AccountId: 011433970860
ContactId: a4855847-5472-4eaa-a2a1-227145c7ccce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2441199 ms
Total Talk Time (AGENT): 1310033 ms
Total Talk Time (CUSTOMER): 1057818 ms
Interruptions: 16
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/a4855847-5472-4eaa-a2a1-227145c7ccce_20250304T20:20_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], how are you? This is [PII].
[AGENT][POSITIVE] Hey, I'm good how are you so?
[CUSTOMER][NEUTRAL] I'm good thank you. I have a member on the line that would like to speak to a representative. He keeps saying that [PII] is the one that processed this claim, but I don't know if we have a [PII]. Yeah, I don't think we have a [PII] in that department.
[AGENT][NEUTRAL] [PII]?
[AGENT][NEUTRAL] We don't have a [PII].
[CUSTOMER][NEUTRAL] Right, that's what I was thinking. I'm like, we don't have a [PII]. Um, it looks like it's the shade bar. I'm not sure if he's just confused. Um, yeah, because I, I've been pulling all the claims and I'm like that's the shade, that's not [PII], that's, yeah, but yeah, he.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Oh yeah, that's not anywhere close to [PII].
[AGENT][NEUTRAL] That's funny. What, what's the policy and claim?
[CUSTOMER][NEUTRAL] It's 243-1002.
[AGENT][NEUTRAL] So I guess before we get in transfer anything what what's going on like what's the question?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Yes. OK, so basically he's calling because he has called before and um he said he spoke to [PII], which I don't know who's [PII]. I'm probably thinking that it's whoever took the last call. Let me see who's that, um, do do do do do do that was [PII]. There's no way that [PII]'s [PII], there's that was [PII] [PII], probably [PII]'s [PII] [PII], yeah, yeah, that's so.
[AGENT][NEUTRAL] Yeah, I know, right?
[AGENT][NEUTRAL] Maybe [PII] and he heard [PII]. That's closer that I can see.
[AGENT][NEUTRAL] Oh Lord.
[CUSTOMER][NEUTRAL] Yes. OK. So, basically, um, he said that he sent the pathology report and then he was told that that's all they needed. And um so he thought that um or he thinks that we do have the pathology report, so why we ask him for the pathology report again? That's basically why he's calling.
[CUSTOMER][NEUTRAL] Because I went ahead and, you know, pull the last uh claim, um, and I told him that that's what we're needing. We need the pathology report to uh process the claim and we have not received any other documents after that. So he's just concerned because he thinks we do have the pathology report and we are still asking for the pathology report.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And he thinks we have it.
[AGENT][NEUTRAL] Oh man, OK. Um.
[CUSTOMER][NEUTRAL] So I don't know if you can go through the claim and see if you can find that pathology report because he keeps saying that it's, it's there.
[AGENT][NEUTRAL] I mean,
[AGENT][NEUTRAL] In the most recent submission because it looks like, OK, so I say if this day is [PII] like we've only gotten the one set of documents so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. I will send the most recent submission online. Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, I say 16 pages. Let's see if we got it. Uh, [PII] is not one to overlook things like that, so I don't think she would ask for it if she felt like she had it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that, that's, I know, that's why I'm like, I, I didn't even, I said no, we just need that, and he's like, but somebody told me, [PII] told me that you have it. I'm like, OK, let me see what's going on.
[AGENT][NEGATIVE] Right, like, no.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] Renal cell carcinoma from [PII] was his diagnosis.
[AGENT][NEUTRAL] OK, that could be different because yes he just submitted this information but I wonder if some of this [PII] stuff is.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] A path for this diagnosis date.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Let me, let me dig, let me dig, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see what those claims that we denied let's see.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] 7008, critical illness, proof of loss.
[AGENT][NEUTRAL] OK, that doesn't mean we don't have a path, so let's see.
[AGENT][NEUTRAL] Oh man, all the time testing my knowledge. OK, surgical path, this says 722 of 24.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Negative for invasive carcinoma, so that wouldn't be covered anyways.
[AGENT][NEUTRAL] Will you look at the most recent while I'm digging through this and see on his claim form what type of cancer I didn't write it down. He's claiming so I can see if anything in these older ones is.
[AGENT][NEUTRAL] The path
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] I pulled up where did it go?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because it looks like he says June, but this was not actually collected until July.
[AGENT][NEUTRAL] But he was positive for malignant neoplasm of sigmoid colon, which is why I'm trying to figure out cause this is a path report for that.
[CUSTOMER][NEUTRAL] Mm, yeah, and the, I do see a surgical pathology report, the first, um, and that 16 pages.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but it says negative for malignancy.
[AGENT][NEUTRAL] Well, they submitted billing too later on that has a positive diagnosis and down there at the bottom, it says sigmoid colon cancer or something, so.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mm, OK, so.
[AGENT][NEUTRAL] It was like certain, certain parts that they resected weren't positive, I guess, but.
[AGENT][NEUTRAL] I'm not sure, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I get, OK, so on this one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Cause it looks like we've paid.
[AGENT][NEUTRAL] 4
[AGENT][NEGATIVE] That cancer already.
[AGENT][NEUTRAL] And that was a [PII] diagnosis.
[AGENT][NEUTRAL] So, maybe he had several surgeries. I'm not sure.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, so I'm trying to figure out on this one like what is he trying to claim because if we've already paid it we're not going to pay anything else.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] And he all the only other policy he has is accident. OK, critical illness, renal cell carcinoma is what he's trying to claim now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that is different.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is this one?
[AGENT][NEUTRAL] OK, we already paid that. OK, so we have a path for his previous colon cancer.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] But we don't have renal cell carcinoma which looks like it's C19.7, nope.
[AGENT][NEGATIVE] I don't know what that number is supposed to be.
[AGENT][NEUTRAL] It's see something but date of diagnosis [PII].
[AGENT][NEUTRAL] It's like just the form and what was filled out by the physicians it looks like.
[AGENT][NEUTRAL] I'm just trying to search through this before you send them over so I know that I've looked through and I can say OK this is what I know we have I've looked through all your documents.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have anything for this diagnosis, but we do have something for this one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Patients a [PII] now who presents for a follow up for renal mass, renal cell carcinoma.
[AGENT][NEUTRAL] That's the one.
[AGENT][NEUTRAL] 362 4.
[AGENT][NEUTRAL] That [PII].
[AGENT][POSITIVE] Maximum payable for this condition.
[AGENT][NEUTRAL] C 18.9 malignant neoplasm of colon.
[AGENT][NEUTRAL] And see 64.1.
[AGENT][NEUTRAL] OK, so I think the reason why.
[AGENT][NEUTRAL] Because I do show records here where we are showing renal cell carcinoma for the claim that we actually.
[AGENT][NEGATIVE] Denied before this one.
[AGENT][NEUTRAL] As needing.
[AGENT][NEUTRAL] Are the maximum payable for this condition has been exhausted?
[AGENT][NEUTRAL] Um, and they included both colon cancer and
[AGENT][NEUTRAL] Renal in the, in the diagnosis code. So it's the 3624.
[AGENT][NEUTRAL] Um, renal cell carcinoma.
[AGENT][NEUTRAL] And I'm trying to see because under his policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Trying to see where it's at.
[AGENT][NEGATIVE] Uh, benign brain tumor, that's not a good coma.
[AGENT][NEUTRAL] I think invasive cancer, so we only pay invasive cancer once.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Now I'm wondering why we're asking for a path report if we only pay for cancer once.
[CUSTOMER][NEUTRAL] Oh boy.
[AGENT][NEGATIVE] It's just all over the place, confusing me.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Imagine me, that I have no idea. None of what you're saying, I have no idea. I'm like, OK, I'm just looking at the paperwork. I'm like, oh, OK.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] No doubt, no doubt.
[AGENT][POSITIVE] Yeah, right, like I'll take your word for it.
[CUSTOMER][NEUTRAL] Yeah. Basically, OK, yeah, I, I see that too, but I, I don't know what it means and what it is.
[AGENT][NEUTRAL] That's hilarious. OK. So in the policy, um, pay applicable critical illness as shown in the schedule for the first time a covered person is diagnosed with any one of the illnesses that are listed.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, must not have been previously paid, must also not be excluded. If after the first one is paid, they're diagnosed with a different one.
[AGENT][NEUTRAL] Then we'll pay that one.
[AGENT][NEUTRAL] Um, if it's not excluded.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] There's no limit on how many additional, basically, we'll pay any of them you're diagnosed with for the first time.
[AGENT][NEUTRAL] Um, the critical illness amount paid for an initial.
[AGENT][NEGATIVE] is subsequently diagnosed with the same critical illness.
[AGENT][NEUTRAL] Then
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] We will pay the critical illness benefit previously paid multiplied by the recurrence amount so that's gonna be a percentage.
[AGENT][NEUTRAL] As long as it's 6 months after the day of the initial critical illness and it's not excluded. I wonder if that's why she's asking.
[AGENT][NEUTRAL] That makes more sense now.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Because we paid for his original, it said [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I believe
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, should I put him in because it's been a while.
[AGENT][NEUTRAL] Yeah, yeah, yeah, go ahead.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for holding Mr. [PII]. I got Miss [PII] on the line. Uh, she's been checking on that for you and she's gonna give you some information, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hi, Mr. [PII], how are you?
[CUSTOMER][NEUTRAL] Fine, how are you doing?
[AGENT][NEUTRAL] I'm doing well um OK so I'm trying to look through everything and just kind of determine what might be going on here because I did see that we had records that indicated both colon cancer and renal on a claim that we previously paid, um, are denied it, it may have been in denial as the max had already been met so then I was trying to determine OK what are we.
[AGENT][NEUTRAL] Looking at so it do you have.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Let me ask you something here now.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The colon cancer was a separate issue that was last year y'all paid on that. I've been diagnosed since then with kidney cancer, the renal whatever you call it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Separate cancer.
[AGENT][NEUTRAL] When, when were you diagnosed with that? Do you know?
[CUSTOMER][NEUTRAL] First of this year, uh.
[AGENT][NEUTRAL] First part of this year?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It, it's in those not my wife sent them to my phone. I'm driving right now. She'd have to be the one that's [PII], but uh.
[AGENT][NEUTRAL] OK, that's OK.
[CUSTOMER][NEUTRAL] When they first diagnosed it the way they do this long story short, they don't even do a biopsy no more. I turned that information over to [PII] that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Handle all this is the company I work for she's no longer here.
[AGENT][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] But I had scheduled a freezing thing.
[CUSTOMER][NEUTRAL] At the doctor's office called me the week of.
[CUSTOMER][NEUTRAL] Saying no we get they are wanting a biopsy now so.
[AGENT][POSITIVE] Hm, that's interesting.
[CUSTOMER][NEUTRAL] First biopsy was a failed attempt. They went into my that gum liver and we're talking about my right kidney had liver sample tissues in there and.
[AGENT][NEUTRAL] Oh my lord.
[CUSTOMER][NEUTRAL] Had to do a 2nd biopsy.
[CUSTOMER][NEGATIVE] And now we're wanting to do the freezing, which is the [PII] of this month on my right kidney. So first biopsy was a failed attempt. My wife sent that. The second biopsy, I think, was the [PII]. The lady and was questioned me about this information earlier when I called.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sent that and and sent it to my phone.
[CUSTOMER][NEUTRAL] Both come from the pathology, uh, department.
[CUSTOMER][NEUTRAL] Which is a it's a separate cancer it's not.
[CUSTOMER][NEUTRAL] Linked to the colon cancer, the colon cancer was isolated and had had not protruded through my colon. I removed a section of my colon last July, so this is a separate claim.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] That being said, do y'all pay on a separate claim?
[AGENT][NEUTRAL] So I actually looked at that in your policy and as long as a 2nd.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Condition, like, or the same condition, so invasive cancer, as long as it is 6 months after the first diagnosis, then it's like a percentage, like a recurrence percentage. Um, let me see what that is in your policy. Um, let's see. It's 100%. So, yeah, yours would be a 100% benefit, it looks like for recurrence, um, or for
[CUSTOMER][NEUTRAL] Be long
[CUSTOMER][NEUTRAL] Yeah, it's been a little longer than 6 months.
[AGENT][NEUTRAL] Yeah, I think the, the data service I saw on the last one was like [PII]. Does that sound right?
[CUSTOMER][NEUTRAL] Yeah, yeah, I, it's been nearly a year, uh, I was first diagnosed.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, it's getting real close.
[AGENT][NEUTRAL] And then this I do show that there's a.
[AGENT][NEUTRAL] Uh, it looks like it's a surgical path for 115 of 25.
[AGENT][NEUTRAL] Does that sound right?
[CUSTOMER][NEUTRAL] Well, that was the first biopsy. I, I talked to a lady earlier said y'all look at y'all look at that as a surgery.
[AGENT][NEGATIVE] OK, that was the first one that was failed.
[CUSTOMER][NEUTRAL] So I've had actually 21 was the [PII] and one is, I guess the [PII]. I mean, uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I see that one on here now too.
[CUSTOMER][NEUTRAL] Uh, um, my wife has sent this information to this lady [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Whoever she is, I don't know when she handled this on the last one too. I, I'm, I'm just, I'm trying to be polite, but this just got me aggravated. I went through this mess last year and I feel this way about it.
[AGENT][NEUTRAL] Oh, for sure.
[CUSTOMER][NEUTRAL] Other than the lady don't work here anymore.
[CUSTOMER][NEGATIVE] I shouldn't have to go. I shouldn't have to be the one in the middle of this because I pay at my company to do this. We have some sort of little half nit with the HR department.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] Oh, no.
[CUSTOMER][NEGATIVE] And we have y'all, so I'm stuck doing it and now the lady that handles it at our company is no longer here. She started this and it's been almost 2 months ago. She's been gone like 6 weeks and she started this before she left.
[AGENT][NEUTRAL] Got you. OK.
[CUSTOMER][NEGATIVE] And I'm stuck with it. I'm confront confronted.
[CUSTOMER][NEGATIVE] What they're trying to patch together with our little flimsy HR department, even the owner of the company was supposed to talk with [PII], whoever [PII] is about 5-6 weeks ago, and I've, so my wife and I just said he pardon me, but the hell with it we're gonna do this. I don't, you know.
[AGENT][NEUTRAL] Right, uh, you know what, I don't blame you because I'd probably be the same way. I'd be like, you know what? No, not at all. Not at all.
[CUSTOMER][NEGATIVE] Don't, don't take that personal. It's just, it's frustrating and uh I don't like I had.
[CUSTOMER][NEUTRAL] Like colon cancer last year and dealt with this and then now this and it's.
[CUSTOMER][NEUTRAL] The, the disease and the physical part and the treatment is not as bad as the red tape hoop on BS is going along with it. I'd rather go through the physical part.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Than this mental part if that makes any sense because it's getting frustrating.
[AGENT][NEUTRAL] Yeah, well, I mean, you're dealing with so much physically, the last thing you want to deal with mentally or, uh, you know, anything emotionally is this, so I completely understand.
[CUSTOMER][NEUTRAL] Yeah, I mean, don't take it personally. I'm just, I'm kind of snappy right now with it because.
[AGENT][NEGATIVE] No, not at all.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And each week is a different story or.
[AGENT][POSITIVE] Look, I'm from Alabama too, so, you know, we, we, I feel like we're on the same wavelength. I feel like we're kindred spirits here. I got you.
[CUSTOMER][NEUTRAL] Oh yeah, yeah, I'm just kind of like snappy right now, but each week it's just been something or the I wouldn't dotted or the T wasn't crossed and we got everything we need a week ago and then now we need a week to look at it and it's been over a week to look at it now we don't have what we need again. I'm like, there go.
[AGENT][NEUTRAL] It's OK.
[AGENT][POSITIVE] Got you.
[AGENT][NEGATIVE] Mm, yeah, yeah, no, that's very frustrating, especially when you're dealing with what you're dealing with. Um.
[CUSTOMER][NEGATIVE] Yeah, so [PII]'s our main contact, whoever she is, my wife, I, I threw my hands up to it. I was ready just, just shut it all down and now I'm back involved with it. My wife's getting frustrated with it no help from work and they figure out our.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh gosh.
[CUSTOMER][NEGATIVE] Whoever they're gonna hire to handle these problems, I don't know anyway here we are I'm done.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] So, I'm going to, this is what I'm gonna do. I'm going to look through everything and kind of
[AGENT][NEUTRAL] Like you said, piece together what we have, what we don't have, what we need, because I do see in what you or what you or your wife, who you know whomever you did this, um, where you submitted for the 2725 um.
[AGENT][NEUTRAL] And when I look at that.
[AGENT][NEUTRAL] Let me see, let me get back over to it.
[AGENT][NEUTRAL] It says.
[AGENT][NEUTRAL] OK, so that's the 115 that you said was the first one, so this is gonna be the 27.
[AGENT][NEUTRAL] OK, so that is a console that you had in December and that's where it looks like they like mentioned wanting to do the cryoablation like the frozen thing that you're talking about.
[CUSTOMER][NEUTRAL] Yeah, yeah, and.
[CUSTOMER][NEUTRAL] And yes, and, and the way I, I have, I'm learning a lot of this as we go when I guess their research and treatment's gotten a lot further and they've eliminated some things but what we were told in December they've just basically go off of MB Anderson studies that place in [PII], and they just treat this because it's a common thing and that's most insurance companies will pay out on it is like the claims like y'all handling and the medical part there's.
[CUSTOMER][NEGATIVE] Really no argument in the past several years.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But once that's is when [PII], the lady that worked for the company I work for here was handling all this and they scheduled the whatever you call it I call it freezing thing they had scheduled the freezing thing and I forget I think the [PII] that that the day of that, uh, first biopsy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well that Monday I'm getting a call from the doctor's office that.
[CUSTOMER][NEUTRAL] Oh, hold on, we're gonna have to do the biopsy because.
[CUSTOMER][NEUTRAL] Y'all needed proof.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Instead of like.
[CUSTOMER][NEUTRAL] I guess the doctors, yeah, just saying this is cancer they want proof.
[AGENT][NEUTRAL] Like just uh, yeah, just them saying, oh, he has a mask. This is what we think, yeah.
[CUSTOMER][NEUTRAL] So that that that Monday they, they just said well we're not gonna do the treatment on the [PII] we're gonna do a biopsy. Well that biopsy like I said, was a failed attempt. He didn't get in the right spot evidently he got dead cell tissue or liver sample tissues or something, so we had to reschedule it, which was I guess the [PII].
[CUSTOMER][NEUTRAL] And then the [PII] that it was another doctor had done and he got in the right area and it came back with the.
[CUSTOMER][NEUTRAL] Uh renal cell I guess is what you call this type of kidney cancer, so they've scheduled the treatment for the [PII] of this month so I've got.
[AGENT][NEUTRAL] Mhm. The renal cell carcinoma. Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Two biopsies and now they're gonna finally do the treatment as long as y'all have everything you need because.
[CUSTOMER][NEUTRAL] Without
[CUSTOMER][POSITIVE] I like if they go ahead and treat it and you don't you don't have all the evidence you need or whatever I have to do another biopsy so I think the second biopsy proved what it was.
[AGENT][POSITIVE] Oh goodness. OK.
[AGENT][NEUTRAL] Yes, so I do see here the ultrasound guided biopsy that was done on [PII], um.
[AGENT][NEUTRAL] I have all this information.
[AGENT][NEUTRAL] It says, let's see, clinical history provided right renal mass pre-op diagnosis same post-op diagnosis, same. It doesn't actually tell us what they think the diagnosis is, but now let me look through the rest of it. Let's see under real time ultrasound guidance, uh, ba.
[AGENT][POSITIVE] Patient tolerated well, no complications, minimal blood loss.
[AGENT][NEUTRAL] Um, a successful renal mass biopsy, and then that's all it says.
[AGENT][NEUTRAL] So it comes across like a path report, but it doesn't give, it's more of a radiology report than it is a path report. So I guess my question is.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The it was Mobile Infirmary Medical Center. Does that sound right?
[CUSTOMER][POSITIVE] Mobile Infirmary is why I had it done, yes.
[AGENT][NEUTRAL] OK, so what I'm gonna do, I'm gonna to keep you from being this go between um.
[AGENT][NEUTRAL] I'm gonna call them. I have a number here and I'm gonna see if they have a physical path report on file for this biopsy. If not, I'm going to ask them.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Who to contact for that biopsy, um, and then I'm gonna see if we can get our hands on it ourselves because like I said, we have the proof that you had the biopsy, we just don't have the path report where they come out and say, yes, this man has cancer.
[AGENT][NEUTRAL] You know, like all they put for the diagnosis was same and same. They didn't put pre-op diagnosis, renal cell carcinoma, post-op diagnosis, renal cell carcinoma or say or just saying the same as with the pre-op. They don't say any of that and so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's not even that we don't think you had the biopsy and stuff, is that they didn't actually put that information in there.
[CUSTOMER][NEUTRAL] I thought it was in there. I haven't read it. Um, let me ask you one other thing. Do what now? my doctor?
[AGENT][NEUTRAL] I mean, your doctor put on his your doctor on, put on his form.
[AGENT][NEUTRAL] But as part of this policy, it requires a path to be on file that backs up the payment because you know most of these critical illness or cancer policies or something like that.
[AGENT][NEUTRAL] When it's cancer or heart attack or something like that, they're not, they're not tiny payments, you know what I'm saying? And so if it were just like $1000 it may not be that much, but your payment is a $10,000 payment so it's one of those things where they um they really want to just have confirmation on file.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I
[AGENT][NEUTRAL] So,
[CUSTOMER][POSITIVE] I tell you, my wife, my wife's company pays more and they already got it. She's got separate insurance on me at work and she's, uh, both times she's received the money prior to me.
[AGENT][POSITIVE] Oh my goodness. That's crazy, ain't it?
[CUSTOMER][NEUTRAL] Ain't that something?
[AGENT][NEUTRAL] I wonder, you know what I have from where you had that one on the [PII]. I have, I wonder if that's if they provide a number on there because I bet that's where I could reach out and get the path report for that one because it's through the same place, right?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I don't know because uh I'm going through I was like I said the lady here at work was handling it now we're going through.
[AGENT][NEUTRAL] Like you went to the same place twice?
[CUSTOMER][POSITIVE] There's a nurse there, she's been very helpful with me and my wife, um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Let me, I can get her number. I tried to call her unless she was out. She didn't even call me back today.
[CUSTOMER][NEUTRAL] There's a number if you let me pull this up.
[CUSTOMER][POSITIVE] And she might give you the right information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] 435.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And her name is [PII]. She's [PII], she's one of the nurses for.
[CUSTOMER][NEUTRAL] I've seen like 6 or 8 doctors. She's been on like 2 procedures with 2 different doctors, so she's in that network.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][NEGATIVE] So I, that this is just, I feel like a walking pin cushion and I was just over it, God, over it.
[AGENT][POSITIVE] I know you do. Oh my goodness, I know you do. OK, let me reach out to them and see if I can get this on your behalf so you don't have to keep trying to figure out what we need and what we don't and then um.
[CUSTOMER][NEUTRAL] Yeah, because
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got a couple of questions for future references.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Say this here being a separate cancer it's.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hypothetically should pay out right?
[AGENT][NEUTRAL] Hypothetically, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause it's, it's been more than 6 months since your last diagnosis.
[CUSTOMER][NEUTRAL] Being it's not.
[CUSTOMER][NEUTRAL] Been OK, been more than 6 months and it's not linked to the colon cancer. It's a separate cancer, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Say for instance, there's some other areas of concern.
[CUSTOMER][NEUTRAL] Well, those
[CUSTOMER][NEUTRAL] Turn in the the cancer thing would they pay out and should I just like.
[CUSTOMER][NEGATIVE] I, I'm ready for a break from this mess because I may have some more testing to do.
[AGENT][NEUTRAL] Got you. OK. So let me look. OK, um.
[CUSTOMER][NEGATIVE] I don't know how this is, I'm ready to shut this down. I'm ready to stop.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] The missing work from this mass, the treatments, the surgeries, the tests, the blood work, oh.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] No doubt.
[AGENT][NEUTRAL] Yeah, I, I don't blame you at all.
[CUSTOMER][NEUTRAL] It's been almost a year straight, almost a year. Yes, May is gonna be a year. I started with a colonostomy and here we are with the surgery and treatment on. I've had cancer twice but in the same year as I've had enough.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] That's a lot.
[AGENT][NEUTRAL] That's not males, yeah, that's just crazy, um.
[AGENT][NEUTRAL] Like, what are, what are the odds? It's, it's one of those things where it's like I didn't have this on my [PII] bingo card, you know.
[CUSTOMER][NEGATIVE] I, I wished I could hit the, uh, I wish I should be able to pick the right lottery numbers, but I can't seem to do that.
[AGENT][NEUTRAL] There you go, there you go.
[CUSTOMER][NEUTRAL] So, uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So all it says is in your policy, it says if the critical illness benefit amount is paid for an initial critical illness, which you've gotten for cancer, right? And you are subsequently diagnosed with the same type of critical illness. So cancer again, which is what we have right now. Um.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] We will pay the critical illness benefit amount that we previously paid multiplied by your recurrence percentage which like I said in your policy shows 100% so essentially you'll get 100% of what whatever that benefit is which I think was $10,000 hypothetically.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, and then it says if the subsequent diagnosis is more than 6 months after the date of diagnosis for the initial, which is, we do have that here. You were originally in May. Now we're looking at another diagnosis in February that's definitely more than 6 months, so that meets it. And then as long as it's not under your exclusions, which this is not. And then it says there is no limit.
[AGENT][NEUTRAL] Um, on the number of recurrent critical illnesses payable, only one critical illness benefit amount is payable per day per person. If multiple, multiple critical illness benefit amounts, uh, would otherwise be payable, we're gonna pay the highest. So let's say.
[AGENT][NEGATIVE] You're going in for this treatment or you're going in for more testing and we've just found another cancer here in February uh last month in February and let's say this month or God forbid at all, but let's just say for hypothetical reasons.
[AGENT][NEUTRAL] This month or next month or anytime you're receiving treatment, they say we've got another suspicious area, let's look at it, um.
[AGENT][NEUTRAL] And it turns out to be.
[AGENT][NEGATIVE] Something else. It wouldn't qualify for, you know, God forbid it's another cancer, but let's say it's another cancer. It wouldn't qualify for a recurrence in that situation because it would not meet the six-month requirement between diagnosis. If it happened to be anything else, any other type of illness, which there's a whole host of issues, um.
[AGENT][NEUTRAL] Let's see, I'm trying to think of something that they might even would find.
[AGENT][NEUTRAL] That would
[AGENT][NEGATIVE] Fall under this.
[AGENT][NEUTRAL] I don't even know, honestly, let's just say.
[AGENT][NEUTRAL] Um, I'm trying to find something that's like lower so I can kinda give you an, an idea of what I'm talking. So let's say that they come back and they say, OK, we know you've had this, but now you also have something completely random, um, like a non-invasive cancer. Let's say that.
[AGENT][NEGATIVE] This one's invasive, this one's not.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Because it doesn't meet the six-month requirement, but you've been diagnosed with a new critical illness.
[AGENT][NEUTRAL] Technically, if I'm not mistaken.
[AGENT][NEUTRAL] It would still meet.
[AGENT][NEUTRAL] The um.
[AGENT][NEUTRAL] Specifications to be payable because it's a different critical illness, but it's one of those things where they would have to, again, have to look at the path report and all that kind of stuff because the only limitation to that was, um, was that the 6 months and then, what does it say? I lost my spot where I even had that at.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Um, only one critical illness benefit is payable per day. So.
[AGENT][NEUTRAL] If on that day they find a non-invasive and at the same time, they find.
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Essentially, you get diagnosed with 2 at a time.
[AGENT][NEUTRAL] One is a $2500 benefit, the other one is maybe a 5000 or $10,000 benefit. Because you were diagnosed on the same day with two different critical illnesses, we would only pay the higher of those two. So as long as, like, I really hope you don't have to deal with another cancer truthfully, I, I mean, you've been through enough.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] God forbid, but yes, but the way my luck is going and.
[CUSTOMER][NEUTRAL] I have probably like I've got a cold another colonoscopy I need to schedule is what I'm worried about.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and a few other things, but I.
[CUSTOMER][NEGATIVE] I think you've answered my question. You need to have a 6 month gap basically to, to really be sure or covered more or less. I, one other thing because this, I'm just being honest here, this has got me worried since I've started this junk.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's fine.
[CUSTOMER][POSITIVE] I've been blessed. Nothing to do with luck. Good [PII] has blessed me. They've caught it in time even though I didn't have a piece of my colder removed and I've gotta go through this treatment now.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Say for instance I come in.
[CUSTOMER][NEGATIVE] Uh, [PII] forbid something else happens and I need to go out. It's, it's bad or I need to go on disability is that y'all cover that because I, I don't want to go that route, believe me, but.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][MIXED] I've seen very little to good experiences with people with cancer through my time and I think treatment and medical things has gotten a lot better, but I'm worried sooner or later this stuff's gonna get me you follow me so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah. No, I completely understand. I mean, it, the treatment can be, it can be hard because it takes a toll, you know, I mean, your body's fighting.
[CUSTOMER][NEUTRAL] I, I don't
[CUSTOMER][POSITIVE] Yeah, so far I've been blessed. Like I said, I just had the surgery removed it like.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Say they got it all last year, but I didn't have to have a follow up chemo or nothing and then this spot come up on my kidney which is cancer and I mean you see where I'm going with it I'm, I'm scared sooner or later it's gonna just get me you know it's just gonna be bad. I hope not but.
[AGENT][NEUTRAL] Yeah, no, I completely.
[AGENT][POSITIVE] I got you.
[AGENT][NEUTRAL] So with us.
[CUSTOMER][NEUTRAL] So did did y'all cover the that or do I go out on something else?
[AGENT][NEUTRAL] Yeah, so with us you have an accident policy and your critical illness policy. We do provide disability policies, but it doesn't look like your company went with us for disability, so I know that you're not fond of your HR department, but if you have any type of short term or long term disability that's who's gonna know who it's through and that's who's gonna have to provide you with where to file.
[CUSTOMER][NEUTRAL] OK, because see, I was getting short term. I thought it was coming from y'all last year. I was out like 2 months. OK, well.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, so and a lot of times once you surpass the time limit for short term if you continue having to be out it will automatically get transferred to long term and long term usually be in a different department, sometimes even a different company will take over and start handling it after that so I'm not really sure how your company has it set up but if you've already received short term then you probably have long term too.
[CUSTOMER][NEUTRAL] Need to talk to
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know we're.
[CUSTOMER][MIXED] Yeah, because this, that lady that's no longer here, [PII] handled all this last year for me, and she was helpful. It just seemed like a lot of red tape and hoops and hurdles right now, and she dealt with it then. I'm having to deal with it now because anyway.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEGATIVE] Nobody here seems to know what's going on. I'm frustrated with that. That's what the heck y'all taking this insurance out of my check every week for. Alright, well, anyway.
[AGENT][NEUTRAL] Oh [PII].
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] That's OK. Look, anytime you got questions, you give us a call. We're gonna do what we can to to figure it out for you, and I'm gonna give, I'm hopefully Ms. [PII] will be available and I will give her a call. I have your number. It's the [PII], right?
[CUSTOMER][NEUTRAL] I guess
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yes, and um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like if she's not my, my wife and I can get this information and.
[CUSTOMER][NEGATIVE] Like I will, we, she's emailed this stuff to whoever [PII] is and just we're getting nowhere. I mean, I ain't trying to get the woman in trouble, but she's got all this information.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Other than we need to add to this information.
[AGENT][NEUTRAL] Right, OK, so let me reach out let me see if we missed anything. I'm gonna, I'm literally gonna dig through everything we have on file and see if we missed anything.
[CUSTOMER][NEUTRAL] Well, what my wife's, what my wife sent me copies of to my phone is part of what you're looking at and we don't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] There's some of them words we had to look up doing this mess to, you know.
[AGENT][NEUTRAL] I know it's.
[AGENT][NEUTRAL] They can be a mouthful.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][POSITIVE] For sure.
[AGENT][NEUTRAL] So yeah, but let me.
[CUSTOMER][NEUTRAL] Alright well if [PII] is not there or can't get the information just uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Get back with me because like I said I'm running out of time here like I go to 21st and.
[AGENT][POSITIVE] I got you.
[CUSTOMER][NEUTRAL] If we need to do another test and I need to do another test prior to before we go forward because then and then there's no more evidence I guess which is what I'm trying to say.
[AGENT][NEUTRAL] Right. So it looks like [PII] and [PII] are both with Crescent City Benefits.
[CUSTOMER][NEUTRAL] All right
[AGENT][NEUTRAL] Which is probably your broker with Crescent City benefits because I just found an email on file and it looks like that's probably your broker for your group.
[CUSTOMER][NEUTRAL] They're what now?
[AGENT][NEUTRAL] Let me look real quick.
[CUSTOMER][NEUTRAL] Really?
[AGENT][POSITIVE] Mhm. And a lot of times they will help with that.
[CUSTOMER][NEGATIVE] Well, see, I might be getting that. See, now that this, I, I feel bad because I got aggravated earlier today because we're, I've tried to call her and no response, so I, I just, I got the number I've called y'all from off of uh.
[CUSTOMER][NEGATIVE] Uh, a letterhead from something that y'all had sent me, so I called y'all, and evidently I should have been calling this [PII] because anyway, I called y'all's main office and got through to whoever I spoke to today. I was probably rude, didn't mean to be, but we just over this mess.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yeah, that's OK.
[AGENT][NEUTRAL] No, it's OK. Look, we understand that it can be really frustrating, so like I promise it's OK, um, but yes, so [PII] I think is how you say his last name, and [PII]. They are both with Crescent City Benefits.
[CUSTOMER][NEGATIVE] OK, well, [PII]'s [PII]'s who [PII] was dealing with, and she sent me the number and then about, and this is sad, about 5 weeks ago I confronted the owner of the company I worked for, and she was gonna get with [PII] or whatever she didn't and I've mentioned it and I'm tired of talking to her too. I'm, I'm done with it, so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] My, my wife and I are in your hands so.
[AGENT][POSITIVE] I'm going to do everything I can.
[CUSTOMER][NEUTRAL] If you can get in touch with [PII] and anything else you need call me back or something.
[AGENT][NEUTRAL] OK, OK, I sure will. Let me see if I can reach out to them and get that passed.
[CUSTOMER][NEUTRAL] And do you have an extension or something in case I need to need to call you or?
[AGENT][NEUTRAL] Um, just ask for [PII] and claims. I'm the only one over here.
[CUSTOMER][NEUTRAL] What was that again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] Yup.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] My phone started cutting out. [PII], OK, well I thank you and I'm sorry if I was kind of aggravated but.
[AGENT][NEUTRAL] That's OK, yeah, I'm the only one in the claims department.
[AGENT][NEUTRAL] No, no, you're fine, you're fine. We're gonna see if we can get this sorted, OK?
[CUSTOMER][NEUTRAL] All right, well you
[CUSTOMER][POSITIVE] Alright well you have a good day.
[AGENT][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] All right.