AccountId: 011433970860
ContactId: 9f0d68dc-6fd2-4df5-ad79-1c2e8a7a8759
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 579950 ms
Total Talk Time (AGENT): 264061 ms
Total Talk Time (CUSTOMER): 308890 ms
Interruptions: 10
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/9f0d68dc-6fd2-4df5-ad79-1c2e8a7a8759_20250303T18:12_UTC.wav
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[AGENT][POSITIVE] Thank you for calling UTL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, good afternoon, with [PII]. Um,
[CUSTOMER][NEUTRAL] I have some question about a claim.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, um, it, it was my first, um, ultrasound that I did. It was back in October and it was supposed to go through my, um, OB. They did, they made a claim, but I don't, I don't think they did it the right way because it's been a while right now and
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I haven't got any news.
[AGENT][NEUTRAL] OK, what's your name, ma'am?
[CUSTOMER][NEUTRAL] What I did, um, my name is [PII]. My policy number.
[AGENT][NEUTRAL] Sure
[AGENT][NEUTRAL] OK [PII], can I get
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It's 25.
[CUSTOMER][NEUTRAL] 41 62 4.
[AGENT][NEUTRAL] OK, [PII], can I get a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, let me pull up your file, OK, get you verified and then we can proceed with looking at that information.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] If you can verify your date of birth, your mailing address, and your email address on file, please.
[CUSTOMER][NEUTRAL] OK, it's um [PII].
[CUSTOMER][NEUTRAL] My mail is [PII]. ZIP code is [PII].
[CUSTOMER][NEUTRAL] Uh, my email is [PII].
[AGENT][NEUTRAL] And so [PII], you are a dependent on the policy. Uh, your apartment number, is there a letter in front of the [PII]?
[CUSTOMER][NEUTRAL] Um, just an [PII]
[AGENT][NEUTRAL] S as in [PII], OK, that's what we have. And do you know the email address of record that's on the file since since you're dependent, it may be.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I think it's my husband, maybe, yeah, cause my husband's. It's [PII].
[AGENT][NEUTRAL] OK. Do you, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for that. OK, and so you're calling about a claim um let me go to your file now what's the data service of the claim?
[CUSTOMER][NEUTRAL] It was um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] the things I see, yeah, yes.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Now, was it submitted to American Public Life?
[CUSTOMER][NEUTRAL] It was supposed to to be like that at the the OB department did that, the billing department, but it's about I did upload the um the bill. I don't know if you can see it.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] For this date of service?
[CUSTOMER][NEUTRAL] [PII]. Yes.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But what I see, yeah, one of them.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The one that was provided, I think it's the one.
[CUSTOMER][NEGATIVE] It's so difficult, honestly, because I don't know if they did the right one and I had so many um
[CUSTOMER][NEUTRAL] Echos
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But I think it's the one that you see there uh that was on [PII].
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I think that. I paid that day 300 to get the first ultrasound.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I have just um the um the receipt that you get from the ATM machine, the, the machine that's the only thing that I got. But then I called them and I, I, I requested for a bill and they sent me this long.
[CUSTOMER][NEUTRAL] Financial, financial ledger.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know if you can see it there too.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Now did you say the date of service is [PII]?
[CUSTOMER][NEUTRAL] Yeah, there was a day that I have my, the first echo.
[AGENT][NEUTRAL] OK, but I don't show an [PII] data service though. I see [PII].
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yeah. OK.
[CUSTOMER][NEUTRAL] Can you see the, the account financial ledger?
[AGENT][NEUTRAL] Uh huh what you sent I'm looking at it now.
[CUSTOMER][NEUTRAL] Yes, I think it's the first one that says charge card.
[CUSTOMER][NEUTRAL] I don't know why you didn't you give a more prescription, but that's the amount that I paid that day.
[AGENT][NEUTRAL] OK, so we cannot process it and reimburse you based off of a receipt.
[AGENT][NEUTRAL] Um, so let me tell you what I have. I showed the cover sheet.
[CUSTOMER][NEUTRAL] Yes, and I did send the EOB also.
[AGENT][NEUTRAL] And the date
[CUSTOMER][NEUTRAL] I uploaded that too.
[CUSTOMER][NEUTRAL] Can you see that?
[AGENT][NEUTRAL] Right, uh-huh, so I'm just regurgitating what I have to make sure we're talking about the same thing. So I show you [PII] as the patient. It, uh, the date of service on here is [PII], and it's showing a total billed amount of $1,125.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a sign.
[CUSTOMER][NEUTRAL] No no no.
[CUSTOMER][NEUTRAL] I guess.
[AGENT][NEUTRAL] And so, it says claim is denied.
[CUSTOMER][NEUTRAL] Yeah, that's, that's another claim, yeah, that's another claim, because this, this is about, yeah.
[AGENT][NEUTRAL] And so that's what I'm saying. I don't show the date of service of [PII] on what you just sent on the [PII].
[CUSTOMER][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] I don't see 1010 on this, in this documentation. I just see 10:15.
[CUSTOMER][NEUTRAL] OK, so, um, I have the ELB from the echo.
[AGENT][NEUTRAL] For 1010.
[AGENT][NEUTRAL] For the 1010 data service?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, I think so.
[AGENT][NEUTRAL] OK, and so kind of like the information that you provided for 10:15, it shows the diagnosis code, the total charges, do you have an itemized bill for data service 1010?
[CUSTOMER][NEGATIVE] It's it's very confusing, I know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Not at hand.
[AGENT][NEUTRAL] Yeah, we'll need an itemized bill from data service 1010.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK, this, this.
[AGENT][NEUTRAL] To go with the, to go with the the primary explanation of benefits. Who's your primary insurance?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To my, my um United Healthcare.
[AGENT][NEUTRAL] OK. Um, and does it show their name on that explanation of benefits? United Healthcare?
[CUSTOMER][NEUTRAL] Yes, UnitedHealthcare.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and so, um, we would need the, the, um, I, the, um, the itemized bill to go along with that.
[CUSTOMER][NEUTRAL] OK, and the claim because I, I think I feel like I have to do it myself because I think it, it was not done correctly.
[AGENT][NEUTRAL] Right. Let me see.
[CUSTOMER][NEUTRAL] Is it, is that the one?
[AGENT][NEUTRAL] Let me see if we received the 10:15 even though you, you uploaded it. Let me see if we received that one from the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just uploaded the documents and I did not upload the claim. OK.
[AGENT][NEUTRAL] No, I was checking to see if we received this claim from your provider, and I think we did for the 1015 data service and I think we did. Give me one second.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Let me pull it up.
[AGENT][NEUTRAL] So we received it [PII]. Is this Vital MD Group Holdings?
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] And it is for an ultrasound.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It was an old town, yes.
[AGENT][NEUTRAL] OK, and I'm showing that the total charge was 500.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, this, OK, this is for 10:15 and so when the provider sent this claim to us, [PII], we sent them uh correspondence asking for the primary ELB, which I think is included in what you just sent on the [PII]. So let me go back in and look to see if United's ELB is attached to what you sent.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So it says claim overview.
[AGENT][NEUTRAL] Um, tell me, where does it say UnitedHealthcare on the document?
[CUSTOMER][POSITIVE] All the way on top.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] I just, I have, what I have here is a summary of benefits and coverage.
[AGENT][NEUTRAL] Right. Um, let me see. I'm just looking for United Healthcare on the document.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Oh, subject primary EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim is denied for primary, OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I can tell it's a major medical EOB, but I don't see United's name on it though.
[CUSTOMER][NEUTRAL] OK, let me, because there's so many games that I have to go to APL right now that I just need to make like an overview so I don't get lost.
[AGENT][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] In all of this, um,
[AGENT][NEUTRAL] Yeah, and I can tell that it's a primary explanation, but it doesn't show their name and it, it, it really needs to show where this document is from.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] Is there a way that um we can communicate via email?
[CUSTOMER][NEUTRAL] Or it's it only via phone?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] say the
[AGENT][NEGATIVE] Yes, yeah, sending yeah claim documentation via email is not secure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] OK, OK, I will, I will make a list of everything and as soon as I get it and I'll call back just to, so, so we don't get lost in all of this.
[AGENT][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] OK. That's fine.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you. I'll call you.
[AGENT][NEUTRAL] You're welcome. Anything else?
[CUSTOMER][NEUTRAL] No, that's it. I'm gonna work on it.
[AGENT][POSITIVE] Alright, thanks for calling APO. Have a good day and thanks for calling us, [PII]. Bye bye.
[CUSTOMER][NEUTRAL] OK. You too. Bye.