AccountId: 011433970860
ContactId: 288163bd-a0be-4e6c-9609-9fa098372bdd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1846829 ms
Total Talk Time (AGENT): 786218 ms
Total Talk Time (CUSTOMER): 811468 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/288163bd-a0be-4e6c-9609-9fa098372bdd_20250224T14:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII] and I have your coverage. I've been trying to um
[CUSTOMER][NEGATIVE] I guess process a claim and I just keep getting pushback saying this isn't sufficient, this doesn't have the correct information, um, and I've been trying to do this since the [PII]. So I'm hoping to get some guidance, assistance or anything.
[AGENT][NEUTRAL] OK, Ms. [PII], so you're the insured and you have filed a claim with us, but we are needing additional information. Is that correct?
[CUSTOMER][NEUTRAL] Yes, um, so I don't know how to, I'd already filed a claim like I said on the [PII], and then on Friday, I think whatever the [PII] was, I went ahead and uploaded the information that I was told that I needed, but then I just looked at the response, and it was a new claim number for some reason. I don't know how that works.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh-huh. Yes, uh-huh.
[CUSTOMER][NEUTRAL] And it's it's the risk, the remark description is it appears to be a duplicate of previously submitted expenses, and then the procedure code submitted is not listed procedure code in the ICD9 procedure manual please submit with a valid code.
[AGENT][NEUTRAL] OK, so yes ma'am, I can help you with this, but first off, um, what I'll have to do is pull up your policy information and verify some things with you first for security. So first off, what is a good callback number for you in case we were to be disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] Um, I don't have my card with me right now. Is there anything else I can provide you?
[AGENT][NEUTRAL] Are you OK, are you logged into your portal that information you were just reading me?
[CUSTOMER][NEUTRAL] Uh, no, I have it printed out. I stepped away from my desk to be in a more private area because I'm at work.
[AGENT][NEUTRAL] OK, um, uh, if the insurance, if you're the primary policy holder, Ms. [PII], I can look it up with your full social.
[CUSTOMER][NEUTRAL] Oh, I think I have it here. Um, it's [PII].
[AGENT][NEUTRAL] It should be on the explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah, it is, it is. Uh, it's [PII].
[AGENT][NEUTRAL] 2,326,720. Is that correct?
[CUSTOMER][POSITIVE] Correct. Mhm.
[AGENT][NEUTRAL] OK, thank you. One moment. Give me just, it's gonna take me a second to get your information pulled up.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, missing on any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Understand.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then also your home mailing address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number that we have on file for you is also the same as the one you gave me. So again, that is your best contact number that we should have, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you, and the last thing to verify is going to be your email address please.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so give me just a moment to get to the claim. Do you have the claim number that you're wanting me to look at?
[CUSTOMER][NEUTRAL] Well, I don't know which one I should be giving you, the initial one or the new one.
[AGENT][NEUTRAL] What's the, OK, so what's the data service?
[AGENT][NEUTRAL] That you filed your claim for.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII] is when my doctor uh prescribed me a CPAP machine for sleep apnea.
[AGENT][NEUTRAL] OK, so let me just look at the over the overall data service because the way the portal works, when you upload additional information, it will assign a new number. The system needs to tie everything together, but it does assign a new claim number. So let me look at your data service one.
[AGENT][NEUTRAL] I'm sorry, 12 of 2025, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I do see that there were two different, well, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I was gonna say I have both claim numbers if you want, I can provide them to you, but like you said, they're, they don't kind of like I can't upload the information on the old, on the initial claim, so that's why I give me claim.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, because I can see. OK. So give me just a moment.
[AGENT][NEUTRAL] OK, so the most recent received claim, the one that's ending in the 905 is the last three numbers. This is for Lin care. So this is for durable, some form of durable medical equipment, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So let's see.
[AGENT][NEUTRAL] The procedure code submitted is not a listed procedure code in the ICD. OK, so the provider, I don't know how, if that was a printed document, but
[AGENT][NEUTRAL] We are in need of a valid ICD code. The, the code that we were provided, it does not exist. It's not in the procedural manual for ICD 9 codes. So the provider would just need to provide you with a correct code.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So, I was on the phone with them last week trying to get this um there's a whole to do um and that was the document that I uploaded. And she circled um what the procedure and diagnos the diagnosis code are. But when I had initially started this, um, I, I don't remember who I spoke to, but someone told me that the diagnosis code is
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] G as in Golf 47.33. And when she, when the new person sent me the printout, um, it said 0.30. And I'm like, oh well, I was told it's 33, and she's like, oh no, it says 30. So, you know, I'm kind of in this monkey in the middle situation where I'm trying to get the information, the information I'm providing is not.
[AGENT][NEUTRAL] That's how it works.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What APL wants and so I don't know how to go about this any other way.
[AGENT][NEUTRAL] And when you contacted them, did you tell them that they have provided you an invalid procedure code that's not listed in the manual?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, because this is the first, this is, this is the first time I see the response from APL because the document wouldn't uh populate. So is that what you recommend that I call them back and say, hey, my uh my gap insurance told me that this code is incorrect and it has to say G47.33.
[AGENT][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, we don't, as far as the code, we can't say what code to put, but you can read in that remark.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because I can see that the G4730.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's the code that was most recently submitted.
[CUSTOMER][NEUTRAL] Like, most recently submitted by whom?
[AGENT][NEUTRAL] You, I mean, as far as mhm, the information that was uploaded, that's a, that's, mhm.
[CUSTOMER][NEUTRAL] Me?
[CUSTOMER][NEUTRAL] On the paperwork.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, I mean, and I'm looking at what they said, and that's the date of service is [PII], and that's when I went to my doctor and he said, yes, you're a candidate for a CPAP machine for mild sleep apnea. Um, and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then I found the information verbally. I, I notated it on the PDF which was not sufficient. So then I did this. So are you just, do you recommend I call them back and say, hey, this is the response I got from my insurance provider, um.
[CUSTOMER][NEUTRAL] Is there a way to
[CUSTOMER][NEUTRAL] Modify or get it corrected.
[AGENT][NEUTRAL] Yeah, I would explain, yes, ma'am. I would read them that, so explain to them that you have filed with your supplemental insurance. However, this is the remark that was on your explanation of benefits.
[AGENT][NEUTRAL] And read in that exact remark.
[AGENT][NEUTRAL] Because that is
[AGENT][NEUTRAL] The, yes, that is one of the remarks. The other portion of it shows is not covered for the 99214 because office visits are not covered under this policy.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] The other
[CUSTOMER][NEUTRAL] What is the procedure code? That's, I don't under, I don't really know what that means, um, cause initially,
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, the OK, so the your diagnosis code is the why you're being treated. The procedure code is the what they are doing or prescribing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I, I understand that the procedure code listed on what I sent is just my um specialist doctor visit. Which I'm not trying to get. I know that it's not covered under APL um benefits, but I'm just trying to show, hey, I went to my doctor on this day, and this is when he said, OK, this is your diagnosis.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. And then we're trying to review the other, it appears this is for some type of durable medical equipment. Is that correct?
[CUSTOMER][NEUTRAL] Right, exactly. So I'm, I've started to receive.
[AGENT][NEUTRAL] OK, but we need
[AGENT][NEUTRAL] Right, so I see under the first set of documents that you uploaded, we were in need of the diagnosis code and all of that. On the second set of information, it's just that the code that was submitted.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] They're stating it is not a valid code. It is not a valid procedure code that's listed in the ICJ 9 procedural manual.
[AGENT][NEUTRAL] Which is the
[CUSTOMER][NEUTRAL] OK. And just
[CUSTOMER][NEUTRAL] I mean, for me to get reimbursed for the equipment, uh, do I need to correct procedure code cause I was told it was the diagnosis code is what matters.
[AGENT][POSITIVE] Yes, you would need.
[AGENT][NEUTRAL] Both, and we now have a diagnosis code, but we don't have the correct procedure code.
[CUSTOMER][NEUTRAL] But the diagnosis code was said to be incorrect.
[AGENT][NEGATIVE] No, we were missing it.
[AGENT][NEUTRAL] Initially.
[CUSTOMER][NEUTRAL] OK, but initially, right, and then I resubmitted some documents.
[AGENT][NEUTRAL] Mhm. And then we got that, so, right. And so it was this second set of documents was not.
[AGENT][NEUTRAL] It was not um denied or, you know, placed in like a holding pattern based on the diagnosis code. This now has to do with the procedure code.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] And how do I know what an accurate procedure code is?
[AGENT][NEUTRAL] Oh well, there's no way for you to really know.
[CUSTOMER][NEUTRAL] So I can be doing this back and forth 20 times because I don't know what.
[AGENT][NEUTRAL] Well, you shouldn't have, you know, and you shouldn't, I mean, we can't, I can't, there's no way for me to tell you what a correct procedure code is because I don't, the doctor's office would be the ones that would have to provide that type of information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Since they are the ones that rendered the treatment.
[AGENT][POSITIVE] Or ordered whatever, you know, they did order for you.
[AGENT][NEUTRAL] That is the providers.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Responsibility on as far as that goes.
[CUSTOMER][NEUTRAL] Right, I get that. I mean, I've been doing this since the [PII] now going back and forth and maybe even the [PII], and the first person I spoke to uh on the APL side said, oh yeah, you just need a diagnosis code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, OK, I guess I will try again.
[AGENT][NEUTRAL] OK, so, um,
[AGENT][NEUTRAL] Now, I can, give me just a moment.
[AGENT][NEUTRAL] Cause I don't see, I see we we receive the diagnosis code, but this is
[AGENT][NEUTRAL] Mhm. Let me look to see if they changed.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, it's gonna take me just a few minutes to look at, look it up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so right, so they did provide us the diagnosis code.
[AGENT][NEUTRAL] But I'm looking to see.
[AGENT][NEUTRAL] About procedure codes.
[AGENT][NEUTRAL] On the second set of information that you uploaded, we did get the diagnosis code, which is what we were missing.
[AGENT][NEUTRAL] According to the review for the first.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Piece of information. So let's see.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] For the claim ending in 61, right?
[AGENT][NEUTRAL] Um, we didn't have a diagnosis code, so that's why that was denied.
[CUSTOMER][NEUTRAL] Right. And then there, I mean, there was no mention of a procedure code or anything on that review. So I don't know why the procedure code now matters.
[AGENT][NEUTRAL] Initially.
[CUSTOMER][NEGATIVE] You know, like, I just, I keep getting bits and pieces of information at different time instead of getting everything that I think I'm supposed to have all at once, and now I'm having to go back and forth. Like, it's just starting to get overwhelming for $136 which kind of feels like is that the point that APL is trying to make, like, oh this is so ridiculous and overwhelming that you're not gonna continue to even try to continue the claim because I'm starting to get to that point.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right. Yes, ma'am.
[AGENT][NEUTRAL] Oh, absolutely not. No, ma'am. No, no, no, no, no. But legally, I mean, they're, you know.
[CUSTOMER][POSITIVE] And I apologize for my
[AGENT][NEUTRAL] No, that's OK.
[CUSTOMER][NEGATIVE] I mean, my frustration is not for you. You're, I know you're trying to help me, but at this point, it's just, it's starting to become tedious, you know.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So why does the procedure code matter if the diagnosis code is what I was told that I needed and it's correct now.
[AGENT][NEUTRAL] OK, so I can see that that, uh, let's see.
[AGENT][NEUTRAL] I'm just looking at your information. So all we did receive on the 2nd upload was a diagnosis code. Now let me look at the information that was received on the initial claim.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Well, on the 2nd upload, it was the diagnosis code and I guess the incorrect procedure code, which is all listed on the same document.
[AGENT][NEUTRAL] Um, I don't.
[CUSTOMER][NEGATIVE] There's 2 circle twice, or not twice, but there's 2 circles.
[AGENT][NEUTRAL] Uh, 99214, 99214 is just the code for an office visit. That has not, that is not a diagnosis, that is not a, the G47.30 is your sleep apnea. That is the diagnosis. Mhm.
[CUSTOMER][NEUTRAL] Right. So that's
[CUSTOMER][NEUTRAL] OK, now the procedure code is the office visit which. That's fine. I'm not trying to get reimbursed for the office visit. I'm just trying to get reimbursed for the cost of the supplies or the additional my out of pocket cost for the supplies.
[CUSTOMER][NEGATIVE] So, I don't understand why the procedure visit is now holding this up.
[CUSTOMER][NEGATIVE] Cause I know that APL is not going to pay my $75 co-pay. I'm not asking for that.
[AGENT][NEUTRAL] OK, so what I'm gonna do is I can.
[AGENT][NEUTRAL] Based on the based on the information.
[AGENT][NEUTRAL] That was received.
[AGENT][NEUTRAL] Initially.
[AGENT][NEUTRAL] It only states we were needing the diagnosis code, which we have now received. So what I'm going to do is I'm going to connect you with one of the examiners since you've called several times on this to verify that there is not anything else needed because based on the remark.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the first review, what we needed.
[AGENT][NEGATIVE] Appears to have been presented with, you know, when you uploaded the second time.
[AGENT][POSITIVE] So just to have them to confirm that there is nothing else needed, I will be happy to get you connected. You will not have to re-verify any information. I will tell them the nature of the call so that they can verify that there's not anything else needed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Because to me it it to me from what I can see it appears that we have everything that we need.
[AGENT][NEUTRAL] But again, I don't review this type of claim, so just to make sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Before we send you back to your doctor again, trying to get an additional piece of information.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK. That would be great.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with um before I get you connected over, Miss [PII]?
[CUSTOMER][NEUTRAL] No, I think, uh, hopefully the next person I speak to will be able to hopefully iron this out and say, oh yeah, you're good and you don't.
[AGENT][NEUTRAL] Yeah, because that
[AGENT][NEUTRAL] Yeah, I think that we are good, but just to let them clarify from someone who actually reviews this type of claim.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][POSITIVE] OK. Well, again, um, if that is all I can help you with, thank you very much for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you, [PII]. You too.
[AGENT][POSITIVE] Yes, ma'am. Thank you so much. So one moment, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Thank you for calling APO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], it's [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good, how are you, [PII]?
[AGENT][POSITIVE] I am ready for Friday again.
[AGENT][NEUTRAL] Oh, so I have a lady that she's just called several times, [PII], and
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] I think we have everything.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But, um, the policy number is 2,326,720.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's data service 12 [PII].
[AGENT][NEUTRAL] Both of the claims on M Tracker for this data service. So the first piece of information we received, we denied it needing a diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, mhm.
[AGENT][NEUTRAL] Second
[AGENT][NEGATIVE] So she got that and she uploaded it, but now we're denied it needing procedure codes.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And I think that
[AGENT][NEUTRAL] We, I mean, we didn't deny it for needing that on the first go around.
[CUSTOMER][NEUTRAL] Yeah let me.
[AGENT][NEUTRAL] She knows office visits aren't covered, but
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And the second go where we said it wasn't a ballad.
[AGENT][NEUTRAL] Procedure code.
[AGENT][NEUTRAL] But we didn't address that the first go around.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Interesting.
[AGENT][NEUTRAL] So she's confused and I'm kinda confused. It's just my.
[CUSTOMER][NEUTRAL] Yeah, OK, so no diagnosis codes.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] But she did come back and get that and that's what was uploaded under the other, the most recent upload, and sleep apnea.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the denial on the other states that it's about invalid.
[AGENT][NEUTRAL] Um, procedure code.
[AGENT][NEGATIVE] But again, because that wasn't addressed. The first go around, she's just confused.
[CUSTOMER][NEUTRAL] Yeah let me.
[CUSTOMER][NEGATIVE] I mean what they're saying doesn't even make sense because it's saying please submit with valid ICD9. Nobody uses ICD9 anymore. We use ICD 10.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So let me, let me see what's going on here because I don't make a little sense.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] See? Ready for Friday. Just ready for Friday.
[CUSTOMER][POSITIVE] I know [PII], look, I was fine and now you got me this and you know what, I might be right there with you.
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] climb aboard. I got here this morning. My system didn't want to let me in. I was like, oh, you've got to be kidding me. You got to be kidding me.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] OK, I see where there aren't procedure codes on the most re no on the first one.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Right. Well, why didn't we address that the first time?
[CUSTOMER][NEUTRAL] That's a valid question, um.
[AGENT][NEGATIVE] And that's why she's upset because she feels like every time she's told what to get, she's getting that and now we're telling her something different. So.
[CUSTOMER][NEUTRAL] Uh, can't blame her.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] No, I can't blame her at all for being.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Frustrated with that because it definitely should have been something that was noted.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Office visit.
[CUSTOMER][NEUTRAL] OK, so we have a diagnosis, we have a code, but she knows the offices it's not covered.
[AGENT][NEUTRAL] And she knows that I.
[AGENT][NEUTRAL] Mhm. So the first go around, we didn't deny it for anything but the diagnosis code and we got, she got that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now we're telling her.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That we need that as well where if she would have been.
[AGENT][NEUTRAL] Well, now we're telling her we need valid procedure codes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean we do unfortunately that's that's not wrong but.
[CUSTOMER][NEGATIVE] It should have been addressed.
[CUSTOMER][NEUTRAL] First, let me make sure there's not.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEGATIVE] I can't even get that.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] What was I gonna do?
[CUSTOMER][NEUTRAL] My coffee hadn't kicked in. I'm trying to remember what I was about to look for.
[AGENT][NEUTRAL] Girl, I ain't kicked in either.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEGATIVE] I mean, I can't even get on base to.
[AGENT][NEUTRAL] Show me what was initially.
[CUSTOMER][NEGATIVE] Yeah, they didn't put an EOB note or anything on there. They just denied for needing diagnosis codes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] So I understand her frustration and I'm sorry that it was not addressed. It is true that we need procedure codes.
[CUSTOMER][NEGATIVE] That um remark code doesn't make any sense, um.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What does this say?
[CUSTOMER][NEUTRAL] OK, that says we need an EOB, but we don't we already have that.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] I feel like the remark code was wrong.
[CUSTOMER][NEUTRAL] Um, so in order to provide further consideration we will need the procedure code which corresponds with, OK, so it should have been a different, I mean it still gets the point across that procedure codes are needed. It's just the wrong.
[CUSTOMER][NEGATIVE] Remarkco was used again it should have been addressed.
[CUSTOMER][NEUTRAL] The first time.
[CUSTOMER][NEUTRAL] But we do need those so because.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The thing is, is that under these Medlink policies, and this is the only reason we need the actual procedure codes under these Medlink policies if it's disposable, it's not covered.
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] So we don't know just by looking at the EOB where it says medical equipment, is it because my husband has a sleep apnea machine so I know filters are disposable.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know, sometimes the hoses and stuff you can have those replaced and those are disposable, but the actual machine, the mask, you know, some of that stuff, um, not necessarily just you may need a replacement, but it's not disposable, you see what I'm saying? So we need the actual codes to determine.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] What's funny is that my husband actually gets it from Lancare as well.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Um, but
[CUSTOMER][NEGATIVE] We need to know what are they providing what of this is disposable and what of this is actually payable and we don't know that when it just says medical equipment that should have been addressed on the first claim. I'm so sorry that it wasn't um I'm going to actually ask my supervisor if that's some type of error or something that needs to go to the examiner because it should have been, um.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Obviously for this reason resulting in our insured being overly frustrated because she provided what we asked for and now we're asking for something else instead of asking for everything at the same time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I will handle that on the auditor side of things um but as much as I wish I didn't have to tell her this or that you or whatever we do need those and I'm so so sorry that it wasn't addressed initially.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So,
[AGENT][NEUTRAL] Do you, I mean, do you want me to tell her or do you want to tell her?
[CUSTOMER][NEUTRAL] That's up to you if you want me to, I can, um, and I'll explain you exactly the what I've told you like the only reason we need them is that because some stuff being disposable is not covered so we need to know what exactly was being provided and then you know apologize for it not being addressed initially so.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And then you're gonna find out that this needs to be.
[CUSTOMER][NEUTRAL] Yeah, I'll find out from my supervisor over the auditors if I need to send something to the examiner about not addressing that and the remark code that was used on the second claim, um, but yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So you just tell me, do you want to tell her all of that and what you're gonna do as far as that goes?
[AGENT][NEUTRAL] Or do you want, or do you want me to pass it on? It, it, it at this point, it doesn't matter.
[CUSTOMER][POSITIVE] I can yeah I can.
[AGENT][NEUTRAL] they.
[CUSTOMER][NEGATIVE] I can, I mean, she's gonna be frustrated either way, so you know.
[AGENT][NEUTRAL] Yeah, 3 years.
[CUSTOMER][NEUTRAL] It's, I don't mind, you know, I know that she's frustrated. I get it. I would be too truthfully.
[AGENT][POSITIVE] Right. Yeah, absolutely.
[CUSTOMER][NEGATIVE] You know if it was my claim I'd be frustrated too so.
[AGENT][NEUTRAL] Absolutely. And I know she's at work, so, yeah, and I know she's at work, so I've been trying to do this, so, yeah. Um.
[CUSTOMER][POSITIVE] I'd be like, seriously, oh God bless her.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you will tell her and then you're gonna, OK.
[CUSTOMER][NEUTRAL] Yeah, I'll tell her.
[CUSTOMER][NEUTRAL] Yep and I'll handle everything else on my side. Her name's [PII], right?
[AGENT][POSITIVE] Uh thank you, [PII]. Yes, it is. Yeah, she's nice, but she's, yeah, and she's fully verified. Mhm, she is.
[CUSTOMER][NEUTRAL] OK, and you've got the everything's been verified I'm assuming.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yep, I got you.
[AGENT][POSITIVE] All right. Well, thank you very much. OK. Talk to you later.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] OK. Ah.
[CUSTOMER][NEUTRAL] All right, bye.