AccountId: 011433970860
ContactId: ba63413f-36e7-4d58-bffc-9b60dcac6563
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2494219 ms
Total Talk Time (AGENT): 763590 ms
Total Talk Time (CUSTOMER): 1504218 ms
Interruptions: 10
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/ba63413f-36e7-4d58-bffc-9b60dcac6563_20241230T19:12_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], I'm [PII]. I um got a couple of denials uh for a claim and the radiology is trying to collect from me and I asked them to submit the claim to you because I wasn't able to. Um, I'm calling to see if this is supposed to be covered and it's just a matter of I didn't have the diagnostic code that you wanted, which is what the rejection said.
[AGENT][NEUTRAL] OK [PII], so you're following up on a couple of claims for yourself, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And who, uh, what is your last name, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you. And then what is a good callback number also for you, [PII]?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] See, I'm not sure I have that. I am at my office. I'm not sure if I can log in from here. I was hoping you could look it up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have your explanation of benefits with you that you received from us?
[CUSTOMER][NEGATIVE] No, that's also at home, but the radiology office called me today and I see in the US mail they have another bill to me. There's like 3 bills. So I, I this is sort of just came up today. I thought I was dealing with it, but they called me and they're mailing me and I don't, I didn't bring it with me. I'm sorry.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] That's OK. What is your full social and I can look up your information that way.
[CUSTOMER][NEUTRAL] OK, good. Uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. So one moment, please.
[AGENT][NEUTRAL] OK, so when was your data service, Ms. [PII]?
[CUSTOMER][NEUTRAL] This was in Octo yeah, there's two bills. The one there's 2, but the one that's uh calling me, I think it's October, let's see, October, hold on, uh.
[CUSTOMER][NEUTRAL] The beginning of October.
[AGENT][NEUTRAL] Uh, this year, were they both? Have they both been recent?
[CUSTOMER][NEUTRAL] Here's my calendar.
[CUSTOMER][NEUTRAL] It was [PII]. I'm sorry, I was trying to answer you. What, what was the next question?
[AGENT][NEUTRAL] Were they this year let's just start there first off and then we can get more detailed in a moment.
[CUSTOMER][NEUTRAL] October, I have my calendar and I'm giving you the answer to when was this and the answer is [PII].
[AGENT][NEUTRAL] OK, so any information that I provide for you today will be a verification of benefits and not a guarantee of payment. I will have to verify several things with you first for security. So first off, what is your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Also your home mailing address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is the same as the one you gave me, so that is still your best contact number. Is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] Thank you and lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So let me see if we, let me locate the claim for 10-1-2024.
[AGENT][NEGATIVE] OK. So it looks like we've received this claim twice. The first time, well, the, the most recently received one, it was just denied as a duplicate of previously submitted expenses.
[AGENT][NEUTRAL] Is this for Minute clinic?
[CUSTOMER][NEUTRAL] No, it's for the radiology, the CT scan.
[AGENT][NEUTRAL] OK, the only claim we have for you on file for 10 1 2024.
[AGENT][NEUTRAL] Is for Minute clinic.
[AGENT][NEUTRAL] Um, but let me, give me a moment to look. No, give me just a moment to refresh something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I show this was for, for 101.
[AGENT][NEUTRAL] Uh, is it [PII]? I don't know how to pronounce his last name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I think that's the radiologist that I, I didn't need him, but I, I think that's what I saw on my explanation of benefits from the primary insurer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yes, ma'am. According to the claim that we received for that date of service, we did not, it was denied and the reason for the denial states to please provide a diagnosis code for this date of service. This information may be obtained from your physician. Yes, and that's all we need for further review.
[AGENT][NEUTRAL] And you can upload, you can get the diagnosis code from the provider.
[AGENT][NEUTRAL] And then that can be you can't even just print off that explanation of benefits. I'll give you the claim number that we reviewed it under.
[AGENT][NEUTRAL] And you can upload that information into your portal.
[CUSTOMER][NEUTRAL] So I've given you the only two things I have already in your portal and, and, and one of it was the primary insurer's explanation of benefits, and the other was the bill from the radiology and they had codes on there. So that's all I, as a patient have in terms of access to diagnosis codes are is the bill and the primary insurance, um.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] You can
[AGENT][NEUTRAL] And that doesn't have it.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] So, so this morning when they asked me for money, I said, can you please bill a American Public Life, that's my secondary, and they said, well, uh, your insurance already paid and this is your deductible. And I said, no, my, my primary insurance paid, but this policy is a secondary insurance, and that is they pay based on what the primary deciding. She says, well, you have a deductible, and I said, I think this policy is supposed to help with the deductibles.
[CUSTOMER][NEUTRAL] So can, can you please submit it uh uh with a diagnosis code, which is what they needed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] Is this supposed to be covered? Is this, is this supposed, I mean, my understanding of the policy was the, the diagnosis code and everything was, was checked by the primary and, and as long as the primary paid, you just kind of followed along. But it sounds like you're, you're kind of making your own decisions based on the codes of what was wrong with me.
[AGENT][NEUTRAL] Is she going to do that?
[AGENT][NEUTRAL] Yes, ma'am, because your, this policy is designed to help with your deductibles, co-pays, and co-insurance of covered services, but it also has to be part of your benefits that are covered under your supplemental policy, which we would have to receive the diagnosis, all of the required information to review the claim, just like your primary insurance company does.
[AGENT][NEUTRAL] But we did not receive the diagnosis code.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Right, which is what I told them, can they bill it because they have a diagnosis code and I don't, I mean, I, I, I had codes on the bill, but and there were codes on the explanation of benefits, but I, that maybe that's not the codes you need. So I asked them to do it this morning.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh. And did she say that they would do it?
[CUSTOMER][NEUTRAL] But, but I'm
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] Did she say if they would file it? Because all she needs to do, she can verbally give you the diagnosis code and you can submit it.
[CUSTOMER][NEUTRAL] Yes, yeah.
[CUSTOMER][NEUTRAL] Well, she said like belly pain, cause it was really a suspected kidney stone was, was what why I saw the urologist and had the CT scan for the kidney. It was a suspected kidney stone, but what they have in their records is just pain, like, like belly pain or something.
[CUSTOMER][NEUTRAL] For their code.
[AGENT][NEUTRAL] Whatever, whatever their code is that the doctor used to order the scan that you had done, that's what we're needing.
[CUSTOMER][NEUTRAL] OK, so I have the doctor's order. I have the prescription, or unless I gave it to them. No, I think they, I scanned it and I, I have the original.
[AGENT][NEUTRAL] OK, and it would have.
[CUSTOMER][NEUTRAL] I heard
[AGENT][NEUTRAL] And it does have your diagnosis code on there?
[CUSTOMER][NEGATIVE] I don't know. I, I mean, I don't pay attention to those things. I'm not the biller, you know, the, the medical billers, it's a full-time job for them, but that's not my job. I mean, I'm a patient. All I have is a bill and, and the primary explanation. And, and what I know, what I know is, was wrong and why I saw the doctor and had the scan. I mean, I can't give you quotes. I don't have them. I don't have training in medical billing.
[AGENT][NEUTRAL] No, ma'am, you would just call the, the provider that ordered your test and explain that you were asking to give you the diagnosis code for your 10-12024 data service.
[AGENT][NEUTRAL] For the, you said it was a CT scan that you had done?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That you were needing to get the diagnosis code for that data service for your CT scan.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] For your secondary insurance.
[CUSTOMER][NEUTRAL] So how do I upload uh a text or a sentence, you know, I mean, I put, I put in the, the um.
[CUSTOMER][NEUTRAL] United Healthcare's payment and decision.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I also put in the, the CT scans still.
[CUSTOMER][NEUTRAL] But how do I verbally say, hey, this is my diagnosis code, please accept this sentence that I'm attesting that this is what, what was wrong with me?
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] Well, you would have to get the the specific code number from your physician and then you're gonna have to submit that to us in, in writing. You can write it on the explanation of benefits for the claim number that went along with this claim where you submitted it. Then I can give that to you.
[CUSTOMER][NEGATIVE] Yeah, I don't have a scan. I don't have a scan I don't have a scanner at home. I mean, I just downloaded that thing, you know, or I actually, I mailed it to you. I mailed it in the mail on the paper. So you're saying I could have written down a diagnostic code on the paper that I mailed to you, which was the explanation of benefits. I should have written down a code for for the diagnosis instead of just sending you the explanation.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Well, the explanation of benefits, it is part of what is required, but it does not have the diagnosis code from your doctor on there.
[CUSTOMER][NEUTRAL] OK. I'm looking in my phone to see if I, I mean, I had taken a picture of the prescription, um.
[CUSTOMER][NEUTRAL] At the time
[CUSTOMER][NEUTRAL] Because the radiologist, uh, company wanted me to send it to them.
[CUSTOMER][NEUTRAL] OK, here it is. I've got it. It says, um there's no diagnosis code on it. It says CT scan, abdominal pelvis without IV or contrast. Diagnosis flank pain, question mark kidney stone.
[CUSTOMER][NEUTRAL] So I can certainly somehow from my phone, try to send you this photograph of this, of the prescription.
[AGENT][NEGATIVE] Now there's no um there's not a way to send it to us from your phone like that. You would still have to like send that to your computer.
[AGENT][NEUTRAL] And upload it you can't send us things via text or email.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] For security.
[CUSTOMER][NEUTRAL] I thought, huh?
[AGENT][NEUTRAL] Due to security measures.
[CUSTOMER][NEUTRAL] Yeah, I've got an email to my work mail we're not supposed to use the work mail for personal, but I just did. Can you please help me log in from my work computer? I know I have it saved on my home computer, but I would just like to get in there. I don't know if it's gonna remember. let's see, OK, it's actually putting in a password invalid.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's probably been changed, um.
[CUSTOMER][NEUTRAL] Let's see submitting, yeah, I it's not the right password, so on my phone it should be the right password.
[CUSTOMER][NEGATIVE] I didn't know. I, I mean, I, I've had this policy about 10 years, and this is the first time I've had such trouble.
[CUSTOMER][NEUTRAL] I, I, I mean it was always like it was tied to the primary policy.
[CUSTOMER][NEUTRAL] And it was all submitted for me by, by United Healthcare. They did it like automatically.
[AGENT][NEUTRAL] Well, they, they would, no, ma'am, UnitedHealthcare would not have submitted it to APL, your provider, your doctor.
[AGENT][NEUTRAL] Just like they file your primary healthcare insurance, it looks like that they, you know, in the past, it's been the providers that are filing your claims.
[CUSTOMER][NEUTRAL] OK, and this, these are people that I don't.
[AGENT][NEUTRAL] So, I don't know why this.
[AGENT][NEUTRAL] It looks like this was the first time you've actually ever submitted a claim.
[CUSTOMER][NEGATIVE] It is and I've had the policy 10 years, so that's why I'm having a lot of trouble because I don't know the rules because I've never had to do it. It's always just uh been done for me, but these people.
[AGENT][NEUTRAL] And there's
[CUSTOMER][NEUTRAL] I'm gonna stop talking when I hear you talk, so please, please go ahead.
[AGENT][NEGATIVE] There's a lag, there's a lag in our call.
[CUSTOMER][NEUTRAL] Mhm. OK. All right, let me see if I can get in. Yeah, I don't wanna talk over you, that's for sure. I don't mean to.
[CUSTOMER][NEUTRAL] OK, so I, OK, I logged in, I've updated the password. I've got this prescription.
[CUSTOMER][NEUTRAL] On my
[CUSTOMER][NEUTRAL] So I OK so upload file.
[CUSTOMER][NEUTRAL] Uh, [PII], I don't know if you can see this.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, select files, maybe I can just.
[CUSTOMER][NEUTRAL] Drag and drop. I can try.
[CUSTOMER][NEUTRAL] Oh man, it's not, it didn't come as an attachment. Let's see if I download the picture.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. So, urologist.
[CUSTOMER][NEUTRAL] T X
[CUSTOMER][NEUTRAL] See
[CUSTOMER][POSITIVE] OK. Do. I, I'm glad I'm not like too old to, to do all this stuff, you know, I used to try to help my parents. They, they couldn't do anything with computers, you know, they would have been lost.
[CUSTOMER][NEUTRAL] With this kind of thing.
[AGENT][NEUTRAL] I, I do understand.
[CUSTOMER][NEGATIVE] Yeah, right? OK, so here's, here's my, now are you gonna be able to, because there's no place to write anything.
[CUSTOMER][NEUTRAL] So I mean I'm submitting this, but it's gonna be like floating out there they are they gonna know which which it's for like which.
[AGENT][NEUTRAL] Well, when you submit it, yes ma'am, if you're in, if you're signed into your portal with your username and password when you upload that.
[AGENT][NEUTRAL] If it, does it have the date for when your scan was?
[CUSTOMER][NEUTRAL] Does what have the date, the picture I just submitted?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, because it's the neurologist telling me I need to go get a scan, so it's his prescription in [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So I saw him [PII]. He says, get a scan in the next two weeks. Can see me in 2 weeks, get a scan in the meantime. Well, I try to get a scan and I have to wait almost a month.
[AGENT][NEUTRAL] OK, so I can see that you uploaded and I can make a note.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] I can see that there has been something received. I can't see it, what it is, but I can see that there was something just uploaded into your portal. Now, I can make a note.
[AGENT][NEUTRAL] But if it, I don't know, you know, that that's, I cannot say.
[AGENT][NEUTRAL] If that's gonna be sufficient or not, [PII], until th[PII] review it.
[CUSTOMER][POSITIVE] Well, how can I, yeah, I appreciate you're making a note um.
[CUSTOMER][NEUTRAL] I don't know, cause there's no, it's really hard to write on a photograph. I mean, I can't like.
[CUSTOMER][NEGATIVE] Annotate it. I, I can't, you know, there's no way to connect it with the day. I mean, it's just.
[CUSTOMER][NEGATIVE] I am logged in but I don't see how when I upload a file, I don't see how I can say what it's for or when it's for what claim I'm trying to get done, you know, it's my 3rd attempt.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I think, and I think they're gonna have, I don't know, can you hold on for me just a second? Can, can I place you on hold? Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], it's [PII]. How are you?
[CUSTOMER][POSITIVE] Hi good how are you?
[AGENT][NEUTRAL] I'm doing fine. I have, I'm not planning on transferring this lady. I'm trying to not do that. Um, but she has uploaded a picture just now into her portal of a prescription.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Cause we have reviewed a claim for her back in October for a scan that she had done, but we denied it needing a diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I don't, I mean, this is not gonna have a code. I think it just has like.
[AGENT][NEUTRAL] You know,
[AGENT][NEUTRAL] Verbally, the diagnosis, not, it doesn't include a diagnosis code. No, but it's on a prescription. It is.
[CUSTOMER][NEUTRAL] So the, the
[CUSTOMER][NEUTRAL] But it is the wording.
[AGENT][POSITIVE] It says CT OK, they're ordering CTs, you know, doctor's writing, gotta love it, right.
[AGENT][NEUTRAL] OK. 9:10 is when the prescription was written. She had her scan done at [PII], but it says CT scan, abdomen pelvis without IV or PO contrast, diagnosis flank pain, questionable kidney stone.
[CUSTOMER][NEUTRAL] OK. Uh, I mean, it, it would, we would be able to, if it's from the doctor and it's a, uh, a description of the diagnosis, uh, we can get a code for it. So as long as it's coming from a doctor, we can use that. But you said that's dated [PII].
[AGENT][NEUTRAL] Is that
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] and the scan was 101.
[CUSTOMER][NEUTRAL] Let me, what's her policy?
[AGENT][NEUTRAL] 206-396-0.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So [PII] is the prescription.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I mean, I told her that I would make a note if that was sufficient, but I mean I.
[CUSTOMER][POSITIVE] It is sufficient.
[AGENT][NEUTRAL] But with the dates not being on there, that was like, because the script is for.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][MIXED] Right, um, I mean, I would, I would tell her the description is OK. However, with the date not matching the service date.
[CUSTOMER][NEGATIVE] Um, because that doesn't make sense. Why, why would they?
[AGENT][NEUTRAL] Well, you know, he writes the prescription, but I'm sure it's just like with anybody else. I know with every scan that I've had done, you know, it's not like you can get it done that day. You've got to get approved that, you know what I mean? So I don't know. Uh uh.
[CUSTOMER][NEUTRAL] Is the doctor
[CUSTOMER][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] She, I'm just I'm ready to be down with her call.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] But let me just ask you this. The doctor on the
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Prescription. Does the name even match this Qualare Medical Group?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, his name on this, oh, I just closed out of it.
[AGENT][NEUTRAL] It has urology. Hold on, I'm trying to open back up. Give me just a second.
[CUSTOMER][NEGATIVE] Let me see, let me look because that was denied as a dupe. Let me look at the first one and see what name we use on there.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Really?
[AGENT][NEUTRAL] Why does it keep pulling back?
[AGENT][NEUTRAL] [PII], let's see.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. I mean, you can, it's not matching information. I mean, the, the date doesn't match and the doctor isn't matching what we originally received.
[AGENT][NEUTRAL] So, yeah, because this [PII] is like the radiologist.
[AGENT][NEUTRAL] Is what she's telling me.
[CUSTOMER][NEUTRAL] OK, so he would read.
[AGENT][NEGATIVE] Yeah, he's not gonna have the, he's not gonna be the one, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With the diagnosis case. This urology.
[CUSTOMER][NEUTRAL] She needs to get a description from
[CUSTOMER][NEUTRAL] The provider for the date of [PII], is she saying, is she explaining why it's not matching [PII]? Because the same way she got it she can.
[CUSTOMER][NEUTRAL] Contact the [PII] and ask for a description or the diagnosis code for her data service of [PII].
[AGENT][NEUTRAL] Well, that's the radiologist.
[CUSTOMER][NEUTRAL] OK, so even the doctor that
[CUSTOMER][NEGATIVE] Supposedly ordered, ordered it. Even his information should match that he's ordering X-rays to be done.
[AGENT][NEUTRAL] Um, this, that's.
[CUSTOMER][NEUTRAL] For the diagnosis, not a prescription. Like there should be matching information.
[AGENT][NEUTRAL] [PII], can I join her in because I, I'm getting.
[CUSTOMER][NEUTRAL] So what is she arguing the like what is her, what you can't join her in but just update me on what, what's going on with her.
[AGENT][NEUTRAL] I don't, I don't
[AGENT][NEUTRAL] Well, she just says.
[AGENT][NEGATIVE] She doesn't, you know, I mean, she doesn't understand why it's not being denied, why there's never been a problem before. It's one of these where you try to tell her, you know, she's like, I'm the patient, I'm not the, you know, I'm not a coder. I'm not this, I'm not that. I can't.
[AGENT][NEUTRAL] It's just that type of call.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like she, you know, she doesn't understand and I said it, it's just like with.
[AGENT][NEUTRAL] your provider filing your primary insurance, there are certain things that they have to provide them. A diagnosis code is one of those things and it's also one of the things that we have to have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, so let's go ahead and put her in it and see if I can simplify it, um.
[AGENT][NEUTRAL] Well, we don't have that.
[AGENT][NEUTRAL] I mean, I don't.
[CUSTOMER][NEUTRAL] I don't know, she may just be argumentative, but or either way, we need the information so you can argue all day or just go get the information and ask for it and in a way that I'm telling you to request it. So let me try to tell her how you don't even have to stay on the call, you can transfer her over.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, that's OK cause I didn't tell her I was gonna transfer, so it just, it would probably just be better if I just kinda conference her in, um.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah, just tell her you, you're bringing in an explanation like a exam examiner or something, yeah.
[AGENT][NEUTRAL] And she's verified, yeah, I am. Yeah. Examiner. Yup, yup, yup, I am. OK, so thank you very much. Hold on, and she's fully verified as well, OK? OK.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Hi
[AGENT][NEUTRAL] Hi, this is [PII], and I also have one of our examiners, [PII] on the line who works in our review department. And we were discussing uh the claim that you and I have been discussing, and [PII]'s gonna give you a little additional information on that to see if she can make this a little um easier to understand on what we need, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Alright, [PII], can you hear [PII]?
[CUSTOMER][NEUTRAL] Yes, I can. Hi, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi. Hi, let me pull up what you uploaded today and.
[CUSTOMER][NEUTRAL] Take a look at it really quick.
[CUSTOMER][NEUTRAL] OK, so I'm taking a look here and I see that you uploaded a copy of a prescription.
[CUSTOMER][NEUTRAL] Yeah, with the DX, uh, the diagnosis that the doc the doctor ordered the CT scan. OK, so I do see that that you know there is a description of a diagnosis here. uh, however, with the date.
[CUSTOMER][NEUTRAL] Uh, because it is a prescription, we need more information that's matching. So, is the doctor not able to give you, um,
[CUSTOMER][NEUTRAL] An actual code because you can request the code from him.
[CUSTOMER][NEUTRAL] Uh, for the, um, X-ray for the order of the X-ray, was there no paperwork provided? uh. I haven't, I, well, I have the paperwork that was provided to me. I gave to you all that I had so I had um I had the prescription to go do the scan.
[CUSTOMER][NEUTRAL] And then after I did the scan, I got a bill uh and and I sent you that um and in between I got an explanation of benefits uh showing payment from the primary insurer and I gave him that and those are the three papers that I received as a patient. OK, let me take a look at what you sent.
[CUSTOMER][NEUTRAL] And so this is for the data service of [PII], correct?
[CUSTOMER][NEUTRAL] Yeah, and I'm sorry with the the primary insurance it was included with like 3 different things. So like the minute clinic was on there is on the same piece of paper they just combined it, I guess they were saving paper so it did lead to some confu.
[CUSTOMER][NEUTRAL] I was not trying to get many clinic again, but it was just on that page so yeah sometimes we do get that in the future if you have to submit a claim just um cross through the dates that you do not want to be considered and that'll uh that way you know we're not asking for information you know that you're not trying to get those charges paid um so let me see.
[CUSTOMER][NEUTRAL] One moment, let me just look at this and make sure before.
[CUSTOMER][NEUTRAL] I ask you, you know, just before I say additional information is needed.
[CUSTOMER][NEUTRAL] Sorry it takes a little time to load. Yeah, I mean the, the, I, I, I was wondering, I was starting to doubt myself. I thought this policy was supposed to help with the deductibles, but the the radiologist's office says I owe it because I have a deductible and I'm like well wait a minute, I have this secondary policy that's supposed to help with that.
[CUSTOMER][NEUTRAL] And she wasn't really that aware of those things, you know, even though I asked her to please give you the diagnosis code it was denied because I didn't have it, um.
[CUSTOMER][NEGATIVE] So you might get another thing from them. I don't know they weren't really that well put together. I because I had trouble with them.
[CUSTOMER][NEGATIVE] Just scheduling the scan. It was hard.
[CUSTOMER][NEUTRAL] OK, OK, so this is a, OK, so I'm, I'm, um.
[CUSTOMER][NEUTRAL] I see that the procedure that we did receive, um, it does show uh the CAT scan of the abdomen and pelvis. I do believe um with the prescription that was written for, um for you to get the CAT scan.
[CUSTOMER][NEUTRAL] I think uh when I first talked to [PII], I was a little confused. I thought it was just like a, a prescription like from the pharmacy type of prescription. So I felt that that would be, you know,
[CUSTOMER][NEUTRAL] Uh, we would have problems with that, but I do believe this would work. Uh, if you don't mind holding really quick, I'll speak with the team lead, um, just to make sure this may be enough information to pay the claim. OK alright thank you I'll hold one moment [PII].
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Uh, I don't know, I can hear music. I don't know if you can, but thank you for letting me join her in and I'm, and she's calling me [PII], but I think I'm.
[AGENT][POSITIVE] But this is still [PII]. I'm still on the line with you.
[AGENT][NEUTRAL] Yeah, I know. Well, we do have a [PII] also, so that's, but that, that's OK. I just wanted to let you know that I was still here.
[AGENT][POSITIVE] Uh, you may be able to hear me better than I can hear you, [PII], because I mainly hear our music, our whole music.
[CUSTOMER][NEUTRAL] I don't, I'm not
[CUSTOMER][POSITIVE] Oh OK, thank you for holding sorry for the way guys so this would be enough information for uh your particular charge, um, just so there's not any issues, I'll go ahead and uh take care of the charge myself, go ahead and reprocess it, uh, myself and get, get this per this, uh, one paid, but your policy is definitely set up to help you with deductible, um.
[AGENT][NEUTRAL] OK. Yeah, it is.
[CUSTOMER][NEUTRAL] In this instance, because it is the radiologist, I'm guessing um.
[CUSTOMER][NEUTRAL] When you go you may the easiest thing is to if you're going to have to file a claim yourself if they're saying that they will not file the claim on your behalf.
[CUSTOMER][NEUTRAL] The best thing to do is ask them for a um an itemized bill with your procedure code and ICD 10 code.
[CUSTOMER][NEUTRAL] And then once you receive your explanation of benefits, you can submit that the documentation uh to us, but if you, um, you know, let them know the ICD 10 code, that is the medical terminology for the diagnosis code, and they would know exactly what you're requesting. OK, so I guess the bill, I mean the bill they gave me had codes on it, but are those not the right codes?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So I'm looking at um I just looked at.
[CUSTOMER][NEUTRAL] I saw the explanation of benefits and the, your explanation of benefits does have the procedure code on there, but the ICD pin code is not there. And most times a provider will not put the ICD pin code, you would have to request that uh just due to privacy, they normally would not put that information uh on your bill, so you would have to request that information.
[CUSTOMER][NEUTRAL] I see, OK, that's all new to me, so thanks for explaining it. No problem, but if you have any other questions or issues just give us a call but I will go ahead and take care of this charge for you. Yeah, there was another claim related to this diagnosis that was also denied um.
[CUSTOMER][NEUTRAL] that they're not coming after me yet, but I expect they will try to get I submitted it.
[CUSTOMER][NEUTRAL] And it got rejected, but I didn't have a bill and it was, it was a procedure at the urologist's office after the CT scan. It was um cystocystography cys.
[CUSTOMER][NEUTRAL] What is the service date? Do you know the service date for it? Uh, yeah, I'm gonna look that up. Let's see. Uh, it was not too long it was, it was in October. Is it the [PII] charge?
[CUSTOMER][NEUTRAL] Yes, exactly, yes. OK, let me look here. It's totally, it's the same diagnosis, uh, for that procedure too. OK, OK, because I do show we did request the.
[CUSTOMER][POSITIVE] Explanation of benefits on that one and it is also on the same explanation. I'm sorry we did request the ICD 10 code, the diagnosis code it is on the same explanation of benefits so I will take care of both charges. Perfect and uh and I'm glad the stone is gone.
[CUSTOMER][NEUTRAL] Well I'm not I'm, I'm gonna drink a lot of water, you know, this has been quite a learning experience I can tell you we did have a hot summer here in [PII] and I probably shouldn't have gone to Disney because I got a little dehydrated, so, um, and, and I take a, I take a blood pressure med and it, it totally dehydrates you, you know, it's a water pill, you know. So um that's true.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, and then, and you know I tell people and then all these stories come out, these kidney stone stories of all these people and I was like, wow, you do, you know, but this is my first time um I'm not sure I would go through all this stuff the second time, you know, I would probably just let let it pass and not do all these tests, but I just did what the doctor told me to do, you know. Yeah, OK, well, we will, uh, like I said I'll get that taken care of, um.
[CUSTOMER][POSITIVE] And uh there shouldn't be any issues with these two charges uh with this diagnosis. That's great to hear. I mean, it's hard enough to be sick and not feel well and then it's, you know, it's an added problem when it just becomes a financial problem too. So I thought it was supposed to be covered and I was hoping it would be, and I'm glad to hear you could help me so much today. I thank you. No problem. You guys have a wonderful day. Is there anything else you need from me, [PII]?
[AGENT][NEUTRAL] You too.
[AGENT][NEUTRAL] No, this is [PII], it's that's, it's OK. I need it. I told, that's OK. I told [PII], well you put us on hold. I said, we do have a [PII]. I said, well, it's all good, but no.
[CUSTOMER][NEUTRAL] Oh, [PII], I'm sorry.
[CUSTOMER][POSITIVE] I'm so sorry.
[CUSTOMER][POSITIVE] Oh I'm sorry. You both have that sweet voice. I'm sorry.
[AGENT][POSITIVE] Oh, well, that's good to know. So I'm good. Is there anything else, [PII], that I can help you with before we go today?
[CUSTOMER][NEUTRAL] No, [PII], thank you.
[AGENT][POSITIVE] Well, you are so welcome and if there is any other questions, you just give us a call, but otherwise, I hope you have a very nice afternoon and happy New Year.
[CUSTOMER][NEUTRAL] Can, can, can, can, can I, can I ask you another question? I know this is like an endless phone call. So, so I don't know if you noticed the policy lapsed because my employer changed. We got, we merged in a new company. So my UnitedHealthcare, I don't have it anymore. [PII] was the date we've changed to Cigna.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can I buy like a supplemental on my own when I have an employer plan or is that something that only an employer arranges?
[AGENT][NEUTRAL] It's only on the group level.
[AGENT][NEUTRAL] So your employer would have to offer it as part of their benefit package in order for it's not something you can get individually on your own.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, no, they.
[CUSTOMER][NEGATIVE] Yeah, but they didn't offer. They, they, what they did offer was an HSA plan, but now I have a $6000 deductible without the assistance of a company like you, which has been really great for like 10 years, you know, but the, but the employer doesn't have that and I'm on the hook for, you know, unless it's preventative, I'm gonna have to pay all of the 1st $6000 unless it's considered preventative and.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] You know, I don't even know what that is yet. Um, but I would, I would expect the kidney stone is not considered preventative and that, and that's probably would have set me back thousands and thousands of dollars, you know, if it happens again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, but, uh, and it is the, the meddling policies are great, but uh, but yes, ma'am, it is only on the group level. The employer has to offer it as part of the package.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, because I would, I would consider staying with you guys because um I thought you've been great, so I just wanna tell you that and um and the reason.
[AGENT][POSITIVE] Oh, that's very nice.
[AGENT][POSITIVE] Well, we have certainly appreciated your business over the years. I can see that you've had your policy with us quite some time.
[CUSTOMER][NEUTRAL] Yeah, and when my boss turned [PII], I think he did that. Now he's [PII] and then he just sold the firm we merged and uh.
[CUSTOMER][NEUTRAL] The, you know, now we have Cigna without without uh supplemental, um, and everybody else I work with is basically on Medicare or their husband's plan, so I'm like the only one here now uh that's working through the high deductible that I have now.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh goodness
[CUSTOMER][NEUTRAL] Well, it is what it is. I'll try to be careful and maybe uh not use the services as much unless the doctor's jumping up and down and saying, you have to have this cause sometimes they recommend something just to cover themselves. um, and it's not really like I don't know if all this was a waste of time. I mean,
[CUSTOMER][NEUTRAL] So, I, I don't know. It's hard to know because they're afraid of if they miss something, you know, that they wanna.
[CUSTOMER][NEUTRAL] Cover their bases, but on the other hand, you
[AGENT][POSITIVE] Oh, sure, and you don't want them to miss anything either for your own self and well-being.
[CUSTOMER][NEUTRAL] Yeah, I know, but uh, but I guess, I guess with the like kidney stone, it, it usually passes. I guess I could have waited, you know, but I didn't know what to do. I mean, it's my fi[PII] [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] And hopefully it will be your last one.
[CUSTOMER][POSITIVE] I hope so, thank you.
[AGENT][NEUTRAL] Hopefully.
[CUSTOMER][POSITIVE] OK, great. Well, thanks for helping with all the questions. I know it was a long call, but you really helped me and I appreciate you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Always. Well, you're very welcome. It was our pleasure in helping you today. And again, I hope you have a very nice afternoon and a very [PII].
[CUSTOMER][NEUTRAL] OK, same to you.
[AGENT][POSITIVE] You, thank you, [PII].
[CUSTOMER][NEUTRAL] OK. Bye.
[AGENT][NEUTRAL] All right. Bye-bye.
[CUSTOMER][NEUTRAL] OK.