AccountId: 011433970860
ContactId: 0b9ae47a-428e-4f0c-914c-17398270e59a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1758489 ms
Total Talk Time (AGENT): 470376 ms
Total Talk Time (CUSTOMER): 1002967 ms
Interruptions: 6
Overall Sentiment: AGENT=0, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/0b9ae47a-428e-4f0c-914c-17398270e59a_20250521T20:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, um, do you need the policy number?
[AGENT][NEUTRAL] Um, can I get your name and.
[CUSTOMER][NEUTRAL] Or you need a reference number?
[AGENT][NEUTRAL] Can I get your name and a good call back first please in case we get disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] 02531373
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and then can I get you to verify your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then your mailing address and phone number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and then what else?
[AGENT][NEUTRAL] Uh, your phone number, that's on file.
[CUSTOMER][NEUTRAL] I just gave it to you [PII] and [PII].
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK, I just wanna make sure that they were the same number and you didn't have a different number, like a home, a home number and um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The home the [PII] is the home number. The [PII], that is the cell number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I just want to make sure.
[CUSTOMER][NEUTRAL] And she just supposed to um.
[CUSTOMER][NEUTRAL] Put that in there like that, but anyway, um, what else did you need me to verify?
[AGENT][NEUTRAL] Oh, that was it. I was wondering, uh, I was ready to see what you needed help with.
[CUSTOMER][NEUTRAL] OK, so you guys sent me uh.
[CUSTOMER][NEUTRAL] A text saying for me to review the claim, so I'm in here and um.
[CUSTOMER][NEGATIVE] Uh, the other day they gave me a different amount than with the payout. Uh, it was supposed to be 56 something and I guess you guys went in and declined some things.
[CUSTOMER][NEUTRAL] What did she give me? It was supposed to be 50 56 6987 because I wrote it down.
[CUSTOMER][NEUTRAL] OK, but anyway, um, now I'm seeing what you guys have submitted for benefits paid was $5050 is that what you see?
[AGENT][NEUTRAL] OK, uh, what was, do you have the claim number or the date of service so I can see which one?
[CUSTOMER][NEUTRAL] Do I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, yeah, hold on, let me get there.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 3602
[CUSTOMER][NEUTRAL] 591.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see what we've got.
[CUSTOMER][NEUTRAL] And I'm sorry I've called like forever, but I'm trying to get.
[CUSTOMER][NEUTRAL] Understanding on how you guys do things and.
[CUSTOMER][NEGATIVE] This is not what I understood for it to be.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Yeah, it looks like you have two partial payments. Um, it looks like with one of the payments, uh, it shows that the calendar year maximum for that benefit had been exhausted with the payment of that claim, and let me see about the denials.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] I don't understand. That's the part you need to uh explain to me because I don't, I don't know what I'm being satisfied for.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And was exhausted, you know what I'm saying? I'm like I just started submitting these claims, so how can something be exhausted?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It could have been your calendar year maximum, and I'll take a look at your policy in just a moment as well.
[CUSTOMER][NEUTRAL] What do you mean the calendar, OK, stop off, OK.
[AGENT][NEUTRAL] Here, give me just a moment, maybe I can look that up for you real quick.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] And it'll take a moment for that policy to upload so while it's uploading, let me go ahead and see what the denial reasons were and see what we can do.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, OK, yeah, you need to be looking at the same thing I guess.
[AGENT][NEUTRAL] OK, it looks like
[AGENT][NEUTRAL] Because your claim is broken up into different parts, it looks like your anesthesia benefit needs some more information. Uh, it says
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That it's allowable under your surgery benefit. So you'll need to send the surgery charges.
[CUSTOMER][NEUTRAL] I haven't had my surgery yet. I haven't had the surgery. The surgery is gonna be on the [PII]. They just gave me the date.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, yesterday, yesterday, so they're working up, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Two people that's gonna be working on me they're trying to partner to see I guess what she's gonna be doing and what he's gonna be doing and then they'll get back to me as far as the time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but as far as the, the, the procedure for the surgery is gonna be on the [PII], so I haven't had that yet. What I have had is the biopsy and the mammogram and the ultrasound and the three digit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mammogram and I understood that all of that is considered as diagnostic testing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that it was supposed to be covered.
[CUSTOMER][NEUTRAL] So I sent you guys the itemized bill.
[CUSTOMER][NEUTRAL] Day before yesterday.
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, over on the weekend I think it was on Saturday or Sunday I uploaded it and it's, it was like.
[AGENT][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] $3000 and something dollars and I'm like it was um yeah because they billed it to my chart you know they send it to your chart.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And it has all the coding and everything and I'm like what the heck why are you guys denying it?
[AGENT][NEUTRAL] OK, so yeah, it looks like, so for the anesthesia one, you'll just wanna wait until you get your um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You'll want an itemized bill from the surgeon's office whenever you do receive that send in that itemized bill.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, and we don't have timely filing either, so even if it takes a while to get all of that, you can still submit it as long as your policy is active, um, just submit it within that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, but for the anesthesia one to be covered, it just needs the itemized bill, uh, with procedure codes, so that can be considered just because that goes under your surgery benefit.
[AGENT][NEUTRAL] So that's all that one is needing.
[AGENT][NEUTRAL] And then you said that you sent in your oh go ahead.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEGATIVE] I'm lost. I'm really lost because.
[CUSTOMER][NEUTRAL] They.
[CUSTOMER][NEUTRAL] They did some form of
[CUSTOMER][NEUTRAL] Uh, I guess numbing when they did the biopsy.
[CUSTOMER][NEUTRAL] You see what I'm saying?
[AGENT][NEUTRAL] Yes, I'm, I'm, and I think I understand what you're going through, um, cause I've had similar and it is very confusing.
[CUSTOMER][NEUTRAL] So I don't know how that was coded you oh gosh Jesus.
[AGENT][NEUTRAL] Yeah, they, they coded it as anesthesia, um, so.
[AGENT][NEUTRAL] I, if I would go ahead and talk with your doctor and see how they coded that because for us, for the claim, we have it as coded as anesthesia.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which means that we'll we'll need.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] The surgery, the itemized bill for the surgery because they listed it as in, yeah.
[CUSTOMER][NEUTRAL] Yeah and see that's not the.
[CUSTOMER][NEUTRAL] Yeah, that's wrong though, because that's, that was a whole different procedure. I didn't have the surgery yet.
[AGENT][NEUTRAL] Yeah, and I think that's why it's because it was a different procedure code um because it's showing it as anesthesia, which is under your surgery benefit. So, um.
[CUSTOMER][NEUTRAL] So it just knocked that whole claim out?
[AGENT][NEGATIVE] No, not the whole claim. I'm going piece by piece on the denials why all of it wasn't covered because it looks like parts of it was covered.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Where you guys only pay $50 of what was covered.
[CUSTOMER][NEGATIVE] Nothing was covered.
[AGENT][NEUTRAL] Looks like your preventative services were covered, partially covered, um, some of it.
[CUSTOMER][NEUTRAL] OK, let's do this. The first a current ben benefit is what you guys paid me for.
[AGENT][NEUTRAL] Some of the charges aren't covered through that.
[CUSTOMER][NEUTRAL] That was it.
[AGENT][NEUTRAL] I see. OK.
[AGENT][NEUTRAL] It looks like the diagnostic testing.
[CUSTOMER][NEUTRAL] Yeah, and that was $50 and that's it, that's it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Out of all the claims that I sent y'all.
[AGENT][NEUTRAL] The imaging one just shows that it needed the itemized bill.
[AGENT][NEUTRAL] From the provider's office now you said that you sent that.
[CUSTOMER][NEUTRAL] I sent you the 3.
[AGENT][NEUTRAL] Um, it could just take a couple of days to process.
[CUSTOMER][POSITIVE] Yeah, I just saved it.
[CUSTOMER][NEUTRAL] No, she included all this.
[CUSTOMER][NEGATIVE] Up underneath the umbrella of of this and she says completed and I go, no this can't be right.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Let me go out of here.
[CUSTOMER][NEUTRAL] I submitted it, uh, let me see if I can click over here.
[CUSTOMER][NEUTRAL] OK, here is the itemized. I just sent it. I sent it.
[CUSTOMER][NEUTRAL] On the uh
[CUSTOMER][NEUTRAL] When did I upload it Jesus.
[CUSTOMER][NEUTRAL] Anyway, uh, OK, uh, anyway, this bill here is $13,000.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you have the digital mammogram, uh, the path, the logic, some whatever all that is. I don't.
[CUSTOMER][NEUTRAL] I'm not into the medical cause I, I, I can't even begin to give a breakdown.
[AGENT][NEUTRAL] OK. Yeah.
[CUSTOMER][NEGATIVE] The codes are the codes not right or what was wrong because this says itemized bill.
[AGENT][NEUTRAL] And if you sent it in for the imaging, for your diagnostic, or I'm sorry, for your mammogram and imaging, um, it's still showing that it needs, and like I said, it has, it might not have updated yet, um, with you sending, sending it in. It may just not have been processed yet since it was sent in.
[AGENT][NEUTRAL] Um, because it's showing that it just says it needs the itemized billing from the provider's office showing the procedure codes and charge amounts for each service.
[AGENT][NEUTRAL] So it looks like that was what was waiting, being waiting on, and if you turned that in, it could just be processing.
[CUSTOMER][NEUTRAL] Uh, which one? Which one?
[AGENT][NEUTRAL] For your imaging.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEGATIVE] OK, I'm lost.
[CUSTOMER][NEUTRAL] OK, do you see the bill that I that I sent in that was $13,793.50 do you see that?
[AGENT][NEUTRAL] Let me pull it up.
[CUSTOMER][NEUTRAL] She says that everything that I've submitted she put completed.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So something and but then you're saying that something is pending but she has everything that I sent in has been closed and then she has that I'm saying she well the representative um is saying that uh I guess the claim was uh direct deposited. I don't see it in my account.
[AGENT][NEUTRAL] You don't see it in your account? OK.
[CUSTOMER][NEUTRAL] No, so when, when will it hit? Tomorrow?
[CUSTOMER][NEUTRAL] Because if they did it yesterday, today's 24 hours.
[AGENT][NEUTRAL] Let me see where it went to.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, because I do see your bank information on here.
[CUSTOMER][NEUTRAL] Mhm. I mean she has the last, um, let me go get my banking information because we verified it like twice.
[CUSTOMER][NEUTRAL] How long does it usually process when you guys do it like that?
[CUSTOMER][NEUTRAL] Is it, does it hit like right away like a wire or does it take like a couple of days to process?
[AGENT][NEUTRAL] It usually takes a few days to process, but you said you did this last week, right? Or you said they give, did you say that they gave it to you last week or they submitted it yesterday?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Hm?
[CUSTOMER][NEUTRAL] No, what I'm saying is that the invoice it says that it was.
[CUSTOMER][NEUTRAL] It was, uh, it says that it was a direct deposit was done on the [PII], which was yesterday.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Today's the [PII], right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So how long I'm asking you because you work for the company I'm asking you how long, what's the normal uh process does when you guys finish your claim and you do a direct deposit, does it hit the same day or it takes a couple days to hit?
[AGENT][NEUTRAL] It should show up if you're doing direct deposit um the next day because we submit them and they go in overnight.
[CUSTOMER][NEUTRAL] Well, when did you guys submit it?
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Oh, I'm looking for my book that's in the kitchen.
[AGENT][NEUTRAL] It looks like it was processed on the [PII], so yesterday, so you're still not seeing it.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, but what time yesterday?
[AGENT][NEUTRAL] I can't tell the time. I can only see when it was uh processed.
[CUSTOMER][NEUTRAL] It says yes it says yesterday but um it's not there.
[CUSTOMER][NEUTRAL] Unless it comes in in the morning, you know, after hours, maybe it takes a couple of days when you guys do that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] And I read everything back to her, when she read it to me. OK, so I have, you ready?
[CUSTOMER][NEUTRAL] Well you know
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have the routing number [PII]. That's the routing number.
[AGENT][NEUTRAL] OK, I see that one.
[CUSTOMER][NEUTRAL] OK, the account number is [PII].
[AGENT][NEUTRAL] OK, and I'm showing that as well.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So it's showing, I mean when I put that information it came up as colo uh can't say the word, Colonial Bank, but they have merged several times and it's BB&T which is Trust now.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, but that when I was telling a young lady that she was like, oh, they probably still have the same routing.
[CUSTOMER][NEUTRAL] Um, when they merge like that. So I guess that's true, but, um, as long as the information is right, I guess it will hit. So the question is is.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yeah, I am showing it's right.
[CUSTOMER][NEUTRAL] Huh, you're showing this right?
[AGENT][NEUTRAL] Yes and so what I would do is if you don't get it by the end of the day today um try calling your bank and seeing and if they have a problem with it, we might have to transfer you to billing.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Mm mm
[AGENT][NEUTRAL] But for your claim and all of the denial codes and needing extra help on that, I'm gonna go ahead and if you're OK with that, transfer you to claim support um because they will have more of the information on that specific claim and why they were denied when you're showing that when you have shown that you have brought in your information and everything that they're they had asked of you. Is that all right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Well yeah I mean because I don't understand uh they got itemized bill.
[CUSTOMER][NEUTRAL] They came from um the hospital, so, uh, I, you know, sent it over to y'all.
[AGENT][NEUTRAL] Right, and I, and I did see what you sent.
[CUSTOMER][NEUTRAL] So I mean that's the, that's the only thing. Oh, you see it now? OK. So I don't, I don't understand.
[AGENT][NEUTRAL] I, yeah, I, I saw what it was.
[AGENT][POSITIVE] And so that's why I'm gonna go ahead and send you to claim support because they're the one who helps process that claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just one moment, OK?
[CUSTOMER][NEUTRAL] OK and then OK, but wait, let's go back to the deposit so can you verify or maybe ask somebody how long does it take for a direct deposit to be.
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Uh, hit somebody's account.
[AGENT][NEUTRAL] Um, it shouldn't take more than 24 hours. That's why I suggested calling your bank because if it's been 24 hours, um, and I saw all
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I, I wouldn't know that unless you guys mhm go ahead.
[AGENT][NEUTRAL] Right, and that's why claim support since they're the ones who help process the claim, they'd know the exact time.
[CUSTOMER][NEUTRAL] Oh, OK, so ask them that, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah yeah you can ask them that as well yeah but I am showing all of your banking information in there and I did see an itemized bill but they'll be able to um dive a little bit deeper into that than I can um so give me just a moment.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Yeah, because they denied that one, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Right, I am showing some more pain and then some of it was denied and then you're also not seeing the payment, um, so they can dive a little bit deeper.
[CUSTOMER][NEGATIVE] Well, I'm only seeing $50 of it, uh, and I don't, I don't know which one they satisfied, you see what I'm saying? So for $13,000 debt, you're gonna get $50 towards it, um, that don't make no sense.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It it went to.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] So, um, let me transfer you to them, give me just a moment and they can dive in um deeper than I can for you, right? So give me just one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling ATL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi, this is [PII] with the care team. I have a Miss [PII] on the line. She's needing a deeper dive into her claim than I can help her with. Um, a lot of it was denied, and she said she only got $50 paid. She's also not seeing that $50 in her bank, but she has some questions about the denials when she said that she had turned everything in. So I was wondering if you could help her.
[CUSTOMER][NEUTRAL] I can try sir. What's the policy number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 25
[AGENT][NEUTRAL] 31373.
[AGENT][NEUTRAL] And she's been verified and her name is [PII]. It's, it's all the same claim, so it's a little confusing to me too, um.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEGATIVE] But I did see that there are some denials. I did see.
[AGENT][NEUTRAL] Some of the itemized bills and so she has questions about.
[AGENT][NEUTRAL] What else she needs done even though I read the denial codes to her.
[CUSTOMER][NEUTRAL] OK, and that's the 3602591, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] For herself, yep, OK.
[AGENT][NEUTRAL] And what was your name again?
[CUSTOMER][NEUTRAL] OK, you can, uh, it's [PII].
[AGENT][NEUTRAL] Oh hi, I've transferred to you before.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Alright, thank you so much. I will say I'm gonna give you a heads up she's upset.
[CUSTOMER][NEUTRAL] OK, you can go ahead and.
[CUSTOMER][NEUTRAL] Oh boy, OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi, I have a Miss [PII] on the line. She can help you with your claim support, OK?
[CUSTOMER][NEUTRAL] I am.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Right, thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi Ms. [PII], my name's [PII]. Can you hear me OK? Hi. Yes, yes, OK, alright, so, um, [PII] transferred you over to me we needed to kind of go over your claim a little bit deeper and see exactly what's going on so I understand um there's some additional information that we're requesting for your claim um and there was also some services that they were requesting it.
[CUSTOMER][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEGATIVE] Uh, they didn't tell me that they were requesting anything. I just happened to, well, they sent a text saying that it was completed for me to look at it, so I got home and signed in and I'm seeing that it says that the benefit paid and then I go, well it's not in my account so that's the first thing.
[CUSTOMER][NEGATIVE] And then it's showing that it was only satisfied for the first occurring benefit with an additional $50 for testing and I go all those claims that I sent the only payout was $50.
[CUSTOMER][NEUTRAL] OK, well I'm showing actually the payout was for the um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] There was a $5000 benefit for the um.
[CUSTOMER][NEUTRAL] Initial cancer, uh, right, that's what I'm saying that was satisfied, but outside of that it was only a $50 payment that was for diagnostic testing.
[CUSTOMER][NEUTRAL] Right, um, exactly, so what they did is they went ahead and converted that over to a preventative service that was payable under your plan for the screening, so they included that $50 benefit there now, um, there is some additional information that's being requested that's needed, um, for the claim.
[CUSTOMER][NEGATIVE] Um, isn't for the surgery they're asking for a fully itemized surgery, but I didn't have no, see this is where it's wrong. I haven't had the surgery yet. I've had the MRI.
[CUSTOMER][NEUTRAL] And I sent that, so you guys are not gonna assist with the MRI?
[CUSTOMER][NEGATIVE] So I don't see nothing for that. I don't see anything for the biopsy. The biopsy is the one that you guys are probably confusing the two. He did not use, he did not put me to sleep. He's dead in the area.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So again for that they do put it as a surgery not to interrupt you but for that biopsy they consider it under the surgical benefit because that's what it, you know, that biopsy is essentially so what we're needing is that itemization that includes that procedure code and you know the diagnosis code usually you can obtain that from the um.
[CUSTOMER][NEUTRAL] The surgeon who performed the biopsy, so like I said that's considered under that um surgical benefit so. OK, so that's the one that I sent on [PII], so you need more information for that.
[CUSTOMER][NEUTRAL] Yes, and like I said I'm in the process, so now I do see the pathology report. I'm in the process of looking up each uh each individual uh claim the claim information that was submitted. So, so, um, like I said, the surgery and anesthesia, like I said, that would be the biopsy and the anesthesia for that we're needing that, um.
[CUSTOMER][NEUTRAL] Itemization so now I'm gonna look at the next one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now I'm looking at the um information that was submitted on the [PII]. Now as far as the um benefit, yeah as far as your benefits um you said they weren't in your account just yet?
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] OK, so the claim was finalized, uh, on yesterday's date, so it usually takes up to 1 to 3 business days for it to, um, deposit into your account, yeah, so, um, if you don't see that by, say, uh, let's see, Wednesday if you don't see it by Friday, which you should, um, you can, you know, alert us at that point, but you should receive it, um, like I said it's usually it's sometimes the next day it really just depends on your banking institution.
[CUSTOMER][NEUTRAL] So, um, some of them are a little bit quicker and posting it sometimes you'll see it as a pending transaction it just depends on your banking account.
[CUSTOMER][NEUTRAL] OK, OK, that makes sense. She couldn't tell me that. I was just like it's not there. I, I, uh, was calling because my husband's check is gonna hit tonight and I was like, well, let me call, you know, when we need to start paying our bills. I was like, well, that's not in there either. Yeah, that's I know.
[CUSTOMER][NEUTRAL] Yeah, no, so yeah, so hopefully like I said it'll show up, um, you know, tomorrow or like I said the latest Friday it's usually it's usually not more than unless there's some kind of problem that we don't know about yet. I mean that does happen sometimes when we send a file to the bank, something could be wrong with it. It does happen occasionally, not it's not a normal practice though so that's why we usually say 1 to 3 business days you should see that uh transaction.
[CUSTOMER][NEUTRAL] OK, and now, um, what I'm looking at on the, um, the information submitted on the [PII], that was that data service, the [PII] which again is that um.
[CUSTOMER][NEUTRAL] Look at that procedure that biopsy procedure, so we're needing that, um, again that itemization and then um as far as the imaging, let's take a look at that one bear with me for one moment because I think. I'll call that's yeah, on the [PII] that's on the biopsy so I'll call them and get.
[CUSTOMER][NEUTRAL] And it looks like for the imaging we're asking for an itemized bill for that as well. Now I'm gonna pull that up. Just bear with me for one because it looks like they're asking for a procedure code. I'm gonna pull that up. Just bear with me for one moment. It just takes a second. I have to go into each one individually, so it takes a little bit more time so OK.