AccountId: 011433970860
ContactId: 854b5b1f-6b97-4488-8e86-a86ea6950a91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 718099 ms
Total Talk Time (AGENT): 207502 ms
Total Talk Time (CUSTOMER): 201668 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/854b5b1f-6b97-4488-8e86-a86ea6950a91_20250617T15:07_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. I received um a, a, I guess it's a notice saying that they're denying my claim and they need explanation of benefits. Uh, they need the hospital bill and everything, but I sent all the hospital bills and the doctor's bills and the my United Health.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, my, um, health insurance explanation of benefits with all the claim details, so I don't understand what else could you possibly be missing.
[AGENT][NEUTRAL] Hm, OK, let's take a look at it. Do you have the claim number, policy number?
[CUSTOMER][NEUTRAL] I have a policy number. It is 01070179.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I also have a reference number. Oh, it's the same thing.
[AGENT][NEUTRAL] Mm. All right. And then if I could just verify your name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and my date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then lastly, just uh last piece of verification I need is your physical address and email, please.
[CUSTOMER][NEUTRAL] [PII] and my personal email is [PII].
[AGENT][POSITIVE] OK, thank you so much. Alright, let me.
[AGENT][NEUTRAL] Let me pull up the last claim I see here.
[AGENT][NEUTRAL] OK, it was the one.
[AGENT][NEUTRAL] OK, so I see where we're asking for the explanation of benefits. I'm just looking at everything that was submitted on there, so give me just.
[CUSTOMER][NEUTRAL] Me and [PII].
[CUSTOMER][NEGATIVE] It's really crazy too is I got another one saying that they weren't gonna accept it for an um a broken ankle that I received in September, but I never put in a claim for that, so I don't know why I'm even getting that.
[AGENT][NEUTRAL] Hm, OK.
[CUSTOMER][NEUTRAL] This is my very first claim I've ever put was for the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So, on [PII], it looks like it's the day asking for it. Were you inpatient on the [PII] as well?
[CUSTOMER][NEUTRAL] Um, I believe I went into the emergency room on the [PII], and then, um, yeah, they were waiting for a room to take me into the, into a room, and I stayed there until the [PII], I believe it was.
[AGENT][NEUTRAL] OK, I'm looking, I see the EOB for the [PII]. I'm still scrolling here to see if I see one for the [PII].
[CUSTOMER][NEUTRAL] Well, I went in in the evening through the emergency room on the [PII].
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] I think I don't remember like [PII] or something.
[CUSTOMER][NEUTRAL] And I was there for an eternity, so they might have not done anything on the [PII]. I don't remember.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, it looks like some of what you submitted in here was for, I don't know, there was some surgery from [PII] that was submitted. You had said something about that.
[CUSTOMER][NEUTRAL] Really?
[AGENT][NEUTRAL] Yeah, there was an EOB in there for that.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, so the only date I'm not seeing from United Healthcare, like the explanation of benefits is the [PII], and that's the date that they're asking for. I see the [PII], um, other dates, but that I don't unfortunately see that date. So that's why that line is asking for that, it looks like.
[AGENT][NEUTRAL] And it's the same for um
[AGENT][NEUTRAL] diagnosis codes, but did you have any sort of like out of pocket left over or did your primary cover everything?
[CUSTOMER][NEUTRAL] Um, well, I had the, yeah, I had to pay the $200 for the hospital and then I paid um.
[CUSTOMER][NEUTRAL] Some doctor's expenses.
[CUSTOMER][NEUTRAL] Out of that hold on I'll tell you, um.
[CUSTOMER][NEUTRAL] This is 1214 150 35. I paid and then I paid uh 2 1875 for digestive and liver disease that was in the hospital as well.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So it looks like what they are needing um to complete the claim is just a diagnosis code for what you were treated for. It looks like that was not included. So, if you were in the hospital, you should be able to contact the hospital and ask them for either an admin discharge summary.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Admin.
[CUSTOMER][NEUTRAL] Discharge summary OK.
[AGENT][NEUTRAL] And that would include the diagnosis. So if you can get that.
[AGENT][NEUTRAL] And then it looks like just the explanation of benefits is needed for the [PII], not for anything else.
[CUSTOMER][NEUTRAL] Oh sorry, I dropped the phone. Give me one sec because I seen something here from the claim medical services. Yeah, it's on there 12-13-2024 claim processing so you, it says that I owe 0, but it was on my paperwork that I sent. It has the date the [PII], [PII], and then [PII].
[AGENT][NEUTRAL] No, you're OK.
[AGENT][NEUTRAL] I'll scroll back through the pages and double check again here.
[CUSTOMER][NEUTRAL] It doesn't have a page number, so if I could oh I actually does this.
[CUSTOMER][NEUTRAL] I don't know, it's a single page it says 3 of 8.
[AGENT][NEUTRAL] OK, where it says provider paid $2,327.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I can circle that and forward it back to claims and have them re-review that, um, for that date and then call you back if there's something that's not there that they need, um, for that. I would still go ahead and contact the hospitals.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'm definitely gonna call the hospital yeah and send that. Can I send it to, let me see, does this have a fax number or I can send it to the email? No, that's a website where can I send it to?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] [PII] OK perfect.
[AGENT][NEUTRAL] And mark attention to claims on it and then [PII] what's a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So I will circle this information, yup, and have them look at it. And if they need anything additional, they'll give you a call, OK?
[CUSTOMER][POSITIVE] OK great thank you.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome bye bye.