AccountId: 011433970860
ContactId: dc386d00-fd58-4a1d-a8d5-dcaae8d8b6b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2384300 ms
Total Talk Time (AGENT): 838168 ms
Total Talk Time (CUSTOMER): 1171729 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/dc386d00-fd58-4a1d-a8d5-dcaae8d8b6b0_20250521T15:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, good morning, [PII]. My name is [PII], and I was calling because I had a couple of questions about um.
[CUSTOMER][POSITIVE] The benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My dad had passed and I'm, uh, you know, I'm handling the all his paperwork that he had that I was submitting for a claim that
[CUSTOMER][NEUTRAL] He had before he passed. And I was going over the summary of benefits.
[CUSTOMER][NEUTRAL] And I was trying to understand some of the um the things that was on there.
[AGENT][NEUTRAL] OK, um, [PII], can you give me your callback number just in case our call is dropped so that I can get um the information for you that you're requesting.
[CUSTOMER][NEUTRAL] Yes ma'am. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number is.
[CUSTOMER][NEUTRAL] 2, I'm sorry, 022.
[CUSTOMER][NEUTRAL] 71513
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[AGENT][NEUTRAL] OK. [PII], what is um your father's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you very much. Let me look real quick.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right. And do you have his um address and phone number that was on the policy?
[CUSTOMER][NEUTRAL] Yeah, the address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] And the phone number, oh, I hate to go back to this phone number. Um,
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me grab it because um.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And I do show that the street address that we have is a different address. Um, it's [PII].
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Oh, is he at [PII].
[AGENT][POSITIVE] Thank you. I appreciate you verifying the policy for me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, Ms. [PII]. You said that you were looking over the certificate and you had some questions about the benefits.
[CUSTOMER][POSITIVE] You're welcome
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And there was a previous claim that was submitted for your daddy before he passed.
[CUSTOMER][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] Yeah, we just had me, well, we just finished um submitting some stuff.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hold on, let me gather my thoughts together. I'm sorry.
[AGENT][POSITIVE] I'm, it's OK. Take your time. I know it's hard.
[AGENT][NEUTRAL] You just let me know when you're ready.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, yeah, when you said the number, it just did something cause I know that I'm not calling no more.
[AGENT][NEGATIVE] Right. Yeah, I lost my dad too, and it's difficult, especially like when things pop up on Facebook that he's written me during the day.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It and those memories that pop up and they have pictures and I just lose it. So I, I understand.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I could really use it and it's still fresh, so fresh.
[AGENT][NEUTRAL] Yes. Yes, ma'am.
[CUSTOMER][NEUTRAL] It's um
[CUSTOMER][NEUTRAL] Um, but yeah, the, uh, I was going over the, the, the, um,
[CUSTOMER][NEGATIVE] The summary of benefits, and I didn't understand. I don't understand some of it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Would it help you if I looked at the um.
[AGENT][NEUTRAL] The um claims that were sent in in March and give you the remarks that's on the claims would that help you any? Because the ones that were sent in May are still being processed and I don't have any information on those just yet, but I do have one that was in March.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That was sent in
[CUSTOMER][NEUTRAL] Yeah, and I'm
[CUSTOMER][NEUTRAL] Hey, that was for the medication. I know that they don't cover the medication, but it was like um let me see.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like one of them is the chemo, um, it says radiation therapy, chemo, immunity therapy, maximum per year. So he did chemotherapy. I faxed that off today. So he did chemotherapy, so that was fine that I sent that in, right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So he because he did the chemotherapy, um,
[CUSTOMER][NEUTRAL] Didn't he have, he did a blood transfusion. I sent that in. The home, the home health care.
[CUSTOMER][NEUTRAL] It says up to the same number of hospital confinement days. So, what is that? Because I sent in he did home help, um, they will come in, the nurse will come in, and then he did physical therapy. I sent that in, but I don't understand what they mean about the hospital consignment. I, I don't understand that because he, he did go in the hospital. He was in the hospital from um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] all the way up until [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then they transported him to.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, do you have?
[CUSTOMER][NEGATIVE] But I just didn't understand it.
[AGENT][NEUTRAL] Right, do you have a claim number that I can look at that is on your paperwork that you have or?
[AGENT][NEUTRAL] The data service
[CUSTOMER][NEUTRAL] Uh, I don't
[CUSTOMER][NEUTRAL] I don't have a claim number. I've just been sending things in since [PII], but I don't have a claim number.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so the information that you sent in on [PII] and [PII].
[AGENT][NEUTRAL] That were submitted those are the ones that are under review right now um through a claim specialist they're processing those and so I don't have any information on those just yet. Once you send them in, it can take up to 10 days to process the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, OK, yeah, but, um, yeah, I was, I was just trying to understand what, uh, with this, um.
[CUSTOMER][NEUTRAL] Understand.
[CUSTOMER][NEUTRAL] About
[CUSTOMER][NEGATIVE] If I needed to, um, um, man, my mind just went blank.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Where are we? Oh, the um
[CUSTOMER][NEUTRAL] So, oh yeah, the home health care.
[CUSTOMER][NEUTRAL] With dealing with the hospital confinement days. I was trying to see what was that. Like, is that what they mean about it is if he was in a hospital and then the hospital had home health come in to help with him.
[CUSTOMER][NEUTRAL] That's what I was trying to figure out, cause I, I didn't, I don't know what that means.
[AGENT][NEUTRAL] Um, let me
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, home healthcare, the way that the policy is reading is per day up to the same number of hospital confinement days. So it can go up to the same number of days that he was confined in the hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, for that,
[CUSTOMER][NEUTRAL] What I, what I need to, um, because I did send in the after summary for for his discharge papers from.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The day he went in, of course, until the day that he was moved to the next facility, and then from that another day cause I sent that in. So do I need to send in, do I need to send in like all of the paperwork showing each day that he was in the hospital? Do I need to send that in also, or would the, what the um the discharge paper, paper.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Be fine, or do I need to print out every day that he was in there?
[AGENT][NEUTRAL] OK, so on the discharge paper, does it have the original admission date and the original discharge date on it?
[CUSTOMER][NEUTRAL] Yes, it has the data.
[AGENT][NEUTRAL] For them to see that he was in.
[AGENT][NEUTRAL] OK, I would send that.
[CUSTOMER][NEUTRAL] Yes, you have that.
[AGENT][NEUTRAL] I would send that in and then if they need any additional information they'll reach out and request that, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. And of course, you know, this is just to verify his benefits. It's not a guarantee of payment, but definitely, anything that you feel will help his claim.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] Definitely send it, but if it has the original admitted state and discharge date, did they give you an itemized statement?
[AGENT][NEUTRAL] With that
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] That shows the diagnosis and procedure codes that were done while he was.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] On home health.
[CUSTOMER][NEUTRAL] So I send all of that in. So I, I send all of that in.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Send all of the uh everything that we had from home health. I sent that to um to you guys. So I also had them because oh my [PII], it was so many papers that was gonna be so expensive, so I.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So I mailed some stuff off. I mailed that up because he had two sessions. He did home help last year and then um so I sent that off and then he did home health this year, um, so I sent that off. So I mailed that. I mailed that off, so you guys should be receiving that on Friday.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Um, the postal service.
[AGENT][POSITIVE] Yes, ma'am. Good.
[CUSTOMER][NEUTRAL] So you guys should be seeing it.
[CUSTOMER][NEUTRAL] And so then I also was um they had one about where that the attending physicians uh per day of hospital confinement. Can you explain what that is to me?
[AGENT][NEUTRAL] OK, let me look what that says.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so on the attending physician.
[AGENT][NEUTRAL] Each day that he was in the hospital.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Benefit amount is $50 for the attending physician.
[AGENT][NEUTRAL] For each day he was in the hospital.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that was, so that particular thing will still go with the, the discharge papers. Oh well, like you say, if they need anything else, they'll ask.
[AGENT][NEUTRAL] Yes, ma'am, they will, but always um try to send in.
[AGENT][NEUTRAL] Uh, anything that you think may help your claim, you can go ahead and send that in. Uh, that just helps, um, because once they ask you for additional information and you send it in, then it can be another 10 days before the claim is, is completed. So it helps with time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I, I, I so I.
[CUSTOMER][NEUTRAL] Yeah, exactly. OK, so I'll, I'll print that out from the day he went in and then all these different things that they, I'll definitely do that. OK, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what else? OK, and then the hospice care, I sent that in.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because he got this, I sent that in and extended care.
[CUSTOMER][NEUTRAL] Extended care facility.
[AGENT][POSITIVE] OK. Good.
[CUSTOMER][NEUTRAL] What is that? What, what is that? The extended care facility?
[CUSTOMER][NEUTRAL] Is that like a nursing home or something?
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] Yes, like a swing bed, um.
[AGENT][NEUTRAL] You know, when the hospital only has so many days that um they can let a member stay in the hospital and then after those days are up, but they still need additional care, sometimes they move them to an extended care facility or a, or a swing bed facility.
[CUSTOMER][NEUTRAL] They did that. So that's what they did when he, OK, so they actually did that. That's when they sent him to Bridgepoint cause he still needed more care.
[AGENT][NEUTRAL] OK, I would send that information and also and the claims specialist can review it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's what I'm gonna do. I'm gonna send that in.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] I sent in the chemo stuff.
[CUSTOMER][NEUTRAL] OK, then we have to extended care.
[CUSTOMER][NEUTRAL] OK, um, we understood what else.
[CUSTOMER][NEUTRAL] The evaluation.
[CUSTOMER][NEUTRAL] Why was that? The evaluate, where did it go?
[CUSTOMER][NEUTRAL] It was something about the evaluation. OK, not something that stuff for the blood. So blood plasma. So is that like for the blood transfusion because he did do that. He did do a blood transfusion.
[AGENT][NEUTRAL] Um, let me see what it, what it states.
[CUSTOMER][NEUTRAL] So I think that
[AGENT][NEUTRAL] And what did you say it was under blood plasma?
[CUSTOMER][NEUTRAL] Yeah, blood, plasma and pallets.
[AGENT][NEUTRAL] Yes, go ahead and send in the information for that also.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] The drugs and medication.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah, inpatient slash outpatient. What what is it pertaining to that?
[AGENT][NEUTRAL] Uh, inpatient is 18 hours or more.
[AGENT][NEUTRAL] An outpatient is anything that's.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not 18 hours or more and wasn't actually admitted to the hospital.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is it like the medication that they was giving him?
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] The inpatient, this is what defines the inpatient. It means a covered person who is admitted as a resident patient or to a hospital for at least 18 consecutive hours and is being charged for a room and board facilities. This does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Include a person who was confined to an observation unit or emergency room in a hospital. So anything that he had done while he was inpatient, I would go ahead and send it in along with the itemized statement um for the hospital stay too.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] I'm trying to make sure that I understand correctly. So, so,
[CUSTOMER][NEUTRAL] Every medication that they was giving him while he was in the state because of course he was there like almost 2 months.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Well, yeah, almost a month.
[CUSTOMER][NEUTRAL] So I would just take that and send every last medication that they gave him while he was in the hospital.
[AGENT][NEUTRAL] Yes, ma'am. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, it's just like I'm just about to be just basically printing out every
[AGENT][NEUTRAL] Every
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Every little tidbit matters.
[CUSTOMER][POSITIVE] Print out every last, every letter, know that they had to print all that out. I thank God I have access to this portal.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Um, OK, that is that.
[CUSTOMER][NEUTRAL] OK, um, OK, I sent that out.
[CUSTOMER][NEUTRAL] Inpatient, you know what? I'm gonna just print the whole portal out.
[CUSTOMER][NEUTRAL] For every last note that he had and just send it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I must just do that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am. What is the easiest for you for sure.
[CUSTOMER][NEUTRAL] Yeah, I, I'll just do that because like literally everything from day one is in this in from the notes that every doctor has said.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I would just print all that out and send all of that because basically that's what it sounds. It it just sounds like majority of everything that I'm asking for the most part.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's what we're saying.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, so.
[CUSTOMER][NEUTRAL] And it'll show like every it'll show like every position that have saw him since he's been in and everything. It should have to have physician's name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes. Um, now,
[CUSTOMER][NEUTRAL] For every day and I
[AGENT][NEUTRAL] On, on the drugs and medicine that you were talking about, it says inpatient per confinement. So per confinement means the length of the stay.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Each day.
[AGENT][NEUTRAL] So if he was in the hospital and he had to leave, that's one confinement, but then he had to come back and stay again and that's another confinement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh-huh, OK, so it's like because he went in, he went in on the [PII]. He didn't leave until [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that's one confinement.
[AGENT][NEUTRAL] For that extended period.
[CUSTOMER][NEUTRAL] OK, so, OK, so it would be 15.
[CUSTOMER][NEUTRAL] For that because he was there for that long period of time.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] OK, but for the
[CUSTOMER][NEUTRAL] The physician.
[CUSTOMER][NEUTRAL] The physician, the attendant physician, per OK, so that'll be
[AGENT][NEUTRAL] Per
[CUSTOMER][NEUTRAL] That would be basically the same thing as the medication.
[CUSTOMER][NEUTRAL] Attendance physician per hospital consignment. So that'll be $150 for that one, even though he was in there from the [PII] all the way to the [PII], it'll be that $50 for that one because that will be one consignment too, correct?
[AGENT][NEUTRAL] It's, um, the attending physician's fee is actually per day of hospital confinement.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what I'll, well, yeah, I'll make sure I print that because that's like everyday.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I really truly appreciate you taking the time out.
[AGENT][POSITIVE] Well, you're welcome. It's not a problem at all. I'm glad I'm able to help you. It's a lot to have to get all this together.
[CUSTOMER][NEUTRAL] People don't have.
[CUSTOMER][NEGATIVE] It is, ma'am, and I'm just so overwhelmed. I'm still having to deal with his death with funeral homes and it's like time to
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Woo I haven't had a break yet.
[AGENT][NEGATIVE] Yes, you need to woosa.
[CUSTOMER][NEUTRAL] So I really
[AGENT][POSITIVE] You need to take some time for yourself and do that.
[CUSTOMER][NEUTRAL] Yes, I, I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yes, and I just have not yet cause I still have to deal with. I'm like, oh my God, he's gone. I thought I would have, you know, but no.
[CUSTOMER][NEUTRAL] It's not over yet.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and ambulance. OK, so.
[CUSTOMER][NEUTRAL] They have ambulance, ground, airfare.
[CUSTOMER][NEUTRAL] 2 trips for hospital consignment. So, do what that applies for him with them transport, transporting him from the hospital to hospice.
[AGENT][POSITIVE] Yes ma'am, I would send that in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Uh, what is this medical, medical equipment. What does that mean with the medical equipment? Um, like, would that be like if he was on oxygen or anything, or if he had to pay for it?
[AGENT][NEUTRAL] Uh, let me look.
[AGENT][NEUTRAL] OK, so
[AGENT][POSITIVE] If he had any kind of medical equipment that he needed to use, it gives a one-time benefit per covered person once a year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of $150. So if there was any medical equipment that he needed, go ahead and send that in.
[CUSTOMER][NEUTRAL] OK, so I could send you oxygen in his pocket because he did have oxygen and we.
[CUSTOMER][NEUTRAL] So I'll, I'll go get that information.
[AGENT][NEUTRAL] Which would be for the
[AGENT][NEUTRAL] Equipment, not the oxygen itself. Does that make sense for the equipment used?
[CUSTOMER][NEUTRAL] OK. Uh, yeah, so he used the oxygen equipment.
[AGENT][NEUTRAL] Mhm, yes, ma'am.
[CUSTOMER][NEUTRAL] If I'm
[CUSTOMER][NEUTRAL] OK, yeah, so he used the equipment. He has the equipment for the.
[AGENT][NEUTRAL] Yes, it
[CUSTOMER][NEUTRAL] So, that'll work, correct?
[AGENT][NEUTRAL] Yes, ma'am. Go ahead and send that in that shows where you guys had charges or whatever for that oxygen equipment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, because I will have to pay $25 what was my extra tanks, OK.
[CUSTOMER][NEUTRAL] oxygen.
[CUSTOMER][NEUTRAL] Yeah, OK. Um,
[CUSTOMER][NEUTRAL] And lump sum for elig eligible dependents. Well, OK, so one maximum per coverage person, so that one pertain because he didn't have, he didn't have any riders on his policy, correct?
[AGENT][NEUTRAL] Let me look and see.
[AGENT][NEUTRAL] Uh, he had, um, a writer for um.
[AGENT][NEUTRAL] Cancer screenings like mammogram, ultrasounds, colon cancer screening, um, colonoscopy. That's, uh, they also call it uh preventative.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, he also had a a writer for MRI, CAT scan, PET scan.
[AGENT][NEUTRAL] Uh, looking, I'm still looking at his policy, see if there's any other writers.
[AGENT][NEUTRAL] He has a surgical benefit rider for bone marrow transplant.
[CUSTOMER][NEUTRAL] Hold
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Let me make this clear. Hold up.
[AGENT][NEUTRAL] If you look, if you have a policy and you scroll down kind of towards the bottom, it'll give you each benefit rider.
[CUSTOMER][NEUTRAL] I don't. That's the thing.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Hold on, hold on, hold on. So if he had needed a colonoscopy, then the policy would have paid for it?
[AGENT][POSITIVE] There were benefits for that, yes.
[CUSTOMER][NEUTRAL] He's the reason why I'm asking my dad, he didn't know this. So why I'm asking because
[AGENT][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] We had to, we paid.
[CUSTOMER][NEUTRAL] For colonoscopy.
[AGENT][NEUTRAL] OK, so if you want to send in that information also so the claims um specialist can review it.
[CUSTOMER][POSITIVE] Wow
[AGENT][POSITIVE] That would be great if you have that information also.
[CUSTOMER][NEUTRAL] To go to the hospital and get the me.
[AGENT][NEUTRAL] Cause there's not
[AGENT][NEUTRAL] Yes, there's not a timely lien limit.
[AGENT][NEUTRAL] So as long as he was covered under the date of service, the policy was active, you can send all this information in at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] See, that man.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the, the benefit, the cancer screening benefit that mentioned the colonoscopy and, and all that on there. So the effective date of that was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So anything after [PII]?
[AGENT][NEUTRAL] For, for like the colonoscopy and any preventative that he had, you can send that in also.
[CUSTOMER][NEUTRAL] So you say it was active [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. The cancer screening benefit rider.
[CUSTOMER][NEUTRAL] OK, so I'm gonna go to the hospital and get that and you said a you said a MRI?
[AGENT][NEUTRAL] Yeah, if you had an MRI CAT scan.
[AGENT][NEUTRAL] PET scan.
[AGENT][NEUTRAL] Um, that was also covered under his cancer screening benefit rider.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] MRI CAT scan.
[CUSTOMER][NEUTRAL] Pet scan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because we pay for that, pay like $1200 or something like that from his co-pay.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So he has to do with colonoscopy. All right. Um.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] They say you have to ask a lot of questions cause I promise.
[CUSTOMER][NEUTRAL] I didn't know that. He sure didn't know that. There's a lot of stuff that I'm just learning and finding.
[AGENT][POSITIVE] You'd be amazed at how many people get these policies.
[AGENT][NEGATIVE] These and they don't read them. They just know they have cancer insurance.
[AGENT][NEUTRAL] And they don't read them, so they don't know, you know, what their benefits are. And I'm gonna be honest, I mean, before I started working here, I didn't read them either. I was like, I got health insurance, but I never looked at my policy to see what it was.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] That's, yeah.
[CUSTOMER][NEUTRAL] Ma'am, we, I think we all, we all may do that.
[AGENT][NEGATIVE] We're guilty of it.
[CUSTOMER][NEUTRAL] It's a business it's like.
[CUSTOMER][NEUTRAL] Oh my God, look at all my money and I'm just like, look at, look at all of this. So yeah, a PET scan, a CAT scan, and then try.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This is crazy. And the colonoscopy, colonoscopy, PET scan, CAT scan.
[CUSTOMER][NEUTRAL] OK. OK. Um,
[CUSTOMER][NEUTRAL] And for that,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And how much do you have like a ballpark of how much for the colonoscopy that it would be?
[AGENT][NEUTRAL] No, it's not
[CUSTOMER][NEUTRAL] Like if they was, OK.
[AGENT][NEUTRAL] It doesn't give me amount so that's one of those things that has to be turned in and it's done by procedure codes, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][POSITIVE] Well, I'm happy I asked about a rider.
[AGENT][NEUTRAL] Yes, I am too.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, a surgical cancer treatment. OK, the cancer treatment.
[CUSTOMER][NEUTRAL] Center evaluation or consultation.
[CUSTOMER][NEUTRAL] her life. So, what is that? Is that um
[CUSTOMER][NEUTRAL] Whenever they go in and they learn about the cancer.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see if it'll give me information.
[AGENT][NEUTRAL] On that
[AGENT][NEUTRAL] And it did it say the first occurrence benefit?
[AGENT][NEUTRAL] That you looked at
[CUSTOMER][NEUTRAL] Uh, what the
[CUSTOMER][NEUTRAL] it says miscellaneous benefit writer.
[AGENT][NEUTRAL] OK, let me, let me find it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That is um.
[AGENT][NEUTRAL] That is uh the, the writers that I just told you about that were added to the policy.
[AGENT][NEUTRAL] For the, um, yes, that's just given the effective date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] When they're effective, which is the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I think, I think that that may be it because I was about to say, I know, so I think he may probably have got paid and got paid. He may have got paid for that, I'm guessing when he first was diagnosed maybe.
[CUSTOMER][NEUTRAL] Probably. Um, so.
[AGENT][NEUTRAL] It could be possible and anything that is sent in that he's already done will just be um the claim will be uh done as a duplicate it'll just give you a remark when they give you you know when you go in the online service center and they give you the progress of the claims it'll come back as duplicate meaning that it's already been processed.
[CUSTOMER][NEUTRAL] OK, OK. Well, I'll just resend it, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'll just, because I don't know. I, I'm, I'm, I'm just now getting a hold of all of this stuff, you know, we had somebody else and stuff, so I'm just getting a hold of all of this stuff. There's a lot of stuff that I'm trying to catch up with that I didn't even know about. So I would just resend it because I know he did just do.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] With his chemo that he did this year, he had to do like a, a, a, a chemo educational thing where, because he, they end up transferring him to a different doctor.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So, of course, he had to take, you know, a, a different um chemo class with this particular doctor. I'm guessing on how they do things.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So,
[AGENT][POSITIVE] Yes, I promise you by the time you finish all this, you are gonna be an expert in filing cancer claims.
[CUSTOMER][NEUTRAL] Man
[AGENT][NEUTRAL] There's so much that goes to it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Ma'am, I am an expert at this dealing with my dad and me finding out last year, well, right now, in May, you know, we was at the cancer doctor at the oncologist, and it's just been going extremely fast for me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] You know, and he found out and it's just been a year that he's found out, and you know, of course he passed away in less than a year of him finding out. And I just you know, and that's why I don't understand. I didn't know nothing about the paper side because I was trying to work to try to, you know, get my dad together to see if we could try to save him or slow it down. So I didn't deal with the paper side. So now I'm dealing with the paper side.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] And it's like, wait, whoa, hold up, this is just so much. I didn't know about this, I didn't know about that. Then I had to deal with the funeral, then I'm going through the things with the funeral home. So it's like, it's so much knowledge that I have learned and and, you know, they say every day is a teaching lesson, and that is for sure true that I'm learning so much. So now.
[AGENT][POSITIVE] Goodness.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I hate to say it, but whenever, you know, I pray no death come upon us anytime soon, but
[CUSTOMER][POSITIVE] I'm on top of it. I know it and I understand now. I understand so much.
[AGENT][NEUTRAL] Yeah, right.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Cause we don't be knowing, you know, because nobody been dealt with a debt before. Sometimes fresh for everyone and so you just learn so much, you, it's just so crazy. It is crazy, you know.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, it's a lot.
[CUSTOMER][NEGATIVE] I wanna go back.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Oh, you like I just wanna go back to.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] When the parents, the parents tell you, you know, you won't see a kid forever, you won't see a child, hey, now I know what they mean.
[AGENT][POSITIVE] Right. And when we're young, we're so uh ready to grow up and be an adult. And when we're adults, we're so ready to just like wish we had cherished our younger days.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][POSITIVE] Yes, ma'am. Yes ma'am. But I really, I promise I appreciate all of this because.
[CUSTOMER][NEGATIVE] I'm just about to go and I'm like, oh my God, I'm about to be overwhelming these people with all these papers.
[AGENT][NEUTRAL] Well, don't feel, don't feel like you're overwhelming. Always.
[CUSTOMER][NEUTRAL] This, yeah, but I
[AGENT][POSITIVE] Feel like you can pick up the phone, we will always help you. We'll, we'll help you every step of the way through this. If you have questions, if you get your claims back and you have questions, please pick up the phone and call us, OK?
[CUSTOMER][POSITIVE] I will do. I, I promise I appreciate this so much, thank you.
[AGENT][POSITIVE] You're very welcome you're very welcome Miss [PII] is that everything today that that I can help you with before we go?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Yes ma'am, you have answered so much for me. I.
[AGENT][NEUTRAL] OK, well, you
[AGENT][POSITIVE] Well, you're welcome. You're welcome. You have a blessed day.
[CUSTOMER][POSITIVE] Have a great day.
[CUSTOMER][NEUTRAL] Oh, do you have a survey? Do you have a survey?
[AGENT][NEUTRAL] Uh, we don't do surveys, but you can, um, send an email to my supervisor. That's what we do instead of surveys. I can give you her email address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, ma'am. I definitely want it.
[AGENT][POSITIVE] Well, I appreciate that. Thank you.
[AGENT][NEUTRAL] Um, her email address.
[AGENT][NEUTRAL] Is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And her last name is [PII]. [PII] [PII]
[AGENT][NEUTRAL] [PII] [PII], [PII].
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what's your name again?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty and last name, well, I know you gotta probably give me the last, the first initial of the last name probably.
[AGENT][NEUTRAL] Yes, it's A, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright, thank you so much, Ms. [PII]. I'm definitely because.
[CUSTOMER][NEGATIVE] Some people don't have patience.
[CUSTOMER][POSITIVE] And I really appreciate it.
[AGENT][NEUTRAL] All
[AGENT][POSITIVE] Well thank you I appreciate you.
[CUSTOMER][NEUTRAL] You just don't know how much it.
[AGENT][POSITIVE] I appreciate you and I enjoyed helping you and talking with you on the phone and getting through this together.
[CUSTOMER][POSITIVE] Yes ma'am have a great wonderful day.
[AGENT][POSITIVE] You too. You have a blessed day too, and thank you for calling APL.
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][NEUTRAL] Bye bye