AccountId: 011433970860
ContactId: 96a75a0a-c73d-4aef-aaca-b3a084caf0f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2055610 ms
Total Talk Time (AGENT): 994366 ms
Total Talk Time (CUSTOMER): 642118 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/96a75a0a-c73d-4aef-aaca-b3a084caf0f4_20250122T19:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I need you to explain to me what I need to do about these bills I sent in.
[AGENT][NEUTRAL] OK, you have
[CUSTOMER][NEUTRAL] They're uh they.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It says that the hospital bills that I that's what I think is the hospital bills.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On two separate claims.
[AGENT][NEUTRAL] OK. So you are the insured and you're wanting to check on a couple of claims that have been filed with APL for yourself, is that correct?
[CUSTOMER][NEGATIVE] No, you sent me two things and you wouldn't pay you nothing or something and I just don't understand what I need to do to have it done.
[CUSTOMER][NEUTRAL] I mean, uh
[AGENT][NEUTRAL] OK. So you need, you're wanting to.
[CUSTOMER][NEUTRAL] But it starts off.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Yes, so go ahead.
[CUSTOMER][NEUTRAL] It starts off with the same people on the same thing on both of the claim things I got but it's got two different claim numbers on the bills.
[CUSTOMER][NEUTRAL] But it's got the same, it's got two different charges where it says total bill charge.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] And it's got two different charges on this. One of them is why I went into the hospital and I stayed for uh in September 5 days and then I went into the hospital again. I'm an outpatient and had no surgery. I had to have reconstruction, no surgery from where I messed it up during my first day in the hospital.
[AGENT][NEUTRAL] OK, so we, you're wanting to understand why the claims were denied, is that correct?
[CUSTOMER][NEUTRAL] Well, yeah, I guess they're denying them but uh.
[AGENT][NEUTRAL] Yes, so well what I'll need to do, OK, so to further assist you with this, first off, I'll need to get your policy information pulled up and verify some things with you for security and then we can take a look at those, OK? I can help you.
[CUSTOMER][NEUTRAL] It's one thing here.
[AGENT][NEUTRAL] So who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And Mr. [PII], what's a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] OK, that's what I'm trying to find it now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I've got it here just.
[AGENT][NEUTRAL] OK, yeah, you're fine.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] It's got a policy is 018.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 26681.
[AGENT][NEUTRAL] 26681. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, thank you. One moment please.
[AGENT][NEUTRAL] OK, so first off, Mr. [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. So first, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have on file for you is the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And lastly, your email address, please.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] All right, thank you so much. So one moment.
[AGENT][NEUTRAL] OK, and did you say, did I understand you to say, Mr. [PII] that you have the claim numbers that you were calling about?
[CUSTOMER][NEUTRAL] Yeah, I got the claim numbers here on.
[CUSTOMER][NEUTRAL] Uh, the papers that y'all got today.
[AGENT][NEUTRAL] OK, you can give me the first one.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It's 355.
[CUSTOMER][NEUTRAL] 2183
[AGENT][NEUTRAL] Alright, one moment please.
[AGENT][NEUTRAL] Is this for Atrium Health Laboratory for [PII]? Is that the date of service?
[CUSTOMER][NEUTRAL] OK, that's the nose sir that's why I had nose surgery now in the hospital.
[AGENT][NEUTRAL] OK, so that claim number that you gave me is the provider is called Atrium Health Laboratory.
[AGENT][NEUTRAL] So let me look to see.
[AGENT][NEUTRAL] OK, so on this, and you should be able to see these remarks.
[AGENT][NEUTRAL] Mr. [PII], on your, I can see you are set up in our portal in the online service center where you can log in but you have your explanation of benefits, right? For this claim number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I get
[AGENT][NEUTRAL] On the 2nd page, it has all of the remarks for each of those codes.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] And several of those were denied because charges incurred in an independent lab are not covered.
[CUSTOMER][NEUTRAL] I know that I just sent the hospital bill.
[AGENT][NEUTRAL] Uh, OK.
[CUSTOMER][NEGATIVE] It says on that one that hospital bill is not being sent in to show what hospital paid it all but so much.
[CUSTOMER][NEGATIVE] And both of them bills was faxed to y'all for why I went in on September the uh fix and for the this one.
[AGENT][NEUTRAL] OK, so all of, OK, the dates of service that I see that are on this particular claim number, there was an office visit on 114, and that wasn't covered because office visits are not covered under your supplemental policy.
[CUSTOMER][NEUTRAL] Oh, I know that. I know that uh.
[AGENT][NEUTRAL] Then I
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] It's just what
[AGENT][NEUTRAL] I can see one of the codes on here for data service 116.
[AGENT][NEUTRAL] We were asking for a diagnosis code. It said to please provide a diagnosis code for this data service, this information may be obtained from your physician.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's for 116.
[CUSTOMER][NEUTRAL] OK, I'll be
[CUSTOMER][NEUTRAL] Will that come from the hospital?
[AGENT][NEUTRAL] That will come from your doctor.
[CUSTOMER][NEUTRAL] From my doctor
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me write that down, yeah, I just think I wouldn't for sure because.
[CUSTOMER][NEUTRAL] I've done one a couple of years ago or something and I just had to get to hospital.
[CUSTOMER][NEUTRAL] On that one bill of diagnostic number and then when I asked them they said what in the world do they need a diagnostic number for? I said I don't know I just need it.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Yes, so the procedure codes are what they did to you. The diagnosis codes is the why. Any of this was ordered for you. So we always have to know the why when reviewing claims. So you can just, if you will look on that explanation of benefits that we sent you for this claim number.
[AGENT][NEUTRAL] You should see that date of service of [PII].
[CUSTOMER][NEUTRAL] Let's see, let me see if it says [PII] on it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] No, it ain't on here nowhere.
[AGENT][NEGATIVE] Is it, you should have received 2 pages. If not, I know you, you should be able to see it in your portal for sure, but um what we mailed to you should have been 2 pages or either the front and back of one page.
[AGENT][NEUTRAL] Because the front, you know, has certain information, the second page or the back sheet would have all of the.
[AGENT][NEUTRAL] Like remark codes written out as to what they.
[AGENT][NEUTRAL] Actually state.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEGATIVE] Hold on one second and then say they ain't got nothing on. Let me go.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] This one here is the.
[CUSTOMER][NEUTRAL] They sent me 3 papers.
[CUSTOMER][NEUTRAL] Let's see this one here ain't got.
[CUSTOMER][NEGATIVE] I ain't got nothing on me yet.
[CUSTOMER][NEUTRAL] It's.
[AGENT][NEUTRAL] Cause I'm actually looking at a copy of that particular explanation of benefits for that.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Give me one sec.
[AGENT][NEUTRAL] I clicked on the wrong one.
[CUSTOMER][NEUTRAL] Yeah, I just can't find
[CUSTOMER][NEGATIVE] I can't find it.
[CUSTOMER][NEGATIVE] The service they don't nowhere.
[CUSTOMER][NEUTRAL] That's what I was trying to figure out which bill it which claim it was.
[AGENT][NEUTRAL] OK, so on that claim number that you provided for me.
[AGENT][NEUTRAL] For data service 116.
[AGENT][NEUTRAL] We need the diagnosis code for that data service.
[CUSTOMER][NEUTRAL] That I messing my papers up. Is that the 2183 or the 253 I give you?
[AGENT][NEUTRAL] Uh, the last four numbers are 2183.
[CUSTOMER][NEUTRAL] OK, OK, it's this one. OK, you need a diagnostic testing in a hospital?
[AGENT][NEUTRAL] Uh, no, it's going to be the remark.
[AGENT][NEUTRAL] Again, if you can't if you didn't receive that and
[AGENT][NEUTRAL] The male, I, I
[CUSTOMER][NEUTRAL] Please for
[CUSTOMER][NEUTRAL] OK, that's it. Please provide a diagnostic code for this.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] A diagnosis.
[AGENT][NEUTRAL] Yeah, diagnosis code for this state of service. This information may be obtained from your physician.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] And that's for the 116 data service.
[CUSTOMER][NEUTRAL] OK, alright, I
[AGENT][NEUTRAL] And then, you know, with all, you've, we've already been over the other codes, but you know that the office visits aren't covered. So on that claim number, we just need a diagnosis code for the 116, so we can further review that one.
[CUSTOMER][NEUTRAL] 11 6 24.
[CUSTOMER][NEUTRAL] OK, OK, yeah, I had a bunch wrote down. I know some wouldn't be covered so.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And this uh
[CUSTOMER][NEGATIVE] I had to send it all in when they when my insurance sends it to me it's got all this on it and I have to send it to you.
[AGENT][NEUTRAL] Now, um,
[AGENT][NEUTRAL] Will your provider not file your claims with APL for your supplemental insurance?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] They won't, OK. And some don't, but uh, it's a lot easier on you, you know, when they do because they're much more familiar with the entire process. So I always recommend that you present your primary healthcare insurance card and your APL card uh when you go for medical services. But if they want, if you know they won't, then
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, yeah, pay that.
[AGENT][NEUTRAL] Then yeser than you would, you know.
[CUSTOMER][NEUTRAL] Yeah, my
[CUSTOMER][NEUTRAL] My other place told me not to present this one just to give my regular health insurance.
[AGENT][NEUTRAL] Always present those.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just wanna know and uh.
[CUSTOMER][NEUTRAL] OK then, OK, I guess I got that and you just need diagnostic OK then how about, uh, I guess we move on to the other claim I guess.
[AGENT][NEUTRAL] All right, we can, whenever you're ready. What's your next claim number?
[CUSTOMER][NEUTRAL] 355-2253
[AGENT][NEUTRAL] All right. So give me just a moment to get that information pulled up.
[AGENT][NEUTRAL] OK, this is uh for there's multiple providers on here. Uh, this is for looks like dates of service 9596 and [PII].
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] 9:16 is the bill that we just discussed here.
[AGENT][NEUTRAL] 9696 is the one we discussed.
[CUSTOMER][NEUTRAL] On the other one.
[CUSTOMER][NEUTRAL] Yeah, 9
[CUSTOMER][NEUTRAL] Hospital, yeah.
[AGENT][NEUTRAL] Cause that is also the 96 we are asking on this particular claim number as well, that the same thing, a diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I think I had to call the hospital for it last time.
[AGENT][NEUTRAL] And also, and again, all of these remarks, you'll be, you should be able to see these, which would be a lot easier for you, Mr. [PII], if you can see them, you know, in your portal because for the 95 data service, we're also asking for a diagnosis code.
[CUSTOMER][NEUTRAL] Yeah, it'd be same doctor probably.
[AGENT][NEUTRAL] Uh, let's see. Is that for, it's Carolina's pathology group, but it would be the doctor that ordered, you know, any of your pathology.
[CUSTOMER][NEUTRAL] Yeah, it'd be all in the information and help at the hospital is what is all billed to.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Usually they they gave me one a diagnostic number for the hospital the last time I filed and they had different doctors that treats you got about 6 doctors in there treat you, but they all do the.
[CUSTOMER][NEUTRAL] They do their thing, I guess.
[AGENT][NEUTRAL] Yeah, they will all, um, yes, they will bill separately for different things. Yes, sir. It's not, unfortunately, it's not just one bill. They all bill independently for the most part. Radilogy will bill, the doctor, you know, that you see will be, the facility, you know.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] But on this
[CUSTOMER][POSITIVE] Yeah, I got one.
[AGENT][POSITIVE] Oh, I'm so sorry.
[CUSTOMER][POSITIVE] Yeah, I got, I got one.
[AGENT][NEUTRAL] Mhm. So you can just look at each one of, right, because there's several of those dates that we're needing the diagnosis. Not now, don't get that confused with the diagnostic because a diagnostic, that's like the test code. That's not what we, we need the diagnosis code.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So why they did it, not what, OK.
[CUSTOMER][NEUTRAL] Yeah, that's what
[CUSTOMER][NEUTRAL] For the hospital and they only give me one.
[CUSTOMER][NEUTRAL] Because they all work for them.
[CUSTOMER][NEUTRAL] So I'll send it to you and and that's the one that didn't want me to give it to me last time but they did.
[AGENT][NEUTRAL] Mm, OK, and I could see one of those remarks for a data service for 98. It shows in order to process your claims we need the itemized bills.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] With the admission and discharge dates and times.
[CUSTOMER][NEUTRAL] Yeah, that
[CUSTOMER][NEUTRAL] Need to, you need to itemize bills from the hospital.
[AGENT][NEUTRAL] Mhm. With the admission and discharge dates and times on.
[CUSTOMER][NEUTRAL] Dang y'all gonna change from around, ain't you?
[CUSTOMER][NEUTRAL] The only time I ever had to do was just send the.
[CUSTOMER][NEUTRAL] The insurance bill.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Well what what insurance.
[AGENT][NEUTRAL] Right. Now, we have, yes, sir. We have to have things just like your primary insurance company does. They have to provide the same type of information when they file with your primary healthcare insurance and your supplement has to have the same type of thing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] In order, OK, I'm gonna need, OK, I get.
[AGENT][NEUTRAL] So there's a lot of data on that claim number we just did ending in the 53, you know, there's multiple dates of services on here ranging, it appears from [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Through [PII].
[CUSTOMER][NEUTRAL] Yeah, I wouldn't didn't. I got out on the [PII], I think.
[CUSTOMER][NEUTRAL] Uh, let's say [PII].
[AGENT][NEUTRAL] So a lot of them require, mhm.
[CUSTOMER][NEUTRAL] 190
[AGENT][NEUTRAL] You know, we're needing the diagnosis codes for several of them from what I can see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's seed.
[CUSTOMER][NEUTRAL] OK, I'll get see if I can get the codes and I'll send that and see if I can get an itemized bill for that one.
[AGENT][NEUTRAL] OK. And, and then you can upload all of that information once you are able to obtain it, Mr. [PII]. You can upload it into your online service center portal for us to review.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know if
[CUSTOMER][NEUTRAL] Yeah, I have to see if I got my daughter done this for me so I have to see if she uploaded in the portal.
[AGENT][NEUTRAL] Let's see, I can look.
[CUSTOMER][NEUTRAL] Uh first you got.
[AGENT][NEUTRAL] Uh, give me a second, I can see.
[AGENT][NEUTRAL] Yes, sir, it looks like the last several things that we've received were uploaded.
[AGENT][NEUTRAL] And that's how it looks like we received that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Information so it would just be the same process of her mhm of her uploading all of that information.
[CUSTOMER][NEUTRAL] OK, alright, uploaded portal.
[AGENT][NEUTRAL] And did you have another claim that um you had a question about?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or was it just those two?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] That was just them too that was the hospital whil[PII] I was in the hospital. That's the 253 and then the nose surgery is 183.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] All right, thank you. I'm glad I figured it out.
[AGENT][NEUTRAL] All right
[AGENT][POSITIVE] Well, you're certainly very welcome. Is there any other questions you have or anything else I can help you with?
[CUSTOMER][NEUTRAL] Not right now I guess I'll see if I can get that and have it uploaded and I guess y'all send me a paper tell me what else I need to do I guess after that.
[AGENT][NEUTRAL] Yes, sir, and again, you know, since she's helping you with your portal, you know, you can see all of that information that we just went over all of those remarks on your explanation of benefits they're viewable in that portal as well.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so I looked on this on this uh.
[CUSTOMER][NEUTRAL] On this one it says on the 2 the 53 it says benefits are payable only if your major medical insurance provider.
[CUSTOMER][POSITIVE] Provides benefits if the claim is later paid uh they did my insurance that's what I uploaded it was the well Aetna sent me the insurance paper on that one.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And when was that uploaded?
[CUSTOMER][NEUTRAL] I guess when you got it I reckon I can't remember what it was but it's on the insurance. I fact I had my daughter to send both bills.
[AGENT][NEUTRAL] OK, so what we're needing, yeah, so what we need, what that is asking for.
[CUSTOMER][NEUTRAL] I said this is for me
[AGENT][NEUTRAL] is we have to receive your primary insurance company's explanation of benefits showing that they paid because we didn't receive that. That's what that's stating. If, if your primary insurance company has paid on that, then we just need to get the explanation of benefits sent to us.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] For that data service.
[CUSTOMER][NEUTRAL] They pretty much paid it off because I didn't pay $173.
[AGENT][NEUTRAL] But that's what that, oh OK.
[CUSTOMER][NEUTRAL] I think on that. No, that's 80 no, that's hospital.
[CUSTOMER][NEUTRAL] That's on the hospital 1 253.
[CUSTOMER][NEGATIVE] Yeah, I had to pay out of pocket like $14,000 at that.
[AGENT][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] Uh, so, OK, I sent you the hospital bill showing what they paid. What else do you need from me?
[AGENT][NEUTRAL] Well, we have to have the primary insurance company's explanation of benefits, showing what
[CUSTOMER][NEUTRAL] Is that not all there?
[AGENT][NEUTRAL] That's what this remark states that that we need that, that it, or that.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] Or that it did not show that it was paid by your primary insurance. So if it is paid by your primary insurance, then yes, sir, we would have to
[CUSTOMER][NEUTRAL] Yeah, when I
[AGENT][NEUTRAL] Um, receive a copy of the primary insurance company. That's for, that's on Data Service 96.
[AGENT][NEUTRAL] Also,
[CUSTOMER][NEUTRAL] Yeah, that's what I sent you.
[CUSTOMER][NEUTRAL] It shows every penny they paid.
[CUSTOMER][NEUTRAL] And it shows for each thing they paid for.
[CUSTOMER][NEUTRAL] So the discount I got through them.
[CUSTOMER][NEUTRAL] It's on that bill that that that she uploaded to you that come from Aetna.
[CUSTOMER][NEUTRAL] It's the explanation of benefits.
[CUSTOMER][NEUTRAL] That's why I faxed it in.
[AGENT][NEUTRAL] OK, this shows for an inpatient, this shows inpatient on 96.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] The remark, all I can see on here, Mr. [PII], it just states benefits are payable only if your major medical insurance provider provides benefits. Um, if this claim is later paid by your major medical insurance, please send the explanation of benefits showing the benefits were paid. So there was something related to that inpatient.
[AGENT][NEUTRAL] And that's also something that we need a diagnosis code for, for 9, well, that's for 99. So, there's a, so this particular claim number ending in 53, again, it has a lot of different dates of service on it.
[CUSTOMER][NEUTRAL] And see
[AGENT][NEUTRAL] Starting with, it looks like the earliest date was [PII], or excuse me, 95.
[AGENT][NEUTRAL] And goes all the way up to [PII], which was a visit, an office visit.
[CUSTOMER][NEUTRAL] Yeah, I ain't worried about that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Fine
[CUSTOMER][NEUTRAL] Aetna.
[CUSTOMER][NEUTRAL] C A
[CUSTOMER][POSITIVE] You see that was the thing right here.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But then I had to call my insurance for that.
[AGENT][NEUTRAL] For, yes, this, this was for 96 and it shows as an inpatient.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And 95
[AGENT][NEUTRAL] Uh, that's the one we need to know about if there, if your major medical insurance has provided benefits.
[AGENT][NEUTRAL] Then we need
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So that explanation of benefits for 96.
[CUSTOMER][NEUTRAL] They put me
[CUSTOMER][NEGATIVE] Yeah 95 they put me down as a self paid.
[CUSTOMER][NEUTRAL] Because I was out of it and I didn't come around.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So they didn't know what my insurance was.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So they put it all down self paid.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And then when I finally talked to him the next day after they got me or that I come to after I fell and all and got knocked up.
[CUSTOMER][NEUTRAL] I went out with my.
[AGENT][POSITIVE] Oh goodness.
[CUSTOMER][POSITIVE] Got my adrenaline back up.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEGATIVE] I had to I had to have them refile it so it the 95 I have to call them for it.
[CUSTOMER][NEUTRAL] The 96.
[CUSTOMER][NEGATIVE] That was the next day I went in, so I should have had my Aetna insurance on it by then.
[CUSTOMER][NEUTRAL] But I'll, I'll just talk to him for 95 and 96.
[AGENT][NEUTRAL] Yes sir, it looks like on that claim number again, look on the claim number ending in 53.
[CUSTOMER][NEUTRAL] And see what
[AGENT][NEUTRAL] Because there's a lot of those lines by the different dates of service that say we need the diagnosis code.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There's multiple dates that say, say that. I mean, from [PII] to.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] 9, let's see, 989.
[AGENT][NEUTRAL] Basically, we need diagnosis codes for almost every one of those dates of service.
[CUSTOMER][NEUTRAL] That's for all the dates that they paid for, is that what you need? That'd be 95 to.
[CUSTOMER][NEUTRAL] Now they only give me the ones where I was in the hospital.
[CUSTOMER][NEUTRAL] Probably one for that bill.
[CUSTOMER][NEUTRAL] I don't know unless he's with Atrium. I don't know if he's with Atrium or not, my nose doctor.
[CUSTOMER][NEUTRAL] So he didn't come to the hospital.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I went to him on the [PII] I think it was I visited him on the [PII].
[AGENT][NEUTRAL] Yes, sir, and I can see that that just, that's one of the ones, you know, for the [PII], that's, there's only one line item on this claim, and that was just the office visit charge. So for your, again, for your dates of service,
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Uh, we need diagnosis codes for all of those dates of service.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] 95968.
[AGENT][NEUTRAL] 68 and 9.
[CUSTOMER][NEUTRAL] 8 and 9.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then also on [PII] we need your primary insurance company's explanation of benefits. If it, if they came back and paid on that for the inpatient, then we just need to get a copy of that explanation of benefits.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'm trying to write all this down. OK, on [PII].
[AGENT][NEUTRAL] I know, and it's a, yes, sir. It's really gonna be easier for you, Mr. [PII], to look at those remarks that are typed out on that document.
[AGENT][NEUTRAL] And then just, you know, maybe write your dates of service on that 2nd page next to each one, you know, where it says needs a diagnosis code.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Because they're gonna be listed out.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Multiple times.
[CUSTOMER][NEUTRAL] Yeah, don't know, the only problem is don't have the dates on here.
[CUSTOMER][NEUTRAL] That you need it for it just tells me me.
[AGENT][NEUTRAL] Uh, the first.
[CUSTOMER][NEUTRAL] Yeah, and I wrote it down. I wrote the dates on the paper.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, let me look at your explanation of benefits because you're.
[AGENT][NEUTRAL] It should.
[AGENT][NEUTRAL] Give me just a sec, on the first page it should show you what dates of service and for each line item and.
[AGENT][NEUTRAL] you a remark.
[AGENT][NEUTRAL] Code and then the actual remark for that code is on the 2nd page.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was backwards she goes.
[AGENT][NEUTRAL] Mhm. Yeah. So, page one has, you should see a from column.
[CUSTOMER][NEUTRAL] OK, I got 98.
[CUSTOMER][NEUTRAL] Na na na na na.
[CUSTOMER][NEUTRAL] 959-59998 and uh.
[CUSTOMER][NEUTRAL] 95.
[CUSTOMER][NEUTRAL] Let's see 95555966 and then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The [PII] and [PII] I ain't gonna need them because they were just office visits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, yeah, I see now I see, OK, I see it.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Uh, you say, OK, so you should, yeah, take it, because that'll be a lot easier for you than you trying to handwrite all that down, you know. So you should see that from column and we'll just do the first, just that first one where it says [PII] and then it has Dr. [PII], the provider of service is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yeah, I'm gonna not even do that one because that was just the office visit for him.
[AGENT][NEUTRAL] Right, but I'm, I'm just, right, but I'm just gonna show you the easiest way to know what, so then if you come on across where it has remarks and you see where it has a number one.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, go to that 2nd page.
[AGENT][NEUTRAL] And look
[AGENT][NEUTRAL] You should see a column that says remark and it has a number one and then a dash.
[AGENT][NEUTRAL] D1H001. Do you see that?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] that be on the back side?
[AGENT][NEUTRAL] Yes, sir. Uh-huh, it would be.
[CUSTOMER][NEUTRAL] Let me get it turned over here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you see where it says
[AGENT][NEUTRAL] Remark
[AGENT][NEUTRAL] And then remark description under your name.
[CUSTOMER][NEUTRAL] Remark remark description. OK, what was the number for the remark?
[AGENT][NEUTRAL] All right. So like that one, that very first line for that doctor was had a one beside it. So anything that has a 1 beside it, that's the that's the remark description out there. Office visits are not covered. So anything, if you come down, anything up that on that other side of the document that has a 2.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] In that remark column, then that's what we need.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, covered outpatient services.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, you have a remark column on the front side that has numbers in it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then on the back side, whatever number correlates on the back, that would be the.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So anything that has a 3 beside it.
[AGENT][NEUTRAL] On that first page?
[AGENT][NEUTRAL] On the front side.
[CUSTOMER][NEUTRAL] Yeah, that's
[AGENT][NEUTRAL] That means that we need a diagnosis code. Do you see what, do you see that?
[CUSTOMER][NEUTRAL] Yeah, I see a 3 and a 4 on this.
[AGENT][NEUTRAL] Uh-huh. And, and then whatever has the number 4 beside it.
[CUSTOMER][NEUTRAL] Now we
[AGENT][NEUTRAL] Then that's what we would need.
[CUSTOMER][NEUTRAL] We, we still on 183.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm getting are we on the 22253 form.
[AGENT][NEUTRAL] Yes, sir, we are, uh-huh.
[CUSTOMER][NEUTRAL] OK, 3, OK, uh the number 2s and 3s and 3 and 4.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, see one ain't gonna work out.
[AGENT][NEUTRAL] So anything that's
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] 23 and 4, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So anything that has a number 2 out beside it on that first page where it lists out all the different line items and dates and the names of the providers, anything with a 2 beside it, then.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] On the back side where you see that it has a 2.
[AGENT][NEUTRAL] And that remark description.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Then that's what we need.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Anything down the front that has a 3 beside it, then that's what we need.
[AGENT][NEUTRAL] Under the remark description side.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And number 4 is itemized hospital bills.
[AGENT][POSITIVE] That's correct, yes sir. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let's see if this is got a 4, yeah, that you got a 4.
[CUSTOMER][NEUTRAL] OK, I'll see if I can get it rounded up.
[AGENT][NEUTRAL] OK, well, is there anything else at the moment, Mr. [PII], I can help you with?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] I think, I think it's it now. OK, thank you very much for taking time.
[AGENT][POSITIVE] Oh, absolutely. It was my pleasure. So if we can help you in any other way, please feel free to give us a call. And otherwise, I hope you have a very nice afternoon and thank you again for calling APL.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] Yes sir, you're welcome. Bye bye.