AccountId: 011433970860
ContactId: 6ddb83b3-b794-4def-9da1-2878e1496d0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1546719 ms
Total Talk Time (AGENT): 1008506 ms
Total Talk Time (CUSTOMER): 530688 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
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[AGENT][POSITIVE] Thank you for contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and um I cannot um I cannot log into the portal at the moment. I just wanted to see if one of my providers has been sending in bills for reimbursement or do I if I need to reach out to them, would you be able to help me with that?
[AGENT][POSITIVE] Yes, absolutely. And what is your policy number, please, [PII]?
[CUSTOMER][NEUTRAL] OK, policy number is 02572506.
[AGENT][NEUTRAL] Thank you. If I could verify your date of birth and a phone number, please?
[CUSTOMER][NEUTRAL] For me or for the um policy holder?
[AGENT][NEUTRAL] For, for you, for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I need to make sure I have the right.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your phone number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Now, are these claims for you or a member of your family?
[CUSTOMER][NEUTRAL] Yes, for me.
[AGENT][NEUTRAL] For you. OK, well, you have two claims, so let's look at them. Um, it's uh [PII] for ENT and allergy Associates. Is this who you're looking for? Is there someone else?
[CUSTOMER][NEUTRAL] Yes, exactly, yeah, so for me there were, there were two on the [PII] I believe and I was, if one was to be for 336 or something like that or what's the value you see on them?
[AGENT][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] Actually 246.
[AGENT][NEUTRAL] Yes, there's $261.81.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, hang on, I'm looking at, I'm looking at the wrong thing. The the amount billed was 640 and the amount billed was 500.
[CUSTOMER][NEUTRAL] Yeah, OK, so what, how did, how did the bill turn out for each of those?
[AGENT][NEUTRAL] Well, now the office visit isn't covered. Um, the office visit is not covered under your, your, your policy, but the, um, treatment was, and, uh, we paid $261.81 which is what was left over from your deductible co-payment or co-insurance. And this is for a data to service [PII]. Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, there, there were 2 bills. Is that for the total of both of them or no?
[AGENT][NEUTRAL] Now as I mentioned, yeah, uh-huh.
[AGENT][NEUTRAL] No, no, there's what I was going to say is that there's another bill also from ENT and allergy Associates for [PII]. They billed this separately and we paid $116.69 which is your deductible, co-payment or co-insurance from your major medical. So the only thing that wasn't paid was the office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that should have been probably paid by um.
[CUSTOMER][NEUTRAL] My, whatever, my healthcare company. OK, my primary. Um.
[CUSTOMER][NEUTRAL] How do I, if, if I wanna file claims, is there a form or do I have to do everything online?
[AGENT][NEUTRAL] You don't, uh, you can get the forms off of our website. Um, when you, when you go to the website, it actually says uh forms and claims, and if you would like to, you can, uh, down, uh, you can print out the claim form and you can mail it to us or fax it to us, um.
[AGENT][NEUTRAL] And uh that's really all that we would need besides your explanation of benefits from your primary insurance. We would also need an itemized bill or a walkout bill, you know, usually they'll give you a, uh, you know, sheet of paper as you're walking out and it will have, uh, it will list what they did and um what, what they charged and also there is a diagnosis code basically why you went in there to see them that day, and we would need that as well. So.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim form can be downloaded or can be printed out from our website and then you will get the explanation of benefits for that data service from your major medical because they send it to you, they mail it to you. And then the walkout bill or the itemized bill that the physician's office gives you that lists the uh uh the treatments, it outlines the treatment, but also the diagnosis code basically why you went in to see them that day.
[CUSTOMER][NEUTRAL] OK, OK, that's good to know um would you mind, can you look at my plan and, and just kind of give me a summary of, uh, what's covered, um, inpatient outpatient um just because I know you know we changed to a different, you know, company this year to you guys, would you mind giving me an overview of what what you guys what's included?
[AGENT][NEUTRAL] Yes, absolutely. I'd be glad to. Um, so your inpatient services, of course, um, uh, they, they're very comprehensive. They, uh, include, um, all sorts of things that a lot of our other policies don't. Uh, there's a maximum of $6000 per calendar year. That includes, um, your normal hospital stay, you know, where, where you're in the hospital 18 hours or more.
[AGENT][NEUTRAL] Um, it includes ambulatory surgery, you know, you have to go into, you know, the surgery centers, I'm sure that you've seen them. Um, it also includes, um, uh, substance abuse, uh, mental health. That is also covered if you have to be, uh, you know, if you're ever in a hospital for that diagnosis. Um, your outpatient services are $3000 per calendar year. This is per individual, by the way.
[AGENT][NEUTRAL] Um, that includes, uh, hospital, outpatient hospital, outpatient, uh, uh, ambulatory surgery, uh, cancer treatments, independent labs, um, diagnosis, uh, uh, diagnostic type of, of services if if you went in for, uh, um,
[AGENT][NEUTRAL] Like an MRI, uh, a, a CAT scan, that sort of thing.
[AGENT][NEUTRAL] Um, durable medical.
[AGENT][NEUTRAL] That's included infusion therapy, um, that's sometimes uh dialysis, kidney dialysis, that's covered.
[AGENT][NEUTRAL] Um, treatment within the physician's office, that's covered, which is what we just got through talking about with the ENT allergy people. Um, physical therapy, sleep therapy, speech therapy, uh, we already talked about surgery. Uh, is surgery in the hospital or in those outpatient, uh, um, centers. Uh, the ER obviously urgent care, um, outpatient mental health, uh, so, uh, outpatient substance abuse.
[AGENT][NEUTRAL] So and that's per individual, that's $33,000 for uh.
[AGENT][NEUTRAL] Um, for outpatient services. So that is, that it's kind of an overview of what your, your policy covers. It covers a lot of things, but one of the few things that it doesn't cover.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Is that office is it?
[CUSTOMER][NEUTRAL] OK, OK, um, can you.
[AGENT][NEUTRAL] It covers more things than it doesn't put it that way.
[CUSTOMER][POSITIVE] Yes, oh yeah, it sounds really good. Um, can you elaborate on physical therapy?
[AGENT][NEUTRAL] Yes, of course, um,
[AGENT][NEUTRAL] Whenever you, you have, uh, um, well, there's different types of physical therapy. They have, um, uh, electric, uh, you know, where they, where they put the, those little uh things on you and they, they kind of, kind of jolt you into, you know, where you, your, the muscles. Uh, yes, um.
[CUSTOMER][NEUTRAL] Like a TENS unit, yeah, electric stimulation, mhm.
[AGENT][NEUTRAL] Yes, um, there's also, uh, they have exercises, um, it's sort of like a, it's not kinesiology necessarily, but they have, but it's any sort of thing that falls under the, the, um, the heading of physical therapy. Uh, sometimes the, the, you know, it just includes uh doing certain walking exercises, uh, certain, um, uh, stretching exercises, that sort of thing, uh, that, uh, hot, cold treatment, that's always, uh, that's also a, a comp component of physical therapy.
[AGENT][NEUTRAL] Excuse me. Um, but that, that's all covered.
[AGENT][NEUTRAL] Now, the um speech therapy, of course, is different.
[AGENT][NEUTRAL] I don't think they do, uh, I don't think kinesiology is covered. Let me just check here. That's, that's usually exercise therapy and that's a bit different. So no, that's not covered, but that's what the physical therapy is. It's just, it's anything that, that's, you know, where they're, where they're doing the, the um movement type of, of therapies and, and the hot and cold, sometimes water treatment that works as well.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, so can I um.
[CUSTOMER][NEUTRAL] Can I, uh,
[CUSTOMER][NEUTRAL] Describe some things and then do you also, would you be able to tell me certain diagnosis code, diagnostic codes if I gave them to you if they were covered?
[AGENT][NEUTRAL] Uh, yeah, what's, what are you looking at?
[CUSTOMER][NEUTRAL] OK, so I had, I had a wrist surgery last year and um I had some uh physical therapy, occupational therapy. I had physical therapy and some of it had continued into like January of this year, which would be part of when you guys would be uh covering me. So I had um.
[CUSTOMER][NEUTRAL] You know, I worked with an occupational therapist for my hands, um, for exercises and manipulation and stretching, and she, she put, I think that three codes that she used. I'm looking at it are 97,110.
[CUSTOMER][NEUTRAL] 97112 and 97,140.
[AGENT][NEUTRAL] Now those
[CUSTOMER][NEUTRAL] And then I also worked with a go ahead, go ahead.
[AGENT][NEUTRAL] Oh, I, I, I was just going to stop you really quickly because um it's going to depend on, uh, they use those exact same codes.
[AGENT][NEUTRAL] For physical therapy. So at this point, it's going to matter what's going to matter is how they bill it to us.
[AGENT][NEUTRAL] Um, because, uh, the, the, let's just say the 9, 97,110.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That is, uh, that is one of the physical therapy, uh, codes, but they have, it, sometimes the, the physician will bill it.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] The person who's doing it, that's also important. If they are an occupational therapist, if their occupational therapist and a physical therapist will look at it. If they, if what they specialize in is occupational therapy, that's not going to be covered.
[AGENT][NEUTRAL] So what we're gonna be looking at is how they bill it to us and one of the things that that uh we always suggest is if you have the documentation, I would always turn in your, your um ATL card wherever you go um because we will always look at a claim with a, with a view to paying it if there's, if it's built in such a way that that it is paid under your um your uh policy, then we'll do it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, uh, with this, it's gonna be a little tricky. We're we're gonna have to, it's not the code so much that we need to look at is the way that they are billing it.
[AGENT][NEUTRAL] If that makes sense.
[CUSTOMER][NEUTRAL] Well, I, I could be using, yeah, I use occupational therapy and physical therapy interchangeably, and I'm not really sure which, how, what, like I see her descriptions, there's therapeutic therapeutic exercises, manual therapy, and neuromuscular reeducation. So.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] She, to me, that sounds more like physical therapy than occupational. I'm not even sure what occupational is, but anyway.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Yeah, that's, um, so, so you have turned it into your major medical, is that correct?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Right, right, and I haven't, and, and I haven't gotten the bills for her from January yet. I expect to get them soon. I'm looking at some from last year, so, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, so I guess she could submit them right and do you guys um.
[AGENT][POSITIVE] Oh, always, always submit them. Yeah, absolutely, because, uh, let's see, see what you had last year, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, December. I'm looking at December going forward. Um, would you like to submit those to us if, if you want to just send them in and, and let us look at them and, and see how, how she is billing them? There there should be, as I mentioned before, there's a walkout sheet that they give you and and let us know who this lady is and if you have her, her card, that's, that's awesome we can look at that as well and we can look at it.
[AGENT][NEUTRAL] And see if it's, if um if she's billing it as occupational or, or physical.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then we can
[CUSTOMER][NEUTRAL] Yeah, I will, um, I, I asked her I just sent a request for the statement from her, um, so yeah, I don't, I don't even know what anyway I see the codes but you're saying, uh, really depends on the description that's used, correct?
[AGENT][NEUTRAL] Yes, because, yeah, because it's, it depends, um, because physical therapy, they consider that for your physi, you know, for, it's very strange, even the way that they, what they describe occupational therapy. It's, it's more like recreational therapy or vocational therapy like for hobbies, arts, or crafts, is the way that they have it listed. And but, but I know it's very strange, but then physical, physical therapy, they, they, you know, they, they have something else entirely, you know, for that. So, um, it's, it's very, very different.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] No, this was to get, this was to get to regain movement. I had a really bad wrist accident. So it was to regain function in my wrist. I mean, you know, it was all bending, twisting, um, movement, lifting with weight, stretching, you know, just all kinds, you know, just to get my, cause I couldn't even use my hands. So, um, anyway, I, I don't know, I didn't know the difference.
[AGENT][NEUTRAL] So that was, yeah, so.
[CUSTOMER][NEUTRAL] Yeah, how do you see my December because didn't you start covering us in January?
[AGENT][NEUTRAL] Uh, we started [PII], so, um.
[CUSTOMER][NEUTRAL] Oh, OK
[AGENT][NEUTRAL] So if you wanted to go ahead and send anything in from [PII] and, and uh or have her, have her bill us or something, anything, uh and let's look at this because it, it could be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm, I'm, yes.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna OK I'm gonna get this list from her. I'll wait until I get it um I was just on the phone with my primary and they said that I thought they said the expenses were billed like per calendar year. So and but I always thought we started 121 so I was very confused. So maybe our maybe our primary is different than you guys so you know what I mean? I, OK.
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] Yeah, because you started, yeah, so it's, it's very, it's very that's also kind of weird. So you started December as a group. You started [PII], but your, your APL, let's see, I think it's, I think it is actually a calendar year. You just got December, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's probably just the way that they, they build the group, uh, but normally the, uh, these are, um, from, uh, [PII]. It's just that your group, uh, as a, as a whole started on [PII], so we just added that in. Yeah, so, so normally the, the, the policies will start [PII]. Uh, you guys just started that [PII], you just got a month in early.
[CUSTOMER][NEUTRAL] First.
[CUSTOMER][POSITIVE] Because that's we had that's what our previous one was OK, well this is cool so what I'm gonna do is um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I am going to um.
[CUSTOMER][NEUTRAL] Talk with her. What do you, so do you pay like you pay a percentage? Do you pay out of pocket? How do you, how does this work on um.
[AGENT][NEUTRAL] Well, let's, let's look at the ones that you just turned in so I can give you an idea. So let's um.
[AGENT][NEUTRAL] So what we do is we pay.
[CUSTOMER][NEUTRAL] So let's look if there's one.
[AGENT][NEUTRAL] Which one are you looking at?
[CUSTOMER][NEUTRAL] Yeah, I don't know. I can't see. I, I, I don't see the ones I, oh, let me see if I can see, uh, from United. Hang on, let me go to their website.
[AGENT][NEUTRAL] It's like if we could go to [PII], um, just the two that we're that you and I just got through talking about if we could look at that, uh.
[CUSTOMER][NEUTRAL] Oh, but those are that's ENT, right? That's not.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's not uh physical therapy.
[AGENT][NEUTRAL] That's all I have for you. No, that's, I don't have anything else for you.
[CUSTOMER][NEUTRAL] Oh, you don't have anything from December, OK.
[AGENT][NEUTRAL] No, ma'am. I don't. I've just got these 2. This is the only 2 that we've got, so let's look at these.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, you wanna just, yeah, and tell me what, alright, so out of the 410, OK, go ahead.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] So what we do is, um, we, we go by uh your major medical, uh, that's, and we pay the deductible co-pay medical insurance. So let's look at that. Um, that's, uh, this was turned in for uh uh [PII], um, for Doctor [PII] You good. OK. And you, I think I'm gonna butcher that name.
[CUSTOMER][NEUTRAL] Go up, Doctor [PII]. Mhm.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] On the UnitedHealthcare thing that we received, they have uh what is the bill amount and then what they will allow and then what we pay. So, um there was a treatment on that day and they charged $400 and, and you were billed $410. The the insurance was billed $410. But UnitedHealthcare has, has contractually uh
[AGENT][POSITIVE] Uh, has contracted with, with this, um, doctor to only allow $261.81. So they're saying, yeah, you build this much, but this is how much we think this is worth.
[AGENT][NEUTRAL] And that is called an adjustment. So they, they adjusted $148.19.
[AGENT][NEUTRAL] And then they have what is called patient responsibility. That's your deductible amount. This is the amount that we are paying to get you towards your deductible.
[AGENT][NEUTRAL] And that's once you met your deductible, that's when United will start paying, and that was the $261.81.
[AGENT][NEUTRAL] So that's the way that they filled out.
[CUSTOMER][NEUTRAL] OK, so you are paying.
[CUSTOMER][NEUTRAL] You were paying that 26261 81 for me because, uh, because I, uh, that's what I would have paid in my in my in my deductible or towards my deductible.
[AGENT][NEUTRAL] It is
[AGENT][NEUTRAL] Right, see, it's not a percentage, it's not a percentage. We will pay up to that $3000. Now once you meet your $3000 you know, once we've paid out $3000 per calendar year, we're done. And then, then you start having out of pocket if you, but in this case it's not a percentage, it's nothing like that. It's, it's, uh, we will pay your deductible, co-payment or co-insurance up to that $3000 maximum per calendar year per individual limit and right now that's what we paid was at 26181.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when you're looking at your um at your United bills um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It, it, it's called service line information and you're always looking for um the, the patient PT responsibility.
[AGENT][NEUTRAL] And it has PR3, PR1, that PR2, that sort of thing, and uh.
[AGENT][NEUTRAL] That's what that's what we will pay that's what that's what we're here for. That's what we'll pay.
[AGENT][NEUTRAL] So remember you, you always have to be in, in the network with your provider for that to happen.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] Let me give you another hypothetical situation, um.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] My physical therapy is covered. I get 20 visits per, per calendar year. So I used up mine um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Like, let's call it, you know, mid November. So, um, let's pretend you get a bill in the first week of December. And um even though I've met my deductible, I've met my out of pocket maximum with the, with my insurance company.
[CUSTOMER][NEGATIVE] They're not gonna cover my physical therapy because I reached my 20.
[CUSTOMER][POSITIVE] My, my 20, you know, whatever it is, things limit, so, so, so, um, the, the bill will be $240 insurance makes all its adjustments and is gonna pay my provider $50.
[AGENT][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] I would have paid that $50 out of pocket. Would you pay that $50 in this situation? Is that what you would pay the $50 then?
[AGENT][NEUTRAL] It's going to depend on the way that um uh United builds it, so.
[CUSTOMER][NEUTRAL] Given that it, yeah, given that, oh OK.
[AGENT][NEUTRAL] So it's the way that it's the way that they um adjudicate the, the, the claim. How are they going to process it? So there's two ways that they can go, well, actually more than 2, but um they can either say, yes, uh, you have met your limit.
[AGENT][NEUTRAL] And we're not going to pay anything and there will be a little code definition, there will be a little definition of why anytime they, anytime they deny a claim, there's always a little definition and a little box right underneath it.
[AGENT][NEUTRAL] And it will say you've met your limit.
[AGENT][NEUTRAL] So what it will say is build $200 and whatever dollars allowed 200 and however much dollars and then um paid nothing, uh uh adjusted nothing, um, patient responsibility, $200 and something dollars, but they won't put that deductible co-payment or co-insurance on it. But to say you owe it.
[AGENT][NEUTRAL] And in that case, no, because they haven't put it towards your, we won't pay because you, we haven't put it towards your deductible, co-payment or co-insurance. And that's because you've met your allotted 2 visits.
[AGENT][NEGATIVE] Per calendar year they they don't they're they're not gonna pay it we won't pay it.
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] Sometimes they will give you a, an adjusted amount or, or, um, we've seen, we've seen uh uh ELBs that have an adjusted amount where they, they give you a little bit, they'll put a little bit towards your deductible, a little bit towards your, your, uh, and not deductible, but your co-insurance or co-payment. Um, so they, they won't pay anything, but they'll they'll give you a little bit of money towards co-insurance or co-payment, and then we would pay that. But, but most likely what will happen.
[AGENT][NEUTRAL] is that they will say that you've met your limit of visits, and if you don't get approved for any more.
[AGENT][NEUTRAL] Then they're not gonna pay it and we wouldn't pay it. Then you'd be on the hook for that. You'd end up having to pay that yourself. Um, I would check with you with United and see if they will, they will extend that because sometimes they will extend more than 20 visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, alright, yes, I'm looking at, I'm looking at one.
[AGENT][NEUTRAL] Is that, yeah, you, you wanna make sure that you don't go over. Yeah.
[CUSTOMER][NEUTRAL] Yeah, I'm looking at one and you're right that they, they were billed $120.
[AGENT][NEUTRAL] Does it say that on there?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's the total amount billed 120. They didn't do a discount they didn't they just said I owe the whole amount and down underneath the claim code says the maximum benefit under the plan has been met. Member is responsible for the amount due, so you would not pay that because they, OK.
[AGENT][NEUTRAL] That's it.
[AGENT][NEUTRAL] That's the, that's the wording.
[AGENT][NEGATIVE] No, because there's no deductible co-payment or insurance. They're telling you you you made your limit with us and we're not, we're not paying for any more.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, and have you seen them extend extend the because I had a pretty bad, pretty bad, um.
[AGENT][NEUTRAL] And then of course now.
[CUSTOMER][NEUTRAL] Uh, uh, a problem with my wrist and it took much longer to heal. Um, so is it possible with like United that you, you, have you ever seen where they would provide offer more
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] I, I don't know enough.
[CUSTOMER][NEUTRAL] Uh, or with a insurance company extend it, OK.
[AGENT][NEUTRAL] The only, the only one that I that I know about that is um
[AGENT][NEUTRAL] Sometimes there's like my own occasionally, if you, if you um if you call it and you get the doctor to see if the doctor will, will, you know, the doctor has to uh send in something, um.
[AGENT][NEUTRAL] And uh
[AGENT][NEUTRAL] They they go back and forth and back and forth and and sometimes you can get one or two more visits or something like that. You could try that. Um, I have seen that happen with my own insurance, but I don't know about United.
[AGENT][NEUTRAL] Um, but you, you would always start with your doctor, um, see if they would request through to the major medical, letting them know cause really all you need to know is that this is, it sounds like it's very necessary. This isn't frivolous. This isn't whatever they would consider frivolous. You know, you, you really do need this, so you could ask them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] But you'd ask, you'd ask through the doctor. I, I would never try, I mean, well, you can, I take that back, excuse me, you could try yourself, but I would always go to your physician first to see if your physician wouldn't mind contacting um the billing department and seeing if, if, you know, letting them know that this is medically necessary and I have to send them some things in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I, I do not know. I've not seen anything before on, uh, I don't see enough of United, uh.
[AGENT][NEUTRAL] And in that particular.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To tell you.
[CUSTOMER][NEUTRAL] All right, well, I guess, um.
[CUSTOMER][NEUTRAL] It's a catch-22. I've got like whatever I've gotten since actually since hm.
[CUSTOMER][NEUTRAL] So there's a month it's a weird situation because like for the month of December.
[CUSTOMER][POSITIVE] I would have been over my plan, my number for my plan starting January my calendar year I get I get my new 20 you know what I mean? So, so that you guys would be paying since January for what I've uh beginning of January, um, but the ones in December would have been rejected so all right well uh you've been really really really helpful thank you I will um.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Well, certainly, absolutely, and, and you know, if you ever have any, and I, I'm excuse me, I didn't mean to interrupt you, but I, I would, I was just gonna say this is what we always tell people, um, if you have any questions, um, and we actually need to look at the paperwork, submit, submit what you've got, you know, submit your explanation of benefits, submit your, your itemized bill. Let us look at it, um, because you know you've got that $3000 per calendar year. You've got that, you know, you've got the money to use. It's and it, you know, you.
[CUSTOMER][NEUTRAL] I'll keep looking at it, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] If we, if it can be paid, then we'll do it. So if you'll send it in to us, uh, we would always, we're always open to looking at it to see if, you know, there's if it can be paid. So please, if you have any questions, um, submit it to us and, and, you know, the worst we could do is say no, I'm sorry you don't, this isn't covered or whatever, but it's always a good idea to send that stuff in and just, you know, just let us we get lots of stuff, so please just go ahead and send it again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. You've been wonderful. I really, really appreciate it. OK, take care.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, thank you for contacting API. You have a very good day.