AccountId: 011433970860
ContactId: 7889fee1-86a4-45a2-bdba-5be20bfb698e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 645070 ms
Total Talk Time (AGENT): 381988 ms
Total Talk Time (CUSTOMER): 272625 ms
Interruptions: 8
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/7889fee1-86a4-45a2-bdba-5be20bfb698e_20250114T18:47_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII]. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] I'm fine thank you but I have an insured on the line that um I think this claim was just processed incorrectly but instead of creating a hub ticket she had called to see if we received the claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But it looks like we put the wrong date.
[CUSTOMER][NEUTRAL] In and we told her that we had already paid the provider.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But anyhow, um, it's on policy 188.
[CUSTOMER][NEUTRAL] 856-0 for Miss [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's the most recent received claim is 355-0282.
[AGENT][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] But the data service that's on that EOB that I looked at has the year is 23.
[AGENT][NEUTRAL] Let me pull it up.
[CUSTOMER][NEUTRAL] All of her claims information has 24, which is what she says is correct, but the denial remark says that we have paid the provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 55 or 24.
[AGENT][NEUTRAL] OK. Do we have a claim out here for 55 or 23 that did go to the provider?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] No, I didn't see that.
[CUSTOMER][NEUTRAL] Uh, uh.
[AGENT][NEUTRAL] OK, let's see. OK.
[CUSTOMER][NEUTRAL] And let's say this policy, yeah, let's see, hold on.
[CUSTOMER][NEUTRAL] Yes, so that, I mean, I don't know the bill amount is not the same. I mean the.
[AGENT][POSITIVE] OK, great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The, you know, the codes look the same, but as far as
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me look. I'm just.
[CUSTOMER][NEUTRAL] But that again is for 23. She says that
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the informa and I did look at the documents that she submitted.
[AGENT][NEUTRAL] What, what date or what page of her documents so, you know, it takes forever to get through this stuff so I can just look.
[CUSTOMER][NEUTRAL] Sure does.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] Oh it's not the softest.
[AGENT][NEUTRAL] Cause I'm looking at like a collision report.
[CUSTOMER][NEUTRAL] For, say what the, but what is, it says
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] Let me pull it up by the mail number because the claim number is.
[CUSTOMER][NEUTRAL] Per the information I was looking at.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That she submitted on that.
[CUSTOMER][NEUTRAL] Claim number
[CUSTOMER][NEUTRAL] Most recently processed. Oh, hold on. I have too many screens. There's no way we have to do things. I got too many.
[AGENT][NEUTRAL] The 282? OK, let me pull by the.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] 282-108-25105. Let me pull it up.
[CUSTOMER][NEUTRAL] Yes, yes. OK.
[CUSTOMER][NEUTRAL] Right, that claim number, the documents that are attached to it in on base.
[AGENT][NEUTRAL] About the mail number.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Has the data services 24.
[AGENT][NEUTRAL] OK. So where, where are you seeing it? Because it looks, this, what I'm looking at, I pulled by the mail number.
[CUSTOMER][NEUTRAL] Which is.
[CUSTOMER][NEUTRAL] I don't know about that male number.
[AGENT][NEUTRAL] Yeah, it's the same cause sometimes it's, it's different.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's like 219 pages.
[AGENT][NEUTRAL] Um, let me see. Yes, 19 pages. Uh, now I see she has dates in the hospital 55-24 to 5556. Is that what you're looking at, date of accident?
[CUSTOMER][POSITIVE] Yeah, the clean sheet
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And the police, right, but this, mhm.
[AGENT][NEUTRAL] And then like the um the.
[AGENT][NEGATIVE] The traffic report or the police. OK, so we really should have denied this.
[CUSTOMER][NEUTRAL] But I don't know again what we processed it was for for [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And saying we pay the provider and I don't.
[AGENT][NEUTRAL] Let me highlight it.
[CUSTOMER][NEUTRAL] I mean this, you know, it's not even for the same amount it's that facility claim that is in there for the same for [PII].
[AGENT][NEUTRAL] Yeah, I mean, it's not even enough information to say pay to the provider. I mean, it's just the.
[CUSTOMER][NEUTRAL] And the build out, I mean, anyway, so I.
[AGENT][NEGATIVE] Yeah, she just sent, it should have been denied for, yeah, I mean, I guess I can just tell her it's gonna be reprocessed because it really should have been denied for correct information. She only sent the.
[CUSTOMER][NEUTRAL] That's why I'm transferring her.
[AGENT][NEUTRAL] A traffic report, like there's no, I don't see an EOB.
[CUSTOMER][NEGATIVE] On base is terrible.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] I don't show we got an ELB. I show she sent the claim and then she sent like the police report of the accident, but it's not a medical bill.
[AGENT][NEUTRAL] It's a collision report.
[AGENT][NEGATIVE] Which we would have denied for the ELB, the itemized bill and the uh.
[AGENT][NEUTRAL] Yeah, the ELB the itemized bill and the diagnosis code, like, yeah, so you can send her over. It was just.
[CUSTOMER][NEGATIVE] And the dates wrong.
[AGENT][NEGATIVE] Yeah, it's not. Yeah, the dates wrong and I, yeah, even she shouldn't even look at, even if it was the same date, it still should have been denied for information cause this is not, there's nothing that on what she sent that matches.
[CUSTOMER][NEGATIVE] There's a lot of stuff wrong.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. 40. OK. I don't know either. I don't know, but it blew, it blew my hair back. But anyway.
[AGENT][NEUTRAL] The claim we paid. So, yeah, I don't know.
[AGENT][NEUTRAL] OK, yeah, you can, uh, where is she getting that charge for?
[CUSTOMER][POSITIVE] OK, but she's fully verified and she's very nice, Miss, she's very nice, [PII], and the phone number in line, which is also the one I believe that's on the screen. Let me pull that up. Yes, that would be the number to call her back on.
[AGENT][NEUTRAL] OK, OK, you can send her over.
[CUSTOMER][POSITIVE] OK, thank you so much. Have a great afternoon, OK? All right. Bye-bye.
[AGENT][POSITIVE] Thank you. You too.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Thank you for calling uh American Public Life. Am I speaking with Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, this is [PII] in the claims department and uh [PII] and I did go over your documents and I show the denial that you received. Um, it looks like the claim was processed incorrectly, of course, because the dates are different. Um, so what I'll have to do is send the claim back through for reprocessing for it to be corrected.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the correct date put in um.
[AGENT][NEUTRAL] On this particular charge.
[CUSTOMER][NEUTRAL] OK, let me ask you something. Is there
[CUSTOMER][NEUTRAL] Do I have to until I hear from them I don't have to send in any kind of other documents.
[AGENT][NEUTRAL] Well, it looks like me, what I'm looking at, we will request additional documents. That's actually how the claim should have been processed. We should have um requested the itemized bill, the diagnosis code, and the explanation of benefits from your primary for this data service. So,
[CUSTOMER][NEUTRAL] OK, so yeah, that's, that's, uh, that's in another, uh, state.
[CUSTOMER][NEUTRAL] So I'm going there this weekend, going back home this weekend, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, this information can be, uh, even if you're not there, that's information you can, uh, either get online. Have you received a bill from the hospital for these charges?
[CUSTOMER][NEUTRAL] So what I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. So what you can do is uh send the, uh, like, you should have, uh, it looks like this is an emergency room. It started as an emergency room visit. When you were uh discharged from the hospital, they should have given you an admin summary.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it's just like a breakdown showing you came into the emergency room for a car accident. So it should in there, uh, have a description of your injury. Uh, did you receive a discharge summary when you left the hospital?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You should have received some paperwork. So what you can do is submit the discharge summary and then the explanation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] of that would come from you.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I think uh.
[AGENT][NEUTRAL] You still have UnitedHealthcare?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, until the end of this month.
[AGENT][NEUTRAL] OK. So, UnitedHealthcare should have processed the same emergency room, emergency room charges, you know, you get a statement after you've seen the doctor.
[CUSTOMER][NEUTRAL] Yeah, I got all that. What I'm, uh, one is the reimbursement of the uh.
[CUSTOMER][NEUTRAL] I think that's the doctor's fee.
[AGENT][NEUTRAL] OK. So whatever the fees are that you're requesting um reimbursement from, we need the explanation of benefits to match uh those doctors charges because we look at the EOB and what it says you owe, and that is what we uh will pay to you. So we will need the matching explanation of benefits uh for the doctor's visit and then the discharge summary for your emergency room visit.
[CUSTOMER][NEUTRAL] OK, that's all you just all I need to see you is the.
[CUSTOMER][NEUTRAL] Doctor see and what you done in the ER.
[AGENT][NEUTRAL] We need the discharge summary, admitting discharge summary from your hospital visit, and then the explanation of benefits from UnitedHealthcare for those charges.
[CUSTOMER][NEUTRAL] Let me, let me this uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And I'll have uh the claim reprocessed, so you will get a statement that tells you exactly what's needed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, ma'am, because I, they said if they paid in [PII] and I said how can you pay something in [PII] for something that happened in [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it looks like they, um, the examiner put the wrong date. Uh, it looks like you did have a hospital bill for [PII].
[AGENT][NEUTRAL] Uh, and so because they looked at the wrong date, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They um
[AGENT][NEUTRAL] You know, said that we paid the hospital, but I, again, I will, uh, have them reprocess the claim and you'll receive another statement with the correct uh information requested.
[CUSTOMER][NEUTRAL] Oh, OK, uh, and what's your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] OK [PII], thank you so much, [PII].
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] OK, thank you so much. Bye-bye.