AccountId: 011433970860
ContactId: b257eca3-7dc4-417d-bb9b-007dd2ace9f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 4270500 ms
Total Talk Time (AGENT): 1266720 ms
Total Talk Time (CUSTOMER): 1618267 ms
Interruptions: 9
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/b257eca3-7dc4-417d-bb9b-007dd2ace9f6_20250124T14:07_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, [PII]. Good morning.
[AGENT][POSITIVE] Good morning. How are you doing?
[CUSTOMER][POSITIVE] So, good, good. I have um a couple of questions.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The first one, it should be the easiest one is uh do I give you the claim number?
[AGENT][NEUTRAL] Well, 1st may I have your name and a good contact number, and are you the insured or you a provider or group?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And what else did you need? My name and my what?
[AGENT][NEUTRAL] Are you the insured or you're calling with a provider or uh employer?
[CUSTOMER][NEUTRAL] I'm the insured, I'm the insured.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And then may I have your policy number?
[CUSTOMER][NEUTRAL] Um, policy number.
[CUSTOMER][NEUTRAL] 2148482
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] OK. So my date of birth is [PII].
[CUSTOMER][NEUTRAL] My email is [PII] or [PII].
[CUSTOMER][NEUTRAL] And what else?
[AGENT][NEUTRAL] The mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And is the question in reference to the most recent claim?
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] In the 5, OK, what's your question?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] OK, uh, OK. The first question with regards to a dependent [PII] the the claim number was 3477771.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] 13.
[AGENT][NEUTRAL] OK, and the claim was denied because the plan.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The service is not covered under the plan's wellness benefit. Therefore, benefits are not payable, OK. So what questions did you have in reference to that?
[CUSTOMER][NEUTRAL] OK. Um, I thought he had a wellness checkup like every time we go to the doctor.
[AGENT][NEUTRAL] Let me see what it has for, there are, so there are limited um.
[AGENT][NEUTRAL] Health screening benefits is this is saying that whatever was done was not under those wellness benefits. Um, hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well that, that answers that question.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I did submit, let me know when you're ready. This is a different claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 347-6130
[CUSTOMER][NEUTRAL] No, not that one. I'm sorry. Wrong, wrong one.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Um, I'm trying to find out, it's cause it was a mammogram.
[CUSTOMER][NEUTRAL] And it says on my wellness claim I can file for mammograms.
[CUSTOMER][NEUTRAL] So, um, I guess it didn't happen. It was, I believe it's 3472583.
[AGENT][NEUTRAL] 0472583. OK, here it is. Hold on one moment.
[AGENT][NEUTRAL] OK, so this one.
[AGENT][NEGATIVE] It was denied, but it was denied requesting the itemized bill.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But what was it for?
[AGENT][NEUTRAL] Um, let me see if I can see what it's for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause usually it says mammogram, but I'm not, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Actually, it says we'll need the itemized bill for treatment and medical records for the data. So this is probably the mammogram, but hold on one moment. I'm trying to pull up the documents to see if I can see what it's for.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEGATIVE] That's just so confusing to me.
[AGENT][NEUTRAL] Hold on one moment I'm just pulling up the document.
[AGENT][NEUTRAL] What is it asking for the itemized bill and medical records, OK.
[AGENT][NEUTRAL] And what is it for?
[AGENT][NEGATIVE] Sorry, the page is downloaded one by one. It's about 16 pages. I'm waiting for it to come up so I can get to what it was.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Next up, pay online now what the charges.
[AGENT][NEUTRAL] Oh no, this is for.
[AGENT][NEUTRAL] OK, so this is several dates of service.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] [PII] is imaging, EKGs, labs, so that's why they're asking for the medical records because to see why all of this is needed, and then the itemized bill to show the diagnosis on why all of this is needed. So yes, that makes sense.
[CUSTOMER][NEUTRAL] So, which one was that one you're looking at?
[AGENT][NEUTRAL] This
[AGENT][NEUTRAL] Is, hold on, are you asking me what claim number is 3472583?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because
[CUSTOMER][NEUTRAL] I'm confused on what um
[CUSTOMER][NEUTRAL] But there's, there's 3, that I saw on my screen, it's like 212, 211, 211, 29.
[AGENT][NEUTRAL] So like are you trying to see the denial why the claims were denied? I don't under I don't know. How, how can I help you? Like what, I don't know what you're trying to figure out, but I can help you.
[CUSTOMER][NEUTRAL] Well, I'm trying to understand how, I'm trying to understand how y'all, OK you see on 3347-5130, they paid me 5000, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And I'm trying to see the other, the other claims why they were denied if they were for the time of service as well.
[AGENT][NEUTRAL] So your claims are denied, not not denied as in this is the final decision. They're denied asking for additional information. So the ones that were paid, we didn't need anything additional. Everything was given, so they went ahead and, you know, they processed the claim. But what's being asked like the itemized bill, because that's the, that's the denial reason for majority of these.
[AGENT][NEUTRAL] Um, the itemized bill and medical records, and then what's this one?
[AGENT][NEUTRAL] And then some of them, the benefit has been exhausted. Um, so between needing the itemized bill and the medical records, the only other denial reason was that the benefit was exhausted for the year.
[AGENT][NEUTRAL] So there's, I mean, it's nothing that you're.
[AGENT][NEUTRAL] Doing or not doing, we just need it anytime a claim is submitted, we'll always need the itemized billing and sometimes they will request medical records.
[CUSTOMER][NEUTRAL] Right, so I submitted everything to cover those dates is what I'm saying, and so.
[AGENT][NEUTRAL] So the itemized bill that you, so there's an itemized bill that you sent in, that's your patient version, but there's a big version of it that your patient bill came from. You see how yours just shows procedure codes. That's the treatment that was done. The big bill shows the diagnosis, the medical necessity for that treatment, so we can pay out, which is why they're asking for that bill because we see what was done, but
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] We need to be able to determine medical necessity to prove why we need to pay this claim.
[CUSTOMER][NEUTRAL] Yes, I understand that portion.
[CUSTOMER][NEUTRAL] But what I'm saying is that I submitted everything. It says receipt of your claim is acknowledged. However, in order to provide further consideration for your claim, we need the itemized bill, treatment received medical records for the date of service. We received the itemized bill. We are needing the admin and discharge summary, so I complied with that. I submitted everything and they still denied it.
[AGENT][NEUTRAL] So that
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so the only other way that I can try to explain it, this is an itemized bill.
[AGENT][NEUTRAL] The itemized bill that you submitted.
[CUSTOMER][NEUTRAL] I understand the difference. I comprehend that. I was, I submitted, I submitted all three the what they were requiring for me.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] That's what I'm saying.
[AGENT][NEUTRAL] Right, and I'm not negating that you submitted it. It was just the wrong document. So we just need to get the correct document and then we can continue processing.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so what is the what is the correct document because I submitted all three of them.
[AGENT][NEUTRAL] So you're gonna call the provider.
[AGENT][NEUTRAL] And let them know that you need the itemized bill. Some places may call it the universal bill. This is a hospital, so they'll have a universal bill.
[AGENT][NEUTRAL] UB04 like umbrella.
[AGENT][NEUTRAL] Baby and then 04.
[AGENT][NEUTRAL] This document shows
[CUSTOMER][NEUTRAL] U B U B
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you say the word again? You be what?
[AGENT][NEUTRAL] U like umbrella, B like baby, and then 04.
[CUSTOMER][NEUTRAL] And that is an itemized cell?
[AGENT][NEUTRAL] Yes, that's the itemized bill from the hospital.
[AGENT][NEUTRAL] It shows every charge and every code from the day you were admitted to the day you discharged, and that's what we're asking for. This is what your patient bill that you submitted was generated from. We need the original though.
[CUSTOMER][NEUTRAL] So where does it, where does it say that to me, ma'am?
[AGENT][NEUTRAL] That wouldn't be for you wouldn't know that. That's why I'm explaining it to you now.
[CUSTOMER][NEUTRAL] So you don't inform people of that.
[AGENT][NEUTRAL] Would you submit it to you.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what you're saying is that you don't, I wouldn't know what UBO4 means, but you expect, but you.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Right, there are some people that do, so.
[CUSTOMER][NEGATIVE] OK, but you expect me to submit a paperwork UB04 when I don't know about it, but you are requiring it, so you deny my claim because I don't submit it.
[AGENT][NEUTRAL] Well, ma'am, to be the provider was supposed to submit this claim, they would have known to send that. In this case, Valley Baptist Medical Center.
[CUSTOMER][NEUTRAL] Who's the writer?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Why would they submit anything to you?
[AGENT][NEUTRAL] Because they're the providers. See, typically the insured does not submit claims, so this is a one-off, which is why you didn't know. So I'm educating you on it.
[CUSTOMER][NEGATIVE] Well, how, how are you educating me now when they should have told me then?
[AGENT][NEUTRAL] The
[CUSTOMER][NEGATIVE] I, I don't understand.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] So we're the insurance company. Yes, your provider should have explained this to you when you were there for the services. I unfortunately can't speak for them, but I'm helping you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But they don't, I, I don't understand.
[AGENT][NEUTRAL] So they were supposed to file this claim.
[CUSTOMER][NEUTRAL] How would they file that claim?
[AGENT][NEUTRAL] It's billing. This is a one-off. Typically insurers don't submit claims, which is why you don't know the information.
[CUSTOMER][NEGATIVE] But how am I supposed to know that when I'm paying monthly for my services insurance through you guys, y'all don't tell me that, that, that the hospital's gonna submit it.
[AGENT][NEUTRAL] Ma'am, that's just how healthcare works. We typically don't have to explain this. When you go to the doctor, they bill us. The problem is they did not do that. So you had to and you should not have had to. So I'm just trying to help you get your documents so you can get your claim paid because they didn't do what they were supposed to.
[CUSTOMER][NEUTRAL] Oh, OK. Oh, OK, so.
[AGENT][NEUTRAL] If you like, I can even call, if you like, I can call them and ask them for the documents that are needed. I just, I just didn't want you to think that APL negated to tell you something. This is because the provider did not file the claim.
[CUSTOMER][NEGATIVE] So I'm lost.
[AGENT][POSITIVE] If you like though, I will be more.
[CUSTOMER][NEUTRAL] The provider never filed the claim.
[AGENT][NEGATIVE] That's the problem. They should have, which is why you're having to go through this. You should not be going through this right now.
[AGENT][NEUTRAL] The document that I'm asking that we're asking for comes straight from the hospital. They know to send that.
[AGENT][NEUTRAL] However, if you'd like for me to reach out to them, I can and I can let them know what document is needed and how to send it to us so that you don't have to do that. Would you like me to do that for you?
[CUSTOMER][NEGATIVE] Yes, and then can you tell me who you contact because I know they're not gonna do it.
[AGENT][NEUTRAL] OK. Do you have a phone number for Valley Baptist Medical Center? I can Google it if you like.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEGATIVE] Go out my way and you're gonna be nasty.
[CUSTOMER][NEUTRAL] Thank you for calling Valley Baptist Medical Center. Graciasoramar uh Valley Baptist Medical Center.
[CUSTOMER][NEUTRAL] For English dial one now.
[CUSTOMER][NEUTRAL] Pa [PII]
[CUSTOMER][NEUTRAL] If this is a medical emergency, please hang up and dial [PII]. Please hold for the next available operator.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Hello [PII].
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm calling from American Public Life. Is this the billing department?
[CUSTOMER][NEUTRAL] No, in a minute, let me connect you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, but
[CUSTOMER][NEUTRAL] Thank you for calling the hospital business office. For English, stay on the line, and for Spanish Press too.
[CUSTOMER][NEUTRAL] We are attempting to locate your account from the number you are calling from. One moment, please.
[CUSTOMER][NEUTRAL] We are routing your call to the next available representative. Please be advised that this call may be recorded or monitored for quality assurance. We also need to advise that this is an attempt to collect a bill. Any information will be used for that purpose. Thank you. We are now looking for the next available agent.
[CUSTOMER][POSITIVE] Hi, thank you for calling the business office. My name is [PII]. Financial assistance is available for those who qualify. And how can I help you?
[AGENT][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from American Public Life. I need a copy of um a UBO4 for a date range um sent over to us. The insured is on the line as well. We're trying to process her claim and we just need the itemized bill for processing.
[CUSTOMER][NEUTRAL] No worries, let me just double check the account and um are you calling from um insurance or attorney's office?
[AGENT][NEUTRAL] Insurance.
[CUSTOMER][NEUTRAL] And it should be the patient primary or secondary?
[AGENT][NEUTRAL] We are her um secondary.
[CUSTOMER][NEUTRAL] And let me just get the um account number if you do have it on your end.
[AGENT][NEUTRAL] The reference number?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Is that the same? 313-549-255.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You so much and let's just verify the account with the patient name and date of birth.
[AGENT][NEUTRAL] [PII], sorry, um, date of birth, hold on one moment.
[AGENT][NEUTRAL] Date of birth is [PII].
[CUSTOMER][POSITIVE] Alright, thank you so much and for what date of service is this for?
[AGENT][NEUTRAL] So this is a date range, um, hold on one second, let me go back to that doc. Um, [PII].
[CUSTOMER][POSITIVE] Alright, thank you so much and in any case, did you also submit a request to fax or mail with us?
[AGENT][NEUTRAL] No, we haven't submitted a request. It's for their claim. She actually had to file this claim. You all should have filed this, and this this document that we're requesting would have been in there.
[CUSTOMER][NEUTRAL] OK, because upon checking here, the secondary insurance was not listed on the file, um, so, um, you.
[AGENT][NEUTRAL] Oh, so that's why she had the, OK, that makes sense.
[CUSTOMER][NEUTRAL] Yeah, so, ma'am, um, do you need to send it over to us through fax or mail as well, um, so we can send you the copy of UBO for an itemized state.
[AGENT][NEUTRAL] Or can you file the claim with us?
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEGATIVE] Um, unfortunately, ma'am, this account goes to collection, so we don't have access anymore, not unless we're gonna have with them.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So she's on the line with us. Can she just request to have it sent to me? Like what is the easier way?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, so if you cannot able to um request through fast or mail, ma'am, um, what we can only do is I'm gonna file this on my end it's just that the patient will be receiving this through her mail.
[AGENT][NEUTRAL] So you're gonna
[CUSTOMER][NEUTRAL] Maybe she can provide.
[AGENT][NEUTRAL] OK, so you're gonna, you're going to send the UBO4 to her home address?
[CUSTOMER][POSITIVE] That is correct uh huh.
[AGENT][NEUTRAL] And then she'll then have to upload it or send it to us.
[CUSTOMER][NEUTRAL] That is right, uh huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, that's fine.
[CUSTOMER][NEUTRAL] And I'm not, OK, so, um, just a second, ma'am for recording purposes only I do need to advise that all calls may be monitored or recorded and financial assistance is available for those who qualify. And this is an attempt to collect a billow to Haringen and information obtained will be used for that purpose. Uh, ma'am, give me 1 to 2 minutes. Let me just process those document requests.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Alright thank you
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So this means that she's gonna send the medical records on the device?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] He's gonna send the itemized and the medical records.
[AGENT][NEUTRAL] Um, I'll probably have to speak with medical records for the medical records. This is just billing.
[CUSTOMER][NEUTRAL] OK, because it says, um, there's two dates, ma'am. There's uh [PII] and then [PII].
[AGENT][NEUTRAL] OK, I'm gonna give her the next um the next one in a second. So what was the second one?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 528, 24.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For uh CIA.
[AGENT][NEUTRAL] And this one needs the medical, I mean, I'm sorry, not the medical bill, the itemized bill. I put it all together.
[CUSTOMER][NEUTRAL] Yeah, it says need itemized bill for treatment, receive medical records, the date of service. So it's 2 dates of service.
[CUSTOMER][NEUTRAL] Please submit the admissions and discharge.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, for the um medical records, you're going to have to sign a release the information.
[AGENT][NEUTRAL] See, this is all because they didn't file it. So, um,
[AGENT][NEUTRAL] But she said they didn't file it because they didn't know, they didn't have the information on file. So next time, just make sure you give them your um policy number for us and they'll go ahead and do all this for you.
[CUSTOMER][NEGATIVE] OK. Well, because ever since 22, nobody's ever done it for me now.
[AGENT][POSITIVE] Well, it's OK. I'm sorry, no one told you before, but now we know and we can do better.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Uh, yes, thank you so much for patiently waiting and I was able to request um I my statement and UVO4 and um.
[CUSTOMER][NEUTRAL] And you will be going to, um, I mean the patient will be going to receive it within 5 to 10 business days through mail. Um, for now, is there anything else that you need for the assistance?
[AGENT][NEUTRAL] Yes, um, we also need the itemized bill and UBO4 for [PII].
[AGENT][NEUTRAL] And then I have a question. Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's the correct date, right?
[AGENT][NEUTRAL] Miss [PII].
[CUSTOMER][NEUTRAL] Um, it's
[CUSTOMER][NEUTRAL] Um, yes ma'am, that is the correct date.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But also there's 2 other dates.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[CUSTOMER][NEUTRAL] Uh, [PII] is the, um, is, is it Ma'am [PII] on the um on your line?
[AGENT][NEUTRAL] Yes, she's on the line as well.
[CUSTOMER][NEUTRAL] Hi, um, can you verify the account with her as well?
[CUSTOMER][NEUTRAL] Can I verify the account? Yes, ma'am, I can.
[CUSTOMER][NEUTRAL] Uh, yes, thank you so much, [PII]. Let me just verify the card with you with your full name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Alright then thank you and what is your address and best contact number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. My contact is [PII].
[CUSTOMER][POSITIVE] Alright then thank you so much and is that a cell phone or a landline?
[CUSTOMER][NEUTRAL] It's a cell phone.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, so the item is a statement and the UVO4 that I was able to request earlier is the um patient reference number that ma'am [PII] gave me. The um date of service is [PII]. And I said that, um, what is the other date range, ma'am, that you need the I message statement for?
[CUSTOMER][NEUTRAL] Uh, is it the [PII]?
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] And then there's [PII].
[CUSTOMER][NEUTRAL] Go ahead, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, upon checking here, ma'am, what I can only see is [PII] and [PII].
[CUSTOMER][NEUTRAL] OK then it must be the [PII], ma'am.
[CUSTOMER][NEUTRAL] OK, it must be the
[CUSTOMER][NEUTRAL] But the other two dates is [PII] and [PII].
[AGENT][NEUTRAL] Are these the same, is that the same provider?
[AGENT][NEUTRAL] For those dates of service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] It is yes.
[AGENT][NEUTRAL] OK, I see him here.
[CUSTOMER][NEUTRAL] Just one second, ma'am. I'm still trying to um check with that.
[CUSTOMER][NEUTRAL] [PII], um, with the [PII] isn't it the [PII] instead, ma'am?
[CUSTOMER][NEUTRAL] What was the date, ma'am? December what?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] No, it's [PII] and I stayed in the hospital through the
[CUSTOMER][NEUTRAL] [PII] something. Uh.
[CUSTOMER][NEUTRAL] Oh, I think that's for um [PII].
[CUSTOMER][NEUTRAL] [PII], OK, so the [PII] through the [PII]?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, yes. Because it was like 3 days, yeah.
[CUSTOMER][NEUTRAL] Yes, it was.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] And this is the easier way that they can um receive the itemized statement and you'll be offered um um in a shorter time period because if the insurance is the one who's gonna request that it would take 30 business days but on your end.
[CUSTOMER][NEUTRAL] Um, it only, um, it only takes 5 to 10 business days. It's just, it's just that you also need that to forward with your insurance. So, um, just a quick recap, ma'am, and, uh, and, uh, ma'am [PII], um, you call in to request an IT my statement and you BO4, and you did process that for a date of service of [PII] and um.
[CUSTOMER][NEUTRAL] [PII], [PII] and [PII]. And again, ma'am [PII] will be receiving it through mail within 5 to 10 business days. And ma'am, for future references only, you can always manage account for payment and give a statement to facilities website. Is there anything else for today I can help the both of you?
[AGENT][NEUTRAL] For the medical records, she needs to go to the medical records department, right, for the release of information?
[CUSTOMER][POSITIVE] That is correct, ma'am.
[AGENT][NEUTRAL] Is that correct? OK.
[AGENT][POSITIVE] Alrighty, well, thank you very much.
[CUSTOMER][POSITIVE] You're so much welcome, ma'am. If there's nothing else for today, I appreciate the time to spend both on the phone with me. By the way, just a quick survey after this call if you would like to participate, ma'am. OK? Have a nice day, the both of you. Bye bye now.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][POSITIVE] Thank you. Thank you.
[AGENT][NEUTRAL] OK, Ms. [PII], so she's going to be sending you the itemized bills um for the dates that we requested, and then you'll just upload them online um or send them in how you have. And then now for the medical records because they're your records, they're gonna make you sign a release the information. Now again, all of this you would not have had to do if they, if they filed the claim. You're only doing this because they didn't file.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. I, I wasn't aware of that.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Well, it's OK, it's no problem at all. Um, once you fill out the, now, I don't know how the, you're gonna have to call, um, you can really just call your doctor's office and um I don't know if they're gonna make you like, if they can send it electronically and you sign or if you have to come in, each place is different, so I don't know how to tell you which one for that one.
[AGENT][NEUTRAL] But once you sign the release of information, they'll go ahead and um they'll ask you, do you want it to be released to you or to us, you decide, and then they can either send it to us or you can go ahead and get it sent to you and then send it to us as well.
[CUSTOMER][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] I'm sorry, but I got
[CUSTOMER][NEUTRAL] Kind of, uh, OK.
[CUSTOMER][NEUTRAL] My policy claim number for for the first two days, which what is what is the policy number for [PII] and the [PII]?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] That's why I was asking, was there another um
[AGENT][NEUTRAL] Provider because we don't have claims for those dates of service. I was looking while you were going over them.
[AGENT][NEUTRAL] We only have um May, hold on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me go back to the claims.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We have [PII].
[AGENT][NEUTRAL] Um, [PII], I'm sorry, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, that one you already said.
[AGENT][NEUTRAL] And then um the last claim has [PII] and [PII] on it together.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] So what I was
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I, I'm just so confused with it, um.
[AGENT][NEUTRAL] Unless now, hold on. Oh, I'm sorry.
[CUSTOMER][NEUTRAL] Cause I had a stroke.
[AGENT][NEUTRAL] Are the dates that you're giving, are these all for you or they are for your dependents as well, because I was just looking for under you. OK, OK, then yes.
[CUSTOMER][NEUTRAL] Just for me.
[CUSTOMER][NEUTRAL] It's for me.
[CUSTOMER][NEUTRAL] But what I, what I'm saying is that I had
[CUSTOMER][NEUTRAL] I had um a stroke in uh July, June, July, August, uh, yeah, July.
[CUSTOMER][NEUTRAL] I had a stroke in July.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] See, mammogram, I did it on uh in [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And they didn't pay it. They didn't pay. They said that it had exhausted.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I was like, well then, why do I report it? I thought I had a wellness check.
[CUSTOMER][NEUTRAL] You know?
[AGENT][NEUTRAL] But it's
[CUSTOMER][NEUTRAL] It says the policy does not provide an accident screening benefit. Am I following the wrong claim, or because it was a mammogram.
[AGENT][NEUTRAL] Yes, that's the wrong type of claim. So accident screening benefit is like if you were in a car accident or something happened, um, and you were getting screened, you know, for injuries or something from that accident, that's different than like a preventative screening at the doctor, like mammogram or Pap smear or something.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So on the group,
[CUSTOMER][NEUTRAL] OK, so what I don't understand is how to file it, I guess, because I'm filing it wrong. On [PII], I did a mammogram and it said
[CUSTOMER][NEUTRAL] The Benetton have been exhausted for the planning year. What does that mean?
[CUSTOMER][NEUTRAL] In [PII].
[AGENT][NEUTRAL] So for the plan here, that means, OK, so your plan became effective on [PII]. So, [PII], that's a new plan year. Um, sometimes it might be [PII] or it it's based off of when your policy became effective.
[CUSTOMER][NEUTRAL] OK, so from [PII], I did a mammogram and they didn't cover it, that I just read to you what it said.
[AGENT][NEUTRAL] So let me see about [PII].
[CUSTOMER][NEUTRAL] Why was that not covered?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] My plan was in effect in March, I mean, um, since [PII].
[AGENT][NEUTRAL] What is it? [PII].
[AGENT][NEUTRAL] Uh, from January to Jay. So for
[AGENT][NEUTRAL] Wait a minute. OK, for [PII].
[AGENT][NEUTRAL] Hold on one moment. From [PII], that mammogram was denied because you had a claim on [PII] that used the screening benefit.
[AGENT][NEUTRAL] Let me pull up your your um policy documents so I can see how your benefits are set up. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause that'll help me explain it. Where is your?
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it was a health spring.
[CUSTOMER][NEUTRAL] And this pay benefits also covered person the plan you no additional benefits to pay for but this.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Oh, OK, I see. I see. In [PII] they covered the health screen.
[AGENT][NEUTRAL] Right, but what I'm trying to see is because they sometimes they have it to where you can pick like a wellness screening or a regular screening or you can have like one of each. So I'm trying to see if it's one of each or
[CUSTOMER][NEUTRAL] That is
[AGENT][NEUTRAL] One per covered person.
[AGENT][NEUTRAL] OK, yeah. So that's why the [PII] um gave you the reasoning of, um, it was maxed out because that health screening is one of the three that you can choose from and that's what was paid out the $50.
[AGENT][NEUTRAL] Did I confuse you?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] I'm so sorry, I hit my mute button. Um, so,
[AGENT][NEUTRAL] Oh, it's OK.
[CUSTOMER][NEUTRAL] From the 3, I can choose 1 per year.
[AGENT][POSITIVE] Right, exactly.
[CUSTOMER][NEUTRAL] Not all 3 per year.
[AGENT][NEUTRAL] Right, it's one or the other.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But now for [PII].
[CUSTOMER][NEUTRAL] So, would that apply, would that apply?
[AGENT][NEUTRAL] I was looking at, I was gonna say now for the [PII].
[CUSTOMER][NEUTRAL] Excuse me?
[AGENT][NEUTRAL] I, I would probably send that one back because I don't see anything else in in [PII]. Hold on, let me look through all the dates.
[CUSTOMER][NEUTRAL] Yeah, cause that's a different year.
[AGENT][POSITIVE] I can do it like this.
[AGENT][NEUTRAL] Yeah, that's the only claim for [PII]. So I would, I would, um, I would probably send that one back to be reprocessed. If you like, I can send that back for you.
[CUSTOMER][NEUTRAL] Yes, please, ma'am.
[CUSTOMER][NEUTRAL] Cause that's, I mean, if it's one a year, OK, and then on one of them it said uh
[CUSTOMER][NEGATIVE] Like not covered.
[CUSTOMER][POSITIVE] That's fine, yes, I would like to do that again.
[AGENT][POSITIVE] OK, well, I'm definitely sending this over for you now.
[CUSTOMER][NEUTRAL] And that one is uh what was the claim number for that one?
[AGENT][NEUTRAL] Um, this one is.
[AGENT][NEUTRAL] 3,458,590.
[CUSTOMER][NEUTRAL] And no, OK, let me see if I can find it because I wanna
[CUSTOMER][NEUTRAL] 3,458,590, and that is from March.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right, now for that one.
[AGENT][NEUTRAL] Let me do this. Let me, I'm gonna place you on just a brief hold if you don't mind. I'm gonna reach out to claims. I don't believe that this is the same as an appeal because we're having it reprocessed, but let me just double check. Um, do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] No, ma'am. Go ahead.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII]. How are you doing?
[CUSTOMER][NEUTRAL] Hi, I'm good, [PII], and you?
[AGENT][POSITIVE] I'm doing good. Um, I don't know if I'm confusing myself or not, but I'm glad I got you.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Um, you want the policy number?
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, it's 214.
[AGENT][NEUTRAL] 8482.
[CUSTOMER][NEUTRAL] OK, alright, let me get that pulled up.
[CUSTOMER][NEUTRAL] And who is that for?
[AGENT][NEUTRAL] Um, it's for part, oh no, this is for her, [PII].
[CUSTOMER][NEUTRAL] OK, OK, what's your question?
[AGENT][NEUTRAL] OK, for claim 3,458,590.
[CUSTOMER][NEUTRAL] OK, the very first one all the way down at the bottom, OK.
[AGENT][NEUTRAL] OK, so we, so we we denied it saying that it was um exhausted in the plan here, but this was the first, the only claim for [PII].
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Let me take a look. OK, go ahead.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] But since it's over 180 days, I didn't know when something is sent back to be reprocessed, is that the same as an appeal?
[CUSTOMER][NEUTRAL] Oh, we don't have, we don't, um, now see that's, that's a new one. I don't know if you heard that somebody told you that, but I've never been told that. I mean, if you find the error and it could be a year, 2 years later, it just goes to that person for them to, uh, reprocess that claim. I haven't, I never heard that.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] What? 180 days?
[CUSTOMER][NEUTRAL] Yeah, I ain't never heard that.
[AGENT][NEUTRAL] Oh, OK. I was, so yeah, I, I had put it in our chat.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I can't even get this. OK. uh-huh, go ahead, you did?
[AGENT][NEUTRAL] I put it in our chat. Yeah, I mean, that's always what they said to me for an appeal, but I didn't know, well then if I take it the way you.
[CUSTOMER][NEUTRAL] But it's, but this, but this is not an appeal if it was processed wrong.
[AGENT][NEUTRAL] OK, that was where I was hung up on. I didn't know. OK.
[CUSTOMER][NEUTRAL] Follow me. So, so if it was processed wrong, then let me take a look at something one why she got all these.
[CUSTOMER][NEUTRAL] Oh, that's the accident. We're looking at the critical illness is what we're looking at. Um, let's take, let me look at it one more time. I just wanna make sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I could tell you because then that's not considered an appeal if something was processed wrong let's see.
[CUSTOMER][NEUTRAL] Year [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Just bear with me one minute. I'm just double checking to see I make sure I see what you see.
[AGENT][POSITIVE] Oh, thank you. I appreciate it.
[CUSTOMER][POSITIVE] You're right.
[CUSTOMER][NEGATIVE] I don't see that that was paid.
[CUSTOMER][NEUTRAL] Uh, for [PII] and I don't see any other policy that it would have went up under like she would have had a continuing this is the only critical illness policy that I see, um, but it was paid for 23 and 24, but I'm not showing that it was paid for [PII].
[CUSTOMER][NEUTRAL] So to me I would send that back to the original processor.
[CUSTOMER][NEGATIVE] Stating what you said that it was never paid, please reconsider mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][POSITIVE] All right. You're welcome have a good one, OK?
[AGENT][NEUTRAL] Alright, you too.
[CUSTOMER][NEUTRAL] Uh huh bye bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello Miss [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So I did um go ahead and send that claim back to be reprocessed. Um, I was talking to a claims representative, they looked at it with me as well, and that was the only claim for [PII]. So I, I do apologize that was um filed or or processed incorrectly.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK, so I'll be sending that 3458. OK.
[AGENT][NEUTRAL] So we're we're reprocessing that one.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] I don't know about my dependents.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But, so my son went to, to get a screening for, cause he has the, the heart pacer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The, I don't know, I don't know what they call it, a pacer. Like they, it's in his heart. Yes, pacemaker. So he went to get a screening on [PII] and [PII].
[AGENT][NEUTRAL] Like a pacemaker?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I didn't know which to file it with critical illness or group accident, so I did both, but they both were denied.
[CUSTOMER][NEUTRAL] And he is my dependent. I don't know if he has a wellness claim for every year, but
[CUSTOMER][NEUTRAL] That's what I'm asking.
[CUSTOMER][NEUTRAL] If you can check.
[AGENT][NEUTRAL] If I can check and see if it was received, which
[CUSTOMER][NEUTRAL] My
[AGENT][NEUTRAL] It's for one
[CUSTOMER][NEUTRAL] It it's uh [PII], and, and he's my dependent, and uh he had a health screening and that's why I'm asking if it just, it wasn't for him, I mean, is he not covered for it, you know, just trying to understand.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's not it. Mhm.
[AGENT][NEUTRAL] It's a type of service. So, because it was for the
[AGENT][NEUTRAL] The pacemaker.
[AGENT][NEUTRAL] That's a that's a, that's.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] That's not really a a wellness benefit. That's more like a
[AGENT][NEUTRAL] It's just a regular visit. Has this been like a physical or um I don't know, I'm thinking of like a test of prostate exam, something for like preventative, that's what.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, he just went in for a checkup. He has to do one every 6 months.
[AGENT][NEUTRAL] A pacemaker is, I'm sorry?
[CUSTOMER][NEUTRAL] So it's not a
[CUSTOMER][NEUTRAL] It, it's a pacemaker. It's not like he's going in for a physical. He goes in to check his machine.
[AGENT][NEUTRAL] That's exactly what I'm saying. That's why it was not covered. That's exactly what I'm saying. Had it been something like a physical or I don't know the male exams, I, I was trying to think of other examples, prostate. I don't know, he might be too young.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I was trying to think of something for the men, but I don't really know their testing, but I'm just saying if it was something preventative or you know how we have our mammograms, our Pap smears, those are wellness.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. OK. OK, then that, that's all I wanted to know because I know he did go in to go and, and check it, so I didn't know if it was just not covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Right, that one would be not covered for him. Mhm.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK. All right. I just wanna make sure cause uh you know, he's gonna see you're coming up again and it's gonna go check it out again.
[CUSTOMER][NEUTRAL] So, all right. Uh, it's because it's with the cardiologist. It's not like he's going for a wellness, you know.
[AGENT][POSITIVE] Right, that's exactly right.
[CUSTOMER][NEUTRAL] OK, um, that way I understand on that one. So on this one, I do not see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You know how I was telling the lady, um, do you not see a claim for me for
[CUSTOMER][NEUTRAL] Cause I uploaded something, um, the forms, but I guess I, they're not there no more. Um, I don't have a claim number.
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I, I, I need a, I just, I need a claim, I need a claim. I had a
[CUSTOMER][NEUTRAL] I, I don't know how to explain it. It was a lot of medical. It, it was like they, I had an angiogram.
[CUSTOMER][NEUTRAL] Uh, in my brain.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um,
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] That's why I was in the hospital as well on [PII] and [PII].
[AGENT][NEUTRAL] Do you know like the
[CUSTOMER][NEUTRAL] But I don't.
[AGENT][NEUTRAL] Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] But what I don't, what I don't see is um
[CUSTOMER][NEUTRAL] So, on the dates, on the dates for [PII] and [PII].
[CUSTOMER][NEUTRAL] I don't see the the [PII] and [PII], so what I'm saying is I need uh to file a claim.
[AGENT][NEUTRAL] Right, so you can either, you have two choices. Either you can call the provider and give them this policy number and have them bill us, um, or you can file the claim on your own.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, well, I never have good luck with the providers, so I'll just submit it on my own.
[AGENT][NEUTRAL] Well, that's totally fine too. You can do that as well. Just make sure you get the itemized bill and um
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Well, they don't, we don't usually ask for.
[CUSTOMER][NEUTRAL] I just requested it from her.
[AGENT][NEUTRAL] Oh yeah, well, then they're already sending it to us, so um just make sure you send that billing with the claim form.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, but when I go to claims and I put, I, I put claims, right? I don't know why I'm having trouble this time around. So, it says file claim, so I said register or sign in, I sign in, and it doesn't take me to a file where I can.
[AGENT][NEUTRAL] In the
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That I can file a claim.
[AGENT][NEUTRAL] So when you're, you're, you're speaking of the online service center?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, so do you see anywhere that says like upload documents?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Go ahead and click that. That's what, that's what you click on to start um uploading the documents for the client.
[CUSTOMER][NEUTRAL] I did.
[AGENT][NEUTRAL] And then when it
[CUSTOMER][NEUTRAL] I did do that already.
[CUSTOMER][NEGATIVE] It just says uploaded and it says confirmation number and I have the confirmation number and it has my first name and then that's it. It doesn't have.
[CUSTOMER][NEGATIVE] They receive policy number, a claim number, it doesn't say nothing.
[AGENT][NEUTRAL] Oh, it won't say that.
[CUSTOMER][NEUTRAL] So, on my screen?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, if you receive the confirmation number, that's how you know it went through. Once the claim is finished processing, then all that other information is gonna populate.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK. So,
[CUSTOMER][NEUTRAL] When we talked to her, that lady from [PII], we, I also requested the other two dates for this next claim.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I just have to wait.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm. And then you'll for one of them, you're going to be, that's gonna be additional information that you're sending.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for the other ones that we don't have, you'll be actually filing the claim with the bills attached.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK. And the one we're pending still is the one we're working on, right? The
[CUSTOMER][NEUTRAL] 74.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Which is we're gonna, we're right now we need the medical records, which I already requested and I already have.
[AGENT][POSITIVE] Good.
[CUSTOMER][NEUTRAL] And we need admission and discharge, cause I think I already had uploaded that.
[AGENT][POSITIVE] And they're going to be mail, oh, I'm sorry.
[CUSTOMER][NEUTRAL] And I had already.
[CUSTOMER][NEUTRAL] No, no, it's because it says that, uh, OK. I just wanted to make sure that I had already processed that.
[AGENT][NEUTRAL] Well, that's totally fine and that's what we're here for, to go over it. That's, that's no problem at all. Um, but she did say that she was going to
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] The itemized bills are going to be mailed to you, right? Yes, she said that, mailed to you, OK.
[CUSTOMER][NEUTRAL] Yes, yes, yes, and that's fine. I'll wait for it in the mail and then I'll, I'll upload them. I'll scan them and I'll upload them and send them to you.
[AGENT][NEUTRAL] And then we'll go ahead and start processing or continue processing.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yeah, and you see, in um in in July, I was starting to tell you earlier, in [PII].
[CUSTOMER][NEUTRAL] I had a stroke as well.
[CUSTOMER][NEGATIVE] But they don't have a way to get the information cause the hospital I went to is in Corpus. And I've reached out to them multiple times, like, I mean, I'm talking about 1020 times, about 1520 times.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEGATIVE] And um they have not responded to me.
[CUSTOMER][NEUTRAL] So, I'm wondering if maybe you can help me or?
[CUSTOMER][NEUTRAL] Um, I don't know that I filed a claim for it. It was
[CUSTOMER][NEUTRAL] The [PII]. Can you see there?
[AGENT][NEUTRAL] There's a claim for [PII], you said?
[CUSTOMER][NEUTRAL] If you have anything else.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Sure, hold on one sec, and it's for you?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I don't, I don't see it on my screen.
[AGENT][NEUTRAL] And that's uh what year?
[CUSTOMER][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] [PII]? OK.
[AGENT][NEUTRAL] Yeah, I don't see anything for [PII].
[CUSTOMER][NEUTRAL] Is there any way that I can have y'all help me obtain that?
[AGENT][NEUTRAL] Sure, so,
[CUSTOMER][NEUTRAL] It was a different provider.
[AGENT][NEUTRAL] So you're just wanting to file the claim.
[CUSTOMER][NEGATIVE] Well, yeah, I wanna file the claim, but I, when I call the provider, they won't get back to me.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you what you want to give them a call now? I can, we can give them a call.
[CUSTOMER][NEUTRAL] I, I don't know their, um, it was in Corpus.
[AGENT][NEUTRAL] Oh, you don't have.
[CUSTOMER][NEUTRAL] And it was the hospital. I don't have the information. I mean, I can Google.
[CUSTOMER][NEGATIVE] But every time I reach out to them and I send emails and, and try to do the medical request through there, and they haven't gotten back to me.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] Well, now that one I don't, uh, I mean, I'll be more than happy to call whoever, but I just don't, if we don't have that, that you want to get that information and give us a call back.
[AGENT][NEUTRAL] So we can try?
[CUSTOMER][NEGATIVE] OK, I mean, I'm never gonna get somebody as helpful as you again.
[AGENT][NEUTRAL] Well, any, all of, all of us here help the same way, but I'm the only [PII] here, so if you ask for me, they'll be able to get you to me. It's only, it's only me.
[CUSTOMER][NEUTRAL] So, uh
[CUSTOMER][NEUTRAL] OK. And it's because I, I googled it, I have the information now, like I have their phone number.
[AGENT][POSITIVE] You want to try now, we can.
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] OK. Cause it's the same number. It's area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling Christaspa Hospital Corpus Christi shoreline. If you know the five digit extension of the person you wish to reach, please enter it now. To hear your menus in English, press 1. Pascucha es en espanol prima els.
[CUSTOMER][NEUTRAL] If you're calling from a rotary telephone, please hold. Cusamano de untelefono rotaiooravoresto un momento. If you need to speak to an operator, press 0 now. ius sesita of Laconnelorador or prima el erro.
[CUSTOMER][NEGATIVE] Yeah, I guess you're getting the same look I got. That's bothering me.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm calling from APL. How are you?
[CUSTOMER][POSITIVE] I'm fine, thank you. How can I help you?
[AGENT][NEUTRAL] Hi, um, I have a, um, we have a mutual insured on the line and she's needing some assistance. You were, um, trying to get the documents, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh, no, ma'am. I need item itemized bill, medical records, admissions and discharge.
[CUSTOMER][NEUTRAL] OK, um, one second.
[CUSTOMER][NEUTRAL] Thank you for calling the medical records department of Chris Spaw Shoreline South and Surgical Hospitals. For English, please press one.
[CUSTOMER][NEUTRAL] Are espanol or prima el numerodos.
[CUSTOMER][NEUTRAL] Thank you for calling the medical records department of Chris Spawn Shoreline South and Surgical Hospitals. For English, please press one.
[CUSTOMER][NEUTRAL] espanol if this is a medical emergency, please hang up and dial [PII]. Our hours of operations are from Monday through Friday [PII] Please listen to the following options. If you are a patient or representative, a physician's office needing to request medical records, please press 1. If you are calling to check the status of an existing request, please press 2.
[CUSTOMER][NEUTRAL] To have these options repeated.
[CUSTOMER][NEUTRAL] Release of information. How may I help you?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] And Ms. [PII], you'll have to speak on this one. I can't get the release information.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, I'm not trying to get them, uh, I'm just trying to get for you to tell them that you need the itemized bill and, and stuff like that.
[AGENT][NEUTRAL] Oh, she, so this is medical records. So my name is [PII]. I'm calling with American Public Life. I have the insured on the line. So we're needing itemized bills um and medical records for claims, but this is just medical records, right? So we'll need to talk the billing for the bill.
[CUSTOMER][NEUTRAL] Yes ma'am. What year was the bill? um, what year is the bill that you're needing?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The [PII] bill I might be able to assist you with that. Um, we're, it's just 2024 moving forward we're not able to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And Ms. [PII], did you want me to hold the line or you're OK now that you got somebody?
[CUSTOMER][NEUTRAL] Well, I was hoping that you could help me, like you talk to the other provider to get the information mailed to me.
[CUSTOMER][NEUTRAL] What, what is it exactly that you're needing?
[CUSTOMER][NEUTRAL] The the she said the UB 04. [PII] UBO4.
[AGENT][NEUTRAL] And the medical records?
[CUSTOMER][NEUTRAL] Yes ma'am. And the records OK and it's on behalf of yourself?
[CUSTOMER][NEUTRAL] It's, it's for me. I'm [PII].
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Yes, it's for her.
[CUSTOMER][NEUTRAL] OK, so in order to obtain that information, have you already submitted a medical record and um billing request?
[CUSTOMER][NEUTRAL] I have several times.
[CUSTOMER][NEUTRAL] OK, how have you submitted that?
[CUSTOMER][NEUTRAL] Online.
[CUSTOMER][NEUTRAL] Let me see if I have a request here from you. What is your first and last name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you, ma'am.
[CUSTOMER][POSITIVE] Miss [PII], thank you.
[AGENT][NEUTRAL] You're welcome. am I OK to end the line? Are you OK?
[CUSTOMER][POSITIVE] Yes, I think she's gonna help me. Thank you so much.
[AGENT][POSITIVE] All right, well, you're very welcome and thanks for calling APL. Have a good day, OK?
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.