AccountId: 011433970860
ContactId: fe8e1b52-eec2-492d-aa42-626d70886fa4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2587679 ms
Total Talk Time (AGENT): 909301 ms
Total Talk Time (CUSTOMER): 822750 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/fe8e1b52-eec2-492d-aa42-626d70886fa4_20250128T17:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good morning. This is [PII].
[CUSTOMER][POSITIVE] And uh I've got a really important call here.
[CUSTOMER][NEGATIVE] My wife passed away on [PII] from cancer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I had APL as part of the benefits that she had.
[CUSTOMER][NEUTRAL] At the school that she worked at, she was a teacher.
[CUSTOMER][NEUTRAL] She went to 2 hospitals primarily.
[CUSTOMER][NEUTRAL] During her fight against the cancer.
[CUSTOMER][NEUTRAL] [PII] [PII] and White, and UT Southwestern, both of them here in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We received compensation from APL.
[CUSTOMER][NEUTRAL] Or the visits that she had to Baylor Scott and White.
[CUSTOMER][NEUTRAL] It took me a while to get the correct printout format.
[CUSTOMER][NEUTRAL] R R UT Southwestern.
[CUSTOMER][NEUTRAL] Where the charges and codes were all included.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I I sent those to APL.
[CUSTOMER][NEUTRAL] And keep in mind that these charges occurred at the same time as [PII] [PII] and White, because she was going to both hospitals simultaneously.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now when I sent the information for UT Southwestern to APL.
[CUSTOMER][NEUTRAL] They came back with, I believe it was 10 letters stating that the services
[CUSTOMER][NEGATIVE] were rendered after coverage was terminated.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And didn't compensate.
[CUSTOMER][NEGATIVE] Didn't compensate me for anything.
[CUSTOMER][NEGATIVE] But that makes no sense because the services were provided at the same time.
[CUSTOMER][NEUTRAL] As those from Bader, Scott and White.
[AGENT][NEUTRAL] As the other one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So you're wanting to know why the claims from UT Southwest were are given the denial that the services, the services were rendered after coverage was terminated when it was the same time as the Baylor Scott services that were that were paid out on.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK. I just wanted to make sure that I was following. I thought I was, but I just want to be on the right page. Um, well, firstly, I do definitely want to, um,
[AGENT][POSITIVE] Say we're sorry for your loss, and if there's anything we can do to help you, we definitely will. Um, may I have a good contact number and then the policy number?
[CUSTOMER][NEUTRAL] Yes, my contact number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the policy number is 015.
[CUSTOMER][NEUTRAL] 927
[CUSTOMER][NEUTRAL] 07
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And this is for the cancer policy.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so we have the records and we
[AGENT][NEUTRAL] I'm just reading through the notes. Hold on one second.
[AGENT][NEUTRAL] And can you verify her, her, um, first and last name and date of birth? I know I'm in the right place, but
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And her date of birth was [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Which um claim, like do you have a claim number that has that denial reason on it because I don't see a claim with those denial reasons.
[CUSTOMER][NEUTRAL] Uh, let's see, the claim number I have there's actually 10 of them.
[CUSTOMER][NEUTRAL] There's a different claim number on every one of these letters that I received.
[AGENT][NEUTRAL] I just need one for an example because like I said, there's from the claims that's here, the codes that I see aren't the the now reason that you're giving, so I just need to match up.
[AGENT][NEUTRAL] I just need one claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 355.
[CUSTOMER][NEUTRAL] 313 2
[CUSTOMER][NEUTRAL] That's just one of them.
[AGENT][NEUTRAL] 35531.
[CUSTOMER][NEUTRAL] 32
[CUSTOMER][NEUTRAL] 313 2
[AGENT][NEUTRAL] Hold on one second. Is this a different?
[AGENT][NEUTRAL] 3553132. This is a different policy number. OK, I'm like, this is not here. OK, hold on one second. This is under a different policy number, so that's why I didn't see the denial reasons you were given.
[AGENT][NEUTRAL] So let me go to the right policy. So this is all filed under uh policy number 1104045?
[AGENT][NEUTRAL] OK, here we go, and now here goes all 10. OK. So I'm in the right place now. Let me see what what's going on. Do you mind if I place you on just a brief hold so I can look through the claims versus the other claims?
[CUSTOMER][NEUTRAL] No, that's fine, and listen, I did call previously.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh the conversation they had was, it was like this, and I'm not sure this is correct, but from what I heard them say was that the Arlington School District, which is who was her employer,
[CUSTOMER][NEUTRAL] That had changed their APL policy.
[CUSTOMER][NEUTRAL] Apparently that's why you have 2 policy numbers because I only have the one original policy number.
[CUSTOMER][NEUTRAL] But the change in policy numbers should not change the coverage.
[CUSTOMER][NEUTRAL] That was available during the same time frame.
[CUSTOMER][NEUTRAL] As Bader Scott and White.
[CUSTOMER][NEUTRAL] You know, we're we're talking a considerable amount of money.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So that's a concern of mine, obviously.
[AGENT][NEUTRAL] Now, one thing I do want to point out in the difference between the two, and again, I'm gonna place you on hold so I can look at everything, but just from what I see right now, the 1104045, that policy is a Medlink policy, so that's not a cancer policy. That's a supplemental gap insurance policy, which might have something to do with the denial, but again, I'm I'm getting ready to look at all of that.
[AGENT][NEUTRAL] But the difference between the 15927007 and the one that we just found is one is a cancer policy and one is a supplemental gap insurance policy. So there are two different types of policies.
[CUSTOMER][NEUTRAL] Oh, I didn't know about the.
[CUSTOMER][NEUTRAL] Supplemental gap. I mean, basically, as far as I knew,
[CUSTOMER][NEUTRAL] It was simply APL that we had signed up for.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] So, yeah, that may be the answer to the question.
[AGENT][NEUTRAL] Because these all came in.
[CUSTOMER][NEUTRAL] Because I'm
[AGENT][NEUTRAL] OK, starting [PII], so from [PII], this is the [PII]. OK. I just want to make sure I had everything in one spot so I can
[AGENT][NEUTRAL] Kind of, I'm gonna compare, but that might be what the issue is, um.
[AGENT][NEUTRAL] Because this particular policy.
[CUSTOMER][NEUTRAL] What is, what
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] What is today's day?
[AGENT][NEUTRAL] Today is [PII].
[CUSTOMER][NEUTRAL] OK, the last, the last letter that I received.
[CUSTOMER][NEUTRAL] From APL was [PII].
[CUSTOMER][NEUTRAL] And the letter said we received your claim and reviewing your claim.
[AGENT][NEUTRAL] [PII]. Now that might be for the other policy because I did see something in processing there.
[CUSTOMER][NEUTRAL] But it doesn't
[AGENT][NEUTRAL] But that's not the same policy.
[CUSTOMER][NEUTRAL] Well, that's what I'm, I'm on.
[CUSTOMER][NEUTRAL] That's what I'm wondering too, OK, because every one of these letters.
[CUSTOMER][NEUTRAL] They all came at the same time.
[CUSTOMER][NEUTRAL] They all indicate the policy 01104045.
[AGENT][NEUTRAL] Yes, now that's the Medlink policy. Um, so when I was looking under the other one, that's why I couldn't see them all at first because it was a different, um, it was a different policy number and a different policy type.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Can you tell me briefly, I don't recall what is Medlik.
[AGENT][NEUTRAL] Um, Metlink is a supplemental gap insurance, so, um, let me see who, who the primary was at the time.
[CUSTOMER][NEUTRAL] Because I don't remember that we, uh, that I, I did all the signing up for my wife.
[CUSTOMER][NEUTRAL] Every time the renewal came up, I was the one that filled out the renewal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the is the is the medic coverage for loss of wages?
[AGENT][NEUTRAL] No, so like if she goes to a doctor's appointment and she gives her primary insurance card, she can give her Medlink card as well. We pay towards like the co-pay, deductible, co-insurance after primary.
[CUSTOMER][NEUTRAL] I don't remember.
[AGENT][NEUTRAL] So just like a
[CUSTOMER][NEUTRAL] I'd have to go back and I, I know I have the record somewhere but I'm buried under paperwork from what happened to my wife, but I don't recall signing up for MedLink.
[AGENT][NEUTRAL] Long time.
[AGENT][NEUTRAL] It looks like this was
[CUSTOMER][NEUTRAL] But I may have, but
[AGENT][NEUTRAL] It looks like it was so, so she's had, so you all have had the one Medlink policy and then two cancer policies. So the Medlink policy and the first cancer policy were both opened at the same time, [PII], and they both turned on the same time, [PII].
[AGENT][NEUTRAL] And then there's the most recent um cancer policy, that's the one ending in 2707. That one was effective from [PII].
[CUSTOMER][NEUTRAL] OK, well, yeah, then that would have covered the point all the way up to her.
[CUSTOMER][NEUTRAL] Passing away because she passed away in [PII].
[CUSTOMER][NEUTRAL] [PII], so we were obviously covered.
[CUSTOMER][NEUTRAL] Well, I'll let you go. I mean, I'll hold on, uh, while you go ahead and do your investigation.
[AGENT][NEUTRAL] OK, so you're wanting to know why the 10 claims were denied.
[AGENT][NEUTRAL] For the
[AGENT][NEGATIVE] Services not being rendered.
[CUSTOMER][NEUTRAL] Well, you've got me confused.
[CUSTOMER][NEUTRAL] You've got me confused now because
[CUSTOMER][NEUTRAL] I thought they were denying.
[CUSTOMER][NEUTRAL] The APL cancer policy.
[CUSTOMER][POSITIVE] That's what I thought was happening because that's of course.
[CUSTOMER][NEUTRAL] What they paid on
[CUSTOMER][NEUTRAL] For grapevine.
[CUSTOMER][NEUTRAL] Beta Scott and white grapevine. I've never run into this Medli Medlink infusion before.
[CUSTOMER][NEUTRAL] The Bader Scott and White payments were made.
[CUSTOMER][NEUTRAL] I want to say at least a month ago.
[AGENT][NEUTRAL] Do you
[CUSTOMER][POSITIVE] And there were no issues with it at that time.
[AGENT][NEUTRAL] Do you have a claim number for the Baylor Scott and White, just so I can try to look at that versus because now one thing that we can do, oh, I see. Hold on one second. Let me go back.
[AGENT][NEUTRAL] I was trying to figure out why this was processed under this policy if it was not active, these 10 that you received the letter for.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The 10 that you received the letter for, I was trying to see why it was processed under the Medlink policy because that one.
[AGENT][NEUTRAL] That one hadn't been open since [PII].
[AGENT][NEUTRAL] But when I
[CUSTOMER][NEGATIVE] Yeah, that makes no sense to me.
[AGENT][NEUTRAL] But when I look at the charges,
[AGENT][NEUTRAL] These are all inpatient hospital charges. Let me, let me take a look at the cancer policy.
[AGENT][NEUTRAL] The coverage on the cancer policy and then um
[AGENT][NEUTRAL] If needed, I can, um, you know, let a claims examiner know that these need to be processed under.
[AGENT][NEUTRAL] The cancer policy.
[CUSTOMER][NEUTRAL] Yeah, because they're, of course not identical charges, but the similar type of charges that both Bader, Scott and White, and UT Southwestern.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] The there were some surgeries done at both hospitals.
[CUSTOMER][NEUTRAL] And uh I guess the thing to keep in mind is, it was during the same period, the period that you just mentioned, through the [PII].
[CUSTOMER][NEUTRAL] It started
[CUSTOMER][NEUTRAL] When we first found out about the cancer,
[CUSTOMER][NEUTRAL] It was the end of [PII].
[CUSTOMER][NEUTRAL] So all of [PII].
[CUSTOMER][NEUTRAL] Until her passing away in January of last year.
[CUSTOMER][NEUTRAL] All those services were provided simultaneously.
[CUSTOMER][NEUTRAL] At Baylor Scott and White and UT Southwestern.
[CUSTOMER][NEUTRAL] Her oncologist was at UT Southwestern.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's why, that's why a number of the charges were at UT Southwestern.
[CUSTOMER][NEUTRAL] But the finding out about the cancer.
[CUSTOMER][NEUTRAL] Initially
[CUSTOMER][NEUTRAL] Came at [PII], and that's where she had her first.
[CUSTOMER][NEUTRAL] Lung drain and heart drain installed at [PII].
[CUSTOMER][NEUTRAL] But bottom line is, it was at the same time, same period of time.
[CUSTOMER][NEUTRAL] So that's why I'm hoping to get this cleared up so that I get.
[CUSTOMER][NEUTRAL] The compensation just as APL did.
[CUSTOMER][POSITIVE] And did quite honestly in a very timely fashion.
[CUSTOMER][NEUTRAL] In fact, all of my communications with APL.
[CUSTOMER][POSITIVE] Including with you, have been excellent. I mean, it's just really
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, they really have been every sometimes it's hard to get a hold of someone, of course.
[CUSTOMER][NEUTRAL] But once you do, people seem to really do care.
[CUSTOMER][POSITIVE] And are very helpful in trying to resolve whatever I'm facing.
[CUSTOMER][NEUTRAL] Which is so important when you're going through losing someone.
[CUSTOMER][POSITIVE] As precious as your wife.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] So I just wanna, I just wanna commend you and.
[CUSTOMER][NEUTRAL] And really everyone that I've spoken to, and I've spoken to a lot of people at APL at different times.
[CUSTOMER][POSITIVE] So anyway, I don't want to go on and on about it, but I just want you to know I'm very thankful.
[CUSTOMER][NEUTRAL] Uh, for the help at APL.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] You're very welcome, and that's the least we can do. This, it's already a hard enough time, so anything we can do to help, we definitely will.
[AGENT][POSITIVE] I think I see the difference.
[AGENT][NEUTRAL] So, let me just make sure I'm in the right um claim. The claim or the payment for the Baylor [PII] and [PII], was that the $22,400?
[CUSTOMER][NEUTRAL] Yeah, I think it was at least that much.
[AGENT][NEUTRAL] OK. So, let me see.
[AGENT][NEUTRAL] What's being built here and paid out versus the others. Um, do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] No, and they did, I did, I should tell you this, I'm sorry to interrupt, but it.
[AGENT][NEUTRAL] OK you're fine.
[CUSTOMER][NEUTRAL] The, when I finally got the documentation, the correct documentation from UT Southwestern.
[CUSTOMER][NEUTRAL] Because at first they were just selling I mean just sending me.
[CUSTOMER][NEUTRAL] Uh, like the medical records, and APL wouldn't accept that. APL wants the
[CUSTOMER][NEUTRAL] Specific treatments and the codes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For those treatments, OK? So I finally got that from UT Southwestern.
[CUSTOMER][NEUTRAL] And I sent that
[CUSTOMER][NEUTRAL] The uh USPS.
[CUSTOMER][NEUTRAL] Because you can't accept FedEx at a post office box.
[CUSTOMER][NEUTRAL] And that was delivered and that's been confirmed through APL.
[CUSTOMER][NEUTRAL] The UT Southwestern documentation was delivered on [PII].
[CUSTOMER][NEUTRAL] At [PII]
[CUSTOMER][NEUTRAL] And that was the last phone call I made the APL because APL was saying they hadn't received it.
[CUSTOMER][NEUTRAL] So APL kind of went on a search, got left a message about maybe 4 or 5 days ago.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Stating that yes, we did locate.
[CUSTOMER][NEUTRAL] Your documentation from UT Southwestern.
[CUSTOMER][NEUTRAL] So it might be that it is already being processed at a different location, the cancer location.
[CUSTOMER][NEGATIVE] And that the confusion is that I received these, these 10 pages.
[CUSTOMER][NEUTRAL] Because of a meddling contact of some sort.
[CUSTOMER][NEUTRAL] But maybe the APL is also processing the UT Southwestern.
[CUSTOMER][NEUTRAL] Maybe you'll find that out, but anyway, the documentation was confirmed as having been received.
[CUSTOMER][NEUTRAL] By APL on the [PII].
[CUSTOMER][NEUTRAL] Of this month.
[AGENT][NEUTRAL] I figured it out. I, um, I see what's going on here.
[AGENT][NEUTRAL] I'm getting the benefits now. I'm just gonna place you on a brief hold, OK, so I can, I'm typing it all together so I can explain it correctly, but it looks like just from what I see, it looks like the
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] This bill is Scott and White, so your cancer policy only has specific benefits.
[AGENT][NEUTRAL] So, uh, like for example, the ICU or physical therapy, the majority
[AGENT][NEUTRAL] Of these um charges can be covered under your cancer policy, which is why this was paid out on.
[AGENT][NEUTRAL] The problem is the other charges from the other 10, like all of those in-hospital charges, and I'm going to look at it, of course, but all those inhospital charges, there's no coverage for that on your cancer policy, which is why it looks like that's why I went to to the Metlink policy.
[AGENT][NEUTRAL] But I'm gonna look at that and get a um get another opinion from a claims examiner to see if that's really what happened and if that could, if those can be processed under the cancer policy. Um, do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Well, yes, that'd be fine, and I was going to say also.
[CUSTOMER][NEUTRAL] That I'm almost certain that the UT, well APL I should say, APL covers uh chemotherapy, immunotherapy.
[CUSTOMER][NEUTRAL] Radiation.
[CUSTOMER][NEUTRAL] And my wife at UT Southwestern.
[CUSTOMER][NEUTRAL] had all of those plus very, you know, others.
[CUSTOMER][NEUTRAL] She had radiation, she had chemo.
[CUSTOMER][NEUTRAL] She had immunotherapy.
[CUSTOMER][NEUTRAL] She had a throat surgery.
[CUSTOMER][NEUTRAL] At UT Southwestern.
[CUSTOMER][NEUTRAL] So I'm sure there's got to be something.
[CUSTOMER][NEUTRAL] That was covered at UT Southwestern under the cancer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 300. Hold on one moment, OK?
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I do apologize for that wait. So I did look over everything and I do see the differences. So,
[AGENT][NEUTRAL] For your policy or for the cancer policy.
[AGENT][NEUTRAL] Well, let me start with the the 10. So for the 10 that were processed under the Metlink policy, they were processed under the Metlink policy, because that's the only policy that has coverage for like the inpatient visits, the outpatient visits, um, those things are not on your cancer policy.
[AGENT][NEUTRAL] The cancer policy, um,
[AGENT][NEUTRAL] Has like the intensive care rider, the physical therapy, all of that, which is why those other um charges were paid out on for [PII] and [PII], because those are different types of charges.
[AGENT][NEUTRAL] Um, the intensive care was $600 a day. There were several on there that gave you those, uh, big balances to equal the $22,000 because that pays you $600 a day and she was, um, there were several days, and then also physical therapy from that last um claim that you received from [PII] and [PII], those were the two main charges on there, the ICU visits and the physical therapy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That's what equal to 22,000.
[AGENT][NEUTRAL] And that's why the other claims were denied because the Medlik policy is not active, even though those charges could only be covered on the Medlik policy.
[CUSTOMER][NEUTRAL] So Medlink Medlink wasn't even an active policy.
[AGENT][NEUTRAL] Right, the mailing policy, um, hold on, let me go back to the date.
[AGENT][NEUTRAL] The mailing policy, um,
[AGENT][NEUTRAL] Terminated on [PII].
[CUSTOMER][NEUTRAL] So it wasn't resigned up, but you tried to.
[CUSTOMER][NEUTRAL] Process the claim through meddling anyway.
[AGENT][NEUTRAL] Right, because there's no deadline to file a claim. So as long as the policy is active on the data service, you can file a claim at any time. So once we receive a claim, we have to process it. um, you know, sometimes providers send claims extremely late, but that's why it was processed because we received it. It just was denied because the policy wasn't active.
[CUSTOMER][NEUTRAL] I guess my question would still be
[CUSTOMER][NEUTRAL] About the commu uh the
[CUSTOMER][NEUTRAL] Chemotherapy,
[CUSTOMER][NEUTRAL] I think she had 6 radiation treatments.
[CUSTOMER][NEUTRAL] Immunotherapy.
[CUSTOMER][NEUTRAL] And she had a surgery.
[CUSTOMER][NEUTRAL] To her throat. All that was done.
[CUSTOMER][NEUTRAL] At UT Southwestern.
[CUSTOMER][NEUTRAL] And I'm almost certain.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Sessions of
[CUSTOMER][NEUTRAL] Chemotherapy?
[CUSTOMER][NEUTRAL] And immunotherapy and radiation.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We're supposed to be covered.
[AGENT][NEUTRAL] Now under the cancer policy, yes, um, but when I look through the charges, like I don't see from the ones that were submitted on the Metlink policy, this is like diagnosis and pathology report, like her her treatment. This is not, this has not, that has not been received.
[CUSTOMER][NEUTRAL] So the UT Southwestern records that I sent to you.
[CUSTOMER][NEUTRAL] Didn't include radiation and chemotherapy.
[AGENT][NEUTRAL] I mean, I can get a claims examiner if you'd like to look further into what was received. I'm just going through the claims and like clicking on each one of the 10 to see what's on there, but like I don't see any, because it'll say chemo or hormone, you know, it'll say what it is like this just says outpatient pathology, so that's a pathology report, like they inpatient, there's there's nothing here that shows treatment.
[AGENT][NEUTRAL] Um, I, I'm just going through each of the claims.
[CUSTOMER][NEUTRAL] Well, no, I
[CUSTOMER][NEGATIVE] But the claims that were sent to me, those 10 pages that I just received,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You said those, those were actually submitted through Medlink.
[AGENT][NEUTRAL] Right, these 10, those 10 letters that you received all say that the services were rendered after coverage was terminated because this policy hasn't been active since [PII].
[AGENT][NEUTRAL] But if you like I can.
[CUSTOMER][NEUTRAL] I, I guess I'm still confused.
[AGENT][NEUTRAL] I mean, I can definitely get a claims representative to go over the claims with you, you know, further in detail, but that's what's going on here. Um, I, I don't see any actual treatment. This is like an outpatient.
[AGENT][NEUTRAL] It looks like outpatient facility, inpatient stays.
[AGENT][NEUTRAL] The physical therapy, hold on one second.
[AGENT][NEUTRAL] This one says radiation.
[AGENT][NEUTRAL] This one.
[AGENT][NEUTRAL] Yeah, these are all non-covered. Um, if you like, I'll be more than happy to get a claims examiner on the line for you to go with, go into this more in detail for you, um, because they're examining the claims, so they'll know what they're looking for. I'm just going through the claims and seeing what the um benefit is and what was done, but I don't see like,
[AGENT][NEUTRAL] Any chemo treatments or anything like that. This is more so like stays, hospital stays.
[CUSTOMER][NEUTRAL] Well, I'm looking at one of these pages. I had, I really hadn't gone through the item by item. I just received those pages.
[CUSTOMER][NEGATIVE] And of course my initial concern is what they didn't pay anything.
[CUSTOMER][NEUTRAL] But I'm looking at one of those pages now as an example, [PII].
[CUSTOMER][NEUTRAL] [PII]. This is one of those 10 pages.
[CUSTOMER][NEUTRAL] And it says neurosurgery radiation.
[CUSTOMER][NEUTRAL] Stereotactic radiosurgery.
[AGENT][NEUTRAL] Right, I did see the radiation one as well, but unfortunately, I can't give you the answer you're looking for because I didn't examine the claims, but I do see radiation on some of these, majority of them are inpatient, outpatient, diagnostic and pathology.
[AGENT][NEUTRAL] Which either way, the the policy still wasn't active on these dates of service, but
[AGENT][NEUTRAL] We could possibly see if they can file it under under the cancer policy, but I don't know how that would work. We will have to get someone from claims to help with the claim further.
[CUSTOMER][NEUTRAL] Yeah, I understand the med link because I'm sure that I probably didn't sign up for it so.
[CUSTOMER][NEGATIVE] Medin doesn't make any sense.
[CUSTOMER][NEUTRAL] Uh, but I would think that there would be at least some of the coverages that occurred at UT Southwestern would fall under the cancer policy. So that's what I'm questioning, and yes, I would like somebody to research that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna reach out to a claims examiner and then also I'm gonna mention the rate because I did see um some radiation charges too. I don't know if that's if there's a difference in anything, so I'm going to point that out to them also um to let them know that I did see radiation as well, um, and if that could be filed under the cancer policy.
[CUSTOMER][NEUTRAL] Yeah, I would like them to take a look at this. Maybe somebody made a mistake and just tried to file them under the Medin only.
[CUSTOMER][NEGATIVE] And didn't even pursue the cancer.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] And they're in the whole, the whole stigma.
[CUSTOMER][NEGATIVE] Might lie under the fact that they didn't, they didn't never process them under the actual correct policy.
[AGENT][NEUTRAL] Cancer, right, and if that is the case, then we can definitely get that reprocessed for you. I just don't want to say it is and it's not or it's not and it is, but we can definitely reprocess if we need to.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, because I think my question will go back to, and that could be incorrect because
[CUSTOMER][NEUTRAL] So much happened during those 13 months, but I just for some reason remember.
[CUSTOMER][NEUTRAL] One of your associates stating
[CUSTOMER][NEUTRAL] That radiation.
[CUSTOMER][NEUTRAL] And chemotherapy.
[CUSTOMER][NEUTRAL] Immunotherapy.
[CUSTOMER][NEUTRAL] And then I would think that surgery also, the throat surgery.
[CUSTOMER][NEUTRAL] But definitely the commun uh immunotherapy and chemotherapy that they weren't, were in fact covered, so I'm definitely
[CUSTOMER][POSITIVE] I'm definitely questioning that, but anyway, I'll let you go and, and you can pursue it. Just, uh, I think you've got everything down now as far as what I'm questioning and why I'm questioning it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] And I do see the radio chemo and immunotherapy um benefit on the
[CUSTOMER][NEUTRAL] So I
[AGENT][NEUTRAL] Um, cancer policy, it'll pay up to $1500 per calendar month of treatment. So I can definitely mention that radiation to them and and um.
[AGENT][NEUTRAL] See if they can process this that was, that was processed on the med, like see if they can process it under cancer.
[CUSTOMER][NEGATIVE] Yeah, because we know now it should never have been processed under Medlink.
[CUSTOMER][NEGATIVE] Because there was no coverage.
[CUSTOMER][NEUTRAL] Under Medin, so why they even did that.
[AGENT][NEUTRAL] Well, it can't
[CUSTOMER][NEUTRAL] I have no idea why they would do.
[AGENT][NEUTRAL] Well, it doesn't really go like that. So if anything comes in, if any claim comes in and it's for services that are on one.
[AGENT][NEUTRAL] Product versus the other, they're going to process it um under whichever policy has those coverages. So for the most part, with the exception of those radiation charges, everything else that's under these 10 would be meddling because it's inpatient, this is outpatient, so they, they processed it right.
[AGENT][NEUTRAL] It, I mean, it just happened to be lapsed and I'm gonna ask him about this radiation, um.
[AGENT][NEUTRAL] Treatments to see if those can be processed under the cancer policy.
[CUSTOMER][POSITIVE] OK, we're good. Well, I'll let you go and.
[CUSTOMER][NEUTRAL] I just have somebody get back in touch with me when they.
[AGENT][NEUTRAL] So I'm gonna send this over to claims. I'm gonna send it over to claims for research and I'm gonna make it urgent and ask them to give you a call within 24 hours with an update. Um, is this a good contact number for you, the number we've been speaking on?
[CUSTOMER][NEUTRAL] Solve it
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and that was the [PII]?
[CUSTOMER][NEUTRAL] That's correct. I would just like them to process everything that I sent them from UT Southwestern.
[CUSTOMER][NEUTRAL] Under the cancer policy.
[CUSTOMER][NEUTRAL] To see
[CUSTOMER][NEUTRAL] You know, I want to verify that they even tried to do that. And #2, if they did, why is not the chemotherapy, radiation, etc. covered?
[AGENT][NEUTRAL] If they process it under under the cancer claim or cancer policy.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, I am sending it over to them now, um, so you should definitely be receiving a call. I'm gonna say 24 to 48 hours at the most, but I did mark this as urgent, um, so we can get you an update.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well, thank you.
[CUSTOMER][POSITIVE] Appreciate it. Thank you very much for your help.
[AGENT][POSITIVE] You're very welcome, [PII]. Um, so you will be hearing from us shortly. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, you did a great job. Thank you.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.