AccountId: 011433970860
ContactId: a18909a0-9a12-4c1a-a650-b1a844426aad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2117129 ms
Total Talk Time (AGENT): 970109 ms
Total Talk Time (CUSTOMER): 543244 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/a18909a0-9a12-4c1a-a650-b1a844426aad_20250311T16:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I, we wanted some information. I'm here with my wife, uh, in regards with cancer insurance that she signed up for this school year.
[CUSTOMER][NEUTRAL] He's an employee at Los Fresno Los Fresno CISD.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so your wife has a policy with APL and you all have some benefits questions, is that correct?
[CUSTOMER][NEUTRAL] I guess.
[AGENT][NEUTRAL] Yes, I can help you and you did say that your wife is present with you. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Please share it with me, yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, alright, I can help you and who am I?
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Who am I speaking with please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh yes, my name is [PII].
[AGENT][NEUTRAL] I'm sorry, Ms. [PII], what was the last name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Area code [PII].
[AGENT][NEUTRAL] Thank you, and your policy number please, Ms. [PII].
[CUSTOMER][NEUTRAL] Um, is that the card that that starts with Z, or am I looking at the group number?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, ma'am, our um policies do not have ID cards for the cancer coverage.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] We don't provide ID cards for cancer policies.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so then, so what I have is my Blue Cross Blue Shield uh medical card and what I did was I, uh-huh.
[AGENT][NEUTRAL] OK, so they
[AGENT][NEUTRAL] Uh-huh. Go ahead. I'm sorry. I mean to interrupt.
[CUSTOMER][NEUTRAL] OK, so what, so what I did was I added the cancer insurance and when I called the Blue Cross Blue Shield, they told me that they were not gonna send another card that it's already added to the.
[CUSTOMER][NEUTRAL] Uh, that I would be using the same card.
[AGENT][NEUTRAL] OK, so any policy that you have with APL, Ms. [PII] would be separate from your primary insurance. What is your social so that I can look up your information in our system?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] 87
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, give me one moment please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know. Let me see.
[AGENT][NEUTRAL] OK, so I have located your policy, Ms. [PII]. I will need to verify several things with you first for security purposes and also any information that I do provide for you would be a verification of benefits and not a guarantee of payment. So if you could first please verify your date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, also your home mailing address, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you gave me, so that is your best contact number, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Thank you and the last piece of information to verify would be your email address and this does appear to be your work email that we have on file.
[CUSTOMER][NEUTRAL] OK. It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you very much. So I can give you your policy number, Miss [PII], and I'm also going to email you a user guide for our portal so that you can set up your profile to have access to your information online. Now I am going to have to request that your policy be made viewable to you because at this point, um, it is not, so that's gonna take a few days but you can still go ahead and set up your profile, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, your policy number is going to be 257.
[AGENT][NEUTRAL] 563 9.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. 257-563-9. OK.
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you have some questions related to your coverage?
[CUSTOMER][NEUTRAL] Yes, um, so I wanted to find out if, uh, through my cancer insurance, if I am covered for a cranial prosthesis.
[AGENT][NEUTRAL] OK, let's see. You're gonna, um, can you give me just a couple of moments so that I can try and pull up some information, um, so that I can look at that with your policy not viewable to me at the moment. I may have to connect you with someone else, but I'm going to try and, and help you first, OK?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Oh, you're welcome. Yes, ma'am.
[AGENT][POSITIVE] And thank you for your patience.
[CUSTOMER][POSITIVE] No, no problem.
[CUSTOMER][NEUTRAL] I found out.
[CUSTOMER][NEUTRAL] Because everybody
[AGENT][NEUTRAL] And I'm still looking at some information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this plan does have a prosthetic benefit. It does not specifically, I was looking, you said this was for a cranial prosthesis, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And you said it does have a what? I'm sorry, I didn't get that last part.
[AGENT][NEUTRAL] A prosthesis benefit on it, but I'm looking to see if that is something.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, can you describe exactly a give me a little more information on this. Is this something that, is this a surgical, like implantation or non-surgical?
[AGENT][NEUTRAL] Prosthetics.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I, I don't know. I, I just know that it, it's, uh, that I would get a, I have a.
[CUSTOMER][NEUTRAL] Uh, it's related to the cancer, uh, cause I'm losing my hair, so.
[AGENT][NEUTRAL] OK, so it's gonna be dependent upon, we would have to receive the claim obviously to review for benefits. Now the, the reason I was asking what the procedure exactly was is because you have a surgical implantation, but that's for a device and that's a maximum of 1 device per site per cover person per lifetime. That is a $1000 benefit.
[AGENT][NEUTRAL] There is a non-surgical prosthetic benefit that does not include a hairpiece.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that is a maximum of 1 device per site per cover person per lifetime with a $100 benefit.
[CUSTOMER][NEUTRAL] OK. So you said that there was a non-surgical, uh, can you repeat that again? Non-surgical.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. On the
[AGENT][NEUTRAL] Uh-huh, for the, OK.
[AGENT][NEUTRAL] A surgical
[CUSTOMER][NEUTRAL] Implant device, did you say? Uh-huh.
[AGENT][NEUTRAL] Yes, a surgical implantation prosthesis, that's a maximum of 1 device per site per person per lifetime, and the benefit amount is $1000.
[AGENT][NEUTRAL] For non
[CUSTOMER][NEUTRAL] What I'm gonna stop.
[CUSTOMER][NEUTRAL] Ma'am, so what does that include when you mean, what exactly does that include?
[CUSTOMER][NEUTRAL] The non-surgical implantation.
[AGENT][NEUTRAL] The non-surgical does not include a hairpiece, and that is a $100 benefit, maximum of 1 device per site per cover person per lifetime.
[CUSTOMER][NEUTRAL] OK. So I, I'm still, I guess I, I still have a question. What is a non-surgical, if it doesn't include a, a hair device, what does it include non-surgical?
[AGENT][POSITIVE] Let me look up the definition in the policy and I'll be glad to read that to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. In addition to that, in addition, ma'am, can you also help us because we don't have any, uh, can you tell me exactly what this cancer insurance covers?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] I can request that, yes, sir, it has a lot of benefits on it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Well, I, I guess my question is, my question is nobody has been able to give us these benefits and we've called different places. Uh, we were under the impression that it was to Blue Cross Blue Shield, and that's why we don't even have a policy number with you guys. So I would like, uh, somebody, somebody, if it's not you, somebody who, uh, is there from your company to give us a brief explanation of everything that it covers.
[AGENT][NEUTRAL] And I'm going
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then this information will also be made viewable in the portal once um you have set up your profile, Ms. [PII]. There will be actually a full copy of your policy certificate, which would be, which is gonna be about 42 pages um of your entire, again, your policy certificate.
[CUSTOMER][NEUTRAL] OK, and then
[AGENT][NEUTRAL] So just a moment for me to look up the first question, which was the prosthetic, the prosthesis benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, on this plan, your policy did not go into effect with APL until [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it states we will pay the indemnity amount shown on the schedule of benefits for a prosthetic device received due to cancer that manifested after the waiting period following the person's effective date of this rider. And if surgery is required, its surgical implantation provided the implantation.
[AGENT][NEUTRAL] Of such a device is prescribed by a physician as a direct result of surgery for cancer. This benefit does not cover prosthetic-related supplies such as special bras or ostomy pouches and supplies. Artificial limbs will be paid under the surgical implantation portion of this benefit. Temporary prosthetic devices.
[AGENT][NEUTRAL] Used as tissue expanders are covered under the surgical benefits and benefits for hair prosthesis are not covered under this benefit.
[CUSTOMER][NEUTRAL] OK, what was the first part that you said that was covered? What was, what was it that was covered?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The first part?
[AGENT][NEUTRAL] The prosthetic device received due to cancer after the waiting period.
[AGENT][NEUTRAL] Is up. Let me see what your waiting period is on this policy, just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and it does not show that there is one.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, now on this policy, there is a waiting period.
[AGENT][NEUTRAL] The policy under which this certificate is issued contains a waiting period during which no benefits will be paid. If any covered person has a specified disease diagnosed before the end of the waiting period, immediately following the covered person's effective date, coverage for that person will apply only to loss that is incurred after 120 days from the covered person's effective date.
[CUSTOMER][NEGATIVE] Mm, I don't understand what that means. Uh, I'm having difficulty.
[CUSTOMER][NEUTRAL] Uh, what does that mean? So what is the, so when did my, when did
[AGENT][NEUTRAL] So there would be
[AGENT][NEUTRAL] OK. Yes, ma'am. Your policy went into effect [PII]. Were you diagnosed with your cancer before or after that period?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So this went into effect on [PII], right?
[AGENT][POSITIVE] Yes ma'am, that is correct uh huh.
[CUSTOMER][NEUTRAL] It was after, it was after that date.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] We will have obviously with any claim that is filed, we will have to have the pathology reports.
[AGENT][NEUTRAL] Um, confirming the diagnosis of cancer.
[AGENT][NEUTRAL] When a claim is submitted to us for review.
[CUSTOMER][NEUTRAL] OK, so you need to have the pathology report, uh.
[AGENT][NEUTRAL] Yes ma'am, and on our cancer claim form, the entire first page, um, Ms. [PII], just for your information has all of the instructions for completing the claim form as well as all of the additional documentation that is required.
[AGENT][NEUTRAL] To be submitted.
[AGENT][NEUTRAL] To ask for review on the cancer policies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you can use that as a
[CUSTOMER][NEUTRAL] Can I ask you a question?
[AGENT][NEUTRAL] Sure, yes, sir.
[CUSTOMER][NEUTRAL] OK, it's because we're, we're a little lost here or I am as we're because so it was, uh, my wife went to [PII], uh, early January, I think, uh, well mid January, and that's when everything with the, you know, just to make sure we, we went through, through the process. So has has this policy paid anything out to, to, because we don't know what because we have, she has the Blue Cross Blue Shield insurance, so I, I'm assuming.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, sir, we've not received any claims.
[AGENT][NEGATIVE] For this policy, no.
[CUSTOMER][NEUTRAL] You haven't.
[CUSTOMER][NEUTRAL] So who would submit the claim? Would it be us or how would this work?
[AGENT][NEUTRAL] Yes, typically it would be you all now there may be someone that would file for you at the facilities again that would be something you would just have to talk to them about.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Otherwise, yes, sir, it would be you all, where she's been receiving her treatment and diagnosis, being diagnosed.
[CUSTOMER][NEUTRAL] And what facilities?
[CUSTOMER][NEUTRAL] And, and so, what do you guys pay? Do you guys pay the money we've already paid in there or what do you guys pay?
[AGENT][NEUTRAL] Again, we would have, I can go over some of the general benefits with you. There's a radiation therapy, chemotherapy, and immunotherapy benefit of $20,000 which is a maximum per covered person for a 12-month period.
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] There are benefits for hormone therapy.
[AGENT][NEUTRAL] Um, a mast, well, your cancer, there are benefits for a mastectomy if that were to be the case. Also, there's a screening benefit for ovarian and cervical cancer.
[AGENT][NEUTRAL] Uh, the prosthetic and orthotic benefit, surgical or non-surgical. There is a first occurrence benefit.
[AGENT][NEUTRAL] Internal first, excuse me, internal a cancer first occurrence. It's a lump sum benefit that's a maximum of 1 per covered person per lifetime in the amount of $5000.
[AGENT][NEUTRAL] There are also multiple different benefits related to surgery and anesthesia.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Transplants.
[CUSTOMER][NEUTRAL] It's good that, that's a lot of information. When you say a lump sum, does that mean that $5000 is it a check that's written to her? Is it, is it something that you pay to the hospital? What do you, what is that?
[AGENT][NEUTRAL] If approved, if approved, that would be, you know, that would go to you all, it would go to Ms. [PII] if it is approved.
[AGENT][NEUTRAL] If you all file the claim, yes sir, that would be, and that is a maximum of one per covered person per lifetime.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So they like we don't have any of this information. None of this is information that we have, uh, so you said she started on.
[AGENT][NEUTRAL] Yes, sir, and I'm going
[CUSTOMER][NEUTRAL] You said that this this uh process started January the [PII] she's uh approved for this, right?
[AGENT][NEUTRAL] That is when this policy went into effect.
[CUSTOMER][NEUTRAL] That it went into effect.
[CUSTOMER][NEUTRAL] So, there's no waiting period or anything like that?
[CUSTOMER][NEUTRAL] Just wanna make sure because uh.
[AGENT][NEUTRAL] Again.
[AGENT][NEUTRAL] Yes, give me just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Bear with me. I'm just still looking through the verbiage on this certificate. Yes, sir, you're welcome.
[CUSTOMER][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And again, I just really appreciate you, appreciate your patience while I'm looking through all of this information.
[CUSTOMER][POSITIVE] No problem. Thank you.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, we, because we were under the impression that when we, we called Blue Cross Blue Shield, so do you, are you guys gonna provide us with a policy number with, I mean not a policy number with a a card?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] No, there are no ID cards for the cancer policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I gave um [PII] her policy number and then she will have access to that as well you know once um the portal profile once she has set that up.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So there is no waiting period.
[AGENT][NEUTRAL] On this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It would only apply if it, if she had been diagnosed prior to the effective date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That would have, um, you know, but you, you said that she was diagnosed in January. Is that correct?
[AGENT][NEUTRAL] That was my understanding. Yes.
[CUSTOMER][NEUTRAL] That they did the pathology, yeah, the pathology report from MD [PII], um, yes, is after the one, yeah, after the effective date of [PII].
[CUSTOMER][NEUTRAL] The pathology report indicates 110, I believe.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so again.
[AGENT][NEUTRAL] If there was a pre-existing condition, then there is a 12-month waiting period. But if she was not diagnosed or received treatment for cancer until after this policy became effective, it does show that there is a zero-day waiting period on here.
[CUSTOMER][NEUTRAL] OK OK.
[AGENT][NEUTRAL] Now, I'm going to request that your policy, as I stated to you before, Ms. [PII], I'm gonna request that the policy uh be made viewable to you in the portal. I can also, uh,
[AGENT][NEUTRAL] I'm gonna email you that user guide so that you can at least go ahead and set up your profile and the user guide will also give you different instructions you know on how to use the portal for different things because if you all will be filing your claims, you can upload your information directly into the portal for review if you would like I can also attach one of the cancer claim forms that I was referring to that has all of the instructions on it.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] I'll be happy to do that as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you're gonna send a request so that I can have access to the portal?
[AGENT][NEUTRAL] Um, no, you will, you can already, you already have access to it once you set up your profile. You just will not see the policy information in there yet. That's gonna take us a few days to get that in there, probably be the first part of next week before that information will be in there, but it will be uploaded where you'll have access to that as well.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And you, and that's gonna be done through an email, ma'am, or what? You send the link?
[AGENT][NEUTRAL] No, sir, we don't. I'm going to send an email.
[AGENT][NEUTRAL] With the instructions for the user guy with that has the portal website.
[AGENT][NEUTRAL] To go to and I'm also gonna include one of the cancer claim forms in my email, but we cannot accept claims via email due to security they can be uploaded to your portal.
[AGENT][NEUTRAL] They can be faxed. Mhm.
[CUSTOMER][NEUTRAL] No, no, no, I, I, I.
[CUSTOMER][NEUTRAL] I understand that my question was for her to for her to uh have access to a portal and for her to sign up, is there an email link that is gonna be sent to her or how is she gonna do that?
[AGENT][NEUTRAL] Yes, so that's what I said I'm going to send, I'm gonna send the user guide that gives the website to go to to set it up and Miss [PII], you will need to use your work email when it asks for an email address because that is what we have on file for you so if you try to use a personal email for security purposes, it's gonna give you an error message.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you all have any other questions? I will send that to you in just a couple of minutes and the email that you're gonna receive from me will come from [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I will put care team, uh-huh.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] Mhm. At where? I what, I'm sorry?
[AGENT][NEUTRAL] And I will put
[AGENT][NEUTRAL] A public like American public so [PII] and I will put APL in the subject line so that that's easy to recognize.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you all have any other questions at the moment?
[CUSTOMER][NEUTRAL] Well, I, I guess I, I, we have so many, to be honest with you. Uh, I, I very, like I said, uh, I know her diagnosis was, we were sent over there [PII] was her diagnosis. Uh, you know, there were some tests done here before we left and things like that. So I guess that that's I wanna make sure that, you know, uh, our coverage is gonna be able to, we were under the assumption, the policy, we're under the assumption that you guys were already paying some of the, the bills and things like that.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, but I, but as far as what I understand now is that, that now that we have to send them straight to you and that you would give us, I guess, cash or something like that, in other words.
[AGENT][NEUTRAL] Well, if you all file the claim and we are able to pay benefits on that claim, then yes, the benefits would be payable to Ms. [PII].
[CUSTOMER][NEUTRAL] So now, let me ask, uh, all the, all the, uh, charges and, and for the services that I've been getting at MD [PII], do we submit those to you or how does that work for payment? Like, uh, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, again, yes, you will have, there's a list of documents that you will have to submit with your claims, um, and on that the first page of the claim form that I'm going to send to you use that as your checklist because it has all of the instructions for what you will need to submit in order for us to review a claim. Now if for any reason, you know.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Fail to submit something that we do need, you know, it will get reviewed and you would still have the opportunity to provide that missing information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So does this include like doctor's co-pay, like every time we go I think we pay like 50 to $60. Does that include, is that covered also?
[AGENT][NEUTRAL] No sir.
[AGENT][NEUTRAL] Now that is not a covered benefit under this policy. Of visits, no, sir.
[CUSTOMER][NEUTRAL] No. So, so I guess I would like to really know exactly, like you think, like, I know there's 42 pages, but I would like to really know what exactly is covered. Uh, can there be
[AGENT][NEUTRAL] Yes, sir. I just
[AGENT][NEUTRAL] Yes, so I just went over the benefits. That's what I was stating when I went through the chemotherapy benefits and the amount and the first occurrence benefit, that was the benefit information.
[CUSTOMER][NEUTRAL] Yeah, you told me, yeah, you
[CUSTOMER][NEUTRAL] But, but
[CUSTOMER][NEUTRAL] But, OK, so, so my thing right now is like the chemotherapy, we're not even paying for it, it's uh I guess we already made our deductible, so, so how do we, do we, how do we submit that if we're not paying because we made our deductible?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] You will still submit the claim because this isn't, you will have to provide the your primary insurance company's explanation of benefits for us, OK?
[AGENT][NEUTRAL] But you can still.
[CUSTOMER][NEUTRAL] And and who gets uh who, who, who, who gets, I'm sorry, I don't mean to interrupt you, but I just, I have.
[AGENT][POSITIVE] The benefits with, yes, sir.
[AGENT][POSITIVE] The benefits would be payable to you all.
[CUSTOMER][NEUTRAL] Who gets us that information?
[AGENT][NEUTRAL] You all will have to obtain that from the hospital and the doctors that are treating her.
[CUSTOMER][NEUTRAL] If that's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The facility and the providers.
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] Now, I think that, I guess to start step one, you need the, before anything e[PII], you need the pathology report indicating the date of her treatment at in the uh or the services, right?
[AGENT][NEUTRAL] Yes, so that will be part of the documentation that will need to be submitted along with, you know, for the with the initial claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, because that is a required piece of information that we have to have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then, so then I guess I'll I'll look for that email did you send that email right now so that I can take a look at it for the portal or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am. I will, yeah, I'm going to send it when we're done with our call. Yes, ma'am. I'm gonna send that to you.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Um, just so that I can start getting all that, uh, ready and filling out whatever I need to do. Um, but I guess so my question was really on the, on the, on the cranial prosthesis, uh, but you said that.
[CUSTOMER][NEUTRAL] I, I guess all that information. Uh-huh. Go ahead, ma'am. I'm sorry.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] No, that's OK, yes ma'am, that is something that you know we will have to review once we receive the um information on it.
[AGENT][NEUTRAL] I can't, but there is a prosthetic benefit on here. Now, whether this particular procedure would be covered under that, we will just have to brief
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Save all of the information.
[AGENT][NEUTRAL] To determine that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And you said all that information as far as the policy information that should be uh uploaded within how many days?
[AGENT][POSITIVE] I would give it's gonna take probably a week for you to be able to see that, yes ma'am, and it could be sooner.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But it will be in a PDF format.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In in your portal.
[AGENT][NEUTRAL] When you click on the policy number in there, it should give you, you know, it should tell you like download available or.
[AGENT][NEUTRAL] Once it's there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, I guess I'll I'll keep an eye out for that then.
[AGENT][NEUTRAL] OK. Well, do you have any other questions at the moment that I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, not, not at this time. I'll call back once I get the policy and I have any look at it, I'll look at it and if I have any questions, I'll call back.
[AGENT][POSITIVE] Absolutely, yes ma'am, and we'll be more than happy to help you.
[CUSTOMER][POSITIVE] OK. Thank you so much. Thank you, ma'am.
[AGENT][NEUTRAL] Well, you are, yes, you're very both very welcome. And just um so that you also know, uh Ms. [PII], now you will have to always be present if Mr. um Mr. [PII] calls in. We would not be able to disclose any information to him without your
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Verbal authorization for that phone call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] OK then, well, if that is all that I could help you all with at this time, thank you again for calling APL and give me just about 5 minutes and you should have that email from me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you so much. Thank you, bye.
[AGENT][POSITIVE] Well, you're very welcome, yes, and have a nice day and thank you again for calling APL.
[CUSTOMER][POSITIVE] OK thank you bye bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.