AccountId: 011433970860
ContactId: c93c92a1-1d82-4ff0-977c-de7a67389f41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2544830 ms
Total Talk Time (AGENT): 1241337 ms
Total Talk Time (CUSTOMER): 1209587 ms
Interruptions: 12
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/c93c92a1-1d82-4ff0-977c-de7a67389f41_20250609T19:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you?
[AGENT][POSITIVE] Good thanks how are you?
[CUSTOMER][NEUTRAL] I'm good. This is so. Um, I have a member on the line that she sort of said that we processed the claim and then added as a duplicate and she said this is not a duplicate that somebody needs to be looking into documents correctly. I don't know if you can assist her, and she has to speak to somebody. She didn't want to call back.
[AGENT][NEUTRAL] OK. All right. What's the policy number?
[CUSTOMER][NEUTRAL] It's 208-876-3.
[CUSTOMER][NEUTRAL] It's a lot of documents, so I don't know if you can, you probably will have to call her back.
[AGENT][NEUTRAL] And is that for her, [PII]?
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] It's for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh yes, this is [PII].
[AGENT][NEUTRAL] And she's the one that called or she's the one on the line?
[CUSTOMER][NEUTRAL] Yeah she's the one in the line mhm.
[AGENT][NEUTRAL] OK, and that's her callback number [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII] and it's claim 361.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 249.
[CUSTOMER][NEUTRAL] 0249. Mhm.
[AGENT][NEUTRAL] And she's saying we denied it as duplicate?
[CUSTOMER][NEUTRAL] Yes, we denied it as duplicate and then that is not duplicate, that is a different claim.
[CUSTOMER][NEUTRAL] She said the item I feel of the surgery, I guess, and that's what we were asking to process the remaining of the claim, so she's a little confused saying why we process the indent.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull that up.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And everything's been verified correct?
[CUSTOMER][POSITIVE] Yes, everything has been verified, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm pulling up the um documents now so you can.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, I know, and it's a lot of documents. I know. I had a point I'm like, oh, that's 31 documents, OK.
[AGENT][NEGATIVE] So she's saying we asked for something and then we denied it as duplicate.
[CUSTOMER][NEUTRAL] Yes, she said we asked for the uh surgical bills so we can pay any ambulance or any charges for the um for the um for the ambulance and stuff like that. And that's what she said, she said. And um that we still, um, we went ahead and denied as a duplicate. So basically she's, she says upset because we denied it as a duplicate and she thought that that's what we needed to process the remaining of the claim that we did not pay.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right. I think I got it.
[CUSTOMER][NEUTRAL] Did I explain myself correctly?
[CUSTOMER][POSITIVE] OK, I'm so sorry. OK, here she comes. Oh, good afternoon, [PII].
[AGENT][POSITIVE] You too. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for you, Ms. [PII]. I got Miss um Miss [PII]. I I do apologize. I got Ms. [PII] on the line.
[CUSTOMER][POSITIVE] Thank you so much. You're welcome.
[AGENT][NEUTRAL] Hi Miss [PII], my name is [PII]. I'm on the claims support team, so I understand that we um had requested some information and you submitted it and we denied it as a duplicate. Is that right?
[CUSTOMER][NEUTRAL] Yes, I don't know why. I mean, it, I mean, they got the stuff. I think it was [PII] or the [PII], and I thought, OK, this probably has a, is it one of their computer new software glitches or something because I called last week and she goes, it's just not showing up yet. So I said, OK. I said, I don't understand.
[CUSTOMER][NEUTRAL] Why it's not even showing up there that I filed the claim. And she said, well, it's in there. You just can't see it on the computer. And I said, OK. So then Saturday, I got an email saying it's been processed. So then I go in there today to look at it and it says it's a duplicate. And I'm like, OK, well, I don't know.
[CUSTOMER][NEUTRAL] I don't know why they say it's a duplicate. It's never been processed once. So,
[AGENT][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] I mean, if they do, if it's a duplicate, they'll have to tell me when they processed it. Because they processed it and said they needed more information.
[CUSTOMER][NEUTRAL] You know, that was my, that was what I got back on it. And then today, I'm looking on there and it goes, this is a duplicate. I'm like, nope.
[CUSTOMER][NEUTRAL] Not a duplicate.
[AGENT][NEUTRAL] Right, so let me, OK, so let me try to kind of.
[AGENT][NEUTRAL] Look through here if you don't mind I'm gonna and what I'm doing is in the process of reviewing the previous uh claim that was sent in so I can determine what exactly was sent before as to why they're denying it for duplicate because what it looks like we were asked for was an itemized bill and we were asking for an itemized bill from the facility and then also from the ambulance.
[CUSTOMER][NEUTRAL] Yes, and that
[CUSTOMER][NEUTRAL] OK, oh well.
[CUSTOMER][NEUTRAL] I sent bills from the ambulance, and then they said, no, you've got to have a bill showing, now you've got to show the bill where he went to the hospital. So you, and I sent that and then they said, no, we need itemized bills. So um I think the [PII] or the [PII], the hospital, I think it was the hospital actually faxed y'all all the
[CUSTOMER][NEUTRAL] I can't remember the number. Let me see the number of that form that y'all have to have that's very detailed.
[AGENT][NEUTRAL] It's a UBL4. Yes, yes, it's a, it's called a UBL4 and it's.
[CUSTOMER][NEUTRAL] Yes, and y'all receive that like on the.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Y'all should have that. So nothing has been processed with any of that.
[AGENT][NEUTRAL] Right. And that's what.
[AGENT][NEUTRAL] Right, so, OK, let me.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Like I said, I'm in the process of looking through what was submitted, so I see the explanation of benefits from your primary insurance. So, um, just bear with me for just a moment. Do you have a time to, to wait while I look through this mail because there are a lot of pages, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I mean, if you wanna call me back, that's fine.
[AGENT][NEUTRAL] Or would you prefer?
[AGENT][NEUTRAL] Well, and that's what I'm also, you know, I wanna do whatever more convenient for you if you wanna wait on the line with me while I review it or I can call you back whichever is easier.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I don't mind waiting. I'll just, I'll kind of just keep my phone here on speaker and let you do what you need to do. I, I hate to call back because sometimes that gets to be tricky, but um I'll just
[AGENT][NEUTRAL] Right, it does and sometimes our number will show up as kind of like a spam or unrecognized call and sometimes depending on how your phone's set up, it will automatically put you to voicemail if you have it set up that way so um understood.
[CUSTOMER][NEUTRAL] Sure. Sure. OK. I'll just hold. That'll be fine.
[AGENT][NEUTRAL] OK, now I'm like I said right now I'm looking for, yeah, now it looks like we did.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] We did ask for some additional information for the physician. OK, so let me kinda go back through that. I think that would be easiest.
[AGENT][NEUTRAL] So we have some attending physician charges and then the daily hospital benefit for the confinement in the hospital and then um like I said, the attending physician and also ICU um charges, and then the ambulance charges. Now, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2 ambulances, 1 November and then January. And both of those had hospital visits.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I say [PII] and then January I'm sorry, [PII], so I do see both of those, OK.
[CUSTOMER][NEUTRAL] Yes, OK.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again those were on the previous mail that we received and we asked for that additional information and so from what I'm gathering from that when we asked for that information, that's when you sent the uh UBO4 form from the hospital or the the the hospital sent it directly to us.
[CUSTOMER][NEUTRAL] Correct. And that, yes, because they were supposed to mail it, send it to me, and I would wait, um, I mean, 45 days, and I keep calling back. I finally said, can you just fax it to them? And maybe that'll cut out or whatever red tape the hospital has.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So unfortunately what we're needing is the itemization of charges so that UBO4 form that we um we received um it is helpful it does have the information however there's certain benefits that do require that itemization and so that would mean um.
[CUSTOMER][NEGATIVE] I thought that's what they sent. I mean, I've talked to y'all 3 times and they told me this was the form I had to have because it itemized everything.
[AGENT][NEUTRAL] They
[CUSTOMER][NEGATIVE] And I mean, in this, I haven't gotten anything back that says they still need additional information. It just says it's a duplicate.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So, I mean, I've sent them everything through Aetna. I've sent them everything through my ambulance service. I've sent them everything through the hospital, like all my ELBs that show that part. And they said, no, we need more itemized. So I don't know, I mean, I thought that when she told me I had to have that.
[CUSTOMER][NEUTRAL] That form you just said that that was supposed to be the most detailed form I could get.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, what else can there be?
[AGENT][NEUTRAL] So when, when, um, the facility which is the hospital when they bill out they use those uh UBO4 forms that's what they sent to the insurance companies, um, and then that's why it's cut to UBO4 it's like a universal billing form and then it has that designation of the 04, so what it is is uh like I said, that's the form that they use to send to uh insurance companies, um, for their reimbursement.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] However, for your particular policy it does need to be itemized. So in other words that there is an itemized itemized bill that the hospital should be able to provide for you that would give us the actual codes that um for those particular benefits like I said, which I mentioned was the um the ICU benefit, the room and board benefit, and of course like I said those uh ambulance charges, those need itemization as well.
[AGENT][NEUTRAL] And what like I said, that itemized bill is just kind of it's it is the same information however it's a condensed form if you will it's a condensed form of information so it tells us like the dates of you were in the hospital it will show us um those room and board charges and ICU charges but it doesn't list them out as a.
[CUSTOMER][NEGATIVE] Well, I thought y'all had that. I, I'm sorry. I thought y'all had that because I thought when I originally filed it, I sent all those pages that I would have gotten in the mail or would have gotten on my thing that showed everything.
[AGENT][NEUTRAL] Itemized.
[CUSTOMER][NEUTRAL] Now, do y'all, I mean, because I went there first. I went like to the, everything that's from the hospital that showed he came, you know, the ambulance, the, the room and board, all that stuff, it showed all that. And um I thought I sent all that at the very beginning of this process. And then they said, no, you've got to go with this other one.
[CUSTOMER][NEUTRAL] So I guess I'm gonna have to look back to see what all, because I uploaded a whole bunch of stuff on this plane, but I guess since they have
[CUSTOMER][NEUTRAL] Udd the software. I don't know if I can see what I uploaded, you know, on the old, old thing, I could see the documents I uploaded.
[AGENT][NEUTRAL] You could you could do it, yes, OK, and that's what I'm in the process like I said now.
[CUSTOMER][NEGATIVE] I don't think I can see on this one.
[AGENT][NEUTRAL] Yeah, I'm looking through to see if there's an itemized bill and so far I haven't seen one on the documents that were previously submitted um and normally what happens is um.
[AGENT][NEUTRAL] And that's what I'm like I said, what I'm reviewing now is when they go through the process they kind of notate, you know, what may be needed what we received and so far what I've found is mainly um the explanation of benefits from the primary insurance um and that's kind of what I'm viewing now so I'm in the bigger one which was 37 pages because yeah you did there was quite a bit of information submitted.
[AGENT][NEUTRAL] So I'm just in the process like I said of reviewing all that.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] But like I said, most of it appears to be explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And usually what happens is when we receive these explanation of benefits we'll match them up with that itemized bill that you received from the hospital so that will kind of match up like I said for those benefits that we're claiming such as the um attending physician benefit, the uh daily hospital benefit again which is that confinement benefit for each day you're confined to the hospital.
[CUSTOMER][NEUTRAL] OK. So.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So I need the itemized bill that would have come to me from the hospital, not the, the, the one that they give to an insurance company.
[AGENT][NEUTRAL] Right, and
[CUSTOMER][NEUTRAL] I mean, that's so crazy because I
[CUSTOMER][NEUTRAL] I, I mean, to me, a bill, I don't know, I've got to go back and look because my husband passed away in January from the last time he was in the hospital. And they do things when you, when someone passes, it's kind of like it's harder to get into their account, like before I could go in there myself and look at stuff. And so, but I just don't, let me see, all these different people I've talked to, [PII], I don't know, all these people I've talked to.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And, uh, you know, American Public, I don't know. They just seem to be talking in circles.
[CUSTOMER][NEUTRAL] I don't know, because they said they need itemized diagnosis codes. So I said, OK, well, what's that going to be on? They said statements, you need the UBO4. And I went, OK, well, I've never seen one, but I'm going to tell the hospital to send it. So I don't really know now what to tell the hospital to send you, or is it going to be coming to me?
[AGENT][NEUTRAL] Well, OK, so what you're, what, what we're needing, like I said is, is actually, it's an itemized hospital bill, and then there's gonna be an itemization you, you would receive from like the attending physician. Like I said, those attending physician benefits, they would have come from the physicians that uh saw, you know, that gave care in the hospital, um, so I can give you like each date for them.
[AGENT][NEUTRAL] So what I think what, what's happened here and my apologies for that. So there.
[AGENT][NEUTRAL] Generally speaking, the UBO4 form that is received from the facility generally that does give us the information that's needed. However, certain policies such as this policy do require cer there there's certain requirements for each benefit that is claimed. So um those benefits are the attending physician, like I said, the room and board charges now, um, on this particular bill, um.
[AGENT][NEUTRAL] Was there, let me take a look here.
[AGENT][NEUTRAL] Just bear with me for one moment.
[CUSTOMER][NEUTRAL] I mean, it's kind of crazy. They're gonna pay a hos, they're supposed to pay a hospital benefit, I mean, an ambulance benefit. He went in November and he went in January. OK, they have the ambulance bill, then he said they have to stay in the hospital. So I sent them proof that he had room and board in the hospital and he stayed for those days. So, to me, that's kind of crazy that that wouldn't say, yes, he did take an ambulance and stay in the hospital overnight.
[CUSTOMER][NEUTRAL] That didn't even have to say he
[CUSTOMER][NEGATIVE] You know, was in ICU or anything. I mean, I don't understand why those are held up.
[CUSTOMER][NEGATIVE] I mean, I don't know what other bills I can get uh an itemized bill from the ambulance company is gonna be what they sent me. It's just gonna be.
[CUSTOMER][NEUTRAL] We picked him up and drove this many miles, and he's there. And like, but I know it has to be connected to the hospital bill.
[AGENT][NEUTRAL] Correct and like I said those charges we have to have an itemization of those charges. So like I said, unfortunately while the UBO4 is helpful, there are certain benefits that do require that itemization like the per day itemization and it like I said it's called an itemized bill um they should be able to provide that to you um from the hospital.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] And then also the attending physician charges, there's an attending physician charge for [PII].
[AGENT][NEUTRAL] Um, and then [PII] there's also a charge for the attending physician and that's based on what we received from the um explanation of benefits from the primary insurance. So like I said, what we have to do is make sure that the charges match up with everything that we see on those explanation of benefits. So that's why the itemization is is needed, um.
[CUSTOMER][NEUTRAL] OK. So when I call my hospital for the [PII] time and say, I need an itemized bill for both of these hospital stays that were each not quite one was a week, one wasn't, and I need an attending physician, is the hospital going to give that to me? Or do I have to figure out which doctors he saw in the hospital and go directly to the doctor?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Um, well, the the attending physician charges, the room and board's gonna be on the hospital bill. The attending physician charges are gonna be based on the physician, uh, charges itself, and I can go through those dates with you and give you that information if that's helpful to you. And then that way you could reach out to that physician. Does that make sense?
[CUSTOMER][NEUTRAL] I mean, he saw 20 physicians. He saw 20 different physicians the week he died.
[CUSTOMER][NEUTRAL] At least 20. And so you're telling me I'm gonna have to get a statement from each one of those physicians?
[AGENT][NEUTRAL] Usually, it's, it should.
[CUSTOMER][NEUTRAL] That he, they actually saw him.
[AGENT][NEUTRAL] It should be like a group um that a lot of times those charges are from.
[AGENT][NEUTRAL] Like a group of physicians. So I'm not sure.
[AGENT][NEUTRAL] Based on what I see from what was um notated on the claim, like I said, the dates of service in question are [PII], and then one on [PII], so.
[CUSTOMER][NEUTRAL] OK. And so, attending to what is that gonna tell you, attending physician statement? Because on the [PII], these are the days he, he arrived at the hospital. Is that what you're having to say that the, that the physician admitted him? Is that what it's gonna come from those? Because he saw physicians every single day he was in the hospital both times. So is that what that one, you're saying it's just gonna be one?
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] physician that saw him when he first checked into the hospital?
[AGENT][NEUTRAL] Well, and, and for the purpose of the benefit, it doesn't matter which physician, it just matters like I said that we have that itemized bill because that's what they're asking for for those benefits. So in other words, um, let's see, like I said, I'm looking through the, the.
[AGENT][NEUTRAL] The what we uh all I have right now is that uh I don't, uh, the excuse me, the explanation of benefits from the primary insurance. So that's what I'm in the process of looking for now and I'm, I'm gonna see if we can line up exactly what uh what days or what physician is billing the those, those are the charges that were on your explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like there's a Doctor [PII] on [PII].
[CUSTOMER][NEUTRAL] I don't know. These were, these were all hospital doctors, you know, because he went to the emergency room both times. It's not like I, we use those doctors, you know, they were in the hospital, hospital doctors. So.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, you, what you can do is when you contact the hospital for the itemized bill for both the hospital stays, you can let them know you're needing the professional charges as well for the attending physician.
[AGENT][NEUTRAL] So those are called professional charges and that would be an itemized bill as well. So in other words, the hospital should be able to provide you that information because if those doctors were employed by the hospital, they still, they obviously billed your primary insurance because those charges went they're on your explanation of benefits from Aetna.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So those charges were also billed to, to your primary insurance, so they should have a record of that as well as uh as far as those attending. So what you would call that again is the attending physician and that would be an itemized bill, um.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And they're called like professional fees because those are for the the physicians that like I said that were in there and gave care and then they like I said they in turn bill you know they add that to your bill and then they bill to the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As well, so it doesn't matter, um, you know, which doctors or which days if they can just provide you that itemization for the attending physician charges those they call them a professional component or a professional fee and they should be able to provide you that information as well.
[AGENT][NEUTRAL] And now it's the ambulance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess so
[AGENT][NEUTRAL] Were they, they were an outside service correct because I don't see them on the UBO for the charges so they had to come from um.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] No, those were outside services.
[AGENT][NEUTRAL] Yeah, so if you just contact.
[CUSTOMER][NEUTRAL] And I sent all the bills and everything for those. I sent all the bills for those and they said.
[CUSTOMER][NEUTRAL] We have to have proof you went to the hospital to verify the ambulance service. I said, OK. So the, this, the, the UBO4 to show an ambulance brought them in. So I'm not sure what else I need about the ambulance because what else can they give me other than they took him to the hospital, they have a
[AGENT][NEUTRAL] Why
[AGENT][NEUTRAL] Yeah, I don't see the bills from the ambulance. I don't.
[CUSTOMER][NEUTRAL] I mean, what else am I gonna have to provide from them?
[AGENT][NEUTRAL] And they should again it's gonna be the same thing they should have an itemization um of charges an itemized bill for the ambulance service and usually what that will entail is um on the on the itemized bill most of the time if you call the ambulance service that provided the service to you they should be able to provide you an itemization of charges for both of those um services for the ambulance ride itself. They should be able to and what they.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, ma'am. OK.
[AGENT][NEUTRAL] It's gonna give us is it usually will give of course the patient information the date um of a pick up and it usually will uh give us um kind of it'll say it went from this address to this address or it might just say patient's home to you know the closest facility most of the time it does list the hospital on there or you know where they, you know, dispatch the patient to so it should contain that information on the itemization as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Well, what I really hate, I mean, I know it's not y'all's fault, but that has been uploaded. And whatever happened to all this stuff and this other claim, that's the part that bothers me that I spent a long time uploading it all. And I don't, you know, that's the part I don't understand where it went to.
[CUSTOMER][NEUTRAL] And I mean, I know it's not your fault. You have software updates and stuff. But uh the girl told me before that had been pretty wild, you know, with, and so I will try to go, but I mean, I don't even know where I go now to do any of that. Do, where do I go to send you those things?
[AGENT][NEUTRAL] Now, did you, um,
[CUSTOMER][NEUTRAL] If when I get those.
[AGENT][NEUTRAL] Did you, have you updated when you sent this last submission and you didn't send it, the hospital sent it, is that right?
[AGENT][NEUTRAL] That you that last submission that UBO for. OK, so have you reregistered for, yeah, did you re-register on the portal?
[CUSTOMER][NEUTRAL] Correct, because and.
[CUSTOMER][NEUTRAL] Yes, they did that directly.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, I did that last Thursday.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And you said you're not able to access.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] The claims, is that right?
[CUSTOMER][NEUTRAL] Well, I mean, it's, it's OK. It's showing me, OK, OK, if I go to claim support before they had a list of all your claims, OK? And um OK, this one thing says claim support products, tags.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Name, uh, how to file a claim, how to do this, how to do all that stuff. OK, when I go to my, uh, these claims like when it shows I just read the thing download the documents on this claim where it says, um, I mean, I don't know where to go to add something to a claim.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Because it's
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I don't know where to go.
[CUSTOMER][NEUTRAL] To add something to a claim. I mean, I go to the claim tab, and then I pull up this claim we're talking about, and
[CUSTOMER][NEUTRAL] You know, before it had a place to go add
[CUSTOMER][NEUTRAL] Yes. This one just says it's processed and finalized. I mean, it doesn't even say it's waiting for anything. So I'm not sure where I go to.
[CUSTOMER][NEUTRAL] Add
[CUSTOMER][NEUTRAL] Things you need for this claim.
[AGENT][NEUTRAL] Well you would just go to like you were gonna file a claim and upload the documents right through there do you see that option there? Like so you wouldn't need where where it allows you to upload documents.
[AGENT][NEUTRAL] Under your policy?
[CUSTOMER][NEUTRAL] Uh yeah, it's not.
[CUSTOMER][NEUTRAL] OK, I'm under policy has processed claims, my details, and then it has claims.
[CUSTOMER][NEUTRAL] Um, open claims, no claims available because they said this one's processed, um.
[CUSTOMER][NEGATIVE] No open ones.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I mean, it's
[AGENT][NEUTRAL] Yeah, well, this would, this would be like you're filing a new claim, so you would just go ahead through the process as you know, do you wanna file a claim you go under there and just upload the documents through there. You won't need to fill out another claim form you've already done that. You're just submitting additional information that was requested for the claim that's out there currently and like I said, while it does show that the claim is closed, it's that's because we have to give a determination.
[AGENT][NEUTRAL] We can't leave the claim open so we have to basically process it and then and that could be another reason why um that information was just um it was noted and then they said it was duplicate because it didn't give us the information that we were requesting which was the itemization for for the charge.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's why it was processed and closed as a duplicate because we can't keep a claim open once we receive it we have to acknowledge it so what they did is went through and just acknowledges the claim lines of the services that we did request that information for the itemized charges and again that's, you know what we went over the the daily hospital benefits.
[CUSTOMER][NEUTRAL] And, and I did, and I, yeah, and I got that one. I got that one where it requested it. So I'm understanding that was months ago. That was 2 months ago or whenever, when I started on that, but I'm not sure which of these claim forms to use to, I mean, it's.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, you don't need another claim form. You can just go ahead and upload the documents once you receive those itemized bills, um, and you do also have that and are you telling me you don't have that option out there from what you're looking at?
[CUSTOMER][NEUTRAL] Uh, it's it
[AGENT][NEUTRAL] Currently?
[CUSTOMER][NEUTRAL] OK, um, I'm
[CUSTOMER][NEUTRAL] I'm going to go back to my dash. I don't know my internet. I don't know if it's.
[CUSTOMER][NEUTRAL] OK, so if I go to my policy and I go to claims, OK, then what you're saying is.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I don't know why this is circling and not coming up, but you're saying next to this claim number while ago it I thought it said download or look at whatever but I'm I don't know where to go to upload documents.
[AGENT][NEUTRAL] OK, let's see if we can.
[CUSTOMER][NEUTRAL] I don't, I don't know. I don't know. This is crazy. I mean, I, I had gotten used to it. I know it's not your fault. I got used to it, but now I'm like, OK, well, where do I go now?
[AGENT][NEUTRAL] Now it seems yeah because we changed it on you, no.
[AGENT][NEUTRAL] Yes, and like I said, and that we we what we're trying to do with that um.
[AGENT][NEUTRAL] Ms. [PII], we're trying to make it a little bit easier, but of course unfortunately they had some um issues when the launch went off so what what we're doing now, they're in the process and it's kind of behind the scenes our um our IT team is working on uh getting those um wrinkles out, but um like I said for.
[AGENT][NEUTRAL] We're trying to make it easier, not harder, so, um, unfortunately, and, and I apologize for that because I know it can be uh a little overwhelming. So once you're on the dashboard, let's see.
[CUSTOMER][NEUTRAL] Oh sure. Yeah.
[CUSTOMER][NEUTRAL] OK, so it did finally, oh gosh, I clicked too soon. It, it comes, OK, I'm on the dashboard with, uh, I don't know. I don't know what my internet's like.
[AGENT][NEUTRAL] Well, of course it's gonna act up because you needed to act right.
[CUSTOMER][NEGATIVE] Struggling to
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know well, and I got new Internet net. OK, so this when I go to claims, I know it says.
[CUSTOMER][NEUTRAL] And November clicked off of that it was saying download documents under that claim number.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] And that would be like if you're wanting to down yeah so.
[CUSTOMER][NEUTRAL] Uh, um.
[CUSTOMER][NEUTRAL] I'm just wanting to look at what the, look at that, uh, thing that you just told me to look at the explanation of benefits that you just told me where it said it's a duplicate. So for this claim to upload documents.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Without filing another claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] That's confusing me where I go to do that.
[AGENT][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Because it's just, it's saying on this one, you know, it's not, there's no tabs to process claims, no claims of other claims available. Um, it's just not giving me unless I go start up, go to a form.
[CUSTOMER][NEUTRAL] Or start, I don't want to start another claim. This is download documents. And when I go to here to download documents, all it has is this explanation, this two-page explanation of benefits that says it was a duplicate. OK. I'm sure that was mailed, probably, just haven't got it in the mail. So now,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And it was mailed on 666.
[CUSTOMER][NEUTRAL] OK, so I'll, I'll be getting that in the mail. So, but.
[CUSTOMER][NEUTRAL] Hm. Where do I go to upload these documents that I need to add that you want me to add?
[AGENT][NEUTRAL] OK, you should just be able to go to your dashboard.
[AGENT][NEUTRAL] And then it's, it's gonna list your policy and then it's a traditional claim meaning that uh you're gonna wanna start the claim type of traditional because it should give you two options of traditional or wellness and you wanna do traditional.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I'm gonna start a another claim.
[AGENT][NEUTRAL] You see that option?
[AGENT][NEUTRAL] Yes, you won't need to, yeah, like I said, you won't necessarily, you don't have to fill out a claim form, just go ahead and and just go through the steps and then it should allow you to go ahead and upload your documents that you have and and you and attach them. You should be able to do that like I said you don't necessarily need to complete another claim form we have the claim form on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. I see where that works. It just, I didn't, that was throwing me off to start a new claim. So, um, I can see now where I can get there to do them. And I, I, it's, I'm, I'm thinking if I don't go travel 30 miles to the hospital, I don't know. They, they took
[CUSTOMER][NEUTRAL] Weeks to send this and finally I got on the phone. I said, look,
[CUSTOMER][NEGATIVE] I'm done with y'all. Get it and fax it. And I, I mean, I was so upset at them because they kept saying, you'll get it in 10 days, you'll get it in 10 days. So it took about
[CUSTOMER][NEUTRAL] A long time to get that form I just sent y'all. So I will go back to them.
[AGENT][NEUTRAL] Yeah, the UBO4.
[AGENT][NEUTRAL] Well, it, you can see it now.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] Um, if it's quicker to fax it.
[AGENT][POSITIVE] Yes, and that's what I was just gonna suggest. if they're able to just fax it over to us, that would be a lot easier and make [PII]fe a lot easier for you. So if they're able to do that, go ahead.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Right. The problem is, is that, right.
[CUSTOMER][NEGATIVE] Right. And the problem is I don't ever see it.
[CUSTOMER][NEGATIVE] That's the only thing that bothers me is that I will never, I don't ever see it when they faxed it directly to y'all.
[AGENT][NEUTRAL] If they send it to you then you don't get that copy of it, right? I understand, I understand completely.
[CUSTOMER][NEUTRAL] But now I probably could get it back from y'all. I mean.
[CUSTOMER][NEUTRAL] That other form they sent, is that something it seems like that the, the claims lady told me I could get a copy of what was filed with y'all? Is that not true? Probably.
[AGENT][NEUTRAL] Um, I'd have to check into that then. I'm not certain of, um, but it is.
[CUSTOMER][NEUTRAL] That's OK. OK.
[AGENT][NEUTRAL] Um, it is
[CUSTOMER][POSITIVE] OK. Well, don't worry about that. I'll just, I'm gonna try this again.
[AGENT][POSITIVE] You know, it is something we could definitely.
[AGENT][NEUTRAL] OK, OK, and again my apologies that you're having to jump through this and, and do all that and um is there, is there any chance the hospital has a portal?
[CUSTOMER][NEUTRAL] Um, no, I'm sorry. It's just.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] That you're able to access.
[AGENT][NEUTRAL] Cause sometimes
[CUSTOMER][NEUTRAL] Well, this is what's crazy.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] I do have a portal with them. And when my husband died, they locked me out.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][NEGATIVE] They locked me out of all his bills and everything. And I'm like, OK, I'm handling and everything. How can you just lock me out? Well, when someone dies, that's what we do. And I'm, I mean, it was real upsetting because I used everything through their portal. We made appointments, we did everything. And I was just
[CUSTOMER][NEUTRAL] I, I mean, it's crazy. I think, OK, and I don't know what they thought I was going to do.
[CUSTOMER][NEUTRAL] But I, I don't know what they thought I was going to do. But anyway, yeah, they do have a portal. It's a big system in [PII]. It's [PII]'s mother, [PII]. So it is huge, but I'll tell you what, I've been
[AGENT][NEUTRAL] Yeah, so I
[CUSTOMER][NEGATIVE] I don't know. And I know everybody didn't know everything, but when you talk to 5 people and get 5 different answers, but I don't even really understand and talking to y'all why they wouldn't tell me I needed 2 or 3 things. I needed the attending positions. I needed the, this other thing, and also the UBO4. I don't know why they didn't just tell me and I could have tried to get it all at once, but I'm going to try again. And then I'm probably just gonna forget it because it's just been
[AGENT][NEUTRAL] Yeah, my apologies. Now, you.
[AGENT][NEUTRAL] Did you, yeah, don't do that. Don't do that. We don't want you to do that. Now, um, can I ask you, I do see here where you talked to one person that told you that you could obtain the UBO4, and my apology, you know, like I said, if you were given, uh, conflicting information.
[AGENT][NEUTRAL] But like I said, the best rule of thumb is to, you know, let that explanation of benefits guide you now the one that you received in April should have indicated that it was an itemization that was needed an itemized bill, um, because that's what I'm seeing from our side so my apologies if that wasn't so what should happen is when you call in and you have questions.
[AGENT][NEUTRAL] They should automatically go to the claim that was um processed and then let that guide them as to what exactly information we're looking for, which in this situation was that itemization of charges.
[CUSTOMER][NEUTRAL] Right.
[AGENT][MIXED] And while that UBO4 is helpful, it gives us diagnosis, it gives us dates unfortunately it doesn't itemize the charges so that like I said, that should have been, you know, what happens when you, like I said, when you call in and my apologies for that if you were given conflicted information.
[CUSTOMER][NEUTRAL] Right, that's OK.
[AGENT][NEUTRAL] But from what I'm seeing, like I said, it is that itemized billing that we're needing and unfortunately like I said I did look through all your documents and I don't see any billing um documents I just see the explanation of benefits from Aetna.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. Well, I'm gonna go back to them and thank goodness y'all don't have a time limit because I had even started on the next claim. He had heart problems and heart attacks. And I don't even know, want to know what that's gonna look like. I mean, I can't, I mean, this part's been, I was like, ah, an ambulance call is just an ambulance, you know, that part that has been
[AGENT][NEUTRAL] Right. Understood.
[CUSTOMER][NEUTRAL] Crazy. But anyway, I'm gonna, but I guess what's crazy is they may also want to think about what has been uploaded and we can't see. I mean, I know I was in a limbo period, but I should be able to see the documents I uploaded.
[CUSTOMER][NEGATIVE] For all these things. You know what I'm saying? And I, I can't.
[AGENT][NEUTRAL] Uh, absolutely, and now you can't look at it because we've updated the system and hopefully like I said they're working on that and working on getting those issues and those those like I said that we're having.
[CUSTOMER][NEUTRAL] I can't see any of that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Um, but I will definitely make a note of that, um, on your file and, um, and I will raise that, uh, concern as well because you're not the only person that has told me that in fact that you're my second caller today. So like I said, we're, we're, we're working on that so if you could just give us a little grace on that and hopefully, yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And that's not your problem when they decide to, yeah. OK, well, I'm gonna, I'm gonna try again and see um.
[CUSTOMER][NEUTRAL] I guess, um, anyway, I guess the hospital was the easiest thing I've done. The hospital bill they took care of everything, you know, it's just, um, I have not had these added on top policies before and, and, you know, realized that
[CUSTOMER][POSITIVE] It, it was, but, you know, it'll, it'll be worth it in the end, I suppose. So, anyway, I appreciate your patience and I will just, uh, you know, I know I can't request the same person to talk to, but I feel like they've probably got crazy ladies on 4 if you want to talk to her again, you can call her up. She's.
[AGENT][NEUTRAL] Well, you're
[AGENT][NEUTRAL] You're welcome to ask for me, Miss [PII] if you have to call back and you're welcome to ask for me because that is, you know, part of, you know, my function is on claims support. So if it's a claims question and it's something that you don't wanna discuss with.
[AGENT][POSITIVE] The care team when you call in you can ask for me if I'm unavailable um they'll send a message to me or they can just put you to my voicemail and then I you know because I do have a secure voicemail so I'll be happy to return your call if that if that helps and again my name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And your name was [PII], is that right? OK.
[AGENT][NEUTRAL] Yeah, [PII] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. You're welcome. Thank you for your patience. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.