AccountId: 011433970860
ContactId: 45686202-8c4d-4131-bd52-9421dddfccd4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1263000 ms
Total Talk Time (AGENT): 519781 ms
Total Talk Time (CUSTOMER): 611400 ms
Interruptions: 8
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/45686202-8c4d-4131-bd52-9421dddfccd4_20250522T18:11_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, I didn't get your name. You sound very far away.
[AGENT][NEUTRAL] Uh, my name is [PII]. How may I help you?
[CUSTOMER][NEGATIVE] I still didn't get that.
[AGENT][NEUTRAL] My my name is [PII].
[AGENT][NEUTRAL] Can you hear me now?
[CUSTOMER][NEUTRAL] [PII], oh, got it. [PII].
[CUSTOMER][NEUTRAL] Yeah, I could hear you. you just sound very far away. Um, my name is [PII]. I'm calling because, um, I've, I've been seeing the explanation of benefits, uh, like a remark description that you guys sent on a claim that I submitted in, um, it's saying that you guys were unable to, um.
[CUSTOMER][NEUTRAL] Um, I processed the claim because you needed more information and so I, it took 2 months literally for United Healthcare to provide with the explanation of benefits for the services that I did and I did just upload them. I wanted to see um if that was enough or if you guys needed anything else for the claim.
[AGENT][NEUTRAL] OK, I'd be glad to look that up. What is your policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number 025.
[CUSTOMER][NEUTRAL] 56537
[AGENT][NEUTRAL] Thank you. And if I could verify your um last name, and date of birth, and a phone number, please?
[CUSTOMER][NEUTRAL] Give me one second.
[CUSTOMER][NEUTRAL] OK, that is [PII]
[CUSTOMER][NEUTRAL] [PII] I have to step out of my office. Uh, what do you need? Um, phone number and date of birth?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, phone number [PII].
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. I'm just looking this up now.
[AGENT][NEUTRAL] And also if you could also give me a phone number in the event that we're disconnected.
[CUSTOMER][NEUTRAL] I think so.
[CUSTOMER][NEUTRAL] I'm sorry? I didn't understand a word.
[AGENT][NEUTRAL] Um, yes, um, do you, could you give me a phone number please in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, the number that I gave you.
[AGENT][NEUTRAL] Oh, good. OK, yes, I'm sorry. I'm having a hard time hearing you. I, I apologize. OK, so we do have your explanation of benefits for the MRI, um, for, uh, Doctor, uh, let's see, is it [PII] So [PII]?
[CUSTOMER][NEUTRAL] That's my cell phone number.
[AGENT][POSITIVE] I do have that um explanation of benefit.
[CUSTOMER][NEUTRAL] Yeah, I don't even know. I don't, I.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][POSITIVE] Yes, I do have your explanation of benefits on this.
[CUSTOMER][NEUTRAL] That you do, you
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what we are looking.
[CUSTOMER][NEUTRAL] You said, OK, and do you
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and so what, what we need is a, is proof of the of the of the diagnosis. So there's a reason, [PII], that you, that you had this done on [PII], um, and your provider will give you, um, what was called the diagnosis code and uh whenever you go into a doctor, did they, OK, I'm looking for that now. Let me see if I.
[CUSTOMER][NEUTRAL] They did.
[CUSTOMER][NEGATIVE] I'm sorry, they, they, they gave you, I, I, I posted up an itemized bill and I contacted them and told them what the issue was that I'm not getting the claim processed because of it, and they're saying that the code that they need is um what we're sending you. They're like, I'm not sure what else you need. They're telling me that, so, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know. That's why I called United Healthcare too to see if they could help me um with the explanation of benefits, and I did see it online, so that's what I posted today, so I.
[CUSTOMER][NEUTRAL] I don't, I don't know what else.
[AGENT][POSITIVE] Yes, yeah, the, the estimation of benefits we, we do have that now. That's yes, but that is certainly something that we need is the explanation of benefits and it looks like we have that now. So thank you very much. um, so what we're there, uh, whenever you have something like this done, um, and, and we do show that, you know, the explanation of benefits, that's great, that lets us know what your deductible, co-payment or co-insurances from your major medical. So yes, we do need that.
[CUSTOMER][NEUTRAL] I don't know what else.
[AGENT][NEUTRAL] There is uh a diagnosis code. It's, it's the reason that you had the MRI done and um and Doctor uh.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Did, did, um, is it on the itemized bill though because they told me that the diagnostic codes are on there that that's the code that you guys should reference.
[AGENT][NEUTRAL] Yeah, there, there's a, there's a difference between the, the codes that, that there's a, there is something like uh it's called a CPT code. It's, it's the actual uh type of a scan they did um like a neck scan, a head scan, a brain scan, um, that's, those are the codes they, they tell you, um, but the diagnosis code is the, is the reason, the, the, uh, health reason that you went into the doctor for. So, um, is it for headaches? Is it for, for fatigue?
[AGENT][NEUTRAL] Um, there's a, there is a health reason in it. It's called a diagnosis or a DX code. And so the, the, the type of scan, pardon?
[CUSTOMER][NEUTRAL] And it's not, I'm mhm.
[AGENT][NEUTRAL] So the type of scan is, it is OK.
[CUSTOMER][NEUTRAL] It's, I understand. I
[AGENT][NEUTRAL] Yes, that, that's what.
[CUSTOMER][NEUTRAL] I'm trying to
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] So the itemized information that you have there, it's not what you're looking for? Is that what you're telling me?
[AGENT][POSITIVE] Yeah, yes, this is, this is fine. Yes, this is, this is good, but we just need that, we just need that diagnosis code it's, it's the, it's the health reason for why you went in and it's not listed on this. So normally, yes, this would be fine and the explanation of benefits we do need that because that lets us know what your deductible co-payment or co-insurance is. That's wonderful. We do, uh, you did send that in. It came through. It's fine. Uh, we do show that there is a $239.48. That's what we needed to know.
[AGENT][NEUTRAL] Um, so that's great. Uh, we just need to know the, the health reason, uh, you know, the reason that you had the MRI done and your doctor can provide that to you. So this is the, you have the, the information that you get from your, um, major medical.
[AGENT][NEUTRAL] Uh, um, your, uh, explanation of benefits, but then we also have something from the doctor showing why the MRI was done to begin with and, uh, that's, uh, we still need that, but we do have this, this is great, we can use this, um, but we do need that, uh, diagnosis code or that the health reason for why the MRI was done.
[CUSTOMER][NEUTRAL] And I could get that.
[AGENT][NEUTRAL] From, from your doctor.
[CUSTOMER][NEUTRAL] How? From my neurologist?
[AGENT][POSITIVE] Yes, yes, ma'am. That's correct.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Would that be the, the after visit?
[AGENT][NEUTRAL] Yes, so they
[CUSTOMER][NEUTRAL] I, I, I, cause I don't know, I don't even know what to ask for.
[AGENT][NEUTRAL] OK, so it's um.
[CUSTOMER][NEUTRAL] Well, let me, let me, wait, wait, before I go, what is it, once I have this through, what is the benefit for me to get this, am I, am I, what am I getting for this?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like um
[CUSTOMER][NEGATIVE] Uh, cause I, I don't, I've never used this insurance before and this is the first time I'm opt in and man, it's such a missing.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] To submit the claims, I don't even know if it's even worth it.
[CUSTOMER][NEUTRAL] Um, so what, what is it that I'm doing like.
[AGENT][NEUTRAL] Well, it would be 23.
[AGENT][NEUTRAL] It would be $239.48.
[CUSTOMER][NEUTRAL] What do you mean?
[AGENT][NEUTRAL] Well, you're, you're asking what the benefit is. That's, that's the benefit that we would pay out. That, that is on your explanation of benefits. It shows what was applied towards your deductible from your major medical, and that's, that's what we pay out and in this case it's $239.48.
[CUSTOMER][NEGATIVE] OK, yeah, well, I'm battling that with radiology because they actually overcharged me big time. So that's another battle I'm going through because if you look at the itemized bill that you have there, the first thing, the first one I sent, you're gonna see how much I paid.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, there. So, I paid that when I was there, and I literally just found out today that the explanation, when obviously I just got the explanation of benefits in my hands and I see what I was supposed to actually pay.
[CUSTOMER][NEGATIVE] So, uh yeah, I'm, I'm dealing with that because the provider never informed me that I overpaid, um, in there, um, while I was doing the, the three imaging, so that's another battle I need to uh.
[CUSTOMER][NEUTRAL] I'm waiting for to hopefully resolve that tomorrow.
[CUSTOMER][NEUTRAL] But um I'm looking to see while I'm talking to you.
[CUSTOMER][NEUTRAL] To see where it is on the notes.
[CUSTOMER][NEUTRAL] Because I do have access. I'm looking in the portal from, from my doctor.
[AGENT][NEUTRAL] Yes. Uh-huh.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] They, they're really good on actually writing out the after visits and
[CUSTOMER][NEUTRAL] That's what I'm looking at right now.
[CUSTOMER][NEUTRAL] That was back in March.
[AGENT][POSITIVE] The [PII], that's right.
[CUSTOMER][NEUTRAL] Yeah, let me, if you bear with me, I'm gonna look at the clinical notes.
[CUSTOMER][NEUTRAL] Um, and what is it, you need, you need to diagnosis and see if there's a diagnosis result here.
[AGENT][NEUTRAL] Yes, it's called, it's, it's called a diagnosis code and it uh begins with a letter or, or they will tell you um patient came in to see it, to see us because of, of this issue or that issue.
[CUSTOMER][NEUTRAL] What is the code start with?
[AGENT][NEUTRAL] It usually begins with a letter.
[CUSTOMER][NEGATIVE] With the what? I'm sorry. I'm sorry, I can't, it's so difficult to understand.
[AGENT][NEUTRAL] a letter, like a letter like A through Z.
[CUSTOMER][NEUTRAL] Oh, OK, got you.
[CUSTOMER][NEUTRAL] OK, yeah, cause I'm seeing here, he, he named the
[CUSTOMER][NEUTRAL] The diagnostics, the diagnosis, right?
[CUSTOMER][NEUTRAL] I did that on [PII], this was not the time. Let me see the visit after. If not, then I'm gonna have to call them and
[CUSTOMER][NEUTRAL] I'm looking right now, and, and ask them that they need, I need a diagnosis code for that.
[AGENT][NEUTRAL] Yes, what, what it is is that it's the, it's the um diagnosis, the, the health reason that you went in to the doctor for and you, you probably would need to explain it to them that way.
[AGENT][NEUTRAL] The diagnosis code.
[CUSTOMER][NEUTRAL] But you, I'm assuming you're, you're gonna need something in writing from them.
[AGENT][NEUTRAL] Yes, they, they, whenever you go to the doctor, they usually will give you what is called a walkout paper. Um, it usually tells you why you that you were seeing that day, uh, what, what complaints you had, um, what the doctor thinks is, is wrong, and that's, that's, it usually will have it listed on there and so you can ask them for, for the, for the notes from that day. What, what did, you know, what is the, the, the reason why they um sent you for an MRI.
[AGENT][NEUTRAL] Uh, and, uh, they, they give you that information. It's usually a walkout sheet about an 8 by 11 piece of paper that they hand you as you're leaving. Now if they didn't do that, you may want to ask them for that because that, that lets you know who you saw, um, the day that you saw them, and the reason that you saw them.
[AGENT][NEUTRAL] And it usually isn't listed on that.
[CUSTOMER][NEUTRAL] I'm looking for it now because I'm seeing.
[CUSTOMER][NEUTRAL] I'm looking at that right now.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] I know what you're talking about.
[CUSTOMER][NEUTRAL] Notes from care team.
[CUSTOMER][NEUTRAL] And history of present illness.
[CUSTOMER][NEUTRAL] Um, it's just add um medications.
[CUSTOMER][NEUTRAL] I'm looking for it
[CUSTOMER][NEUTRAL] OK, here's where he's, this is where, OK, the part review of diagnostic data and counter diagnosis.
[CUSTOMER][NEUTRAL] But there's no code. He, he's just listing out what it is. Uh, and then I'm seeing here it says MRI neck without IV contrast, um, routine ancillary performance and for them includes symptoms and it says trauma, then MRI brain without IV contrast it says for dizziness.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] And then there's no codes though.
[AGENT][NEUTRAL] OK, but, but it does put the, the reason you saw him that day is, is for dizziness, is that
[AGENT][NEUTRAL] Is that what is listed on there?
[CUSTOMER][NEUTRAL] So the MRA, the two MRAs are for trauma, and then MRI, the MRI for the brain, it says dizziness.
[AGENT][NEUTRAL] OK, did, and uh
[CUSTOMER][NEUTRAL] But there's no code though.
[AGENT][NEUTRAL] Does it say what the trauma was or or what um what the reason was for the
[AGENT][NEUTRAL] Is that is that it is that work?
[CUSTOMER][NEUTRAL] Well, that's what he's putting, he's putting, so, so right under, right under um review for diagnostic data assessment plan, it says encounter diagnosis, right? And then it says the procedures. So where he's sending me to his order signs, um, he's sending me a medication for my dizziness. He's sending uh me ambulatory referral for ENT.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, he's sending me for physical medicine, uh, rehab, and, um, ambulatory for for uh physical therapy. And then under that are the three orders, and I'm looking, it says MRI brain without IV contrast, MRI neck with IV contrast, and then MRI brain without IV contrast. And then each one, it says this exactly for each one. It says routine, comma, hospital performed reason for exam.
[CUSTOMER][NEUTRAL] And then it says in parentheses include signs and symptoms, and then there's a semicolon, right? Those three tests have the same exact thing, and so, right after the semicolon for both MRA's, it says trauma, that's all it says. And then after the MRI brain, the semicolon, it says dizziness.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But it doesn't say it there's no code and I'm looking at this is called a progress no office visit that happened on [PII].
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] With um Doctor [PII].
[CUSTOMER][NEUTRAL] And he's my neurologist.
[CUSTOMER][NEUTRAL] And it's, it's, it's part of the summary of that, um, it's called neurology consultation visit and it says my, it talks about my history, the medications I'm on, um, you know, that normal intake, the, my blood pressure, all that kind of stuff that comes out on that.
[CUSTOMER][NEUTRAL] And then at the very bottom right before the the ending of it and then it says here um an assessment plan.
[CUSTOMER][NEUTRAL] And um it says um my symptoms that I've had, uh, I have vestibular symptoms, had trauma, and then it says BPPB versus vestibular migraine.
[CUSTOMER][NEUTRAL] And he says vestibular rehab will consider Polar if rehab fails, brain MRI ordered, um, it's his notes that he, he was just putting down, but there's nothing.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Nothing that that has any specific coding that you're telling me.
[AGENT][NEUTRAL] OK, well, what I would do is I would go ahead and, and, um, you can submit that to us and then what we can do is that it, it will be easier for us to, to actually look at it once we have it. Um, we will be glad to look at that and, and if there's no specific codes but it does tell us what the, what the issue is, um, we'll see if we can't look at the codes ourselves, but, um, that sometimes the doctor's notes are, are what we're looking for, it just really depends.
[CUSTOMER][NEUTRAL] I don't know what to do.
[AGENT][NEUTRAL] Um, so if, if that is, uh, it's what you have, you can go ahead and submit it the same way you have your, um, uh, your explanation of benefits.
[AGENT][POSITIVE] And then what we will do is we can um go ahead and review that. So if you would like to submit that to us, we would certainly be glad to look at that and see if that.
[AGENT][NEUTRAL] If we can utilize that.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And you can do that online if you want.
[CUSTOMER][NEUTRAL] Yeah, the only thing is that it has, I think.
[CUSTOMER][POSITIVE] It has a lot of information, like all my, my medical stuff.
[AGENT][NEUTRAL] OK, well, if you would like to redact that, um, you, you can, uh, you know, the only thing that we were really looking at is for this, this one event. So if it, if it has a lot of medical, uh, issues that, and of course you want to keep this private, you can redact that before sending it to us if you would like.
[CUSTOMER][NEUTRAL] I just don't know.
[CUSTOMER][NEUTRAL] OK, so I could like maybe black it out or write it out?
[AGENT][MIXED] Yes, if you, if you would feel more comfortable doing that, because the only, the only thing that we're looking for right now is this is one, this one issue, this is one thing.
[AGENT][NEUTRAL] And um you know we, we don't, you know, we don't need to see everything obviously it's just for this one issue and we're only looking at things for this one issue so if you would like to have that, um, uh, you know, if you would like to send in um bits and pieces of it or if, if you want to, uh, send it in the the bits that you don't wanna, you know, that you want to redact that, uh, you can certainly do that because the only thing that we're looking for is this March event. We're, we're not looking for a, you know, the history, you know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Well, I could, I could send that, but my thing is that I don't want it to, to be in vain, you know, because if you guys at the end of the day are looking for specific codes, there's no code there it it like what exactly what I was telling you, I'm reading it out from the visit summary that that uh that the doctor's office uploaded and this is from the Memorial Health System. So I'm on my chart and on my on the patient portal.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And, and I have access to, to that, so I just right now I just, oh gosh, that's so loud. I just forward it to um to my email, uh.
[CUSTOMER][NEUTRAL] But if you, if you're telling me that you're looking for an exact code, then I don't know, like, I don't know if, if it's better for me to just call them and tell them to redo the visit summary. I don't know. I don't know. I just think it's just a mission and I get my, my, my notes are gonna prove that, you know, this is from the doctor. I went to Memorial Healthcare System and this is notes from the doctor's office himself. And he just didn't, they didn't put codes in there.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Well, if you, if you would like, you can also.
[CUSTOMER][NEUTRAL] But he is laying out the trauma and, uh-huh.
[AGENT][NEUTRAL] Right, well, you, we can do, you know, if you want to, you can go ahead and and ask them for that information, but, um, because they, they won't give it to us.
[CUSTOMER][NEUTRAL] Oh my God.
[AGENT][NEUTRAL] Uh, they, they won't, uh, they won't supply us that information. We do need to know what the, what the event was for. So if you would like.
[AGENT][NEUTRAL] To ask them to to uh.
[CUSTOMER][NEGATIVE] The trauma, knowing that it's for trauma, for dizziness, for vestibular migraines, for that stuff that he's saying, that he's putting in there, that's not enough for you guys to go by?
[AGENT][NEUTRAL] That should be, yeah, that it should, it should be fine. It's we really do need to look at it. I, it's really hard for me to tell you that over the phone, but usually that's what we're looking for. So if you, if you'd like to just send us, you don't have to send us everything, but if you want to send us just that amount for, for that one particular event, we'd be glad to look at it and see if that if that would work. It it does it sounds like it, but I would like, but before I say that I'd like to actually see it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] because it is hard to tell you, you know, exactly what.
[CUSTOMER][NEUTRAL] OK, so I'm gonna.
[CUSTOMER][NEUTRAL] So do, do I do it the same way that I uploaded the, the explanation of benefits just upload it to there?
[AGENT][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, please.
[AGENT][POSITIVE] That's exactly what you do.
[CUSTOMER][POSITIVE] OK, perfect. OK, I'll I'll work on it today. I'll I'll send it by the by the end of today so you guys could, could take a look at it then.
[AGENT][NEUTRAL] OK, then if you want to call us, um, we're open until [PII], Central Standard Time. If you want to call us, we'll be glad to look at it and make sure that that's what we're looking for.
[CUSTOMER][POSITIVE] OK wonderful all right thank you so much I appreciate your help. I'm gonna get on it.
[AGENT][POSITIVE] OK, thank you for contacting me too. Uh-huh, thank you for contacting me too.