUTRAL] So, it should break it down and tell you, depending upon what you're filing for. So, the first like bullet point talks about if you're doing initial diagnosis, new diagnosis, or surgery, and it tells you when you're filing that type of claim, a pathology report must be submitted with that.
[CUSTOMER][NEUTRAL] The first
[AGENT][NEUTRAL] And then down below, you should see if you're filing a claim for hospitalization, chemo, surgery, radiation, we need itemized medical bill and explanation of benefits. Do you see that page?
[CUSTOMER][NEUTRAL] I'm looking at a 4 page cancer claim form.
[CUSTOMER][NEUTRAL] And I don't see anything about.
[CUSTOMER][NEUTRAL] See, let's see here, maybe I just need to.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Look through it more carefully here. Um, like I don't see anything about the hospital. I see like about the insured, about the patient, um, non-local transportation, family member lodging.
[AGENT][NEGATIVE] OK. Yeah, it seems like you just have, that's the first page that you're gonna fill out statement of insured, but that's page 2 of 4. So it seems like you're missing the first page, which is instructions.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] All right, and I see the first page um.
[CUSTOMER][NEUTRAL] Saying complete.
[CUSTOMER][NEUTRAL] The statement of insured, let's see sections A through D, which is what I think I was just talking about, yes, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then complete section. What is section E here? OK, section E is authorization to request information including protective health, um.
[CUSTOMER][NEUTRAL] Alright, so all I'm doing in section E is giving you permission to like.
[CUSTOMER][POSITIVE] Check with other people on me that's fine I'll be glad to.
[CUSTOMER][NEUTRAL] Let you do that, um, like what I don't see though is um.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] I don't see anything about
[CUSTOMER][NEUTRAL] Like the hospitalization or the surgery.
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Is that part of the ABCD or is there some additional.
[CUSTOMER][NEUTRAL] Because I think the whole claim form is the 4 pages, correct?
[AGENT][NEUTRAL] Right. So you fill out the statement um about the insured, about the patient, and then section C would not be applicable if you're not gonna claim any lodging.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then down below on page 44, you'll just put your policy number and sign. If you're submitting the claim for hospitalization, surgery,
[AGENT][NEUTRAL] Radiation, chemo, any of that. You'll fill all that out with a claim form. You'll also include an itemized medical bill from each medical provider and then the explanation of benefits from any other medical carrier showing the allowed and paid amounts for each service.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so I do need.
[CUSTOMER][NEUTRAL] I need both the itemized medical bill from.
[CUSTOMER][NEUTRAL] The person that performed the services but I also need the.
[CUSTOMER][NEUTRAL] Explanation of benefits from my insurance that goes along with it.
[AGENT][NEUTRAL] Correct. So if you have a major medical, another carrier, then we'll need the explanation of benefits from them, showing the amounts allowed and paid for each service.
[CUSTOMER][NEUTRAL] On each of those?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so I just send in because like some of those forms themselves are like pages and pages like when I was in the hospital um because of some complications I was in for 4 days and they did all sorts of different things while I was in there related to the surgery and then related to after the surgery and things of that nature so just send that that whole EOB with and let you go through and figure out like what.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Doesn't doesn't apply.
[AGENT][NEUTRAL] Yup.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and let's see here.
[CUSTOMER][NEUTRAL] Um, on that topic, does it matter?
[CUSTOMER][NEUTRAL] What portion of a
[CUSTOMER][NEUTRAL] Does it matter how much coverage I had or didn't have as to what my.
[CUSTOMER][POSITIVE] Allowable benefit is for y'all, for example.
[CUSTOMER][NEUTRAL] On the.
[CUSTOMER][NEUTRAL] section for
[CUSTOMER][NEUTRAL] Physical.
[CUSTOMER][NEUTRAL] And psychotherapy, uh, which is sort of the last part, well, close to the last part, the FF.
[CUSTOMER][NEUTRAL] Part of the schedule of benefits.
[AGENT][NEUTRAL] Oh, you're looking on the schedule of benefits. OK. All right, uh-huh.
[CUSTOMER][NEUTRAL] If there were different amounts of coverage for, because I had to do some physical therapy, I had 11 visits for that and then I also did some follow up psychotherapy, had 5 visits for that.
[CUSTOMER][NEUTRAL] Does it, does it matter or not matter like what percentage insurance paid and what percentage I paid in terms of getting the $25 per visit benefit or.
[CUSTOMER][NEUTRAL] I mean, does the amount I paid have anything to do with the amount of the benefit or you get the benefit just because you had those services provided and if I can provide the itemized coverage.
[AGENT][POSITIVE] Correct, yeah, correct. So you're eligible for the amount based off of the visit and having the insurance. It doesn't, yeah, in this case, it would not matter what you paid for the visit.
[CUSTOMER][NEUTRAL] OK, so because what was odd about last year is because my expenses were so high related to the surgery and all I met my maximum out of pocket and then like the follow up visits for physical therapy and psychotherapy I didn't pay anything because I was fully my insurance fully paid them but that doesn't matter you still get the $25 per visit for those as long as you provide the itemized proof that you did it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, exactly, and then it's just not gonna exceed $1000 in the calendar year. So if the amount exceeded that, then you just would not be paid over the $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, um, let's see here just a few more questions and I appreciate your.
[CUSTOMER][NEUTRAL] Help with this on the.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Family transportation, if I had the surgery done locally.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And it was only about a 40 minute trip from my house to my, to the hospital, but my.
[CUSTOMER][NEUTRAL] My wife, like we still have kids and my wife came every day to check on me as well as dropping me off for the surgery and then bringing picking me up, um, does that count as like there won't be any family lodging, but would that count for travel by car or does that not count like the her daily trips back and forth to see me while I was in the hospital.
[AGENT][NEUTRAL] I feel like it has to be. I'm gonna double check the policy here, but if memory serves me, I feel like it has to be over 50 miles each way.
[CUSTOMER][NEUTRAL] OK, good, OK, each way, so not combined because actually it's 28 miles one way. So like on a daily trip round trip it was 56 miles for but it doesn't count because it had to be more than 50 miles one way.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm, yeah, I'm double checking on it. Let me see here.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So it does say 50 miles. It doesn't really say one way though. The way that it reads is that
[AGENT][NEUTRAL] We will pay the actual amount by bus, plane or train per mile shown on the benefits page.
[AGENT][NEUTRAL] At least 50 miles away from a covered person's residence using the most direct route.
[CUSTOMER][NEUTRAL] OK, that part did sort of sound one way if it has to be.
[CUSTOMER][NEUTRAL] Um, 50 miles, well, I mean it was 56 miles for her to, to come to come there and then come back home. That was 56 miles, but to get to the hospital from our house was 28 miles.
[AGENT][NEUTRAL] Yeah, cause it says benefits will be provided for only one mode of transportation per round trip.
[AGENT][NEUTRAL] And subject to the maximum number of trips shown.
[AGENT][NEUTRAL] So then, you know, it does say that like the maximum it'll pay is 1000 miles round trip.
[AGENT][NEUTRAL] And then it states benefits will be paid for only one mode of transportation per trip.
[AGENT][NEUTRAL] So, I may need to get clarification on that because the way I read it, I would say one way, but then down below, it kind of eludes, makes me think that maybe it's
[CUSTOMER][NEUTRAL] To the trip
[CUSTOMER][NEUTRAL] Like the entire trip as opposed to just uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um.
[CUSTOMER][NEUTRAL] At your convenience then whether.
[CUSTOMER][NEUTRAL] And I don't know if it's better now or just to follow up with me later if you could give us some direction it would really just be for those 4 days that I was in the hospital um and it would just be for about um 216 miles um because she.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But other than that, there, we didn't have any other kind of transportation or lodging or anything else.
[AGENT][NEUTRAL] OK. Let me just see if I can find.
[CUSTOMER][POSITIVE] Thank you for checking.
[AGENT][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] OK, let me see if um I can get claims to respond to me on that to see if it needs to be one way or if it's the round trip.
[AGENT][NEUTRAL] And then in regards to is just as far as where to start on the claims, that's really up to you um if you want to start with the most recent.
[AGENT][NEUTRAL] Um, because you have bills coming in for that, then you could definitely do that. It's really just personal preference as far as where you wanna start, as far as filing the claims, you could start with just one item. If you're wanting to just do hospitalization and surgery, just focus on those and file all those together for hospitalization and surgery, um.
[AGENT][POSITIVE] Whatever you feel like it's gonna make it easiest.
[CUSTOMER][NEUTRAL] So that is just
[CUSTOMER][NEUTRAL] And and that is just one claim and not separate claims then like if I, because that is the biggest of all of these is is like I wouldn't send I wouldn't do one claim for the hospital portion and one claim for the anesthesia portion and one claim for the surgery portion. I just do one claim for all of that hospitalization and surgery together as a group.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, you can just do that all in one, yes. Um, you don't need.
[CUSTOMER][NEUTRAL] Because they'd all be like in the same 4 day time frame together.
[AGENT][NEUTRAL] Right, right, exactly, yeah, so you could do that all with one claim form all at once and then that would take care of that and then if you had, let's say um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Some other things relating to that surgery or hospitalization, then you could do that separately if you wanted to. Um, just cause I know it's a lot of paperwork and the examiners are definitely used to having to look through all of these, especially on these types of claims.
[CUSTOMER][POSITIVE] OK, last couple of questions and, and thank you for checking on the, the, the um transportation issue at your convenience. I appreciate that. I, I noticed as a part of, let's see now where is, where did I see that?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well now I don't see it. I was looking at something a minute ago.
[CUSTOMER][NEUTRAL] It said something about.
[CUSTOMER][NEUTRAL] One type of claim and then it had another separate thing that talked about a wellness claim, is there, is there a wellness claim like if you go in for just a annual wellness checkup is that something that is in any way reimbursed or am I misinterpreting.
[CUSTOMER][NEUTRAL] The wording on that, although I can't even find where I saw that. Don't you remember when I showed you that the thing on the wellness oh it's on that is that it right there?
[CUSTOMER][NEUTRAL] Yeah, that's it. OK. oh OK now I know this is I printed out the instructions online for how to use the portal, and I noticed that on page two of the instructions it tells me or explains to me how to file my claim online but then on page 3 of the instructions it talks about how to file your wellness claim. Is there a wellness benefit?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Because I don't see like a general wellness benefit anywhere on my schedule of benefits and I didn't know this wellness just mean like your your once a year checkup is covered in general or?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I was confused by what that meant because it actually the instruction says this feature is available for all wellness benefits under APL accident cancer, critical illness and hospital indemnity products which makes me think that there is some type of wellness claim, but I'm not even sure if I'm interpreting that correctly. Does that mean that when you go in once a year for a wellness checkup that that's something that you could get reimbursed for or or not?
[AGENT][POSITIVE] So that is what a wellness claim is. Yes, absolutely. Your plan on the schedule benefits doesn't show a wellness benefit, um, but yes, that, yeah, that's what it would be. It would be for like women when they go in and have their yearly mammogram, or if you had a physical, or for men, if you had a colonoscopy once a year, that's a wellness benefit. It's a preventative basically test, yes.
[CUSTOMER][NEUTRAL] I didn't see one, OK.
[CUSTOMER][NEGATIVE] And so that does that does not apply to me because that is not on my schedule of benefits.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I think my last question, let's see here, oh, when, when I went in and I had the surgery performed.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] They did everything and I did everything that I was supposed to do in terms of getting up and walking every day and they put some kind of sleeve things on my legs to like keep my the blood flowing while I was.
[CUSTOMER][NEGATIVE] In the hospital bed for those 4 days, even though I was getting up like they told me to and trying to walk each day, but as a result of the surgery on my cancer, um, I developed a DVT blood clot in my leg. Is that in any way.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Related or or just the fact that it is not cancer at all it doesn't, it doesn't really pertain to anything because what I was wondering is for the, for the next 6 months I couldn't even go see a physical therapist because they wouldn't see me um because of my.
[CUSTOMER][NEUTRAL] Blood clot and it wasn't until I had to go back to have another what's it called sonogram had to go back to have another sonogram to confirm that the clot had gone away as a result of taking myeliquis blood thinner for 6 months and at that point.
[CUSTOMER][NEUTRAL] Then they allowed me to go see um the physical therapist, but the physical therapist would not allow me to come see them until all of that.
[CUSTOMER][NEUTRAL] Cleared up for I guess their own liability purposes that they were afraid to see someone that had a blood clot in the leg. What I, what I was wondering is, is I went to the physical therapist.
[CUSTOMER][NEUTRAL] After that, as a result of of that, does that apply for.
[CUSTOMER][NEUTRAL] Physical therapy as well or does that not apply like and, and I'm sorry to be sort of confusing here. I, the one type of physical therapy that I know applies is because I had my prostate removed, they sent me to a, what's that called Joan? A pelvic, they sent me to a pelvic therapist to help me recover from my cancer surgery and removing my pro so I'm, I'm clear on that one that that's.
[CUSTOMER][NEUTRAL] That type of therapy would qualify because it was the direct result of the cancer. Well, you know what, let me make sure, does that qualify like if my, um, what is Doctor [PII]?
[CUSTOMER][NEUTRAL] OK. If my urologist told me that I needed to go to a pelvic therapy for physical therapy as a result of my
[CUSTOMER][NEUTRAL] Radical prosectomy where they removed my prostate. Does that, is that included as part of the therapy or not included as part of therapy for the, the $25 visit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see what it says in here about.
[CUSTOMER][NEUTRAL] Because I guess I'm not quite sure if if it um.
[CUSTOMER][NEUTRAL] If it has to be like 100% cancer or some somehow related to cancer or if it is a byproduct of the like I would have never ever gone to that physical therapist if I hadn't had to have my prostate removed and the reason I had my prostate removed was because of my cancer.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I did get a response on the transportation. It is 50 miles each way.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] So OK then I will not file for.
[CUSTOMER][NEUTRAL] Because it, it's we did not do that. OK, thank you for you by by each way you are saying like one way has to be more than 50 miles one way.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you for clarifying that. I won't bother sending anything on on that and that's good that helps me to check one thing off the list or one less thing that I need to get ready for you, um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it looks like it says we will pay the indemnity amount showed on the schedule of benefits for physical occupational speech therapy.
[CUSTOMER][NEUTRAL] But is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] These therapies, these therapies must be as a result of cancer or the treatment of cancer and be performed by a licensed physical occupational speech therapist.
[AGENT][NEUTRAL] Um, if 2 or more therapies occur on the same day, only 1 benefit will be paid. So it looks like the therapies must be a result of cancer or the treatment of cancer.
[CUSTOMER][NEUTRAL] OK, so in that case,
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The, the pelvic physical therapy to work with me on since I had my prostate removed would for sure count, it seems like, but the other one, I'm not sure like I would have never had a DVT blood clot in my leg if I hadn't had cancer.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Because I've never had a blood clot in my life, but the fact that I had the cancer surgery and the fact that I was in the hospital bed for 4 days, um, resulted in me developing the DVT blood clot in my leg which later had me go to the physical therapist once 6 months later the blood clot was gone, so that, that also would qualify or would not qualify. I'm not sure.
[AGENT][NEUTRAL] I mean, I, I feel like it would be worth submitting because it was a portion, you know, it was caused from that. Um, so, yeah, I mean, I would definitely
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead and file it personally.
[CUSTOMER][POSITIVE] OK, I'll do that and I believe that.
[CUSTOMER][NEUTRAL] For now I think that's all my questions. Thank you for your patience. I may have to call back once I actually start digging around and all the papers here and, and see, try to, um, so if I do have a question, if I'm looking at something.
[AGENT][NEUTRAL] No, that's fine.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That I'm just not sure whether it applies or it doesn't apply. Do I call you all back and then I ask you and I do I read like what's on it and say does that apply to this or not or is that better ask to my doctor or?
[CUSTOMER][NEUTRAL] Do I just send it and say, hey, you all look at this, it was in that 4 days that I was in the hospital, you all sort of figure out what what applies and what doesn't apply or?
[AGENT][NEUTRAL] Yeah, I mean, as long as you have the itemized receipt or in you know if it asks for the explanation of benefits and you submit all of that, you don't need to go through it to find out exactly which pages. I would just send all that information um if you're gathering information and you feel like it may be too much or not right I mean you can always call us and you know if we can't help you in customer care, which is where I'm at.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Then we can always have a claims examiner call you or we can transfer you and they can give you more detailed information if needed, you know, so that's always an option you can always call and ask questions we're happy to help.
[CUSTOMER][NEUTRAL] OK, and, and I promise this is my last question, but I, I just noticed that I didn't have it on my list, but I do have it checked here on the thing. There is one section of the schedule of benefits called drugs and medicine, um, and I promise this really is my last question, how do I, um, because I had.
[CUSTOMER][NEUTRAL] Like, I know they gave me a lot of different types of drugs.
[CUSTOMER][NEUTRAL] As a part of the surgery, um, but that'll be just like on, I guess whatever.
[CUSTOMER][NEUTRAL] Documents I send you and, and would it be similar like I, I was on Eliquis for six months because of my DVT blood clot that developed in my leg, would that qualify as drugs and medicine or is it specifically saying like.
[CUSTOMER][NEUTRAL] Drugs and medicines that are treating the cancer or because I wasn't sure cause I even had to take like some drugs before I went into the hospital and then I had to take some drugs after it, um, which drugs in particular that they're talking about they would or would not qualify for the drugs and medicine category.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Looks like it says we will pay the indemnity amount shown on the schedule of benefits, subject to maximums for anti-nausea and pain medication prescribed by a physician and administered to a cover person who is receiving radiation therapy, chemotherapy, and immunotherapy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] This benefit covers drugs and medications only. It does not include administrative charges. This benefit does not include any drugs or medicines cover.
[AGENT][NEUTRAL] Covered under radiation, chemotherapy, immunotherapy benefit. So, it looks like the drugs and medicine is for anti-nausea and pain medication provided by the physician.
[CUSTOMER][NEGATIVE] All right. Well, then I think that doesn't apply, right, [PII]? Cause there's nothing. I didn't have any nausea and I didn't have. Like the pain. Well, they, they did give me pain stuff for the surgery, like in the days after cause I could hardly move. And remember, when I did move it.
[CUSTOMER][NEUTRAL] So if I could get
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Yeah, I'm not even sure how to do that because I, I was on pain medication because for like the first month or so because even when I came home after 4 days I could like barely get out of bed without sort of letting out the screaming because they cut me in like 4 different places in my midsection area so any kind of.
[CUSTOMER][NEUTRAL] Uh when you were saying pain for nausea and is that like just and I I didn't have any nausea, but is it for pain just during the surgery itself or would it be for medication that they gave me to deal with the pain for about was it about a month after, um, like I took quite a bit the first two weeks and then I sort of weaned myself off of it by the end of that first month.
[CUSTOMER][NEUTRAL] With, with that kind of pain medication count in terms of trying to recover from the surgery that they performed?
[AGENT][NEUTRAL] Yeah, because it says pain medication um for a covered surgery and so that would be a covered surgery.
[CUSTOMER][POSITIVE] Then we need to go back and try to find, I don't know how we'll find that, but we need to look for that too. All right, hey, thank you so much for your time and patient help. I'm gonna start digging through this now and I sure appreciate your guidance to help me. Thank you. Bye-bye.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] My pleasure. I hope you have a good day. Bye-bye.