AccountId: 011433970860
ContactId: a76fb126-9463-4112-9449-4a9f533d4ca1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 3060199 ms
Total Talk Time (AGENT): 965517 ms
Total Talk Time (CUSTOMER): 1184475 ms
Interruptions: 6
Overall Sentiment: AGENT=0, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/a76fb126-9463-4112-9449-4a9f533d4ca1_20250219T13:55_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi [PII], I have a bunch of questions for you. I hope you have patience today.
[CUSTOMER][NEUTRAL] I need to check and see.
[AGENT][NEUTRAL] I do.
[CUSTOMER][NEGATIVE] OK, I need to check and see if claims were submitted to APL and if APL paid and what they paid because I believe you have and I believe they're trying to get more money out of me.
[AGENT][NEUTRAL] OK, so we need to see, yeah, so we need to see if claims have been processed from APL to the provider.
[CUSTOMER][NEUTRAL] If you know what I mean.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, because they're still trying to collect.
[CUSTOMER][NEGATIVE] Yeah, they're they're sending me a bill saying hey you owe this and I'm like going uh I'm looking through some of my APLs going uh they paid you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I can definitely look for you.
[CUSTOMER][NEUTRAL] I'm just calling basically to confirm it, you know what I mean?
[AGENT][POSITIVE] Mhm. I sure can help you look. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII]. My phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, sure, it's on the paper here let me look.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Policy number 02300701.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, all the claims I'm looking for is I, I'm in the year of [PII], so let me just wait the the other way.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and I'm in the policy here. I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] It is [PII] and the mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so did you want to search, like, do you have dates of service there?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do, I do.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then they're all for you, right? Or do I need to go to your husband?
[CUSTOMER][POSITIVE] Yes, ma'am. Let's make like, yup, all for me, just make it all easy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then you can either give the list, um, however, however many data services you have.
[CUSTOMER][NEUTRAL] I have 13 days.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the amount?
[CUSTOMER][NEUTRAL] You wanna, you wanna start up with this, no, I don't have the amounts. Well, actually I do have the amount, sorry.
[AGENT][NEUTRAL] OK, sure, just you can just let me.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I have for $60.
[AGENT][NEUTRAL] Of 24?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you, do you want them all at one shot?
[AGENT][NEUTRAL] Um, you can give them all to me at once.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] $1,621.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], $60.
[CUSTOMER][NEUTRAL] [PII] $60.
[CUSTOMER][NEUTRAL] [PII], $60.
[CUSTOMER][NEUTRAL] [PII] $210.
[CUSTOMER][NEUTRAL] [PII] is $60.
[CUSTOMER][NEUTRAL] [PII] is $60.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's $11 and I think 14 cents.
[CUSTOMER][NEUTRAL] [PII] is $60.
[CUSTOMER][NEUTRAL] [PII] is $11.14.
[CUSTOMER][NEUTRAL] And [PII] is $60.
[AGENT][NEUTRAL] And this is all of 2024, right?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Alrighty. And do you mind if I place you on just a brief hold while I go through the dates?
[CUSTOMER][NEUTRAL] Nope.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I just literally saw it.
[AGENT][NEUTRAL] Should you book it.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. I'm, I'm almost done with the, um, going through the claims, but I just have a question for the ones that are like $60 is it like $60 even because I see some that are like $69.67 dollars, or would that be different?
[CUSTOMER][NEUTRAL] You know, I, that's what I'm wondering why are they sending you $69 bills?
[CUSTOMER][NEGATIVE] You know, if they submit it to the insurance as they do, and I only have a copay, they should only be submitting the copay to you. Why be submitting more money? This is what I'm finding really freaky with them.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Hm, um.
[AGENT][NEUTRAL] I'm not sure because that so, so, OK, so like for example, the $60 so, so your copay is like $60 but they're sending like $69 or $67 to us, but then there were some that I did see for $60.
[AGENT][NEUTRAL] Did it, did you have to pay something other than the 60? Did it ever fluctuate for you?
[CUSTOMER][NEGATIVE] See, like right now I'm staring at the bill they sent me. They waited on here to send me this bill of 13 different, you know, bills, and I'm like, like, what the heck?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You know, and half the time they would send you a bill and not send you the EOB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then a lot of these
[CUSTOMER][NEUTRAL] So I'm not sure.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, I'm not sure what they're doing or how they're, you know, like they put probably I got.
[CUSTOMER][NEGATIVE] And I'm not kidding you, 12 different pages for the same data service of 1023, and I've told them, you know, my out of pocket, you know, my benefits have been met. Why are you sending it to them in 1012 different times? What are they trying to do is my thing.
[AGENT][NEUTRAL] Yeah, I don't, um.
[AGENT][NEUTRAL] I don't know about that. Now, they could, it could just be a case of where it's in the system, so they have to bill it because some, some facilities are set up like that. What when a when a claim, when they're processing a claim or sending a claim, whatever insurances are in the system, they bill it. So that may be and it's just an automatic thing, so maybe that's what's happening.
[CUSTOMER][NEGATIVE] No, that's not an automatic thing with them. They seem to be either not doing it or going overboard with it, or, you know what I mean, it's like a constant thing with them, and I'm like, OK, I'm getting aggravated.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now
[CUSTOMER][NEGATIVE] Now I've got a bill sitting in front of me that I shouldn't have, but I do.
[AGENT][NEUTRAL] A lot of these that I've gone through so far, so so far I'm on [PII]. So a lot of the ones that I have gone through, um, there were two that didn't have a claim on file, [PII] and [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so they never submitted a claim for that day.
[CUSTOMER][NEUTRAL] And [PII] and.
[AGENT][NEUTRAL] Unless the $60 is really like a $69 then there's one here for $69. Do you want me to look for that one?
[CUSTOMER][NEUTRAL] Which one's [PII] and which one was the date did you not find the claim for?
[AGENT][NEUTRAL] Um, [PII] and [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But [PII] does have one for 69.
[CUSTOMER][NEUTRAL] See what I mean?
[AGENT][NEUTRAL] Well, actually it's the one for 69, 67, 62, 39.
[CUSTOMER][NEUTRAL] And what
[CUSTOMER][NEGATIVE] See, I don't understand what the heck they're doing.
[AGENT][NEGATIVE] And then these are being denied because like you said, the max has been met.
[AGENT][NEGATIVE] See, when it's something like this, now that would make, that's what's making me think it's something automated because a person would see that this is the same thing and they would see that denial reason.
[AGENT][NEUTRAL] And know it's been max, so why send it?
[CUSTOMER][NEUTRAL] But see, here's the problem, here's.
[CUSTOMER][NEGATIVE] Here's the problem with this.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] At the beginning of the year I would not have met that out of out of pocket, especially if they submitted [PII].
[CUSTOMER][NEGATIVE] For $60 you wouldn't.
[CUSTOMER][NEUTRAL] I wouldn't have met my, you know.
[AGENT][NEUTRAL] You wouldn't have met it already.
[CUSTOMER][NEUTRAL] You see what I mean? And so they're what they're doing is they're going to the year and then backtracking.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, I see what you're saying. So they wait till the end of the year and then they just file the claims yeah now.
[CUSTOMER][NEGATIVE] They seem to yeah they seem to submit them and I'm like OK this is not how it's done.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because by that time, you have other claims coming in and like this here, it's gonna be maxed out because there's other things coming in using it.
[AGENT][NEGATIVE] versus sending it when, now that's one of the downsides to.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] The providers and then we don't have a, um, you know how some insurances have like the deadline, like major insurance. I think there's, it used to be 60, it might be, I mean it used to be 90, it might be 60 now that you have like that amount of time to file your claim. If not, you can't file the claim like 60 days after the date of service.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So that could be what they're doing, waiting until the end of the year and then the benefits are used.
[CUSTOMER][NEGATIVE] Yeah, well, here's the problem with that because if they had done it submitted the claims as you know, they were supposed to, I would have been.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, at my capacity with your, with your, you know, benefits in [PII], which they did not do that.
[CUSTOMER][NEUTRAL] Can I ask you another question?
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEGATIVE] This one, well, if this is gonna mess you up, just tell me we'll work on this one later. I am now going through all the claims from beginning of this year now to make sure that they, you know, don't do this to me again this year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have claims ready for this year and I have dates.
[CUSTOMER][NEUTRAL] If they didn't submit anything, I'm gonna get on the phone with them.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, you want me to see, OK, what's what's the date you have?
[CUSTOMER][NEUTRAL] We, we, yeah.
[CUSTOMER][POSITIVE] We ain't wait to the end of the year this year.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEGATIVE] Now I'm gonna raise hell with them.
[AGENT][NEGATIVE] Because that's not right.
[CUSTOMER][NEGATIVE] No, it's not. I, you know, I'm like going, why the hell you wait till the following year.
[CUSTOMER][NEUTRAL] You know, and you send me 13 bills.
[AGENT][NEGATIVE] To start sending my claims.
[CUSTOMER][NEGATIVE] And I've been, I've been with you every month and asking you, what do I owe? Oh, nothing, nothing, nothing to still panic. Y'all don't know what the hell you're doing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Not you, but them, obviously.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So let me know when we're done with, you know what, let's just finished last year.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I wanna see what they didn't submit. I wanna go farther and then you know then we'll go to this year and I'll make sure I'm, I'm on it, you know.
[AGENT][NEUTRAL] OK, so I'm on.
[CUSTOMER][NEUTRAL] So [PII] and [PII], no, no, no claims were submitted to you, OK, got those.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, for, OK, so I'll just go down the list. So for [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was, it wasn't $60 it was, let me go back. Hold on one second. Um, let me write this one down for August and then I'll go back to February. Hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 67.
[AGENT][NEGATIVE] Um, so it wasn't $60 it was $69 but it was denied, um, because it's not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Now what was it that they billed you for?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] 637225.
[AGENT][NEUTRAL] I'm just getting the codes to see what it is. Hold on one moment.
[CUSTOMER][POSITIVE] No problem, honey you take your time.
[CUSTOMER][NEGATIVE] This ain't fun stuff. You deal with it all day long.
[AGENT][NEUTRAL] OK, so one of them looks like it's a
[AGENT][NEUTRAL] Diagnostic injection?
[AGENT][NEGATIVE] It doesn't, and that's just going off of the CPT code. It doesn't give me like a description of what was done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the other was
[AGENT][NEUTRAL] This may be the name of the.
[AGENT][NEUTRAL] Medicine
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, that's the name of the man.
[AGENT][NEUTRAL] OK, so that was the medicine for that injection.
[CUSTOMER][NEUTRAL] So I'm assuming that
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, so that's not covered when performed in a doctor's office or clinic. Um, [PII] didn't have, now, let me go back to [PII].
[AGENT][NEUTRAL] Yeah, [PII] didn't have one on around 60 at all. There was a 50.
[AGENT][NEUTRAL] But I didn't see like a 60 or 69 like the other ones.
[CUSTOMER][NEUTRAL] A 50 for what?
[AGENT][NEUTRAL] Mm let me see what that is.
[CUSTOMER][NEGATIVE] See that makes no sense.
[AGENT][NEUTRAL] 1167 hold on one second 11.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so this one is a PET scan.
[AGENT][NEUTRAL] And what's this other code?
[AGENT][NEUTRAL] Yeah, it was a PET scan and then this is also medication. OK, I'm gonna try to pronounce it.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Don't worry about pronounce the medication. It's, it's just they did submit the PET they did submit the PAT scan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, that was the PET scan, the $50.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] $50 for a PET scan?
[AGENT][NEUTRAL] Now, I don't know, hold on one second.
[AGENT][NEUTRAL] If that's just what's left over after they sent it to primary, but that's what they sent to us.
[CUSTOMER][NEUTRAL] Cause that ain't how much PET scans.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Did they send you the EUB?
[AGENT][NEUTRAL] Mhm. So that was just for that one line.
[CUSTOMER][NEUTRAL] Because 50
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's $50.
[AGENT][NEUTRAL] I mean, altogether it was 500.
[CUSTOMER][NEGATIVE] And it ain't what they submitted to me.
[AGENT][NEUTRAL] Altogether it was $500. It's just broken down by code, so one code was paid $50 the other was paid $450.
[CUSTOMER][NEUTRAL] So was anything paid to them?
[AGENT][NEUTRAL] Yes, $500.
[CUSTOMER][POSITIVE] Was paid OK.
[AGENT][NEUTRAL] And then which one?
[CUSTOMER][NEUTRAL] So that was submitted.
[AGENT][NEUTRAL] Oh, I see. The 16, 1621, it was.
[AGENT][NEUTRAL] It came over as $4,686.
[CUSTOMER][NEUTRAL] So they tried to overbill you.
[AGENT][NEUTRAL] That was the total.
[CUSTOMER][NEUTRAL] Yeah, and they didn't do it by the discounted the 1621.
[AGENT][NEUTRAL] Oh, no, no, no, no, no, no, no. So the $4,686 was the total bill before primary touched it. Anybody touched it. That's just the total charges. Then it goes to primary and then it comes to us.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So when I'm looking for a dollar amount, I'm looking for $1,621 but it's reading $4,686 so it's like,
[CUSTOMER][NEUTRAL] And then it
[AGENT][NEUTRAL] It looks like there's no claim on file.
[AGENT][NEUTRAL] You see what I'm saying, because it's two different amounts, but once we looked into it, that's the same claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you only paid 500 out of the 1621.
[AGENT][NEUTRAL] Well, that's all they that's all that came over for the charges, $450 for
[AGENT][NEUTRAL] Code 78815 and then charge $50 for code 89552. So we paid all of what they sent to us.
[CUSTOMER][NEGATIVE] Oh my, um, let me write that down. Let me get, let me get a little section of this one because this is what I said, they don't know what the hell they're doing and I'm, you know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm just gonna talk. You just correct me when I'm wrong, total of $4,686 was sent to you at the primary.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm married. OK, and there was a balance left of $1,621 but the only bill.
[CUSTOMER][NEUTRAL] Only was billed.
[CUSTOMER][NEUTRAL] Bills
[CUSTOMER][NEUTRAL] $450 which was what, what was that called?
[AGENT][NEUTRAL] 78815.
[CUSTOMER][NEUTRAL] And then $50.
[AGENT][NEUTRAL] 4 A.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] 9552.
[CUSTOMER][NEUTRAL] 2, so only a total of.
[CUSTOMER][NEUTRAL] $500 was billed, not the full amount of $1,621.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so that's where they.
[CUSTOMER][NEUTRAL] Excuse my French effed up.
[CUSTOMER][NEGATIVE] See, they don't know what the hell they're doing.
[CUSTOMER][NEUTRAL] And that's obvious from that.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] PL OK now.
[CUSTOMER][NEUTRAL] Alright, so we got, see what I mean? that if they build that alone I would admit my.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You see what I'm saying?
[AGENT][NEUTRAL] If they would have built that, you would have met your um your max.
[CUSTOMER][NEUTRAL] Well that's correct at that point. So they, you know, they, they slow road it all the way out to the rest of the year and then backtracked is what they did.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And bills for all, all the dates of service until the end of the year or up until the end of the year.
[CUSTOMER][NEGATIVE] Yup. Mhm. Yeah, so now I'm like what, you know, wasting time, wasting people's time, and we was the paper.
[CUSTOMER][NEUTRAL] So, hm.
[CUSTOMER][NEUTRAL] See, now I have other services that have been paid too though.
[CUSTOMER][NEUTRAL] That they're billing me for.
[CUSTOMER][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Was, you didn't see anything from them?
[AGENT][NEUTRAL] Let me, um, look again for [PII].
[AGENT][NEUTRAL] OK, so [PII] has several, but there's none for 60. Do you want me to look at the other ones?
[CUSTOMER][NEUTRAL] Because there.
[CUSTOMER][NEUTRAL] Yeah, let's see because they're charging me, I see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], OK, for [PII], they're charging me in, OK, injections and infusion. OK, so that, so that $60 would be my responsibility because it's in the doctor's office, correct?
[CUSTOMER][NEUTRAL] That's the same as [PII].
[AGENT][NEUTRAL] Oh, performed in the doctor's office at clinic, right.
[CUSTOMER][NEUTRAL] Injection.
[CUSTOMER][NEUTRAL] Yes, OK, well, I'm gonna go with it through, yeah, I see, I, you all you have to do is tell me once.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII] there's one too. That's I that's what I'm saying, you know, [PII] would be on like a Sunday or Monday.
[CUSTOMER][NEGATIVE] What the hell are they doing?
[AGENT][NEUTRAL] Now, [PII], I didn't see one, so there's only one claim that came in from [PII]. Um, I didn't see the 60 on there. I saw 69, hold on, I'm pulling it back up. 816.
[CUSTOMER][NEUTRAL] Miss
[CUSTOMER][NEUTRAL] Actually what [PII] says on this bill is.
[CUSTOMER][NEUTRAL] Miscellaneous drugs and tests, $960 minus 900 and equals 60. Could that be an injection too?
[AGENT][NEUTRAL] Let me see if these are the same codes. Oh yeah, these are the same codes.
[CUSTOMER][NEUTRAL] OK, so that, that would say that's an injection.
[AGENT][NEUTRAL] So this is an injection also.
[CUSTOMER][NEUTRAL] OK, injection.
[CUSTOMER][POSITIVE] Hm, oh see, I'm a fast learner.
[CUSTOMER][NEUTRAL] I don't know why everybody else can't be, but you know what I'm saying? OK, so now, now we get into [PII], diagnostic radiology.
[CUSTOMER][NEUTRAL] See this is where it is. It says $1440.
[CUSTOMER][NEUTRAL] And I owe is 210.
[AGENT][NEUTRAL] So, for [PII], there were
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Quite a few claims, um.
[AGENT][NEUTRAL] Actually, there may just be, yeah, hold on, let me, 123.
[CUSTOMER][NEUTRAL] For that one day, huh?
[AGENT][NEUTRAL] It may just be multiple lines, 67.
[AGENT][NEUTRAL] OK, so there's actually only 3 claims that was received for this day. Do you want to go through all three?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Because I don't think any of them have that. Um, I'm looking, I was looking for 210, but you want me to look for the 1440 and see if I can find one?
[CUSTOMER][NEUTRAL] No, because on [PII] they, they have it here service category, diagnosis diagnostic radiology $1440.
[CUSTOMER][NEUTRAL] Subtotal billed $1440. Insurance covered $1230.
[CUSTOMER][NEUTRAL] Which left me with the amount of $210 which tells me, did they, you know, bill APL $210.
[AGENT][NEUTRAL] Let's see if I want 28.
[AGENT][NEUTRAL] This may be it.
[AGENT][NEUTRAL] See, I keep coming up. I, I see 1520. So far, two of the claims that came, two of the three claims have that total.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] How else can I break it down to see?
[AGENT][NEUTRAL] If this is the claim you're looking for, there is different amounts.
[CUSTOMER][NEUTRAL] You see what I'm saying? They don't even, how can you be saying different amounts to, you know,
[AGENT][NEUTRAL] Let me see what this last one says.
[CUSTOMER][NEUTRAL] I'm wondering what they
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, wait a minute. So this last one I see 228. How much did you, but you said 210.
[CUSTOMER][NEUTRAL] That's what it says the amount I owe is $210.
[AGENT][NEUTRAL] Oh, I saw the 200 and I was thinking maybe that was it, but this one says 228.
[CUSTOMER][NEUTRAL] And was anything paid on it?
[AGENT][NEUTRAL] Mm let me see.
[AGENT][NEUTRAL] $37.44.
[CUSTOMER][NEGATIVE] That still wouldn't make.
[CUSTOMER][NEUTRAL] Since because
[AGENT][NEGATIVE] I'm not sure how they're breaking this up.
[CUSTOMER][NEGATIVE] $1.44. That's what I'm saying. You see where I'm going with this? Now you see my confusion? Somebody don't know how to have a bill.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] That's why I'm like, you know, what are you, what are you doing?
[CUSTOMER][NEUTRAL] You know, half the time I call them, or did you, did you submit it to APL? Oh they denied it. Well, did you send them to EOB because they're gonna deny it if you don't send them to EOB.
[CUSTOMER][NEGATIVE] Oh no, we didn't do that. Well, no, what about it and I did. They ain't gonna pay a full amount of bill.
[AGENT][NEUTRAL] and the, the, so for this one, the, the other two clothes that that were denied was denied because
[AGENT][NEUTRAL] Of the explanation of benefits is showing that primary didn't apply anything, so we can't apply if primary hasn't.
[AGENT][NEUTRAL] That's what these other two codes on [PII] are saying.
[CUSTOMER][NEUTRAL] Mm, hold on, let me get that I write that down.
[CUSTOMER][NEUTRAL] So they're not putting in, they might not be putting in the same codes for them as they put. I don't know what they're doing. I'm trying to figure this out.
[AGENT][NEUTRAL] And then the ones that we did pay, so it looks like, OK, so.
[AGENT][NEGATIVE] It was paid a total of $37.44 but that's what they billed us for, like 11 code they billed for $26.30 the other code was $11.14 and then the other two didn't show that primary paid anything to it.
[CUSTOMER][NEUTRAL] OK, let me write that one down.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right, OK, we're talking [PII]. OK, now.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Good Lord, people, I'm telling you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, let's go through that again. [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3 were submitted, right? OK, what was the first amount was submitted.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So the first one is
[AGENT][NEUTRAL] [PII], 3555442.
[CUSTOMER][NEUTRAL] Wait a minute, that's cold.
[AGENT][NEUTRAL] That's the claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's the
[CUSTOMER][NEUTRAL] 355
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And how much was billed on that one?
[AGENT][NEUTRAL] This one is
[AGENT][NEUTRAL] 1520.
[CUSTOMER][NEUTRAL] 1520 and the code for that one was?
[AGENT][NEUTRAL] Code for this one is 712 I'm sorry. Oh yes, that's right, 71,260.
[AGENT][NEUTRAL] 741, 0 I'm sorry.
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] Is it a different 741 is a different one?
[AGENT][NEUTRAL] Mhm, um, it's 2 more, so 741-777.
[CUSTOMER][NEUTRAL] And how much was that one?
[AGENT][NEUTRAL] Um, this one, wait a minute, so you want me to give you the codes that are on this claim, right?
[CUSTOMER][NEUTRAL] Yes, please, and and the breakdown of the money that the center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for.
[CUSTOMER][NEUTRAL] So the 15 1520 and 711,260, the 7417 OK.
[AGENT][NEUTRAL] Mm mm mm mm.
[AGENT][NEUTRAL] Hold on, the $1520 is just the total charges. For 71,260, it was $550.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For 741.
[CUSTOMER][NEUTRAL] And then for 7417.
[AGENT][NEUTRAL] Mhm. It was $890.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the last one was Q 9967 and that was $80.
[CUSTOMER][NEUTRAL] But one of them had somebody read it.
[CUSTOMER][NEUTRAL] You gotta get all technical on this stuff. OK, so that was a CAT scan on [PII].
[CUSTOMER][NEUTRAL] OK with that and then this one was PET scan.
[CUSTOMER][NEUTRAL] OK, so we're past [PII] now, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] We need to figure it.
[CUSTOMER][NEUTRAL] It just says other $300.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Let's see for that one, we only have one claim. Oh, you said 300?
[CUSTOMER][NEUTRAL] Which I'm assuming is an office visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, that's a part of it and then the other was $69. Um, so let me look at this one, hold on. You need the claim number is?
[AGENT][NEUTRAL] 352.
[CUSTOMER][NEUTRAL] Yeah, I don't
[AGENT][NEUTRAL] You don't need the claim number?
[CUSTOMER][NEUTRAL] 3352. I'll just put it down.
[AGENT][NEUTRAL] 0808.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I would say bill $300 and then.
[CUSTOMER][NEUTRAL] Insurance covered $240.
[CUSTOMER][NEUTRAL] And then the amount I owe is $60.
[CUSTOMER][NEUTRAL] See, they don't say that.
[CUSTOMER][NEUTRAL] Oh, they make me crazy.
[AGENT][NEUTRAL] So now this claim was denied because the the outpatient max of the calendar year was met.
[CUSTOMER][NEUTRAL] Mhm and so we met at [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, hold on. That's not what that means. So, what's the, hold on, let me go back 808.
[CUSTOMER][NEUTRAL] Literally.
[AGENT][NEUTRAL] Well, no, so it's not saying in July the max was met. We didn't receive this until October, so it's saying in October, the max has been met.
[CUSTOMER][NEUTRAL] Yes, October it has.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, OK, [PII], let me go back in here.
[CUSTOMER][NEUTRAL] Where am I at? [PII] says, OK, injections. OK, we already know about that. We can skip that.
[CUSTOMER][NEUTRAL] Um, that's an office visit.
[CUSTOMER][NEUTRAL] OK, [PII], they built $29.
[CUSTOMER][NEUTRAL] Uh, then insurance covers $17.86 but I do have one here that shows $11.14.
[AGENT][NEUTRAL] So for this one, they actually charge or they actually bill for, let me get the total, hold on one second, 772.
[AGENT][NEUTRAL] A total of $96.
[AGENT][NEUTRAL] They billed us $67 for code 36591.
[AGENT][NEUTRAL] And $29 for code 85025.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the claim was denied because the max had been met by the time the claim came in.
[CUSTOMER][NEUTRAL] OK, because that's where they're backtracking, see what I mean? That's where it starts backtracking.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Cause I would admit it in March, as you see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, they wait a long time to process their claims. That's almost 2 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so now I'm gonna be on their asses.
[AGENT][NEGATIVE] But rightfully so, because you're paying for the insurance and that's not right.
[CUSTOMER][NEUTRAL] And that's why.
[CUSTOMER][NEUTRAL] No, it, you know what, a lot ain't right, but you know when I start getting at them, they're gonna know it. OK, so let's now forget about last year because last year I will be dealing with them this year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And wonder why I get attitude.
[AGENT][NEUTRAL] It's OK. So, um, what's the dates that you have for this year?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I already have the explanation of benefits from United Healthcare in front of me, so the data service is 1:15.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] In 117.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So if they can't believe you me, I'll be on them like they don't know what hit them right now.
[AGENT][NEUTRAL] Alrighty then, so we have, let me just double check.
[AGENT][NEUTRAL] 11:15.
[AGENT][NEUTRAL] Alright, so for
[AGENT][NEUTRAL] [PII] we have, let me see how many claims or is this all one? This is all one hold on one second, let me get it for you.
[AGENT][NEUTRAL] 356-5162.
[AGENT][NEUTRAL] Alright, so for.
[AGENT][NEUTRAL] [PII], um we have claim number 356-5162.
[AGENT][NEUTRAL] We finished processing it yesterday.
[AGENT][NEUTRAL] Um, a payment of $272.51 is going to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, how much total did they bill to you?
[AGENT][NEUTRAL] Uh let me see.
[AGENT][NEUTRAL] $9920. 0 well.
[AGENT][NEUTRAL] That's the total bills. Let me see what each of these lines are.
[AGENT][NEUTRAL] I keep
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think, yeah, they, that's they submitted to $920 was what they submitted to UnitedHealthcare.
[AGENT][NEUTRAL] Let me do it this way.
[AGENT][NEUTRAL] I'm just pulling it all up. Hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] 123456 different charges I see on this EOB.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah, and um so they billed $272.51.
[CUSTOMER][NEUTRAL] They paid
[AGENT][NEUTRAL] And then, um, that's the amount we pay $272.51.
[CUSTOMER][NEUTRAL] Why does it say amount I owe is $249.47 from um from United Healthcare?
[AGENT][NEUTRAL] I'm not sure. Um, did they do some adjustments or let me see if the, let me see if I can see the.
[CUSTOMER][NEUTRAL] Let me see, let me see if you see diagnostic service is.
[CUSTOMER][NEUTRAL] Provider bill $69 amount.
[CUSTOMER][NEUTRAL] Plan allowed $19.53. I owe is $19.53.
[CUSTOMER][NEUTRAL] Medical services.
[CUSTOMER][NEUTRAL] The provider Bill United Healthcare is $303.
[CUSTOMER][NEUTRAL] Mount Iow is 14614.
[CUSTOMER][NEUTRAL] Then diagnostic services $61 was billed to.
[CUSTOMER][NEUTRAL] UnitedHealthcare, which leaves me with a balance of $22.16.
[CUSTOMER][NEUTRAL] Office visit
[CUSTOMER][NEUTRAL] $339.
[CUSTOMER][NEUTRAL] Left me a balance of $60.
[CUSTOMER][NEUTRAL] Prescription drugs $9 left me with 33 cents.
[CUSTOMER][NEGATIVE] And another prescription drug was billed for $6 and that means no damn sense. One is $9 they charged me 33 cents for. And another one is $6 they charged me $1.31 for. How the hell does that make any sense?
[AGENT][NEUTRAL] I have no idea, but I do see that here on the explanation of benefits. Oh, those are the adjustments.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, OK, OK, I see now. I'm looking at it.
[CUSTOMER][NEUTRAL] It's, but it says, but it says the amount I owe is $249.47.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So you, so you paid them $272 so I should.
[CUSTOMER][NEUTRAL] But that don't that don't.
[AGENT][NEUTRAL] How much was your patient portion?
[CUSTOMER][NEUTRAL] It says
[CUSTOMER][NEUTRAL] You want me to break it down?
[AGENT][NEUTRAL] No, no, no, I see the like the adjudication information and all the dates and the codes and stuff, but I'm saying on I mean maybe it's at the end.
[CUSTOMER][NEUTRAL] This amount you owe is 249 47.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Was it? OK, here's that they billed a total of $787 amount saved, I guess that's what they deduct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] was 446,000.
[AGENT][NEUTRAL] I think you have something different than me.
[CUSTOMER][NEUTRAL] Uh, and the plan allowed amount was $340.14?
[AGENT][NEUTRAL] Oh yeah, no, it doesn't have any of this on it. Oh, that's your, I got it. That's your patient explanation of benefits. This is from
[CUSTOMER][NEUTRAL] Your plan
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] Florida cancer specialist sent over, it's like a
[AGENT][NEUTRAL] It looks like just information from the explanation of benefits.
[CUSTOMER][NEUTRAL] Did they actually send you the EOB that was sent from United?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Don't they have to do that?
[AGENT][NEUTRAL] They can or they can send, um, well, it's different forms that they can send. Yes, we were, we prefer the explanation of benefits. This this is kind of like a provider copy of the explanation of benefits. So I guess for them, yes. It's different than yours though, like it doesn't show patient responsibility, what was applied, it just shows what was billed, what was adjusted, that's it and codes.
[AGENT][NEUTRAL] There's no totals or anything. So what did it say that your total was for the patient responsibility?
[CUSTOMER][NEUTRAL] And then I when I continue it on the back.
[CUSTOMER][NEUTRAL] It's telling me, you know, one section shows me for, you know, 115 for diagnosis, all this diagnosis, the 5 that I read the 5 that are 6, excuse me, that I read out to you said 249 47.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then you go on the back.
[CUSTOMER][NEUTRAL] Can we go with more prescription drugs?
[CUSTOMER][NEUTRAL] And all that there's another total of amount I owe is $314.
[CUSTOMER][NEUTRAL] And then again on the bottom is the amount I owe of $23.04.
[CUSTOMER][NEUTRAL] So from this total here.
[CUSTOMER][NEUTRAL] There's $249 there's $314.23 dollars.
[AGENT][NEUTRAL] OK, yeah, I'm not sure because they only billed for the 270, 251 and we paid it.
[CUSTOMER][NEUTRAL] That's all they bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] They didn't bill the, see, they're not billing the submit. They're not submitting the full EOB because that's what I have before me.
[AGENT][NEUTRAL] Let me look for the [PII].
[CUSTOMER][NEUTRAL] That's an injection.
[CUSTOMER][NEUTRAL] We already went through that one.
[AGENT][NEGATIVE] Yeah, we haven't received anything for the [PII] yet.
[CUSTOMER][NEGATIVE] OK, I'm gonna write it down here [PII] not received.
[CUSTOMER][NEUTRAL] IPL.
[CUSTOMER][NEUTRAL] OK, and then there's um let's see we're in February right now, February.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Was the last data service.
[AGENT][NEUTRAL] [PII], let me see.
[CUSTOMER][NEUTRAL] Yeah, yeah, this year.
[AGENT][NEUTRAL] And there's no claim on file for February yet.
[CUSTOMER][NEUTRAL] OK, great. I haven't got that EUB so that's not surprising.
[CUSTOMER][NEUTRAL] Hold on file yet, but I'm gonna be checking every month.
[CUSTOMER][NEUTRAL] Because I don't wanna get this little surprise.
[CUSTOMER][NEUTRAL] At the end of the year.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] With this bills.
[CUSTOMER][NEGATIVE] I know. I'm like, God, where do you think you're gonna pull this out of right now? And you think, oh, we're gonna, I was like, do what you gotta do because, you know, if you would have done what you had to do at the beginning, we wouldn't have this problem.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You know, I gave them all the information, and there's several times that I have to say, hey, did you build API? No, well, what the hell are you waiting for?
[AGENT][NEUTRAL] Because I need my payment, right?
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Right, you want your payment. This is what you get. I give you all the information. What is it that you.
[CUSTOMER][NEGATIVE] What is it that I, you know, if I need to do your job, y'all need to pay me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's how I look.
[CUSTOMER][NEGATIVE] And they think I'm being mean.
[AGENT][NEUTRAL] Well, it's not being mean, it's just, I mean, you're paying for it and they're waiting until the end, so you can't use your benefits because other things have used, I mean, you're using it, but not for that.
[CUSTOMER][NEUTRAL] Right, so.
[CUSTOMER][NEGATIVE] Right, I'm like, I mean, you know, if I tell you, you know, you can't, you can build them all you want, but they ain't gonna pay nothing, you know, why waste the time?
[CUSTOMER][NEGATIVE] I just don't get people sometimes, you know, it's like they don't communicate, they don't, they don't understand English. I don't know.
[CUSTOMER][NEGATIVE] I'm just, you, you see my baffled, you know, self with this.
[AGENT][POSITIVE] It's totally fine. That's what we're here for.
[CUSTOMER][POSITIVE] Y'all been wonderful. Every time I call, I'm like going, you know, OK, it's just, you know, explain to me what it is. I've got it, I'm good, but, you know, they didn't like you didn't pay it. Well, did you do what you're supposed to do? No. Well, then why are you coming at me for it? Oh, that's the easy route.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Well, my dear, thank you so much for your patience.
[AGENT][POSITIVE] Oh, you're very welcome.
[CUSTOMER][POSITIVE] Thank you so much for your help. I'm sure I will be on the phone again soon to check the [PII] 1 too now.
[AGENT][POSITIVE] Well, I hope I get you so I can help you, but anybody here will be more than happy to help you, but it has been a pleasure talking to you.
[CUSTOMER][NEUTRAL] Oh, they make me crazy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] What's your name again, dear? [PII]?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And uh, I thought that was something easy, but I can't remember easy.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Give me difficult. I can remember difficult. Oh Lord. [PII], thank you so much, my dear. You have a wonderful week.
[AGENT][POSITIVE] Thank you, you also, and thanks for calling APL. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Not today, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] OK, alright, bye bye.