AccountId: 011433970860
ContactId: 32eba189-8bb8-4ed9-a555-f7a220d8517b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1861910 ms
Total Talk Time (AGENT): 1165768 ms
Total Talk Time (CUSTOMER): 557113 ms
Interruptions: 14
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/32eba189-8bb8-4ed9-a555-f7a220d8517b_20250414T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][POSITIVE] Hi [PII], it's [PII]. Happy Monday.
[AGENT][NEUTRAL] Hello [PII] how are you?
[CUSTOMER][POSITIVE] I'm doing well, thank you. I have policy number 85303.
[CUSTOMER][NEUTRAL] I have Ms. [PII] on the line verified all of her information.
[CUSTOMER][NEUTRAL] And she is calling regarding her claims.
[CUSTOMER][NEUTRAL] Now she said that she thought that she had sent over everything and the only thing that's been paid so far is $110.
[AGENT][NEUTRAL] OK, just give me one second let me pull that up.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] Just need some she needs some further assistance pulling up the documents and seeing what all she needs.
[AGENT][NEUTRAL] 853-03.
[AGENT][POSITIVE] And it's for uh [PII] you said I'm sorry.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] And everything's been verified.
[CUSTOMER][NEUTRAL] Everything has been verified.
[AGENT][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] And your phone number is the number on file, but I can give it to you if you'd like.
[AGENT][NEUTRAL] OK, the number is showing [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][POSITIVE] You got it, girl.
[AGENT][NEUTRAL] OK, and she's just needing further clarification of what's needed for her claim, is that right?
[CUSTOMER][NEUTRAL] Right, because she said she'd send in uh documents with codes. Now we did talk about the revenue codes and that being a hospital code that they use.
[CUSTOMER][NEUTRAL] But that's not a code that we use, right?
[AGENT][NEUTRAL] Um, I'd have to look at it the.
[AGENT][NEUTRAL] Is that the latest claim, the 422 and 4225 she's speaking of?
[CUSTOMER][NEUTRAL] Yeah and I was looking so.
[CUSTOMER][NEUTRAL] It looks like they're needing something for the hospital, the women's hospital charges.
[CUSTOMER][NEUTRAL] And I think that that was what she was mainly referencing other than what else is needed for her radiation.
[AGENT][NEUTRAL] OK, yeah, I'm looking at I pulled up the documents from that previous claim and then I'll pull up the newest ones and see exactly what we're missing but you can go ahead and um transfer her when you're ready.
[CUSTOMER][POSITIVE] All right. Thank you, [PII]. It's always a pleasure to talk to you. I hope you have a great day. One moment.
[AGENT][POSITIVE] You too, [PII], thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Miss [PII], thank you for your patience. I have a claims specialist on the line, uh, [PII], and she is looking at your documents as well and going to assist you further as to what's needed, OK? OK, thank you very much and thank you for calling APO Mississippi. You have a happy Easter week and weekend. Enjoy that crawfish bowl.
[CUSTOMER][POSITIVE] OK you take care thank you bye bye.
[AGENT][POSITIVE] Thank you [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi, Ms. [PII]. My name is [PII]. I'm in the claim support team and so I'm looking over your documents now. It looks like we're, we were asking for some additional information. So right now I'm reviewing uh that previous claim that we um initially requested. It looks like we were requesting some um additional information regarding the surgery that you had on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The surgery and anesthesia. OK. So I'm gonna look over those documents first and then we'll move on to that last uh information received.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I just, I just don't quite understand. I thought I have what you needed.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Apparently not.
[AGENT][NEUTRAL] Understood, so let me just take a look here.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I see that um.
[AGENT][NEUTRAL] The previous claim that was received um in December uh I'm sorry, early January it looks like.
[AGENT][NEUTRAL] Um, I see.
[CUSTOMER][NEUTRAL] Right, that's what I send it in the first time and you'll ask for more information.
[AGENT][NEUTRAL] But and
[AGENT][NEUTRAL] Yeah, we received it January.
[CUSTOMER][NEUTRAL] And that's what I'm responding to.
[AGENT][NEUTRAL] OK, alright, so we received the pathology report. Now I'm just looking through those documents. There's quite a few documents, so just bear with me while I take a look through here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So the surgery was [PII], is that right?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If it helps the um hospital bill that I'm looking at which I thought was what you needed was sent in on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so, um, I'm looking like I said through the first documents received um on that larger, um, mail where we received the pathology report. So while we do have the billing, um, while we do have the billing, it wasn't uh itemized and what itemized would be listing out those procedure and and diagnosis codes. So now let me take a look at the additional information that was sent in that we received in March. So and you said that on [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, yeah, that's.
[CUSTOMER][POSITIVE] That's the one I hope will help you.
[AGENT][NEUTRAL] I'm just reviewing that, uh, charges that we received.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] It's a lot of information.
[AGENT][NEUTRAL] Yeah and it looks like what happened is while they did give you what they consider an itemization of charges, it doesn't give us a procedure code so um when you're looking at that hospital bill, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And and I know it does say itemization, however, when you're looking at that bill.
[AGENT][NEUTRAL] On that first page it does give us some, some procedure codes, but most of the codes.
[CUSTOMER][NEUTRAL] It says procedure code right, yeah.
[AGENT][NEUTRAL] Right, so on that first page like there's a couple of things that have the actual procedure code. The other ones are like a series of number and it's actually the revenue code. Now let me just like I said, let me kind of break this down a little bit because it looks like.
[AGENT][NEUTRAL] What they're asking for is that surgery. Let me just take a look here. Um, bear with me for one moment. Cause sometimes what they do.
[CUSTOMER][POSITIVE] Oh sure I appreciate it.
[AGENT][NEUTRAL] Sure, sometimes what they do is they run the numbers together and it looks like so that first day, first column is the date, the second column is the revenue code, and that third column is the procedure code and they're they're mixing it with that actual revenue code and not giving us the procedure. So like for instance um um like I said on that page one there's a couple of um let's see the first.
[CUSTOMER][NEUTRAL] Looks like a lot of medicines here.
[AGENT][NEUTRAL] Yeah, so on that first, very first page they list that that first procedure and they list the revenue code and then they give the procedure code but it doesn't give us the actual code it's just running those uh revenue codes with some other numbers. Now if you, if you look down and you see where it starts at 1114 where they have the 636 revenue code, they actually put the procedure code that's the J 3490, the J2.
[CUSTOMER][NEUTRAL] They stood.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] The J's and the Q's OK.
[AGENT][NEGATIVE] Yeah, but unfortunately, when we're looking for that actual surgery, which that's on that next page, which is um it's page 2 of the itemization.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, if you go down about halfway through the page when you get to that 0360 revenue code, that's the actual surgery, surgery, um, and that surgery doesn't give us the procedure code itself. Now, um, what you may be able to do, and I know that they say the hospital says that's their, um, that is their itemization.
[CUSTOMER][NEUTRAL] Ah,
[AGENT][NEUTRAL] Um, it's possible that you may be able to reach out to the surgeon that did your surgery and ask them to provide you that surgery, uh, billing that will give us that surgery and, um, anesthesia codes. Because what they've done at the hospital, like I said, is they're just giving us the revenue codes and they don't break down the surgery. And the reason for that surgery code is it does, um, it is.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] When it's broke down for, for a surgery, we need to have the actual surgery code and anesthesia codes, not just the revenue codes from the facility, you know, the hospital. Um, so it looks like that's what's missing because it isn't giving us those procedure codes. So, I'm gonna continue to look here and see if I can um
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEGATIVE] Find anything else. So then there's an additional page for itemization that's on 1114 and see they don't give us any codes at all and that's on this one looks like.
[AGENT][NEUTRAL] It's still Women's Hospital 1114, but they don't give us any codes, they just give us the surgery date, the service date, and then they give us a, uh, yeah, and they give us the explanation of the procedure but not the actual codes.
[CUSTOMER][NEUTRAL] Right, I see that.
[AGENT][NEUTRAL] So it looks like that's what's missing so I would suggest and also it looks like we need the actual um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now just give me one minute. I'm looking at this last page here.
[CUSTOMER][POSITIVE] Sure, I'd rather know exactly what I need to ask for.
[AGENT][POSITIVE] Right, absolutely.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And it looks like they were also asking about the radiation, so we're needing the itemized bill for the, for the radiation, um, and you should be able to obtain that as um.
[CUSTOMER][NEUTRAL] Wow. OK. Yeah, I see.
[CUSTOMER][NEUTRAL] The radiation was done locally. I live outside of [PII], you know, it was close to me. I went and talked to them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Specifically, and I waited like a week to get this information and I told them I said they need a specific.
[CUSTOMER][NEUTRAL] Information for filing with a cancer policy and this is what they gave me.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mm, so those numbers in front like the 772-90CT and the 77385, that is not a procedure code for radiation treatment.
[AGENT][NEUTRAL] Um, now on that, yes, on the, yes, I'm looking at that final page that was submitted and that's from the, um, the Baton Rouge General Cancer Center. So it does give us that appointment date on [PII], but it only tells us that it's a new patient consultation and then um so these additional.
[CUSTOMER][NEUTRAL] Do you see, uh, are you looking at the.
[CUSTOMER][NEUTRAL] Right, the final page.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] The 773-85s were my 5 radiation treatments.
[AGENT][NEUTRAL] And we've got
[CUSTOMER][NEUTRAL] Which is what should be covered, correct?
[AGENT][NEUTRAL] I see that 1:13, 1:15, 117, 120, and 123.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, that was my entire radiation there.
[AGENT][NEUTRAL] So that does
[AGENT][NEUTRAL] OK, so, um, now.
[AGENT][NEUTRAL] Also, and I'm not sure, did you, um, when you filled out your cancer claim, did you see on that first page where they give us, uh, where they give you the uh what's needed to accompany your claim?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And what that entails is, let me just go over that.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] OK, let's see, I've got my claim form here I sent a whole bunch of stuff the first time.
[CUSTOMER][NEUTRAL] That has, that was the um my insurance policy information, stuff like that.
[AGENT][NEUTRAL] Yeah, but what we're needing basically um those instructions on that first page let me pull that up, just bear with me for one moment while I pull that up.
[CUSTOMER][NEUTRAL] OK, I'm, I'm looking for it. Let's see.
[AGENT][NEGATIVE] There should have been a very first page that gives you the instructions for what's needed to accompany your claim.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Find form
[AGENT][NEUTRAL] It would say, um, you know, it would have our our logo at the top and then cancer claim form.
[CUSTOMER][NEUTRAL] Cancer claim form statement of insured that it's got my name, uh, his name, and then my name.
[AGENT][NEUTRAL] OK, that's just the first page of the actual claim form. The instructions are on that very first page. Do you have that page?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I don't see that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next page I have is claim claim form fraud fraud statements and then authorization to request information.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Instructions um statement of insured.
[CUSTOMER][NEUTRAL] Documentation, initial diagnosis, new diagnosis, surgery, including biopsies, that kind of thing.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that's on that
[CUSTOMER][NEUTRAL] Now I have that page.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's, it's, it's page 10, I'm sorry, it does page 1 of 4, sorry.
[AGENT][NEUTRAL] That's OK, that's OK.
[CUSTOMER][NEUTRAL] OK, yes, I do have that page in front of me now.
[AGENT][NEUTRAL] OK, so we're where it tells you know to complete the claim form and then it tells you that um that that actually the section E which is I believe the um um that portion of the claim form that um.
[AGENT][NEUTRAL] Is for your release of information that's section just so you're aware of that because it says it's not necessary but it could delay your claim and you know, but you did complete that page I believe and that was submitted on that first submission. OK, so um for the pathology you sent us that we did receive that pathology.
[CUSTOMER][POSITIVE] Yes, right, I did.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it says because we have to have that pathology report and then when you're filing claim for services such as hospitalization, surgery, chemotherapy, immunotherapy, and radiation therapy to send us the itemized medical bill from each provider.
[AGENT][NEUTRAL] And that would include, like I said that um of course the facility information, the dates of service and and then uh the services that were provided and like a breakdown like I said, itemizing each charge with those um those procedure codes and and and usually it should contain a diagnosis code as well. however, we have the pathology report to verify your diagnosis code so as long as we have those procedure codes, the charges and the um.
[AGENT][NEUTRAL] You know, date of service that should be sufficient. Now, um, also just so you're aware, for those services if you have an explanation of benefits, do you have primary, you have a primary medical insurance like a major medical, is that correct?
[CUSTOMER][NEUTRAL] Yes, we have uh Medicare and then Blue Cross.
[AGENT][NEUTRAL] OK, so you wanna go ahead and send those explanation of benefits from your uh from your medical carrier.
[AGENT][NEUTRAL] Um, showing the amounts allowed and paid for each service, so you'll wanna go ahead and, and I'm just kind of like I said, I'm just kind of going one by one just so that you're aware of what's needed. So if you are able to obtain this billing that we're asking for, include those explanation of benefits from your primary insurance so that doesn't further delay your claim because they're gonna need those that information as well.
[AGENT][NEUTRAL] And also a lot of times that that explanation of benefits, especially from Medicare can provide us those itemized, uh, they'll list it out Medicare usually will list it out by procedure code, what's allowed, how much they paid, and then what your responsibility is, and then usually if you have a secondary insurance, your secondary insurance will pick up that amount that's not paid by Medicare.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Correct, so those two, if you're, if you're able to send those explanation of benefits that can further help us determine those services that were provided and once we verify that they're payable under your policy, then we can go ahead and process them as such and reimburse you for those amounts.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] OK, this has gotten way more complicated. This is actually our 4th cancer we've had to put a claim in on and we've never had to go through all this before.
[CUSTOMER][NEUTRAL] This is, I just, I, I guess I just don't understand what is so different.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK well I will see if I can find.
[AGENT][NEUTRAL] I could pull up those those previous claims, but I can tell you right now looking at the previous claim from [PII] for you, I do see the procedure codes listed there, the amounts, so it looks like whatever you provided then was sufficient enough. I do also see the.
[CUSTOMER][NEUTRAL] Where
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] It was sufficient.
[AGENT][NEUTRAL] Yeah, the chemo treatment. Like I said, I see the procedure codes. I see the charges, so it looks like whatever you had sent previously was what we needed, um, but like I said, it, it appears that what we have thus far for this claim is that we're still needing that breakdown, like I said, of those procedure codes, the charge amount, um, and then also, like I said, that's both for the surgery, the anesthesia, and then also the treatment itself, your radiation or chemo treatment.
[AGENT][NEUTRAL] And like I said, uh, now you don't remember providing I mean I can pull it up and look at it you don't remember providing those explanation of benefits?
[CUSTOMER][NEUTRAL] No, no, no, that's OK.
[CUSTOMER][NEUTRAL] I, I know I do not, I do not remember having to send what Medicare and Blue Cross paid. It was my understanding that that what we get from our insurance company has nothing to do with this policy. This is separate, but what you're saying is that the codes that they provided would help you in paying this one, right? I am, am I understanding that right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, and I'm, I'm taking a look at that real quick just to see because I didn't um now of course I, I.
[AGENT][NEUTRAL] I don't see that we've changed so much as to what the requirement is um so let me just take a look at that real quick because like I said that's why we put those instructions on that first page so that you can you know you can know what's gonna be needed to accompany that claim um but I'm taking a look at it right now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, well, I, I'm truly.
[CUSTOMER][NEUTRAL] Sure, I mean I truly thought I had everything you needed, but I don't, I don't know what codes look like. I don't know what these codes look like so I don't know one from another.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, and that's understandable, yes. Um, and so.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, it does look like we did receive um.
[AGENT][NEUTRAL] On that previous claim and like I said, I'm speaking of the claim in [PII], it does look like that we received like that breakdown of services and it does give us those CPT codes, the charges amount and what was allowed and you know, paid by your insurance. So I mean that could be the only difference and I do see some Louisiana blue uh information also included in the documents that you sent on that previous claim. So like I said it it might if.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Hm, OK.
[CUSTOMER][NEUTRAL] OK, I just don't remember it, yeah.
[AGENT][NEUTRAL] Yeah, um, and that that's understandable, um, and like I said, we're not trying to not, you know, pay your claim, it's just like I said that that's why we did that detail of what's needed on that first page so that it doesn't delay your claim as long as we've gotten, you know, what we needed and you know, to process your claim and make that determination.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] But I just wanted to see for myself because like I said I don't I didn't think it had changed, you know what was required um now sometimes you know and just so you're aware I mean sometimes 11 adjuster might um you know when they're processing your claim it's not always the same adjuster and one adjuster might see a document is is being sufficient whereas another will say well I don't have the exact procedure code or I don't have this so they might go ahead and.
[CUSTOMER][NEUTRAL] Well, like I said it.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Request that and like incidentally when she processed uh when your claim was processed the first time they requested that information for the billing and then the second time when the adjuster processed it, she asked for that itemization um for the radiation treatment and then just put in there that we that the surgery and anesthesia was a duplicate and that's because we did request it on that previous claim and so that's why it was denied a duplicate.
[AGENT][NEUTRAL] So just so you're aware of that, so, so kind of and and it's not, yeah, and I wanted to explain that part to you too so it's not that she's thinking that all of the duplicate charge and we're not paying that we've already previously requested that information so it was kind of letting you know that while we've we've already seen this information however it's and it's not that it's based.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, I didn't know what the duplicate, yeah.
[AGENT][NEUTRAL] it's not that it's denied it's kind of in the pending status so what happens when you send that information to us we're supposed to go back and look at that previous information to be sure that we checked all the, you know, we've made a checklist of everything that we asked for and we've gotten it so like I said I just wanted to explain that to you as well.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, OK, well, yeah, that's what I wondered if it kind of threw me for a minute and I said, OK, no, that's, I'm not worried about that. I know, I know it's not a duplicate claim. I know that. So, um, OK, so I'm well.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, right, and like I said, now, and, and like I said, sometimes another adjuster might have just said, oh, and requested that same code again, you know, with that same d or that same remark code is what we call them when we're requesting information instead of doing that, she just went ahead and put it as a duplicate because we've already requested it.
[AGENT][NEUTRAL] So, so basically, what you, yeah, what you wanna do is get that surgery and anesthesia, and then your treatments. Just if you
[CUSTOMER][NEUTRAL] OK, I get that.
[CUSTOMER][NEUTRAL] I'll go back to the surgeon for that.
[AGENT][NEUTRAL] Yeah I would and and then like I said if they're able to break down those charges for us for the radiation um and give us an itemization rather than that list that you provided and then if you send those explanation of benefits and from Medicare.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And Blue Cross that should give us um those codes as well and that could kind of um reinforce that billing is so to speak but it will have those like I said somewhere in that information we should be able to gather everything needed for your claim.
[CUSTOMER][NEUTRAL] OK, OK, well I'll just have a little bit more homework to do then.
[AGENT][NEUTRAL] Yes, and, and I'm sorry. Um, yeah, and hopefully you have those EOBs and uh that won't be too much of an imposition for you to send those in. And like I said, you'll just wanna go ahead and, and submit that all back to us and like I said, they'll be able to look back and see, OK, we requested the surgery, we requested the anesthesia and we requested the, the radiation.
[CUSTOMER][NEUTRAL] And I can do that.
[CUSTOMER][NEGATIVE] Oh no, no.
[CUSTOMER][NEUTRAL] OK, well I'll do that. I'll get to work on that and look what I'll have you, I'm gonna ask you a question that puzzled me when I got a response the first time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I got a check attached to the bottom of the explanation of benefits.
[CUSTOMER][NEUTRAL] But I got 2 of them.
[CUSTOMER][NEUTRAL] Two pages of the same thing.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] With the same check with the same check number.
[CUSTOMER][NEUTRAL] For $110.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And I didn't deposit but one of them.
[CUSTOMER][NEUTRAL] I said I'm not supposed to get this twice, am I?
[AGENT][NEUTRAL] Well we paid you it looks like there was an, uh, they paid you for an X-ray that was taken and that was and we what we did is we processed under that like you have a wellness screening benefit so that particular procedure was eligible so we paid the $75 benefit and then also within your itemization there was a physical therapy charge and that was where the $35 came from so it actually.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that was a total of 110, but you said you got two separate checks?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I've got 2 checks. It's like I got the same page twice and each one had a check attached to the bottom.
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] But it had the same check number, the same date, it looked identical, so I just assumed I don't get but one of those checks. It's still sitting here. I've got the other one in front of me.
[AGENT][NEUTRAL] And the check number is 2025523?
[CUSTOMER][NEUTRAL] Yes ma'am, dated [PII].
[AGENT][NEUTRAL] Yeah, and I do show that that's what it was made out to and was made to of course to the payee which is the insured um for $110 and I just show that one check so that is your check um but you said you got two so it kind of duplicated it.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It does it's like it duplicated it it's like, OK, when it was printing it out, it printed it twice. That's what it looked like to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That could have just been a clear yeah that just could have been a clerical error because I don't know why it would have duplicated it, um, but if you, if you did um cash that one benefit and it is the 100.
[CUSTOMER][NEUTRAL] So I deposited one check.
[CUSTOMER][NEUTRAL] That's what I think.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I only see the one check number and so like I said, and I do show that it cleared the bank and that's what it tells us that looks like you cleared it well it was cleared in our system on [PII]. Does that sound about right?
[CUSTOMER][NEUTRAL] Right, the 1:10.
[CUSTOMER][NEUTRAL] OK, well.
[CUSTOMER][POSITIVE] That sounds about right.
[AGENT][NEUTRAL] Yeah, so I would just um.
[CUSTOMER][NEUTRAL] Well, I'm just gonna write, I'm gonna write duplicate across this just for my benefit.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] If I come back and look at it later.
[AGENT][NEUTRAL] OK, and like I said I do I think it was.
[CUSTOMER][NEGATIVE] Yeah, and I, I promise I won't try and deposit it again.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, probably what would happen if you deposit it would just kind of bounce back and say that that that this.
[AGENT][NEUTRAL] Um, this check has already been cleared the bank or however they might do it, but I wouldn't want you to get charged for it, you know, on your end from your bank, um, you know, your banking institution would say, yeah, so I would just kind of put it aside and it looks like to me that it was just probably some kind of cle error because I only see the one payment. I only see the one check number and like I said now I do see that it is cleared the bank.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Nope.
[CUSTOMER][POSITIVE] It's it's no problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well that's good we're good it's got duplicate written on it, so if I should forget in the future it's on there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you have any other questions, Ms. [PII]?
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Um, no, [PII], I do appreciate your help, um, and I'll see if I can gather up all this, um, this information and get it sent in to y'all again. Now when I do send it in again, do I, I need to just send another copy of the, the form or should I send what you requested just to make it easier but.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just, yeah, you shouldn't need to include the copy of your claim form or anything um that you've already submitted to us. You can just submit the information that we're requesting um and if you'd like you can, you can go ahead and do you have the claim numbers um from the previous submission if you'd like to go ahead and write that claim number, um, just make sure most importantly, make sure your policy numbers on there.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Absolutely, OK, OK, that sounds good. Well, let me, let me see what I can do and I appreciate all your time and your help.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You're so welcome, Mr. [PII]. I hope, uh, I hope it was helpful and hopefully we can get that settled for you, um, and I thank you for calling in today and I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye-bye.