AccountId: 011433970860
ContactId: 95cf05da-0bb2-4fd8-aaef-7c85b78bca9a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1728260 ms
Total Talk Time (AGENT): 883892 ms
Total Talk Time (CUSTOMER): 830644 ms
Interruptions: 8
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/95cf05da-0bb2-4fd8-aaef-7c85b78bca9a_20250403T20:22_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, [PII], um, my name is [PII] Um my guess is the place you'll probably want to start out is my uh policy and group number.
[AGENT][NEUTRAL] Yes, please, um, and your, your number, please?
[CUSTOMER][NEUTRAL] Sure, my, my policy slash cert number is 021-917-46.
[AGENT][NEUTRAL] Thank you. And if I could just verify your date of birth, sir, and the phone number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I'm not sure what phone number you have listed for the phone number. My personal number is [PII].
[AGENT][NEUTRAL] OK, yes, sir. How may I help you?
[CUSTOMER][NEUTRAL] So, um, just out of curiosity, so, um, my, my understanding was that, um, the way that our coverage is set up is so through UnitedHealthcare I have a, uh, $5000 deductible. Um, my understanding was, is that what your company does is that you take over a big chunk of that deductible and brings my deductible down to a grand.
[CUSTOMER][NEUTRAL] Um, so I'm just curious, I, I'm trying to figure out how it is that I have, I don't know, $1300 worth of billing that's due to me, um, when, when I, I, I certainly understand having a deductible. I'm just trying to understand how it is that, um.
[CUSTOMER][NEGATIVE] Like, in other words, I feel like I'm, I'm gonna be asked to be paid more out of pocket than what I should be, and so I have roughly $330 from SSM that's been billed to me and $980 from Saint Louis Hospital that's been billed to me and like I said, I'm trying to to figure out why those two things don't end up add up to somewhere closer to $1000.
[AGENT][NEUTRAL] OK, yes, sir. Let me just see what we have here.
[AGENT][NEUTRAL] And is there any particular um uh data service that I should look for?
[AGENT][NEUTRAL] This or
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] The date of service for the SSMs I believe was in [PII].
[CUSTOMER][NEUTRAL] And the uh.
[CUSTOMER][NEUTRAL] Uh, from, um, Saint Louis or from, uh, it'll either be through Saint Luke's Hospital or Premier, uh.
[CUSTOMER][NEUTRAL] Premier pain consultants would have been in [PII].
[AGENT][NEUTRAL] March. OK, thank you. Let me just see what we have here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry that I wish I could give you more exact dates, but I don't have my my billings pulled up in front of me. I apologize.
[AGENT][NEUTRAL] No, no, that's.
[AGENT][POSITIVE] No, no, that's quite all right. Thank you very much. Let's see what we have here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And like I said it's possible that I just have a misunderstanding of of the way that things work but um that's why I'm making a call. I'm not upset one way or the other I'm just wanting to.
[CUSTOMER][NEUTRAL] You know, um, and plus I have an $80.
[CUSTOMER][NEUTRAL] An $80 bill from Ernst radiology.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see if I I'll have the service actually the service for that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, that was last year. So, well, yeah, that was still, that was last year of [PII].
[AGENT][NEUTRAL] OK. Well, I think, uh, first of all, let's go over your benefits. Um, it seems like all of these, uh, that I was that I saw were for outpatient services. Does that sound correct, sir? I mean, it's not an inpatient service or outpatient?
[CUSTOMER][NEUTRAL] Yes, the SSM, the SSM bill was, the SSM bill was for physical therapy.
[CUSTOMER][NEUTRAL] And um the other service was a uh a steroid was a steroid injection.
[AGENT][NEUTRAL] Of course. OK. Absolutely. So, um, and I do see all those facility bills. So, uh, first of all, um, your policy has, uh, for outpatient services for each individual. We'll pick up the deductible, co-payment, or co-insurance up to $6500. Now, with this policy, with this policy, you have a $1000 deductible.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] That now it does look like you have met that so beginning on let me see what we have here, there was a facility bill for [PII], um, that we actually paid so you you have met your deductible for [PII], um, so from this point forward, uh, we, we're going to go on and, and, uh, um, pay the, the bills that uh that you know, like this, this uh facility bill.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I'm, if you're doing, um, physical therapy, I I understand, so you probably have more of that perhaps or?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Oh yeah, so, um, I had physical therapy, so I, I, I'm sorry, I found my bill. So, um I had physical therapy on 120, 127.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 203-26213 220 and 227.
[AGENT][NEUTRAL] Absolutely. OK, so I see where each one of those bills, uh, were, were submitted, and, um, with each one of them, uh, the $156 benefit went towards your deductible. Now with the [PII] bill, you, you have now met that $1000 deductible. So from this point forward, um, any of the, uh, the, the claims, uh, we, we'll just for, for SSM uh select rehab.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] When they submit more of those to us, um, and they have that $156 benefit, uh, we will just go ahead and pay it towards the hospital. So that is what has happened, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, um, OK, I'm gonna ignore the $80.01. So do you, so the, the.
[CUSTOMER][NEUTRAL] So, but again, so 9, what is it? 990.
[CUSTOMER][NEUTRAL] Or $928 or whatever it's, it's roughly $900 that that that um that there that my portion is being asked to pay for. I understand that I have a $1000 deductible. How does 9 and 3 and 3 equal $1000? That's $12 and change.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Hm, well, let's, let me go, let's just go over all the bills for [PII]. Absolutely. So let's, let me tell you what I've got.
[CUSTOMER][NEUTRAL] See what, see what I'm saying?
[CUSTOMER][NEGATIVE] And, and I don't, and, and I don't mean to be a jackass about $200 but like, you know, like $200 is, is quite a bit of money to me.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] $200 right. Absolutely. Sure, I, I do completely understand that. So let's just see what we've got here because I think there's one thing here, um, that, uh, so we're, these are all facility bills, so let's just look at the facility bills and see what's going on with us. Now there's one of them that didn't show a deductible, co-payment or co-insurance and I'm wondering whether that's the one that we need to look at. So we're gonna start off with the very first one.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one of them that I already paid was for 3 was for, um, I don't know it was around $300 like $286 or something like that um because I was told that um.
[AGENT][NEUTRAL] And uh
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I had to get anesthesia.
[CUSTOMER][NEUTRAL] Um, and because they, they, they did the steroid injection through my neck. And so, um, they recommended that I do anesthesia and I was told that SSM does not or that my, um my regular insurance does not cover the the.
[CUSTOMER][NEUTRAL] That they do not cover anesthesia and so like I'm not so much concerned about that particular payment unless you guys are gonna accept it as things that my insurance wouldn't pay um.
[AGENT][NEGATIVE] So that when you say that they wouldn't accept, what, what do you mean that they wouldn't accept it? I, I'm not, I don't, um, you mean they, they didn't.
[CUSTOMER][NEUTRAL] Uh, my, my.
[AGENT][NEUTRAL] They said that there was no.
[CUSTOMER][NEGATIVE] They won't pay for it.
[AGENT][NEUTRAL] Oh, so they're saying that it's, that there's they're denying it. Is that, is that what I understand you're just saying? Oh, OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right, that they were denying the anesthesia. Correct. But, but
[AGENT][NEUTRAL] Is, oh, OK, I understand.
[CUSTOMER][NEGATIVE] Yeah, so I told them I I what I told them there at the thing is like go ahead and turn it in because I'm still paying that out of pocket and I didn't know how it was gonna apply, um.
[CUSTOMER][NEUTRAL] And so anyway, that that that I think is it and I don't remember the exact amount I I can um I can look it up but um.
[CUSTOMER][NEUTRAL] You know, so I have, I have a remaining bill.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] From Saint Luke's Hospital of 9 $40.70.
[CUSTOMER][NEUTRAL] That was sent to me saying that I owe plus this bill from SSM which is $312 so $940 plus 312.
[AGENT][NEUTRAL] Well, let's, let's see what they've turned into us. Let's let's go. I think that'll probably be the way that we can, OK, so let's go over what they, what they've done with, with us now, um, there is one claim that we're going to, that we are going to revisit. I'm gonna send it back to the examiner to look at for, uh, for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2025, um, now that should have gone towards your deductible, it didn't. So I'm going, I think we can probably pay this one. So that, that's $156. So let's just say that and now that we've met our deductible, we can probably uh look at this and probably pay it. So we have um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that was uh [PII].
[CUSTOMER][NEUTRAL] Oh, of [PII], the [PII] that I owe.
[AGENT][NEUTRAL] Yes, yeah. So let me, let me go ahead and, and, uh, um, before you pay that, sir, if you could let me uh send this back cause I think we can probably pay that. So, um, let's just, if you don't mind, I do apologize, but let's just see if we can get that one fixed. Um, now, there's another one, yeah. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, and, and
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the, the, the, the next bill that we received, get off of that. The next bill that we have is uh is uh [PII]. Um, this, uh, so that was um a $156 that went towards your, uh, deductible. So there's that one. The next one, yeah, the next one we have is [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And uh that went towards your deductible, so I think.
[CUSTOMER][NEUTRAL] Right, which I, which I haven't been, which I haven't been billed for yet.
[AGENT][NEUTRAL] Ah, I see. OK, well, that's, that's OK. They send it to us, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, [PII], that's another one.
[AGENT][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And do you see, let's see, do you have, let me see what else we have, uh.
[AGENT][POSITIVE] Oh goodness, OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII], these will all be $156.
[AGENT][NEUTRAL] Absolutely. So you know something, I think, uh, I think the problem that we have is with this [PII]. Um, so what we're going to do.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] We're gonna go back and we're gonna see if we can't get that fixed so that it can be paid. So I think that was an error on our part.
[AGENT][NEUTRAL] Let me just see, uh, Mr. [PII]. Excuse me.
[CUSTOMER][NEUTRAL] OK, can I ask, can I ask you a question? So, uh, um.
[AGENT][POSITIVE] Yeah, sure, absolutely.
[CUSTOMER][NEUTRAL] OK, again you have to do, you have to do so even if we take off that $156 OK, that still leaves me almost $100 over my deductible if I pay if I pay the bills that I have in hand.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, well, I'm just, yeah, that's what, that's why I think we need to go over each one of these facility bills because I think, um, you may have bills that we haven't, that we haven't, uh, looked at yet so let's what I wanted to do if we if we could serve if we could go over them so let me just get this out of the way first, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] If you are willing, I tell you what, I've, I've never called it, it, it always, and this is not you, and it's not your fault. I have yet to call an insurance company or a thing where they didn't completely give me a runaround. So if the fact that you're actually willing to help me and look into this thing, I will sit here until doomsday with you.
[AGENT][NEUTRAL] OK, that's great. That's, that's, well, I hope it doesn't take that long, but let's just look and see what we've got here, because I think there's, because, see, I'm showing that we've, that we've made that $1000 and, and I just, I'm, I'm thinking that there might be a bill that we haven't we haven't looked at yet. So let's just look at this. We're gonna look at the [PII] as though it's gonna be paid, OK, because we're just gonna, we're gonna reprocess that one. I think that was an error.
[CUSTOMER][NEUTRAL] OK. So, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, so, so [PII], now these are all facility bills, Mr. [PII], we have received. Um, I think it's possible that you may have received bills that we haven't gotten. So let's just go over this. [PII], [PII]. These are all $156 mind you. Um, uh, [PII], [PII], um, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, where else am I again? [PII].
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Now on [PII], you made your, um, you, uh, the, the $1000 was met and then we actually went out and, and we were able to pay something on that one. Now what are you, these are all facility bills, OK, so these are all facility bills.
[CUSTOMER][NEUTRAL] Yeah, they're they're physical they're physical therapy appointments.
[AGENT][NEUTRAL] What have you, do you, do you have something there that we have not received yet? Is that, is this um.
[AGENT][NEUTRAL] Do you have a bill then?
[CUSTOMER][NEUTRAL] I, I have a bill from Saint Luke from Saint Luke's Hospital from [PII] for $940.70.
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] That's what I don't have. OK, so let's just say that that they're going to send it to us. This is hypothetical. Let's say that they're going to send it to us. You have now met your deductibles, so we don't have a problem with that anymore. So nothing else is going to be put towards your deductible, um, obviously. So at this point, we're going to be paying that $6500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, when, when did I meet my deductible?
[AGENT][NEUTRAL] Yes, sir. Let's see what we have here.
[AGENT][NEUTRAL] 9746. OK, so you met your deductible that was on the uh [PII]. Let me see what here uh now we received it with the actual claim. Now see, remember that I'm gonna receive your your claims at a different date. So for the, for the date of service [PII] I received your claim.
[CUSTOMER][NEUTRAL] Sure, no, I understand.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] On [PII], and we processed it on [PII], and on that date with us, you met your deductible and we were actually able to pay something else. Now, um,
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when we get the February, February, what was that? What did you say that was February the?
[AGENT][NEUTRAL] What date of service do you have, sir, that February, what date?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] [PII], excuse me, [PII], [PII]. So when we get the [PII] bill from the hospital?
[CUSTOMER][NEUTRAL] Well that that's when that's when the statement was generated. Let me see if I can find out when the service was actually completed.
[AGENT][NEUTRAL] Yes, yeah, that's the one that we need to look at is the the actual service date.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, great. Well then we haven't received that one yet, so that's wonderful, um, because hang on just a second. I've, I've got something for you and, and, yeah, OK, so that's wonderful. So that's, that's great. So when we get that one, we will be in good shape. We will be able to um uh pay that, um, and I think that's the bill that you've gotten that we haven't gotten yet. So, so here's, here's what, here's what we have found out the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bill, I think probably should have been paid, so we're gonna look at that one again uh we're sending that one back to be reviewed, uh, the January the, the, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well, all I've actually received, so all I have received payment for or or or received a bill for for all those those those dates, they're all close together in January and February, um, I've only received a bill from them for the $300 for the for $312 for the 1st 2 for the [PII] and the [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I show at least for right now I show no patient response I show no patient balance for any of the rest of those services.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, which is fine because probably because you just like you haven't processed it and told them that you're not paying them yet on those services or something along those lines.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And you and and I I'm just, I'm just verifying like I said, the only thing that I have received in the mail from, from, from those from SSM is a bill for $312.
[CUSTOMER][NEUTRAL] It shows all these other descriptions on here.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Like it shows the exact date that you're talking about, but it does not show any patient balance to me whatsoever.
[AGENT][NEUTRAL] OK, OK. So.
[CUSTOMER][NEGATIVE] Which that I don't understand because if you're telling me that I gotta pay those to make the to to pay the deductible, you know what I mean, my deductible, that's fine. I mean, I'll, I don't like from my point of view, I don't care whether I pay SSM or whether I pay Saint Luke's. I don't care who I pay as long as my my amount is what it's supposed to be, right? OK, oh.
[AGENT][NEUTRAL] Right, yes.
[CUSTOMER][NEUTRAL] OK, so from my understanding of what you're telling me, um.
[CUSTOMER][NEGATIVE] I'm going to go ahead and pay since you're telling me that I, these first two charges from the [PII] and the [PII], that 156, I need to pay that to go to my deductible.
[AGENT][NEUTRAL] Well, um, no, because, um, so what we did was, uh, uh, the, the DOVs are a little bit confusing. It's UnitedHealthcare. Um, so, uh, in the remark code, it's saying that it's, that it wasn't a, a global, um, that it wasn't, uh, performed within a global period of service, but the actual deductibles at $156. So what I'm gonna do now is I'm gonna have this reprocessed so that we
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Pay it so let me see if we can't, if we can't do that sir, and, and let's see if we can't get that one out of the way because I, I believe that this is an error um that's, that is what I'm concerned about is I believe that this was processed in error.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And that was [PII].
[CUSTOMER][NEUTRAL] When is it showing that I met my when is it showing that I met my deductibles with you?
[AGENT][NEUTRAL] Uh, that was the day the serve. Let me see if I can go back to that. That was the.
[AGENT][NEUTRAL] I think it was the one where we received it in March, um.
[AGENT][NEUTRAL] Let's see. So you met your deductible with me, or, excuse me, with APL now.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The date, the date of service, the date of service.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Was [PII], the date that I received your claim.
[AGENT][NEUTRAL] Was [PII], but we're we always need to look at the date of service rather than the date that that I receive it. So the, the date of service [PII] is the one that's uh going to be revisited and I believe we can get that paid. So I'm just going to see if that can't possibly happen here um because I, I think that an error was made on that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, do, do I run.
[CUSTOMER][NEUTRAL] OK, is my deductible with you on a 12 month or an 18 month cycle?
[AGENT][NEUTRAL] Uh, let's see, your deductible, uh, uh, actually, it's gonna be the same as your benefits. So your, your, um,
[AGENT][NEUTRAL] Uh, it's a calendar year, so we've met the calendar year deductible, so we, we don't need to worry about that again for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, right, but that, that, that service that I did on the [PII] was the only service that it was the only, as far as I know, was the only medical thing that I've been billed for in in [PII]. Like that was the first time I saw a doctor in [PII].
[AGENT][NEUTRAL] Well, that's weird because they, they send us stuff for all these other dates of service, the [PII], the [PII] the [PII] the [PII] the [PII], yeah.
[CUSTOMER][NEUTRAL] I believe.
[CUSTOMER][NEUTRAL] Yeah, right, yeah, yes, but the, the, the, the [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Was that was the first, that was the first time that I had seen a doctor, but you're telling me that that was when I met my deductible.
[AGENT][NEUTRAL] Uh, no, what I'm telling you is that, um, is that when we received it, uh, we thought that the EOB said that there, that there wasn't a deductible co-payment or co-insurance, so.
[AGENT][NEGATIVE] That was an error on our part.
[AGENT][NEUTRAL] There what it looks like there is actually a deductible co-payment of that $156. Um, that's why I was saying that the explanation of benefits is, is very difficult to read. Um, so what we did was, I believe that we, we misread that. So in the normal course of events, um, what I, what I'm saying is that nor in the normal course of events, had this been processed properly, we would have put that $156 towards your deductible and you would have met your deductible with us sooner.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I understand and I'm not.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] But because of this one error,
[CUSTOMER][NEUTRAL] OK, like, in other words, I would have, I would have met my deductible with you on the on with my [PII] visit.
[AGENT][POSITIVE] Very likely, yes. Very likely, yes, absolutely.
[CUSTOMER][NEUTRAL] Had all this been processed correctly, OK, so that.
[AGENT][NEUTRAL] Yes, this one claim, this one claim, and that's why we're revisiting it.
[AGENT][NEUTRAL] So let's just see here, um, it is $156 so what we'll do is we'll go ahead and and pay that to the to the um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, to the hospital. Now, you're telling me, sir, that you have received a bill for that amount? Am I correct in saying that?
[CUSTOMER][NEUTRAL] So what I have sitting in front of me, I, I have, I have received, um, I have, I have received, uh, two bills. This bill was sent out to me.
[AGENT][NEUTRAL] For $156.
[CUSTOMER][NEUTRAL] On was mailed to me on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For amount of $312 which shows the uh which according to this is the patient balance from the [PII] and [PII] visits.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Now the the the [PII], like all of those other facility fees from SSM on this statement that I have in my hand are telling me that they're still in process.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, what I have done, uh, what, what's gonna happen is that we will go ahead and pay that $156 for [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] On [PII], um, all of that went towards your deductible and we can't do anything about that. Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so why did, why did it? OK, all right.
[CUSTOMER][NEUTRAL] No, I mean, like from what I under from from basically what I, so how many of these are how many of these facilitate 12345678.
[AGENT][NEUTRAL] Uh, there's 1234567. Yeah, there's 8 of them. Yes.
[CUSTOMER][NEUTRAL] OK, so that, that total amount when you take $156 and multiply it times 8 is $1,248.
[AGENT][NEUTRAL] Um, that time, uh, now remember that [PII] wasn't paid, so let's go to [PII]. Let's go to [PII] we're starting on [PII].
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] So that's
[CUSTOMER][NEUTRAL] OK, what
[CUSTOMER][NEUTRAL] What do you mean [PII] wasn't, I don't, what do you pay by whom on [PII]?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so the claim that you that we received a claim for [PII], that's the very first claim that we received for for 20, OK, so when.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEGATIVE] Right, and you did not pay on that. You should not have.
[AGENT][NEUTRAL] We did not pay that. Well, actually, um,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Under nor had it been, had this been processed correctly, that money would have gone towards your deductible, but, but it didn't. So now, so now we are reprocessing it, and you have already met your deductible. So I can't put it towards your deductible now because you've already met your deductible.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So now, yeah.
[CUSTOMER][NEGATIVE] But ma'am, I haven't, I, I, I don't understand. I haven't made any payments to any of these people to have met, oh, OK, cool, I.
[AGENT][NEUTRAL] You, yeah, so, so.
[AGENT][NEUTRAL] Yeah, see they, they send in that you, you haven't made any payments, um.
[AGENT][NEUTRAL] But the what would normally be a benefit.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] It is confusing. I, I understand. Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] If, if I, in order for me to pay my deductible, I have to pay somebody. I have to write a check to somebody. I have to give them a credit card. I have to pay them like you're not like that's what I don't understand is how it is that I've met my deductible without actually having paid anybody in the year of [PII].
[AGENT][NEUTRAL] Ah.
[AGENT][NEUTRAL] OK, OK. So, um, yes, I think I can explain that.
[AGENT][NEUTRAL] So let's just say uh we're gonna go.
[CUSTOMER][NEUTRAL] OK, and if you're telling me I don't have to pay somebody and you're going to like I'm all over that, but.
[AGENT][NEUTRAL] OK, so yes, absolutely. So, um, so here's, here's what we're, what, um, let me see if I can if I can get this, um.
[AGENT][NEUTRAL] So as your secondary insurance, as your as your secondary insurance, what we do is we pay it, so you, you pay us each month and what we will do, what we will do is that we will pay um it towards your deductible so my guess is what it what it is is that um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] We've put those uh that $156 all those months, we've put it towards your deductible with us, but my guess, my guess is that um SSM select rehab.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Has just not gotten around to billing you yet for those amounts. So eventually,
[CUSTOMER][NEUTRAL] Right, so like I actually owe, I actually owe SSM for that for that bill on the [PII] and [PII]. OK, now, which is fine like I'm OK with doing that and I realized that they haven't billed all of it to me yet um.
[AGENT][NEUTRAL] Eventually, yeah.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, so I just need to, what I need to do is be patient until you guys pro I now I know what to pay. I think I know what to pay um I am going to.
[CUSTOMER][NEUTRAL] Um, I'm going to recon I'm gonna contact the billing department at Saint Luke's Hospital and make sure that they sent that state that bill to you, and I'm gonna pay the $312 that I currently owe to SSM and I'm gonna deal with the rest of it when I get my next bill from SSM or when I get another bill from Saint Luke's Hospital.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, sir. Yes, sir. And, and um if you do end up calling us again for anything, I went ahead and put notes in here so that they, if they have any questions. But um do, do you have any more questions about, you know, it's.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, because somewhere.
[CUSTOMER][NEUTRAL] Yeah, because by the time that I pay all these SSM bills like through, let's call it through the through the 1st 6 of them.
[CUSTOMER][NEGATIVE] That'll pay my $1000 deductible and then after that you guys will pay the $1156 that I'm gonna get billed for the [PII] and the $156 that I'm gonna get billed for the [PII] and the $900 and something dollars that I'm getting billed from Saint Luke's Hospital. You guys are gonna be the ones to pay those things because I will have met my, uh, deductible.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] OK cool uh I know you, you sound a little more confused. I, I, you have answered my questions without knowing that you answered my questions. I have a better understanding of what is happening um I'm getting billed because they wanna get paid sooner or later and it just hasn't been processed through you guys yet that is what is taking place, um.
[AGENT][NEGATIVE] It is, it becomes confusing.
[CUSTOMER][NEUTRAL] And, and it answers my question of whether I should pay that bill to Saint Luke's Hospital or not, which I should not, so, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm sorry, I'm very excited.
[AGENT][POSITIVE] Oh, OK, good.
[CUSTOMER][NEUTRAL] Because my insurance
[CUSTOMER][MIXED] No, well, you guys are doing what you're supposed to be doing and I and I appreciate that it's just taking a little while for everything to get processed so um.
[CUSTOMER][POSITIVE] Thank you very, very much for your help. And um yeah, if you can get.
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][POSITIVE] Yep, thank you very much. I'm gonna let you go.
[AGENT][NEUTRAL] OK, well, there's anything else, um, Mr. [PII] that you need, please just let us know.
[AGENT][NEUTRAL] OK, otherwise,
[CUSTOMER][POSITIVE] I will, you've been more than helpful. Thank you very much.
[AGENT][POSITIVE] All right, thank you for contacting AP have a good.