AccountId: 011433970860
ContactId: 02a2c351-a160-410f-882a-9b0f4f97b49f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 838830 ms
Total Talk Time (AGENT): 233089 ms
Total Talk Time (CUSTOMER): 401388 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/02a2c351-a160-410f-882a-9b0f4f97b49f_20250226T18:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, I do, um, I, uh, [PII] called me, uh, um, left a message on my voicemail, uh, regarding a claim I submitted this morning and I, I couldn't take the call so I don't know what the, what she wanted to talk about or if she needed more information, etc.
[AGENT][NEUTRAL] OK, I can verify that for you. And your name is?
[CUSTOMER][NEGATIVE] [PII], I, if you need my account number, I'm gonna have to, I'm, I don't have my computer with me. I'm gonna have to put you on speaker and I'll look, you know, I'll log in, but if you need the account number, but I'm, I'm away from my house right now.
[AGENT][NEUTRAL] Oh, you're fine. Uh, what's your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, ma'am. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, OK, let's see.
[CUSTOMER][NEUTRAL] Like I said, I don't have the paperwork in front of me, so hopefully it was a quick something she needed to tell me.
[AGENT][NEUTRAL] Uh, Ms. [PII], and verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. Um, looks like she was wanting to know.
[AGENT][NEUTRAL] If there were any services rendered on the date of service of [PII] of last year.
[CUSTOMER][NEUTRAL] Yes, there was, I mean, he had a, he had an appointment with that doctor. It's my son.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] So yes, he had, the service rendered with a medical, but, you know, with a doctor's office appointments, which I know you don't cover. So that's what the um
[CUSTOMER][NEUTRAL] Uh, yeah, that didn't I give you the EOB for that?
[AGENT][NEUTRAL] What was that date of service in which, um, what's your son's name?
[CUSTOMER][NEUTRAL] [PII] was when he met with this, uh my son [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He went to a, a surgeon. Um, he has a had a hernia, and went to the surgeon who, you know, obviously gave him, and you'll see in the doctor's notes, gave him, uh, the referral to go get a CAT scan, which, with the $400 charge is. I know you don't pay for the office visits. So the CAT scan you have the EOB for.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And the diagnosis code is actually embedded in the doctor's notes. So I called last night and they said the only thing they need is the EOB for the appointment on the [PII], which I submitted, and the diagnosis code, not the, um, not the CPT code. So I, the diagnosis code, you already had me, again, it probably was embedded in the notes. You'll see it if you look at the doctor's notes I provided about 2/3 of the way down. It shows the diagnosis code.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In his notes from the initial appointment.
[CUSTOMER][POSITIVE] Yeah, because I keep submitting stuff. I'm glad you guys called because I was like, OK, what's going, what's called last night? What, what, what am I, what's what's missing? And she said the EOB and the diagnosis code. I said, OK, I can get those for you.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] C 43.
[AGENT][POSITIVE] And I thank you so much for being patient with me. I'm just looking at um.
[CUSTOMER][NEUTRAL] No, no problem. I'll just let you look things over and then ask me questions. I, I had to submit some several different things, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] It looks like we have them.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Now, I was looking at the information. It looks like we have the diagnosis code. It looks like they were just needing the the EOB and it looks like um
[CUSTOMER][NEUTRAL] Which I
[AGENT][NEUTRAL] The rep that called, uh, going by what she has in her notes, uh, she was calling to see if there was any other services besides the office visit, because on the EOB we received, it only showed just an office visit charge. It didn't show any, they only charged just for the office visit.
[CUSTOMER][NEUTRAL] That's exactly it.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, he only charged for the office visit. Yes, and I know you don't pay for office visits. So, yes. He didn't do anything at that time. He just ordered the CAT scan for my son. And I think now they're just waiting. Yeah, he's the one who, he had to, in order to get the CAT scan done, you know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the doctor ordered it and confirmed he has a hernia, but it's gonna be a weight thing now. It's not urgent, so.
[AGENT][NEUTRAL] OK. So, he hadn't had any surgery yet. He just had like a CAT scan to um
[CUSTOMER][NEUTRAL] And all these uh
[CUSTOMER][NEUTRAL] Exactly. And you'll see another bill, and it's kind of unclear on how they did the billing statement from um in Enovo, which is [PII]. It, it, it, it, there's another $6996 charge which is for another guy's name. I don't know, but he's another, uh, he's, he's actually the radiologist who reinterprets the CAT scan. So there's a the $400 for the CAT scan, which has already been paid.
[CUSTOMER][NEUTRAL] And then there's a 6996 that was a different bill from Enovo that you'll see on the billing statement, but there's no EOB for that because that's considered part of the CAT scan if you will.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So if you look at the bill for the CAT scan, you'll see, it's kind of confusing how they did UHC write off, and that's, it looks like they wrote it off, but they didn't and that's what UnitedHealthcare paid. And then you'll see, and I think I circled 6996, and there's a
[CUSTOMER][NEUTRAL] Can't remember the doctor's name. It's on there, Lang or something that he's the one who actually, you know, reads the CAT scan.
[CUSTOMER][NEUTRAL] So there's a total of, you know, one charge for $400 and another one for 6996, but I know not the office visit, so.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Just so it's clear. So if you need anything else, um, you know, because I keep going back and forth, and I feel like I'm probably confusing the issue by sending more stuff, but you're asking for more things. And then I, I can't get it to link to, to, you know, what you're asking, you know, when, when I see the claim, I don't know how to connect them. There's a different code that gets created every time I upload something.
[AGENT][NEUTRAL] Yeah, and um I think I see, but let me get Ms. [PII] or an examiner look at it so I can tell you exactly what is needed, um, because I see the EOB for the office visit charge and then there was another data service for diagnostic, yeah.
[CUSTOMER][NEGATIVE] And there was nothing, there was nothing done in.
[CUSTOMER][NEUTRAL] So, so the office visit, he, he went, and you'll find doctor's notes. I uploaded, I think I labeled it doctor's notes, one of my submissions. And those are actually the handwritten notes, the doctor, and then at about 2/3 of the way down, you'll see uh lingual hernia, you know, CAT scan required, no dye, and then that's where the diagnosis code is, and I can't remember. OK, something, don't remember. Anyway, that's where the so, so that was all that doctor did. He didn't do any procedure. There's no other.
[CUSTOMER][NEUTRAL] I don't expect any money, any, any, any, you know, APL to pay for anything from the doctor's visit. But the CAT scan, when he went to the CAT scan, I think on the [PII], that's where we paid $400 and then another 6996 to the hospital, which was actually for the radiologist that read the CAT scan, and that's all there is.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So the EOB for the 6996 is actually part of the um.
[CUSTOMER][NEUTRAL] Um, uh, uh, the bill for the CAT scan, you'll see, you know, we're.
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEUTRAL] And the way you said for 6996, uh, when was that 699.
[CUSTOMER][NEUTRAL] 6996.
[CUSTOMER][NEUTRAL] The same day, it would have been the same day he had the CAT scan, which was at the [PII] at the top of my head.
[AGENT][NEUTRAL] Uh, I think it's the [PII], um.
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] Yeah, that maybe 9:27. It was, it was, it's and and you have that you have a copy of that billing statement. It's from Enovo INOVA hospital system.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And, and it'll show, and that's where it breaks down where it's kind of unusual and that's where the doctor's name is. So there's not a separate EOB for that, but that's where the doctor's name is, and it says, you know, he owed $400 for the CAT scan and then another 6996 for Enovo's radiologist to interpret the CAT scan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then that's all he's done.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Regarding that.
[CUSTOMER][NEUTRAL] That's why I called last night. I just, I'm be I keep sending stuff and I keep getting confused, so.
[AGENT][NEUTRAL] I know, I understand you wanna make sure we sending what we needed, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She must be in the process of processing it. OK. Uh, give me one quick moment. Let me see if I can get her or an examiner and they can verify this.
[CUSTOMER][NEUTRAL] Yeah, if you, if, if you, if you talk to somebody and they're processing a check for $469.96 then they've got everything they need. But if it's for $400 they might need something else to get the $69.96. So, OK, OK.
[AGENT][NEUTRAL] OK, yeah, hold on one moment for me please.
[CUSTOMER][POSITIVE] No worries. Uh-huh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] 69 960.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hey [PII], um, I have an insured on the phone. She's calling about, um, she had received a voice message, uh, for a call back regarding her son's claim, and it looks like my kid, um.
[CUSTOMER][NEUTRAL] From who?
[AGENT][NEUTRAL] Say again?
[CUSTOMER][NEUTRAL] Did you receive a call back from me?
[AGENT][NEUTRAL] No, from [PII].
[AGENT][NEUTRAL] And it doesn't look like she, yeah, looks like she's gone for the day, but um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like [PII] was um
[AGENT][NEUTRAL] Going by the notes, it looked like she was inquiring if the patient had any other services besides just an office visit, which it doesn't.
[AGENT][NEUTRAL] Look like it
[AGENT][NEUTRAL] Uh, and the insured did confirm that, but she is wondering if it's for this other data service.
[AGENT][NEUTRAL] And she's inquiring about the status of this claim or if additional information is needed?
[CUSTOMER][NEUTRAL] What's the policy number [PII]? I could see if I can help her because I don't know what [PII] called her for, but I can see if I could assist her.
[AGENT][POSITIVE] OK thank you.
[AGENT][NEUTRAL] Uh, it is 1,807,330, and it's for part four.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And which claim is it?
[AGENT][NEUTRAL] Um, it's for, I'm assuming.
[CUSTOMER][NEUTRAL] Look like somebody got an open claim now.
[AGENT][NEUTRAL] Yeah, and I looked at that one.
[AGENT][NEUTRAL] Uh, or did I look at that one? Yeah.
[CUSTOMER][NEUTRAL] [PII] working on it now.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Look like [PII] probably going to lunch. Oh, [PII] is back. She's back. I'll transfer her over to if she's back.
[AGENT][NEUTRAL] I guess
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Oh, is she?
[AGENT][POSITIVE] Oh, if you would, or um, yeah, that way she can speak with her since she talked to her. It's a good deal.
[CUSTOMER][NEUTRAL] But how could I do that with the thing, but you can send it over I transfer over to [PII]'s.
[AGENT][POSITIVE] OK, I appreciate you, [PII]. Have a great one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You're welcome, [PII]. Thank you. Have a good one.
[AGENT][NEUTRAL] Mhm. Nah.