AccountId: 011433970860
ContactId: 76783d71-a455-4097-a1cb-0d36664889f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2736419 ms
Total Talk Time (AGENT): 1057493 ms
Total Talk Time (CUSTOMER): 1307608 ms
Interruptions: 5
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/76783d71-a455-4097-a1cb-0d36664889f5_20250103T19:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I have just finished chemo for um cancer, so I haven't really been able to look through some various things that were sent back to me about nonpayment and so I needed to speak with someone regarding what I was sent back.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. Well, I'll be more than happy to help you with your claims. And may I have a good contact number just in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] Um, sure, it's my number again. I'm [PII], and it is [PII].
[CUSTOMER][NEUTRAL] 681.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. and Ms. [PII], may I have your policy number?
[CUSTOMER][NEUTRAL] Yes, it's 0242.
[CUSTOMER][NEUTRAL] 858 9.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And I have you here and I just need you to verify your date of birth, your mailing, and email address on file.
[CUSTOMER][NEUTRAL] OK, it is [PII].
[CUSTOMER][NEUTRAL] My address is [PII].
[CUSTOMER][NEUTRAL] And I have a lot of emails, so I'm gonna try this first one. Is it [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, that's correct.
[CUSTOMER][NEUTRAL] OK, good. I thought it might be but I was like maybe possibly.
[AGENT][NEUTRAL] Well, thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. And do you have, I can look up like the data service or if you have the claim number, I can look it up that way.
[CUSTOMER][NEUTRAL] OK, um, so I guess I could go with some of the information that I have that wasn't that was indicating that it wasn't covered, um, so I have these two. I don't know if you want the claim number, would that be?
[CUSTOMER][POSITIVE] Helpful
[AGENT][NEUTRAL] You know what, I just noticed, um, so most of the claims came in on the same day with the exception of [PII]. Do you just want to go over the ones that were denied because it looks like it, I can, I can pick it out that way if you like.
[CUSTOMER][NEUTRAL] I mean that'd be great um I'm hopeful that I have everything out here because it was just so much. I don't, I think we may have just brought out the things that weren't covered but maybe there's more.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, the claim number, the first one I have is 561.
[CUSTOMER][NEUTRAL] And then there's 564-570, those are the last three.
[CUSTOMER][NEUTRAL] Numbers of course.
[AGENT][NEUTRAL] Oh, wait a minute, hold on one second.
[AGENT][NEUTRAL] 566.
[AGENT][NEUTRAL] Would it be, um, because I don't see that. Would it be easier if I just
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have your explanation of benefit there?
[CUSTOMER][NEUTRAL] Um, yes, and it's from APL and it has dates of service and then they these three different ones have different claim numbers on them.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, cause I'm just going through.
[CUSTOMER][NEUTRAL] So I think
[AGENT][NEUTRAL] All the um denied claims, is one of them 3491557?
[CUSTOMER][POSITIVE] Um, OK, that's one that I did just fine. I can't believe it. OK, so that was the surgery. OK, good, good, because that's what I wanted to talk about.
[AGENT][NEUTRAL] OK, good. So you want me to just look and get all the denied claim numbers and go through them with you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, I think that might be the best thing to do.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one sec. Do you mind if I place you on just a brief hold? I'm almost done.
[CUSTOMER][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 3491557, 3491559.
[AGENT][NEUTRAL] 349, uh 0.
[AGENT][NEUTRAL] 349.
[AGENT][NEUTRAL] 1562.
[AGENT][NEUTRAL] 56568.
[AGENT][NEUTRAL] And 93491569.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, the first one.
[AGENT][NEUTRAL] DH 0086.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So,
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] For the first one, this is claim number 3491557 for the surgery on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] That's correct, yes.
[AGENT][NEUTRAL] OK, so one of the codes were denied, but it's requested, it's because it's anesthesia, so it's requesting the actual surgery bill.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] And then let me see what the other part of that was.
[CUSTOMER][NEUTRAL] Um, so.
[CUSTOMER][POSITIVE] Because I have here that I've sent that and I'll go through that with you when you're ready.
[AGENT][NEUTRAL] Oh, go ahead, I can hear you.
[AGENT][NEUTRAL] OK, and then let me see what that other than that. OK, so it's both for the surgery bill. OK, so let me look at what was submitted for this one.
[CUSTOMER][NEUTRAL] Right, because to me it looks like it's fully itemized because it has like.
[CUSTOMER][NEUTRAL] Lidocaine, implantable tissue marker, ultrasound, I mean, just.
[AGENT][NEUTRAL] Oh, OK, so that sounds like, OK, so there's a
[AGENT][NEUTRAL] Itemized bill, some places call it a universal bill. That's like the big hospital bill that has all the codes, all the charges of everything, everybody all that day. Now, what you're describing sounds like the patient copy of that, which just shows, like you said, all the treatment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But we need the medical necessity, which is the diagnosis code and then all the charges from that surgery, but I'm pulling up the documents now just to make sure.
[CUSTOMER][NEUTRAL] Because I requested, you know, everything from the hospital and I was gonna go over that I have that too, but it's, it's the only thing they would provide to me so I'll talk to you about that.
[AGENT][NEUTRAL] OK, so yeah, this explanation of charges, this is your, this is an itemized bill, but you see how it has like the date and then it says procedure code.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] See, there's a, so basically they made this bill from the big bill, and we need the big bill.
[CUSTOMER][NEUTRAL] OK, and they told me they were sending me all the super bills is that what you're talking about?
[AGENT][NEUTRAL] No, a super bill is what you'll send to your insurance for like reimbursement and things. You're, you're wanting to call, so you're going to call the hospital.
[AGENT][NEUTRAL] Ask to speak to the billing department.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're gonna ask them for an itemized bill. You can even say UBO4, depending on the facility, it's the same.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me write you.
[CUSTOMER][NEUTRAL] OK, hang on, I'm just gonna write this down. UB 14.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] UB 04.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because I went by and of course I don't remember exactly because I've done this months ago but they sent me a whole list of everything that had been done.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And they told me this was all they could give me. And it, I sent a copy of this in, but it doesn't go through.
[CUSTOMER][NEUTRAL] Anything else it has some numbers which I'm not.
[CUSTOMER][NEGATIVE] Totally sure, but that was really all they provided to me. They said your information is gonna be on your insurance, so, or what we're sending is an explanation of charges. So see, they're telling me that one thing and they're saying that's absolutely all they have.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, let's do this. Um, I see this customer service number here. Do you want me to give them a call?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, sure, I mean if you don't mind on that.
[AGENT][NEUTRAL] No, I don't mind at all. What I need to do to get the help, but um, yeah, it's, it's two different documents, um, but I can definitely call them and help you if you need it. Did you want to go through the other ones? Well, actually there it's all the same reason.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That'd be great.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, for these first, yeah it is.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And then the other one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The other ones that were denied, so these were
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] DC.
[AGENT][NEUTRAL] 756.
[AGENT][NEUTRAL] OK, now, for claim, is there more multiple parts? OK, no, this is it. So for
[AGENT][NEUTRAL] Claim number 3491569.
[CUSTOMER][NEUTRAL] OK, I'm not.
[CUSTOMER][NEUTRAL] 256 9 I'm not finding that one.
[CUSTOMER][NEUTRAL] There's just so many papers. I am not finding that one. Can you tell me what that one was?
[AGENT][NEGATIVE] Yeah, so this looks like these are wellness um expenses, but the policy doesn't have a wellness expense, so that's why these 1234 were denied.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] So were those all different?
[AGENT][NEUTRAL] Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Oh, did you say 559? I'm sorry.
[AGENT][NEUTRAL] No, no, not, not 559-569, but you do have a 5592.
[CUSTOMER][NEUTRAL] Is that what you're saying?
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, yeah, that's what we looked at. OK, so all of those were just well.
[AGENT][NEUTRAL] Now the
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Were any of those dates in late January?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, one was [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] The other was
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, oh, sorry, I hit the wrong button.
[AGENT][NEUTRAL] The next one was, OK, this one is [PII].
[CUSTOMER][NEUTRAL] OK, and that must be the first mammogram I had that turned out to have a problem, so that would make sense that that would be considered wellness.
[CUSTOMER][NEUTRAL] Until we found the diagnosis, so that makes sense.
[AGENT][NEUTRAL] Yes, so that's why those were denied, but then you have, please provide itemized bill. OK, let me go back to the claims.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You have 3491562, which was also a surgery on [PII].
[AGENT][NEUTRAL] That one is also asking for the itemized bill, so I can call if you like.
[CUSTOMER][NEUTRAL] OK, is it the same covenant that you're calling?
[CUSTOMER][NEUTRAL] I guess it is.
[AGENT][NEUTRAL] Um, let me see. Oh, that's a good question because this one doesn't show me the provider. Let me see what was submitted.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 22 you said February?
[AGENT][NEUTRAL] Mhm. [PII].
[AGENT][NEGATIVE] This is no.
[CUSTOMER][NEUTRAL] I'm just looking, looking.
[CUSTOMER][NEGATIVE] Somehow these are not.
[CUSTOMER][NEUTRAL] The ordered and I'm finding.
[AGENT][NEUTRAL] OK. So I'm pulling up the documents to see if this is covering it as well.
[AGENT][NEGATIVE] I hope so. Oh no, it's not. This is uh
[CUSTOMER][NEGATIVE] Yeah it's not.
[AGENT][NEUTRAL] [PII] [PII] [PII].
[CUSTOMER][NEUTRAL] Yes, yes, OK, so I didn't, I didn't have any surgery there, so at that time, so I can under that one too might have just been.
[CUSTOMER][NEUTRAL] Checking and doing various.
[CUSTOMER][NEUTRAL] Test to find out more about the cancer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I could see why that might.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I was trying to look through these to see if it, this is just like a
[CUSTOMER][NEUTRAL] Not
[AGENT][NEGATIVE] It's just a list of charges, but there's no.
[AGENT][NEUTRAL] Yeah, this one is no title, so I, I don't have a number for that one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But I mean if you have one, I can still call after we call the other people.
[CUSTOMER][NEUTRAL] Huh
[CUSTOMER][NEUTRAL] Well, I mean if you've got the phone number for Covenant.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, oh, I mean, I'm sorry.
[AGENT][NEUTRAL] Yeah, that's Covenant.
[CUSTOMER][NEUTRAL] Yeah, I don't, I don't know exactly with that one so um I can give you MD [PII] number in a little bit. Do you think we could go back to that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, whatever you need me to do.
[CUSTOMER][NEUTRAL] Before I forget what I got out in front of me, oh, OK, yeah, maybe we can go back to that one.
[AGENT][NEUTRAL] OK, so you want to call Covenant now?
[CUSTOMER][NEUTRAL] Um, I'm trying to remember.
[CUSTOMER][NEUTRAL] Well, yes, uh, do you have time to go back over these other ones or would you rather wait?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Before you call
[AGENT][NEUTRAL] The other ones, hold on.
[AGENT][NEUTRAL] Let me go back to your.
[AGENT][NEUTRAL] Claims.
[AGENT][NEUTRAL] Which one, which other ones?
[CUSTOMER][NEUTRAL] OK, this one is showing claim 5,703,491,570.
[AGENT][NEUTRAL] Oh, OK, this one. Let me see.
[CUSTOMER][NEUTRAL] And then there's
[CUSTOMER][NEUTRAL] It's transportation.
[AGENT][NEUTRAL] OK, so it was paid out on, but there are some codes better than that. Let me see what this means. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I can.
[AGENT][NEUTRAL] OK, so for
[AGENT][NEUTRAL] Wait, we paid the transportation. This is lodging.
[CUSTOMER][NEUTRAL] Yes, um, and then there was the rental car is the other thing that was on there.
[AGENT][NEUTRAL] Hold on one sec.
[AGENT][NEUTRAL] The transportation and lodging benefit is payable when a covered person has been diagnosed with cancer to receive radiation, chemo, or immunotherapy, bone marrow transplant or surgery in a hospital that is at least 50 miles away from the covered person's home. On your recent claim, it appears there were no covered treatments received. Therefore, transportation and lodging is not covered for this data service.
[CUSTOMER][NEUTRAL] OK. I had the surgery on um
[CUSTOMER][NEUTRAL] [PII], and I stayed overnight.
[CUSTOMER][NEUTRAL] and was dismissed on
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] So do would that only pay I mean.
[CUSTOMER][NEUTRAL] I could, I, this is several 100 miles away from where I live. So naturally, I couldn't travel right after surgery. It, there were a few days in there that I had to stay, um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I don't know how that works.
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] Miscellaneous 25.
[CUSTOMER][NEUTRAL] So it paid for one night.
[AGENT][NEUTRAL] Because we paid for, that's what I'm looking at. We paid for [PII].
[AGENT][NEUTRAL] For lodging and transportation, I mean, I'm sorry, [PII], oh, it's too, it's the same thing. Wait a minute, I'm sorry, let me look at this.
[CUSTOMER][NEUTRAL] Or the
[CUSTOMER][NEUTRAL] Well, yeah, it's, I've submitted all of the bills from Rotary House which is like a place that patients stay before and after surgery and so I had to get there early because they had to do tests on me right before like blood work and X-rays and stuff right before they did the surgery like the days before. And so I arrived on um the [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so that was paid our airline tickets were paid. And then I sent in all the Rotary House Hotel and they um I was only approved for the one night and that was the night of the surgery, but um.
[CUSTOMER][NEUTRAL] I guess maybe that should be my family member lodging actually because I was in the hospital that night.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] But anyway, um, so I had other days that I had to be there in preparation for the surgery, but those were denied.
[CUSTOMER][NEUTRAL] Does that make sense?
[AGENT][POSITIVE] Oh, it does. I just had a whole conversation on mute. I'm so sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] Um, so for this one, I would get you to a claims examiner to talk more in detail about the Rotary house and the days. But do you want me to call Covenant first and then handle that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, may I ask you one more thing to look at and then I promise this is the last thing it's the claim, it's another claim. It's 3491561.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] You're totally fine.
[AGENT][NEUTRAL] 61. OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one second. 1561, OK.
[AGENT][NEUTRAL] I'm waiting for it to come up here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for this one, what question did you have?
[CUSTOMER][NEUTRAL] OK, so the 1st 3 things on there it's saying 0, which is a little confusing to me because we have.
[CUSTOMER][NEUTRAL] Two surgery benefits, one was paid and the other one wasn't.
[AGENT][NEUTRAL] The 1st 3 things, let me see.
[CUSTOMER][NEUTRAL] Um, and it's saying.
[CUSTOMER][NEUTRAL] They need the pathology report.
[AGENT][NEUTRAL] OK, hold on one second. So I see that.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I see that one for the pathology report.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But I've already sent in the pathology report to say that I have cancer. So,
[CUSTOMER][NEUTRAL] I don't know what that's about.
[AGENT][NEUTRAL] Now, for that, let me write a note. Hold on one second.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] The other claim number that we talked about was 3491562, right?
[AGENT][NEUTRAL] The one we just went over?
[CUSTOMER][NEUTRAL] Um, the one that we just talked about about the lodging and everything or different one, that one was 3,491,570.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] 0 70, OK, hold on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this one is gonna go to claims examiner.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Info on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Would I be able to talk to that person? Would you be able to connect? Oh good, OK.
[AGENT][POSITIVE] Oh yes, I'm gonna connect. I'll get her, uh, I'll get the representative on the line and then I'll connect you to and then drop the line.
[CUSTOMER][NEUTRAL] OK, should I ask them then about the surgery benefit thing as well and it's saying they need the physical address and that's a confusing thing to me as well, so.
[AGENT][NEUTRAL] That's on the same claim here?
[CUSTOMER][NEUTRAL] It's on um 561 so I have information on 561 and 570 that I was gonna wanna ask them questions about I guess.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] TE 156.
[AGENT][NEUTRAL] According to the information.
[AGENT][NEUTRAL] And you file your legal residence. OK, this is the one you're saying.
[AGENT][NEUTRAL] Asking for the
[AGENT][NEUTRAL] Address. According to the information in your file, the legal residence is less than 50 miles from the current, OK, so then let me put a note on that 1. 161. We're gonna talk to claims about.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Transportation.
[CUSTOMER][NEUTRAL] Yeah, what that means.
[AGENT][NEUTRAL] And then I see another one here.
[AGENT][NEUTRAL] Oh, that was just saying that the policy does not provide a benefit for laboratory or diagnostic tests.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then all the other codes on here were um paid.
[CUSTOMER][NEUTRAL] That benefit, yeah, that surgery benefit I'm not sure what that's about.
[AGENT][NEUTRAL] The surgery benefit. Oh, the one, the first, the, um, hold on, let me go back to that code.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, with the pathology report.
[AGENT][NEUTRAL] For that one, I'm still gonna talk to, I'm gonna mention that to claims. I don't know, I, I don't think you will have to submit a new pathology report for, for the claims if you've already submitted, but I'm gonna check and see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, for that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, what's it about transportation and surgery benefit.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so then, so for 561 and 570, we're gonna talk to, I'm gonna get claims after we call Covenant and then
[AGENT][NEGATIVE] The other ones were denied because of the wellness benefit and then the ones we're calling Covenant on need the bills.
[CUSTOMER][NEUTRAL] Yes, and I also then have after all this I have another question that about something I'm about to file.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, just to get help with that, so I don't know what's best for me to do.
[CUSTOMER][NEUTRAL] Should that be another conversation or?
[AGENT][NEUTRAL] Can you ask me, can you say that one more time? I don't, I, I'm.
[CUSTOMER][NEUTRAL] Yes, yes, I'm also I was calling today because I also need some advice about something I'm about to file and it's for my immunotherapy, which is a huge expense and so I just wanted to find out the best way to send that in and make sure I have everything because there's like 83,000, 43,000, all these figures from what I'm having done and I know it doesn't.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Covered all of that. I think it's like 15,000.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] So should that be a different conversation or?
[AGENT][NEUTRAL] So you're just wanting to know the best way to submit the immunotherapy, uh, bills, I guess I can say, charges.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, because I have, you know, charges from these various things and um one of them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's the explanation of charges.
[CUSTOMER][NEUTRAL] And it tells on here, the actual, it tells all the various things that are a part of what I get like um IV fluid and stuff, but this one is for the actual transubalo, which is Herceptin and it's 43,13459.
[AGENT][NEUTRAL] Do you go
[CUSTOMER][NEUTRAL] So I'm just.
[AGENT][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] No, so I'm just wondering if I just send that one I've had several treatments.
[CUSTOMER][NEUTRAL] But if I, if this is gonna be enough information to send because it's again my explanation of charges, but it has all the procedure codes and that one by itself would be the only thing.
[AGENT][NEUTRAL] OK, so for the immunotherapy, the policy is going to pay up to $15,000 per 12 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] So, I, so it's kind of the same thing. We would, is it, is that covenant as well?
[CUSTOMER][NEUTRAL] It is, yes.
[AGENT][NEUTRAL] Well, I'll just mention that to him when I call because we're gonna need that same type of billing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that one is on 5:30-24. I don't know if you need that date, but they have several that I've done and so um.
[AGENT][NEUTRAL] Yes, 5:30.
[CUSTOMER][NEUTRAL] I know that I
[CUSTOMER][NEUTRAL] Needed to just go with the first one.
[CUSTOMER][POSITIVE] I felt like that was the easiest thing to do since it's so much.
[AGENT][NEUTRAL] The, well, you know, when I talk to Covenant, I ask them how they send it out. If it's like multiple, is it like multiple bills for each of the days, or?
[CUSTOMER][NEUTRAL] Well, it's telling every part of what they did that day when they gave me immunotherapy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So they did a whole bunch of other stuff like hepatitis B test, blood tests, CBC insert the needle in my arm, chemo infusion, initial charge, all these other things they gave me. But the actual chemo, I mean, the immunotherapy agent itself, by itself is $43,000 on that one day. It's insane.
[AGENT][NEUTRAL] And was that immuno I I'm sorry, was [PII] the only day you received the actual immunotherapy?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, I've, I've had it every 3 weeks since then, but I was just thinking, you know, if this is all I need to send in because obviously it's far and above every time the 15,000 so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't see any reason to turn in the rest of them, right?
[AGENT][NEUTRAL] Right, I don't think you should either. Um, but because the first one cover, the first one is over the 15, it's just the billing. I'll just mention [PII] when I mention the others.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, [PII], yeah, and it's, do you want me to tell you the name of the medication? Would that be helpful when you talk to them or not?
[AGENT][NEUTRAL] Oh, no, ma'am. I just need the um the dates and you know what, let me get that together so I have it all in one spot.
[CUSTOMER][NEUTRAL] OK, OK, but I haven't sent that to you yet that, that's something I haven't sent in.
[AGENT][NEGATIVE] Well, don't send what you have because it's going to be denied again.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] I'm, I'm gonna, I'm gonna mention that to Covenant, so when they send you the the bills that we're needing, they'll send this [PII] too.
[CUSTOMER][POSITIVE] OK, yes, please, that'd be great. OK, yeah, that was kind of my question.
[AGENT][NEUTRAL] OK. Um, let me, no, go ahead. I, I can hear you. I'm sorry. I'm trying to get this list.
[CUSTOMER][NEUTRAL] No, that's it that's it that's the end of the question.
[AGENT][NEUTRAL] OK. Well, hold on one moment. Let me get these dates of service, so [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then does this have a different one or it's the same day?
[AGENT][NEUTRAL] OK, so it looks like it's just [PII] and then [PII].
[CUSTOMER][NEUTRAL] Yes, that seems to be the two that we're just needing clarification on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, is it alright if I place you on just a brief hold? I'm gonna call on the other line and then I'll click back in with you. OK, hold on one second. You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh, what am I trying to do? Covenant, cover it, cover it, cover it.
[CUSTOMER][NEUTRAL] Thank you for calling Providence billing office. Did you know that you can view and print your detailed bill at [PII]?
[AGENT][NEUTRAL] Ms. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm still here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If this is an emergency, please hang up and dial [PII].
[CUSTOMER][NEUTRAL] Please listen carefully as our menu options have changed. To check your balance or make a payment using our automated system, please press 1.
[CUSTOMER][NEUTRAL] To make updates to your insurance information on file, please press 2.
[CUSTOMER][NEUTRAL] To request an itemized statement, please press 3.
[CUSTOMER][NEUTRAL] For our financial assistance program, please press 4.
[CUSTOMER][NEUTRAL] For accounts placed with a collections agency, please press 5.
[CUSTOMER][NEUTRAL] To make a payment with a representative and all other inquiries, please press 6.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Your call may be monitored for quality and training purposes.
[CUSTOMER][NEUTRAL] Our representatives are continuing to assist other callers. To make a payment using our automated system, please press [PII] or remain on the line for the next available representative.
[CUSTOMER][NEUTRAL] Did you call Covenant or MD [PII]. This is Covenant, right?
[AGENT][NEUTRAL] Yes, this is Covenant. I don't have the number for MD yet.
[CUSTOMER][NEGATIVE] OK. They changed their music now they both have the same music so. It's sad that I just take your place in line and request a call back please press one.
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Not that
[CUSTOMER][NEUTRAL] If you'd like to save your place in line and request a call back, please press one.
[AGENT][NEUTRAL] Nope.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Oh, I wonder if they hurt me.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEGATIVE] No, no, it's not.
[CUSTOMER][NEUTRAL] And how we have the hands going on.
[AGENT][NEUTRAL] Oh, wait, I can't hear you.
[CUSTOMER][NEUTRAL] Our representatives are continuing to assist other callers to make a payment using our automated system, please press [PII] or remain on the line for the next available representative.
[CUSTOMER][POSITIVE] Hi. Thank you for calling the Providence Business Office. My name is [PII]. How can I help you today?
[AGENT][NEUTRAL] Hey, [PII], my name is [PII]. I'm calling from American Public Life. How are you?
[CUSTOMER][POSITIVE] I'm doing good uh thanks for asking and yourself?
[AGENT][NEUTRAL] I'm doing well. Um, I have a, well, we have a mutual patient and I'm needing some help with itemized billing. Um, she requested itemized bills previously, but the what was submitted or what was given is the patient bill. We need the itemized bill or the universal bill from like the big bill from your facility with all the ICD 10, CPT.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And all the charges and surgery charges so that we can process the claim.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, OK. Well, for that one, it's not the itemized statement, um, that you need, but the UBO4 or the CMS 1500, that's the one that includes the CPT codes.
[AGENT][NEUTRAL] Right, itemized billing you for, yes, whichever you guys use for that facility.
[CUSTOMER][NEUTRAL] I think the part.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. Sure thing. Well, I can definitely uh send a request for that one. this will be sent to the patient address um if we will be the one,
[CUSTOMER][NEUTRAL] Processing the request or um I can give you a fax number or um let me see here one sec where you can let me I'm here on the phone man um I did request.
[CUSTOMER][NEUTRAL] You can hear me right?
[CUSTOMER][NEUTRAL] Yes, is it great? OK, good. I requested this information. I went up to another building they needed me to go physically to go sign for some papers. Perhaps you know what I'm referring to and so they sent me a big pile of information and I submitted that here to this this insurance company and that didn't have everything on it either.
[CUSTOMER][NEUTRAL] Mm, well, let me take a look at the account and see what was processed. You're welcome. uh, do you have like a guarantor ID number for me so that we can pull up your account?
[AGENT][NEUTRAL] So it's
[AGENT][NEUTRAL] Um, I have it here. It's 1408643021.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That's me, yes.
[CUSTOMER][NEUTRAL] OK, thank you. Let me just um try to pull up the account here real quick. Give me one second.
[AGENT][NEUTRAL] OK, and Miss [PII], does it, does, um, what it looks like this release of information, is that, is that, that sounds like what you signed and then they sent you your your records and everything. Yeah, that was the release of information.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I had to go up there in person and sign for that.
[CUSTOMER][NEUTRAL] And that's when they sent me this stack in the mail and it had all this that I'd submitted to y'all.
[CUSTOMER][NEGATIVE] Um, but it, I can't really read it the way it's written out, but I don't.
[AGENT][NEUTRAL] Oh, it's OK.
[CUSTOMER][NEUTRAL] It has the procedure number but
[AGENT][NEUTRAL] Yeah, they sent you your patient bills.
[CUSTOMER][NEUTRAL] But like I
[CUSTOMER][NEUTRAL] I've got the patient bill but I also.
[CUSTOMER][NEUTRAL] I think I've sent in a copy of this other, but we'll see what they say.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yep, um, just waiting for the system to locate an account and uh can I get your first and last name? Um, this is for the patient.
[CUSTOMER][NEUTRAL] For me, the patient?
[CUSTOMER][NEUTRAL] Yes, is that what you're saying? I'm [PII], your first and last name.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] OK. With this um guarantor number um that was provided, it's not um giving me an account here.
[AGENT][NEUTRAL] I have an account number also, but I'm looking at the explanation of charges and it says guarantor account ID. That's the number I just gave you, but I can give you the account number if you like.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Um, yeah, no worries. Um, I tried the other, um, tool here that I have and I was able to pull up an account, and, um, [PII], is it OK if I call you by your first name, um, mhm. Oh, [PII], sorry, um, can you verify your date of birth and the address that's on file?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, it's [PII] and my address is [PII].
[CUSTOMER][NEUTRAL] Thank you. Thank you so much. OK. Let me go ahead and review the account here and see what was uh requested. And um [PII], uh is it OK if I get your last name as well for documentation purposes?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] You need my full last name?
[CUSTOMER][NEUTRAL] Um, if it's OK with you, that's fine. But if you are only, um, you only need, you only want to provide the initial, that's fine as well. Um, just, this is.
[AGENT][NEUTRAL] Oh, whatever you need. My last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And um for which um date of service did you request the record?
[AGENT][NEUTRAL] So we need, we need [PII].
[AGENT][NEUTRAL] That's already been requested and then I want to speak with you about [PII], but we'll need that UBO4 for both dates.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][NEUTRAL] January, is this for [PII], do you need both hospital and physician's um bill?
[AGENT][NEUTRAL] The hospital bill is the bill that has the surgery charges and everything on it, right?
[CUSTOMER][POSITIVE] Mhm. Yes, correct.
[AGENT][NEUTRAL] OK, so just the, I was in both, just to be on the safe side, um, the physician and the hospital.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the last request I'm seeing here.
[CUSTOMER][NEUTRAL] This was in June where uh an itemized statement was requested. Um, is that correct, uh, [PII]? You requested this in June or is there another date?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Honestly don't know. I only went one time, so I guess that's the date.
[CUSTOMER][NEUTRAL] That's the one like I mentioned where I had to go over in person.
[CUSTOMER][NEUTRAL] Mm, I see. All right. So that's the request that I'm seeing here, um, on my end. Um, but I'm gonna go ahead and submit the bill for request as well so that you'll be able to receive um the one that includes the CPD code. So this is the claim that is being sent to insurances.
[CUSTOMER][NEUTRAL] And that's the copy that you need, [PII], correct?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] No, not the one with the procedure codes. I, well, it does include the procedure codes, but I need the, it needs to have the diagnosis codes, the procedure codes, all the surgeries, all everything, all the charges, um, what's being sent to her is just her patient bill showing the procedure codes, the treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. Got you. OK.
[CUSTOMER][NEUTRAL] Got it. So it's um this request, uh, aside from the procedure codes and um
[CUSTOMER][NEUTRAL] The procedure amounts. Um, this is the medical record request. This will include all of, uh, what happened during that visit. So that's the one that I'm gonna be requesting, OK?
[AGENT][NEUTRAL] Are you saying medical records or the itemized billing? because that's two different things. We don't need the records, we need the bill.
[CUSTOMER][NEUTRAL] OK. Well, for the medical records, that will include all um the charges, the diagnosis, um.
[CUSTOMER][NEUTRAL] On, on that particular visit as well as with um the cold.
[CUSTOMER][NEUTRAL] Because, um, our itemized statement, this will just include the whole charges, um, specifically, uh, on what was provided and then the amount. That's for the itemized billing.
[AGENT][NEUTRAL] OK, now I'm confused. So are you sending the UBO4 or you're sending medical records? because that's what she signed the release of information. She has all that. We need the we need the UBO4, we need your bill, the hospital bill.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] So I'll, I'll be sending the UBO for then.
[AGENT][NEUTRAL] For May.
[CUSTOMER][NEUTRAL] And not the medical records for January and May.
[AGENT][NEUTRAL] Right, we need the.
[AGENT][NEUTRAL] Yes, [PII] and [PII].
[CUSTOMER][NEUTRAL] OK. 135.
[CUSTOMER][NEUTRAL] Yes, that's correct. So I'll be sending that request. Um, it's gonna be the same um process with, um, any document that's being requested 7 to 10 days for [PII] to receive that on the address that's on file.
[AGENT][NEUTRAL] OK, and what was your name? Oh, [PII], I'm sorry, I thought I didn't write it in my notes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you're going to mail it to my address?
[CUSTOMER][NEUTRAL] Is that what you said? OK, and it's called the UVO4.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're you and just to be on, I just want clarity because I don't want her to have to keep going through this. The your your version of the UBO4 has ICD diagnosis codes, procedure codes, and all of the charges including surgery, right?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm yeah.
[CUSTOMER][NEUTRAL] Mhm. Right.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEGATIVE] OK, I just want to make sure cause she was already denied. I don't want her to go through it again.
[CUSTOMER][POSITIVE] Got you. No worries. Um, that is the request, um, that you needed uh to receive. So I have already submitted that. And, um, aside from this one, anything else or have I answered all of your questions for today?
[AGENT][NEUTRAL] Um, you answered all my questions, [PII]. Are you OK?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I think I'm good right now. Thank you.
[AGENT][POSITIVE] All right, well, thank you, [PII].
[CUSTOMER][POSITIVE] You're very much welcome.
[CUSTOMER][POSITIVE] Thank you for both of your time as well, um, [PII] and [PII]. You have a good day and both of you stay safe, all right?
[AGENT][POSITIVE] Thank you you also. Happy [PII].
[CUSTOMER][POSITIVE] Alright. Happy [PII].
[CUSTOMER][POSITIVE] Happy [PII]. Bye for now.
[AGENT][NEUTRAL] Hold on one moment, [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK. So, they're going to be sending you everything in 7 to 10 days. I think she was going to send you those medical records all over, but she got it now, I hope. So.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Good, yeah.
[CUSTOMER][POSITIVE] Oh, I'm glad you were on the phone because I would have never been able to articulate all that.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Well, anything I can do to assist, that's definitely what I'm here for. Um, and then the other two claims, I'm going to reach out to claims to get an examiner for you to talk about those two.
[CUSTOMER][NEUTRAL] OK, for
[CUSTOMER][POSITIVE] OK, great, thank you.
[AGENT][POSITIVE] You're very welcome. Before I get a claims representative, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] I don't believe so [PII] if I call back regarding this that she's sending to me, should I ask for you specifically or what would be the best route?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's up to you. I'm the only [PII] here, so whoever you speak with will be able to assist you, but if you want to speak to me, they can get you to me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great.
[AGENT][POSITIVE] OK, so hold on one moment. I'm going to get the claims examiner and thank you so much for calling APL. I hope you have a great weekend and a happy New Year.
[CUSTOMER][POSITIVE] You too thank you [PII].
[AGENT][NEUTRAL] You're very welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][NEUTRAL] I'm doing good. Um, I have an insured on the other line. Um, we've been on the phone for a little minute, but I just called their provider. They're sending in the UBO4 to her, um, but there's two claims that she has questions about her transportation and surgery benefit, and I don't, I couldn't answer it.
[CUSTOMER][NEUTRAL] OK, sure, what's the policy number?
[AGENT][NEUTRAL] It's 242-858-9.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. And it's um I'm sorry, claim number 3491561.
[AGENT][NEUTRAL] And 1570.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, hold up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1570. OK, alright, you can send her over.
[AGENT][NEUTRAL] Alright, thank you, [PII], hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] in the claims department.