AccountId: 011433970860
ContactId: a27de275-4bb0-434a-8faf-accfa7887254
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 3373360 ms
Total Talk Time (AGENT): 1831389 ms
Total Talk Time (CUSTOMER): 1499265 ms
Interruptions: 56
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/a27de275-4bb0-434a-8faf-accfa7887254_20250219T22:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking to? How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII]. Um, hey, I.
[AGENT][NEUTRAL] Hey, girl.
[AGENT][NEUTRAL] Yeah, what, what you got?
[CUSTOMER][NEUTRAL] Um, I have, I'm assuming she's a.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Lord, she
[CUSTOMER][NEUTRAL] I guess she's a beneficiary under an insurance policy, and she was calling someone back because they had talked about a claim that she said that was submitted in June, but they said all she had to do was submit the claim information, which she said she did, which I see information has been received like a power of attorney. Oh bless it. 207842-2.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's that policy number?
[AGENT][NEUTRAL] OK, and who do we have on the line that we're speaking with?
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I don't see any claims. I just see.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let me take a look and let me, let me take a look at it, [PII] and see because even though she may have submitted.
[AGENT][NEUTRAL] OK, so [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, we like to call back.
[AGENT][NEUTRAL] And I see her listed.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What is [PII]?
[AGENT][NEUTRAL] And is she the beneficiary? Let me take a look and see.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEGATIVE] Oh [PII], I went the wrong screen. Sorry, that sounds loud.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, so she is the legal power of attorney and we have that noted. So when you look at, uh, I don't know if you could see the PR PRTQ screen, it has relationship L next to [PII], that's who we're speaking to, right? The [PII]? OK, so she is listed, but what is she wanting to know?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Well, and I told her it looks like she spoke with a representative, and I explained to her, uh, that since she is a beneficiary, she just needs to submit the claim, and she said that she submitted it, but in June, but I don't see any information. I'm gonna.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] We haven't, we, we haven't received the claim. No.
[CUSTOMER][NEUTRAL] To call back later to talk informed that all documents have been set up on you need to submit the claim, yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see I take but this policy is not.
[CUSTOMER][NEUTRAL] Oh well that's
[AGENT][NEUTRAL] And then it looks like she spoke to [PII] in July.
[AGENT][NEUTRAL] And [PII] oh let's see, let me take a look at one more thing, uh, yeah, um, you know, if you want me to tell her that, I can tell her that. She just needs to file a claim. We've not received a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If you would, please.
[AGENT][NEUTRAL] Yeah, sure, go ahead and what's the callback number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, fudge monkey. I forgot that. I'm sorry.
[AGENT][NEUTRAL] I never mind, it's, I think it's on the caller ID and I'll verify.
[AGENT][POSITIVE] All right, girl. All right. Take care. Have a good evening, OK? Send her over. You're welcome. All right. Bye-bye. You too.
[CUSTOMER][POSITIVE] I appreciate you. All right. Have a great one. Bye.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. Is this Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] OK, so I understand that um did you verify the policy holder's name and date of birth?
[CUSTOMER][NEUTRAL] I did
[AGENT][NEUTRAL] OK, and the physical mailing address you verify that as well?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] His address? Hold on.
[AGENT][NEUTRAL] Yeah, his address, do you know that?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yes, I do. Hold on. I have all that in my book.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It is.
[CUSTOMER][NEUTRAL] That's it now.
[CUSTOMER][POSITIVE] Yeah, I have the address. Gosh, have so many.
[CUSTOMER][NEUTRAL] It's going on though um when that was happening.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEGATIVE] I feel like I've had so many paperwork to go through.
[CUSTOMER][NEUTRAL] Customer service and we the Blue Cross Central calling where is it at?
[CUSTOMER][NEUTRAL] I'll find it.
[AGENT][NEUTRAL] What about his email? if you don't don't have that, did you know his work email? What was his work email?
[CUSTOMER][NEUTRAL] Yes, yeah, I.
[CUSTOMER][NEUTRAL] Uh, uh, I don't know the work email at all. No, that was, yeah, it might be the same. I mean, it was [PII].
[AGENT][NEUTRAL] Oh, OK. All right, OK.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, that's not it. No. Mm mm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, yeah, I think he had, I don't know, he had a problem logging on to his email from work I know that, so I didn't give you anything else that you need, so.
[AGENT][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] Uh, that's OK. Um, well, I think you verify. Don't, don't worry about it. Um, I do see that you are listed as a power of attorney and we did receive the paperwork saying that you are the power of attorney, but we have not received the claim. You have to file a claim, so this is a cancer policy.
[CUSTOMER][NEUTRAL] And she's left in him.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But I did.
[AGENT][NEGATIVE] We didn't receive it.
[CUSTOMER][NEUTRAL] I did. I have a copy and I have receipts to uh the UPS store when we sent them. I have everything here. um, I made copies of everything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, so do you have a UPS, do you have a UPS tracking number? OK, what's that tracking number?
[CUSTOMER][POSITIVE] Yes, I do.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, I don't know what the tracking number, well.
[CUSTOMER][NEUTRAL] Maybe this is the last transactions uh there's a number here this might be it. It's 1-8773659423. got the time, the date.
[AGENT][NEUTRAL] No, that's a phone number that's not a tracking number that's a phone number too.
[CUSTOMER][NEUTRAL] And it's an actual receipt, OK, fax log um.
[AGENT][NEUTRAL] No, it's a tracking number and if it was you.
[CUSTOMER][NEUTRAL] That would have been on the receipt then, right? Hold on, let me see. I might have the the receipt receipt.
[AGENT][POSITIVE] Exactly, exactly. Mhm.
[CUSTOMER][NEUTRAL] I have so many soldiers from because I was the only dealing with you guys. I was dealing with a lot of people hold on please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] A lot of different entities, um, we're trying to beat the clock and he ended up passing away before all that. Here's the receipt. I'm so glad I kept it. Hold on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It should be on here, right?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Employees item.
[CUSTOMER][NEUTRAL] There's a tracking number. OK, here it is. I think it's the number below the little, the, the little thing they scan, the long number, right?
[AGENT][NEUTRAL] I'm not sure. I'm not sure.
[CUSTOMER][NEUTRAL] OK, it's 1212.
[CUSTOMER][NEUTRAL] 407-257-159 B as in boy 033293.
[AGENT][NEUTRAL] OK, that's 124072 57 15 9 B like boy, 03 3293.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And when did you send this?
[CUSTOMER][NEUTRAL] On the same day, let me look at the date on this receipt, [PII].
[AGENT][NEUTRAL] OK, so I'm looking at what was sent on [PII]. Let me take, oh, and it was sent from the UPS store at [PII]. Uh, let's see, I'm looking at what you sent, but I'm not, I, I, I have to go through this to see exactly what this is.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, Texas oncology.
[CUSTOMER][NEUTRAL] This year was a disclosure for um I guess the HIPAA form to protect health information release information um.
[AGENT][NEUTRAL] So what I'm looking at so far was the 19 pages and all this is is everything that has everything to do with power of attorney. There is no cancer claim form inside of these documents. You have to file a cancer claim form. You have to submit the pathology report, diagnose him with cancer. You have to get an itemized bill. mhm uh-huh, go ahead.
[CUSTOMER][NEUTRAL] Medical records.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Oh my gosh.
[CUSTOMER][NEUTRAL] OK. OK. OK. OK, ma'am. Ma'am, I know all this. You guys have already, I'm not trying to be rude, but you guys have already told me all this when I did it, OK? And I sent it. I actually went to the oncology, um, what was it called? Texas Oncology. Uh-huh, and they, and I gave them a copy of this form.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Texas Oncology. Uh-huh.
[CUSTOMER][NEUTRAL] with him fine because we needed it and um so that they can fax everything to you guys and with me being the durable power of attorney right but they told us they did we don't have ways to know that until afterwards right? like I am finding out right now I already knew this when I first called um back in September maybe but anyway um.
[AGENT][NEUTRAL] And they did not
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Right. You're right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that
[AGENT][NEGATIVE] And I see, I see the claim form. I see the cancer claim form. We just don't have and I see, uh, the instructions were sent back where it tells you what I just stated if you're filing it that you have to have the cancer claim form the past so you, you sent all that back, but um they didn't do what they said they were going to do. I'm just gonna let you know we have not received anything.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right. Right, right, right, right, right, right, right.
[CUSTOMER][NEUTRAL] OK, so where do, so where I understand that. So where do we go from here? What do I do?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You would have to reach out to Texas oncology to get that information. Mhm.
[CUSTOMER][NEUTRAL] Because at this point, my brothers, my brother, my brother is deceased. He passed away in August.
[CUSTOMER][NEGATIVE] I was a durable power of attorney then. How are they going to release anything? Yeah, thank you. However, um, they're not gonna, they're not gonna do anything for me now because my brother, the, the, the durable power of attorney is only good while he's alive.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] So sorry to hear about, sorry about your loss. Mhm.
[AGENT][NEUTRAL] They will
[CUSTOMER][NEGATIVE] So I can't call there and request anything, so why couldn't the insurance do that?
[AGENT][NEUTRAL] Um, I'm not, I'm.
[AGENT][NEUTRAL] And, and, and, and
[AGENT][NEUTRAL] No, ma'am, because just like you don't have the right to do that, we don't have the right to do that. There are laws in place and you have to have certain documents unfortunately. So my suggestion to you is that you need to tell them you have power of attorney you need to present that death certificate.
[CUSTOMER][NEUTRAL] I mean that's what you guys
[CUSTOMER][NEUTRAL] OK. So,
[AGENT][NEUTRAL] That's something that they're gonna look at, and they will tell you whether they can give you his records or what they may need from you, but people get their siblings' records, their non-parents' records all the time when they file claims for a deceased person without a problem. But we can't just call and ask for it because we have to have.
[CUSTOMER][NEUTRAL] They have it, yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, OK. All right, I get it. I get it. I get it. You, I don't, I've never worked there, so I don't know. That's why I'm calling you guys. So um I will just have to make a trip there and go there myself. I live in another state. I live in the state of [PII]. He lived in [PII], so, um.
[AGENT][NEUTRAL] Permission from him and like you said, he's a deceased. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, try calling them. Try calling them and explaining that to them. You know, maybe you'll get somebody that's, you know, uh, will be really sympathetic and willing to, you know, just go the extra mile to help you and let them know you live in another state. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, I, I, I know that that I
[CUSTOMER][POSITIVE] Right, and I know you guys deal with this all the time. I'm sure there's been other patients that passed away while they were, you know, in the middle or in the process of filing a claim. So there's that I know there's a way to do something. I just didn't know where to start. So I started with you guys. I'm just now feeling better. I'm just now getting over my, my, my, I'm still mourning, you know, I didn't want to deal with all this when I got back.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes. And then I'm so sorry for your loss. Mhm.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEGATIVE] And, and, and things are coming up so it's like I need to do this. So here I am again doing it, um, which I, it was, I, I honestly wasn't gonna do anything. I was so upset over everything, you know, but at this point I have to because he's getting bills that are coming in and um there was the will wasn't signed, so there's nothing, nothing I can.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] And can I ask you one question? When was he diagnosed with cancer? Do you know when he was diagnosed?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh my gosh, many years ago.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's why he has two policies, I believe. I think he started with one policy, and then he started with a different one later on. I don't know how that happened or what happened. But um I don't know all that. I'm his sister, I'm not his wife, you know, um, I don't have, I had access to, I was very limited. My brother was not good at.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, cause I'm, I'm looking.
[AGENT][POSITIVE] OK. OK, no problem.
[CUSTOMER][NEUTRAL] Um, following up on these things. Obviously, he never filed a claim.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] And he had cancer for years.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You know, I never filed a claim with you guys so.
[CUSTOMER][NEGATIVE] You know, and I can see why you guys don't make it easy, you know, so, and he was sick, you know, he was very ill.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, you know, we, we do require a lot of information. I will say that, you know, um, you know, I've, I've, sometimes they ask us, what do you think we can do to make it easier for the uh for the insured?
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] And I myself um I'm a cancer survivor and I said, well, the insurance company I had was not the company that I'm with now. I said I didn't have to go through all of what everybody on with APL has to submit and you know they explain it that every insurance company is different and quite naturally that is true they all.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Make their own rules and um but I did throw that out there and have said, I, you know, I wish we could streamline things for people because especially when you're diagnosed with cancer. I've been there. I know what it's like. Nobody wants to deal with all of this. You got, you know, the, the, the fact of the C word alone and uh, you know, you ain't thinking about nothing else, you know.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, um, you know, hopefully we'll change that one day, you know, because like I said, I have mentioned that and I was just told, hey, that's the way our policies, that's the way it's the way our policies are written and that's the information we have to have, so you know.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, I, I get it. I mean, it's like everywhere else. It's like where I'm at. We have our policies. We'll have to go by our our requirements and all. I get it. However, um,
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I, I didn't know even where to start. I thought all of this was taken care of. Obviously everybody dropped the ball somewhere, you know, nothing was done.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Here I was trying to take care of my brother while he was dying and take care of his business and nothing was done. This is a very disappointing. I'm beyond pissed off right now. Yeah, I'm very upset.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, I hope you, uh, you know,
[AGENT][POSITIVE] You know, take care of yourself, number one.
[AGENT][NEUTRAL] And handle continue to handle your brother's business, but #3, know that we don't have a timely filing limit.
[AGENT][MIXED] So what, if it takes you, now I know it ain't gonna take you this long, but if it takes you a year to get it in, it's still fine.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEGATIVE] And, and I'm, I'm so pissed. I'm, I'm gonna go raise hell and every entity that I went to and wasted my time with, which it starts with the oncology, oncology and the um the FedEx place. They're gonna get an earful from me, you know, I spent a lot of money faxing and sending crap to them, lots of money. Not only to you guys, you know, hospitals, doctors, I mean, we were dealing with, I was dealing with a lot of stuff.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][NEUTRAL] I kept the reason why I kept receipts for everything. I have proof.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] But you guys still don't have the records or you guys still don't have the claims, so.
[AGENT][NEGATIVE] No, they never, they never sent it we don't, we did not receive it. We only received what you faxed from the UPS store. I found that.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] That's all we receive.
[CUSTOMER][NEUTRAL] And which is like just the durable power of attorney that was it?
[AGENT][NEUTRAL] Basically, yes, and the cancer claim form and then the, you also put a copy of the Texas Oncology authorization that you gave them to release and disclose the records.
[AGENT][NEGATIVE] But we never received them.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And you have, you have the beneficiary one then, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it looks he signed it, yes, he signed it, of course you know that was [PII] he signed it for his medical records to be released, but um, and it says on here to send to us and and has our PO box has the correct PO box and address but we never received it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, all right. Well, I'm gonna have to call them and
[AGENT][NEGATIVE] So they shouldn't give you, they should not give you any problems because you should present that to them. It's time stamped at the top. [PII] from the UPS store. Clearly their authorization form that they had your brother sign, he signed it, he dated, they shouldn't give you any problems. They should give this information over because they were supposed to do it and they never did it.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] This is unbelievable. So, OK, so I'm, this is, this was the name of the organization which was you guys, him giving them permission to send everything to you all. I even have his medical record number on here, so, um, so yeah, they just never did it, so I will contact them and um.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][NEGATIVE] They never did it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] I also had called um MD [PII] because he was also a patient of MD [PII]. We made many trips to MD [PII]. He had many surgeries and procedures out there. I mean, he's been going through this for a while. So, um, I also contacted them and, and gave them um the signed forms so that they can um send everything to you all as well, and apparently they didn't do anything either. So everything I did.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEGATIVE] didn't get done.
[AGENT][NEUTRAL] You know, we have not received any medical records, yes, and like you said, I would start with uh this is, I mean, uh, this is clear as plain as day, what he asked them to do and it has American Public Life IPO box.
[CUSTOMER][NEUTRAL] I, I, I don't understand.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And our phone number and our fax number, our fax number is [PII]. I'm not I I don't understand. I, I don't.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Right. And I wrote down what you guys needed um the last time that, um, when I called you guys after he passed, I'm trying to find it, um, which is why I was trying to tell you I already knew all that. I wasn't trying to be rude. Um, but I don't see, I just saw it a while ago where I wrote it down. They wanted to know um when he was diagnosed and what are the things exactly you want me to tell them to fax over to you guys again cause I can't find that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh no, you're fine. You're fine.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Exactly what we need is um we need the pathology report that originally diagnosed him with the malignant cancer.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, hold on, pathology, I have that.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I just got so many things here I I'm sure I'm missing it, but, but I wanna make sure I have it up, OK.
[AGENT][NEUTRAL] Uh-huh. And the itemized bill.
[CUSTOMER][NEUTRAL] Uh, with original, original, original diagnosis?
[AGENT][NEUTRAL] Uh, that originally diagnosed him with uh cancer, the malignant cancer. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we need itemized bills for all surgeries with procedure codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Dates of service.
[CUSTOMER][NEUTRAL] OK, now let me tell you this while I was at [PII] the last time we went, which.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, that was the last visit. I did get all the records.
[CUSTOMER][NEUTRAL] An itemized records of all of his um.
[CUSTOMER][NEUTRAL] His billing, so would that include um what you guys need from the itemized uh.
[AGENT][NEUTRAL] It may be. If you, if you're getting all his medical records from them, requesting everything, I'm pretty sure everything is more than likely, more than likely it's gonna be in there. But they may have, you know, you, it may not have that pathology report. Uh, usually, Texas Oncology is pretty good about sending itemized bills, but the path report, you may wanna just mention that to them. Do you all have this? Make sure you send that as well. Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause I, I
[AGENT][NEUTRAL] Because I see a lot from Texas Oncology, but usually it's just itemized bills.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Yeah, so we just need to itemizes bills from them, OK.
[AGENT][NEUTRAL] Yes. And then MD [PII] [PII] is more than likely gonna have that path report. Both of them should have it because they took care of him and they have to have that when they're, you know, treating you, so.
[CUSTOMER][NEUTRAL] And also from [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, he was, he was diagnosed stage 4 from the get-go.
[AGENT][POSITIVE] Oh my God. Wow.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Yeah, and he, and he lived for years. I mean, [PII] kept him alive for a while, but, but, um, he was at a stage 4 when he was first diagnosed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, OK, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And this is why nothing was ever done. He, he honestly didn't even know what he had.
[AGENT][NEGATIVE] Yeah, he was too sick. He was too sick dealing with all that, you know, I, I, I, I'm just telling you, it, it drains you and then the treatments, it just drain you and sometimes it make you a little brain foggy. Um, it's just, it's, it's some, it's an ordeal. It's an ordeal, you know? So.
[CUSTOMER][NEUTRAL] You know, so, yeah.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] He went through so much treatment. Yeah. Yeah. He went through so many um sessions of, of chemo, so many. And he had several surgeries, 12, maybe 3 surgeries at MD [PII], he had lots of procedures where they put uh stents in his liver.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Cause it, you know, they originate, it originated from his um colon, so they called it all colon cancer, but it spread to his liver and to his lungs.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So, yeah. So he, I mean, I don't know if that's like 3 different diagnosis. I, I don't know.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean, it was at different times, not all at once. You know, first they found it in the colon and then they found it in the liver, and then they found it in the lungs. So it was, it's growing, yeah, it was spreading.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So it spread it. Mhm.
[AGENT][NEUTRAL] Mhm. Yes. OK. OK. Well, just make sure since he has several diagnosis, tell them to send us, we need all the pathology reports, all of them, OK? Because when somebody gets assigned his claim, we don't want there to be any uh issues or hang ups or having to ask you for any additional information so after reports are needed. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so is, are those the, the only, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, right. Well, I pay, I pay for all of his um funerals, all of, I paid for all of his travel time in the last 4 years, hotel stays, everything. I did everything. I completely took care of my brother and now I'm getting like um I I I'm getting some bills from the bank for things that I was not even responsible for that because
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] [PII] bless you.
[CUSTOMER][NEUTRAL] My name was simply added to his bank account. Now the bank wants to come after me for um a loan that he had.
[AGENT][POSITIVE] Wow. Yeah. Oh Lord. Yeah, yeah.
[CUSTOMER][NEGATIVE] I'm like, how is that possible? I'm not his wife, I'm his sister, and it was just for that reason and apparently I guess they can do that, so now I'm like, I wasn't gonna do this, but now I'm like, you know, I have to because I've already paid out enough.
[AGENT][NEUTRAL] Lord have [PII]. Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, well.
[CUSTOMER][NEGATIVE] Yeah, we'll see. I didn't want to, but my, my daughter-in-law said, you know, you've been paying out, but it's all been coming out of your pocket all the time. You should be entitled to this, you know, for everything that you did.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's right. That's right. Yeah, that's right.
[CUSTOMER][NEUTRAL] You know, and, and, and I, I was gonna give it to his children, but at this point I want to at least be able to pay off whatever debt they're saying that.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] I'm, I'm, you know, attached to, which is unbelievable. I don't, I don't understand that. I might have to hire an attorney for that.
[CUSTOMER][POSITIVE] So, yeah, lesson learned in a lot of ways.
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Well.
[CUSTOMER][NEUTRAL] All [PII]. Well, I thank you for your help, and those are the only two things. The original pathology report with all, all um diagnosis and then all itemized bills.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, this is what we're gonna, this, I want you to scratch that. We want pathology reports now. I thought it was just one diagnosis. We want all the pathology reports. So every biopsy he ever had the uh whatever it was, uh, you know, if it was the, the colon, we need every biopsy and uh pathology report that was performed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, so just say I need all his pathology reports. That's what you need to tell them. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's it. No medical bills?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] The itemized bills, that's right, that part is right mhm mhm.
[CUSTOMER][NEUTRAL] That too? OK.
[CUSTOMER][NEUTRAL] So we need all pathology reports and all itemized bills.
[AGENT][NEUTRAL] Yes, ma'am. Mhm. Mhm.
[CUSTOMER][NEUTRAL] OK, alright, and I think whatever I have here I'm gonna also mail to you guys because I did pick up a whole packet from MD [PII] before I left. We already knew there was nothing they could do, and we took them one last time to get a a sent put in.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So, um, while I was there, I went ahead and, and signed these, you know, release forms and everything so that they could fax everything to you guys, but they didn't. So I, luckily I did ask for a copy of everything as well, so I do have that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can at least send that to you guys in the meantime. Does it make a difference, or should I wait to see if they send you something because I don't wanna send you something and then you guys think everything's in there and it's not. So I might wait a little bit. I'll wait to see what they do, yeah, yeah.
[AGENT][POSITIVE] OK, sounds good.
[AGENT][POSITIVE] It's, yeah, it's up to you. It's up to you. Mhm. It's up to you. Yes, that'll be totally fine. Let me take a look before we, before we get off the line, I wanna take a look cause I just wanna see what all type of benefits your brother had under his policy. That way, um I make sure you have everything.
[CUSTOMER][NEUTRAL] Because we get that here sometimes too.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That you need make sure you know everything and um exactly what all you need so we already say all file your reports all the itemized bills um and those itemized bills have to have procedure codes, dates of service and charge amounts.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and you and charge charge amounts.
[CUSTOMER][NEUTRAL] Date of service and what?
[CUSTOMER][NEUTRAL] Charge amounts, OK.
[AGENT][NEUTRAL] Uh huh and so looking at his benefit.
[AGENT][NEUTRAL] That he did not have any surgery benefits under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I do see.
[AGENT][NEUTRAL] Now it just depends because your brother had several policies.
[AGENT][NEUTRAL] So, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me take a look here. Looks like he has several policies and one might have had something and other 1 may have not.
[AGENT][NEUTRAL] OK, so let's see.
[CUSTOMER][NEUTRAL] Yeah, I have 2 different policy numbers and that's what you're referring to.
[AGENT][NEUTRAL] And have you sent in his death certificate yet?
[CUSTOMER][NEUTRAL] No, I haven't.
[CUSTOMER][POSITIVE] But I will, I'll send that in right away.
[AGENT][NEUTRAL] OK, you need to do that because I'm showing that his policy is still active and the premium of $25 will still collected so um you need to get that to us immediately um so that we can because customer service is not gonna, they're not gonna lapse his policy or term his policy until we receive that and what was his date of death?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, I have it here. I had, I called you guys to report it when it happens.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] They just said to send it to you guys when I got it, but like I said, I was really mourning. I hadn't, I didn't wanna pick up anything for a while, you know, but here I have it right here. The date of death is [PII], I believe.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of 24
[CUSTOMER][NEUTRAL] I'm looking, I'm looking. Let me get my glasses. Yeah, it was this last year. Hold on, yeah, [PII]. So where do I fax this to? I can do that tonight.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me take a look at this other policy.
[AGENT][NEUTRAL] Sure. Um, fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 94
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, let me repeat that fax number [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is correct. Mhm. And I'm just looking at his other benefits under these other policies cause since I don't know when he was diagnosed, sometimes when people get a different policy number, you have a different policy number cause you may have added something to your policy or you may have taken something out. So I just kinda have to scan to see.
[AGENT][NEUTRAL] So that one didn't have any surgical benefits either. Uh, let me check the one last one.
[CUSTOMER][NEUTRAL] How many did he have?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Well, it's, it's technically it's one policy but the way, the way we do it at APL when they come up for open enrollment if they decide, oh, I wanna add this writer that writer makes them get a whole new policy number. I, I don't know why we do that, but they get a whole new policy number so it's not like you have 3 policies you just at that something was either taken off or you added an extra benefit in.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, um, and so then that would cause you to get a new policy number for that date span and it looks like from [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He had uh a policy, um, that the benefits changed slightly um and then from [PII] to [PII], he had a policy, but then it looks like uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that would have been correct. OK, but then it looks like there was a gap in coverage from [PII] because it looks like you didn't have anything.
[CUSTOMER][NEUTRAL] I paid for that. I paid for it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's something that.
[CUSTOMER][NEUTRAL] I paid through uh his employer through his employer, and I have receipts of that as well. um I make sure I make sure, yeah, yeah, I make sure that um I paid all of his insurance up to date.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, good, cause you'll have to take that up with customer service. Mhm. OK.
[AGENT][NEUTRAL] OK, so looking at all of.
[CUSTOMER][NEUTRAL] All of his medical insurance and his.
[AGENT][NEUTRAL] Mhm. So looking at all of these policies, he indeed did not have any surgical benefit up under either of them. So that means any surgeries he had performed including biopsies, uh, they won't be uh considered because there's no surgical benefit and that's what it falls up under, but we still need all pathology reports, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so what does it cover? What did it cover?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] It covers radiation, chemotherapy, and immunotherapy up to $20,000 per 12-month period. And because he resides, OK.
[CUSTOMER][NEUTRAL] OK, hold on, hold on.
[CUSTOMER][NEUTRAL] Chemo and what else?
[AGENT][NEUTRAL] I'm sorry, radiation.
[CUSTOMER][NEUTRAL] Radiation?
[AGENT][NEUTRAL] Immunotherapy.
[CUSTOMER][NEUTRAL] Immunotherapy.
[AGENT][NEUTRAL] $20,000 per 12 months.
[AGENT][NEUTRAL] It covers let me know when you're ready for me to.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] It has a lump sum one time benefit of $10,000.
[AGENT][NEUTRAL] For the diagnosis of malignant cancer.
[AGENT][NEUTRAL] And again if you made that payment because there appears to be a gap in his coverage that's something that you're definitely gonna have to take up with customer service it's saying from [PII] that second policy terminated and then he didn't pick up a new policy until [PII], so there's like a 30 day gap.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the gap? Where's the gap?
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Mm mm, because I went, I went to his employer to pay for everything.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] So I could get that from the employer, right? from the school district because I went there to to pay for everything and.
[AGENT][NEUTRAL] Yes. And let me take a look, let me, let's take a look at one other thing. Uh-huh, go ahead.
[CUSTOMER][NEUTRAL] And the last payment
[CUSTOMER][NEUTRAL] Yeah, the last payment I made was, oh, I sent his daughter the money and she sent me a copy of the receipt over the phone because I made sure because.
[CUSTOMER][NEUTRAL] That was my biggest concern. I wanted to make sure that he was paid up for all of his insurances and um.
[AGENT][NEUTRAL] OK, well, he's still, he still should be OK, but we'll get that straighten out with customer service, um, and then the last benefit that he has.
[AGENT][NEUTRAL] I imaging if he had a CT, a cat.
[CUSTOMER][NEUTRAL] Mhm. Oh, he had all of that. OK, let me write this down.
[AGENT][NEUTRAL] A pet
[AGENT][NEUTRAL] Or MRI this policy will pay for 1 test per year, $500.
[AGENT][NEUTRAL] And then if he had a chest X-ray.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, PSA lab results.
[AGENT][NEUTRAL] Um, colonoscopy?
[AGENT][NEUTRAL] I can't think of everything. Something that's considered preventative, we pay $50 per year for preventative and he can go all the way back to [PII] on those things, OK?
[CUSTOMER][NEUTRAL] You did.
[AGENT][NEUTRAL] So that's when his policy began.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And that's the benefits that he has.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Mhm. Let me see when this effective date was, and I'm gonna get you back over to uh customer service because um they need to get that uh gap in coverage. They'll be the ones to.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then, what you're saying then if, if he had like a CAT scan, which he had several, if he, every time he had one, you would cover 500 per year.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Per year, only 1 test. We're only gonna pay 1. So if he has 5, we're only gonna pay 1.
[CUSTOMER][NEUTRAL] OK. So then if he, OK. So.
[CUSTOMER][NEUTRAL] OK. So if he had a CT, a CAT scan, and a MRI, and a PET scan.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We're only gonna pay one of those.
[CUSTOMER][NEUTRAL] You pay 500 for each one of those? Oh, just one of those, not all of them?
[AGENT][NEUTRAL] No, we're only gonna pay 11 per year. It, it, it could be either one of them, but only one per year.
[CUSTOMER][NEUTRAL] Per year. OK.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the lump sum, OK.
[AGENT][NEUTRAL] It's $10,000.
[CUSTOMER][POSITIVE] Oh, that would be great, because he owes over 5000, yeah.
[AGENT][NEUTRAL] For the lifetime of the policy, but um, you know, again that's, that's his benefits but we have to receive the death certificate um and then so when we go back to because I don't want you to get too much information because them giving you too much information now me looking at this policy that would just be uh bothersome too, OK? Um, you need itemized bills.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] For only
[AGENT][NEUTRAL] Radiation?
[AGENT][NEUTRAL] Chemo
[AGENT][NEUTRAL] And immunotherapy.
[AGENT][NEUTRAL] The medical imaging, whether it was a pet, a CT, a cat, a MRI, whichever it was.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so we need itemized bills for all of this as well.
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] Only, only for these things that we're going over. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh for the diagnostic test, whether it was a chest X-ray, it could be the results. It could be the results from the chest X-ray, the results from the colonoscopy, uh, or it can be an itemized bill. But for, for that only, for the wellness diagnostic only, but for the medical imaging and the radiation, the chemo or the immunotherapy, we need an itemized bill with procedure codes, dates of service and charge amounts. Now, let me explain something else to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because his policy uh uh is for the state of [PII], and I know you're not gonna like this, you're going to have to get his primary explanation of benefits for all radiation, chemo, and immunotherapy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Primary.
[AGENT][NEUTRAL] Explanation
[AGENT][POSITIVE] Of benefits.
[CUSTOMER][NEUTRAL] From who do I get this from?
[AGENT][NEUTRAL] His primary insurance? Who did he have? Was he on Aetna, Blue Cross, Medicare? Who did he have?
[CUSTOMER][NEUTRAL] Um, OK, here's, here's the receipt. It has, um, we pay $205 a month.
[CUSTOMER][NEUTRAL] And um he had help TRS Active Care HD, whatever that means. He had vision for Humana, and then he had MetLife Optional Life.
[AGENT][NEUTRAL] OK, so you
[CUSTOMER][NEUTRAL] And then he had MetLife dependent life.
[CUSTOMER][NEGATIVE] And then he had um cancer.
[CUSTOMER][NEUTRAL] Accidental insurance?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] OK, so whoever that primary is, it sounds like the first person you said it, uh, first company you said it, that's who you reach out to and tell them you need, uh, the EOBs, that's short for explanation of benefits for all chemo, radiation or immunotherapy. We will not process any benefit without it because that's the state of [PII], we have to have that and I'm gonna explain to you how that works even though he has a 20.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. The ELD, the ELD for all chemo radiation and what else?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, OK, you'll be OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm gonna explain to you.
[CUSTOMER][NEUTRAL] For all chemo radiation and
[AGENT][NEUTRAL] Immunotherapy if he had it, whichever one he had.
[CUSTOMER][NEUTRAL] OK, he had chemo.
[AGENT][NEUTRAL] So how that, OK, so how that $20,000 works is once we receive that primary uh EOB and this state pays actual charge, actual charge is defined as what his primary insurance company paid to the provider on his behalf plus his responsibility.
[AGENT][NEUTRAL] So
[CUSTOMER][NEGATIVE] How does that, I, I'm not understanding. Mhm.
[AGENT][NEGATIVE] I'm gonna give you an example. I'm gonna give you, I know, but I wanna tell you because a lot of people think, oh it's $20,000. Why didn't I get $20,000? It's not gonna work that way, not with this, not with the state of [PII]. So what that means is if his chemo one round of chemo, I'm just gonna use a fictitious number was $10,000 of that $10,000 his primary insurance company I'm using a fictitious company Aetna says, OK, you're a network provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of that $10,000 you bill, we will pay you $5000. That's your provider, uh, discount for being a network provider of that $5000 they say oh he's responsible for 20% so then that means it's $5000 but it makes him responsible for 20, which is what $1000 so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Aetna would have actually paid the doctor 4000, so in a nutshell, the payment on that claim would be 5000, not the actual charge that shows the provider bill $10,000. Does that make sense? It might not make sense to you, but, but that's how it goes. It's only gonna be what his insurance company paid to that provider plus his responsibility. That's the best way to me for anybody to remember.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So if they pay 5000 and then they say, oh, Mr. um um Mr. uh [PII] was responsible for uh 1000 then.
[AGENT][NEUTRAL] That's what we would reimburse the 4 that was paid to the provider plus Mr. [PII]'s 1000, which would be a total of 5000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So what is this 20,000 all about though? I don't understand.
[AGENT][NEUTRAL] I just say well it's what I just explained. It's not, it's, it's, it's going to be only.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not an automatic 20,000. It's up to 20,000 that you will pay out if, if, oh.
[AGENT][NEGATIVE] No, not for the state. No, no, no, no, no.
[AGENT][NEUTRAL] Oh, go ahead, go ahead, go ahead.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I was thinking that um you were pay up no more than 20,000 depending on whatever treatment he had minus what he's responsible for the 20% that you used as an example.
[AGENT][NEGATIVE] Mm, no, it doesn't work that way, um, they're not for the state of [PII], you know, if this was not the state of [PII] and this was some other state that we pay by bill charges, that's the key word by bill charges that means if they bill 10,000, we pay 10,000. State of [PII] is not that way. We pay actual charge. What's actual charge? What the insurance company pay the provider plus Mr. [PII]'s responsibility.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] And we'll continue to do that until it caps out at 20,000.
[CUSTOMER][NEUTRAL] OK, OK. Now, um, I do have the receipt that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That says um
[CUSTOMER][NEUTRAL] Please remit payment to cashier's office by [PII] to avoid any lapse in coverage, and this was paid on this was paid for [PII] through the [PII], and we paid it on [PII]. So then on [PII].
[CUSTOMER][NEUTRAL] We paid it again.
[CUSTOMER][NEUTRAL] So where is the, where's the gap coming from?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's that's something that customer service is gonna have to assist you with. I, I cannot answer that. That's why I said when we finish discussing what we're discussing, I'll get you to customer service.
[CUSTOMER][NEUTRAL] OK, so what do.
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] OK. All right. Did you have any other questions about the claim uh piece?
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] Uh, no, so, basically, basically, I'm, I'm requesting all um.
[AGENT][NEUTRAL] Any questions
[CUSTOMER][NEUTRAL] Oh, gosh, where did I write it up, all of his um.
[CUSTOMER][NEUTRAL] I wrote it. What did I write it? Uh, I got it right here, all of his pathology reports.
[CUSTOMER][NEUTRAL] All of his itemized bills with dates of services and charge out.
[CUSTOMER][NEUTRAL] And that includes everything and, and procedures, procedure codes.
[AGENT][NEUTRAL] And procedure codes, procedure codes.
[AGENT][NEUTRAL] Uh, procedure codes. And that's only for chemo cause you said he only had chemo, diagnostic tests, and the medical imaging, that's it. We don't need it for anything else because he doesn't have any other benefit. He doesn't have a surgical benefit, so we don't need it for any surgeries performed.
[CUSTOMER][NEUTRAL] OK, so we just need it for chemo?
[AGENT][NEUTRAL] we
[AGENT][NEUTRAL] We need to, yes, chemo.
[CUSTOMER][NEUTRAL] Uh-huh. Or any diagnostics?
[AGENT][NEUTRAL] Diagnostic test.
[AGENT][NEUTRAL] And medical imaging. Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Or medical imaging, OK.
[CUSTOMER][NEUTRAL] That's it? OK.
[AGENT][NEUTRAL] Yep, that's it.
[CUSTOMER][NEUTRAL] 2, OK, 123 and it's all for all of these, OK, and I would ask MD [PII] for the same thing, right?
[AGENT][NEUTRAL] Yes, mhm, yes.
[CUSTOMER][NEUTRAL] OK, alrighty, I'll get on this and where do we send it to?
[AGENT][NEUTRAL] Uh, the fax number that I gave you, mhm, yep, claims department.
[CUSTOMER][NEUTRAL] When we fax it just that fax number, who do we address it to?
[CUSTOMER][NEUTRAL] My apartment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Addres yeah.
[CUSTOMER][NEUTRAL] Clas department.
[CUSTOMER][NEUTRAL] That's it, right? So we have to put his policy number or anything on there?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] Yes, you will need to put that policy number on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But both policy numbers. OK.
[CUSTOMER][NEUTRAL] And that's it on the facts.
[AGENT][NEUTRAL] That's it. That's it. That's all. OK.
[CUSTOMER][NEUTRAL] OK. All right. So I have all that and um so now the business part on his insurance that I paid for, um, I would have to call the school? I mean, I, I have like.
[AGENT][NEUTRAL] No, I'm, I'm no I'm gonna transfer you to customer service and they're gonna tell you what you need to do. I that's, that's not a claims issue that's a customer service issue. That's why I say it once we finish discussing claims, if you don't have any more questions about any claims or any information you need to submit because I have thoroughly, thoroughly documented what we discussed and what I advise you is needed, OK?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To do, right, so are you with the insurance company or are you with the school? I'm a little confused.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, you're talking to the insurance company, APL.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] So now I'm gonna talk to your business office to find out about the payment on the insurance, OK?
[AGENT][NEUTRAL] No, no, you're gonna go back to customer service who was what you, who you was talking to that transferred you to me originally.
[CUSTOMER][NEUTRAL] Oh, OK. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So well let me get you to hold for a moment and thank you, Ms. [PII] for calling APL. You take care of yourself. You're welcome. And if you have any other questions, give us a call back. Hold on, OK, for the next rep. All right. Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. You've been very helpful.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Bye. You are on hold.
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][POSITIVE] Hey [PII], I hope you're doing fine today. This is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Um, I have something for you. Um, and she's, I've been on the phone, I know about 45 minutes maybe with her. So she may get a little confused. She should not ask you anything about claims. I have thoroughly gone over claims and what is needed. I have thoroughly told her, I noted thoroughly what I advised her what is needed.
[CUSTOMER][NEUTRAL] Uh oh.
[CUSTOMER][NEGATIVE] Oh no. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But her brother passed away. She's the legal power of attorney. Um, we never received the medical records that MD [PII] and Texas Oncology was supposed to send, but in thoroughly looking at her account, I noticed I'm gonna give you the policy number, his policy number is 242.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 691-7 and it's for [PII].
[CUSTOMER][NEUTRAL] Oh, I just worked on him.
[AGENT][NEUTRAL] OK, so here's what I noticed when you look at that one, it shows, um, well, I told her she hasn't sent us a death certificate yet for him, but you see that gap in coverage? It's like that policy ended [PII] then he has a GC 7002 with an effective date of [PII], like it's a 30 day gap, and I don't know if that's a error.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Because when I went to the PIN AM screen I see [PII] is listed as yes, and we have that he's been with APL since [PII] so I don't, you know.
[CUSTOMER][NEUTRAL] Yeah. When did he die? you know?
[AGENT][NEUTRAL] He passed away on [PII].
[CUSTOMER][NEUTRAL] Uh, so they probably didn't pay that premium.
[AGENT][NEUTRAL] Oh, she's saying they did and she's saying I have receipts.
[AGENT][NEUTRAL] So she's telling me that they made this payment.
[CUSTOMER][NEUTRAL] OK, that
[CUSTOMER][NEUTRAL] But I need to check in billing to see if I've got it then.
[AGENT][NEUTRAL] OK, alright. Well, let me call and see if I can get someone over there, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, but I, I do have her added to all three policies as the, well, power of attorney's not any good once he dies, but, um, I do have her in there as beneficiary.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, alright, thank you. All right, thanks, [PII], bye bye.
[CUSTOMER][POSITIVE] Oh, uh-huh, thank you.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Ferring
[CUSTOMER][NEUTRAL] Thank you for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] I'm sorry, who am I speaking with?
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Hi, [PII]. This is [PII] in the cancer department.
[AGENT][NEUTRAL] Um, I have insured sister on the line. Her name is [PII]. Uh, the insured's policy number is 242.
[AGENT][NEUTRAL] 6917 for an [PII].
[AGENT][NEUTRAL] He passed away on [PII]. Um, she was the legal power of attorney, but I just spoke to [PII] in customer service, and she said that she's now the beneficiary. Um, uh, the reason I'm calling you is because customer service pointed me in your direction. When we look at the policy number I gave you, it has an end date paid to date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But his new GC 7002 policy has an effective date of [PII], so there's like a 30 day gap.
[AGENT][NEUTRAL] And his sister Ms. [PII] is saying that they paid the premium.
[AGENT][NEUTRAL] And that she has receipts to prove it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let's see, as far as I'm paying, that wouldn't have anything to do, um, with us like if they pay the premium as far as it getting to us, that would be the group which is the Fort Worth ISD um but give me a second, let me see what his other.
[AGENT][NEUTRAL] Yeah, because if he, if he's filing claims within that, that, that time frame that there is no coverage, that's gonna be an issue.
[CUSTOMER][NEUTRAL] 1.
[CUSTOMER][NEUTRAL] 18293.
[CUSTOMER][NEUTRAL] And what's his name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is it ME some like [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Is he just listed on the policy and he's not the actual policy holder?
[AGENT][NEUTRAL] OK, uh, did I give you the policy number? He's deceased.
[AGENT][NEGATIVE] His sister is on the line who is his beneficiary, and she had legal power of attorney, but we know that that's no good when he passed away. She's the one that's handling all his business.
[CUSTOMER][NEUTRAL] Oh, I don't, I'm asking because, well, I'm not showing a policy with his name with the policy number you gave me. I'm showing uh.
[AGENT][NEUTRAL] OK, well, let's go over that policy number again because maybe I gave you the wrong one so 252.
[AGENT][NEUTRAL] 762-2. He has several.
[CUSTOMER][NEUTRAL] 762
[CUSTOMER][NEUTRAL] Uh, that's showing.
[CUSTOMER][NEUTRAL] The same person that's not here.
[AGENT][NEUTRAL] And the one I think I gave you.
[CUSTOMER][NEUTRAL] So this is showing a [PII].
[AGENT][NEUTRAL] I don't, no, I don't.
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] She is the beneficiary. That's why you see that's who's on the phone. You see a M for relationship and the M stands for beneficiary. The policyholder [PII], part one, this is his policy. I see his name customer service saw his name. I don't know why you're not saying it.
[CUSTOMER][NEUTRAL] Um, just when I pull up BTPHI it shows her name, but I'm trying to see in GRP IQ so I can see all of his policies. So I'm looking in labs because it looks like his policy is not active.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, he has the, the GC, the GC 7, let me take a look.
[CUSTOMER][NEUTRAL] None of his
[AGENT][NEUTRAL] Yeah, that 1 may not be. She may have lapsed it because she said she was working on him. Yeah, they all are lapsed.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] The reason I need to know this lady is on the line who she needs to speak to. Is it you or you mentioned [PII]. She said they made a premium and there should not be a gap if you're looking at all his policies, there should not be a gap where you see one ended [PII], the GC 14 CL4 TXR.
[AGENT][NEUTRAL] And then it picked up with GC 7002 on [PII]. She said there should not be a gap.
[AGENT][NEUTRAL] A 30 day gap is there because she said they paid the premium and she has a receipts so who does she speak to? Did she speak to you all or who did she speak to?
[CUSTOMER][NEUTRAL] Oh, well, give me a second. I'm looking at the policy.
[CUSTOMER][NEUTRAL] Not because of overdue on 111.
[CUSTOMER][NEUTRAL] The other one.
[CUSTOMER][NEUTRAL] This your last day added by customer service on 828.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Let's see, the reason that one policy was canceled and.
[CUSTOMER][NEUTRAL] August is because that's the date that it was paid to before the overdue department lapsed it so it was auto lapsed by the system because of nonpayment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the other one.
[CUSTOMER][NEGATIVE] Uh, customer service added a future lapse date on.
[CUSTOMER][NEUTRAL] [PII], so I'm assuming they would have received some sort of notification to do that and see if it's an on base because it's looking like from what I can see.
[AGENT][NEUTRAL] I'm not worried about that one. I'm not worried about that one because he, he passed away. What I'm concerned about is the one that you just said it was for nonpayment. She says that she has receipts to prove that they made the payment. So does she speak to you all?
[CUSTOMER][NEUTRAL] Yeah, so.
[CUSTOMER][NEUTRAL] No, she needs to speak to the group, or sorry, well, their employer, um, gentry.
[AGENT][NEUTRAL] Group
[AGENT][NEUTRAL] So the [PII] ISD?
[CUSTOMER][NEUTRAL] Yeah, then, or they might refer her to entry. Hold on. Let me see.
[CUSTOMER][NEUTRAL] The number.
[CUSTOMER][NEUTRAL] Let me make sure I have anything in the system.
[CUSTOMER][NEUTRAL] Yeah, with the they if money's been taken, been being taken out of the checks or they've been paying them somehow we haven't been getting it, so they need to speak with um [PII] ISP, which was the employer.
[AGENT][POSITIVE] OK, I will let her know because she's hung up now. All right, thank you, B. Have a good day.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Bye bye