AccountId: 011433970860
ContactId: db112a98-4365-4670-8bfd-4716c6627f60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2726709 ms
Total Talk Time (AGENT): 852259 ms
Total Talk Time (CUSTOMER): 1989691 ms
Interruptions: 32
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/db112a98-4365-4670-8bfd-4716c6627f60_20250226T19:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with Integris, um, Integris Medical Group, and I was calling about a claim, um, if you can help me out with information please.
[AGENT][NEUTRAL] Sure, I can look at that claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah sure it's gonna be [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I do, um.
[CUSTOMER][NEUTRAL] 86 I'm sorry, um, I'm trying to ask.
[AGENT][NEUTRAL] Are you're OK.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] OK, um, thank you, you're so nice. Um, so the subscriber you are, um, the subscriber ID is gonna be 02136508.
[AGENT][NEUTRAL] OK, and then, uh, what was the name and date of birth for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, sure, it's gonna be uh it looks like uh [PII].
[AGENT][NEUTRAL] Do you have a date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's um [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, sure, it's gonna be [PII].
[CUSTOMER][NEUTRAL] Um, let me pull up a build out for you here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, thank you, um, bill amount is $343 even.
[AGENT][NEUTRAL] 343. OK, so I did just check this policy that you gave me, [PII], it terminated, uh, [PII]. I did check to see if uh they had another one that was active and they do not. This was the last policy they had with us. um, but let me see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] It does look like we did receive this claim though if you needed that um EOB I can send that to you.
[CUSTOMER][NEUTRAL] Um, no, I think, let me see.
[CUSTOMER][NEUTRAL] Is the claim number 342-875-7?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, um, we are, we have that EOB, so it, it the way it transmitted, it just says non-covered charges, so I was just.
[AGENT][NEUTRAL] Oh, so it didn't say why. Makes sense, yeah, well.
[AGENT][NEUTRAL] Um, yeah, so the policy terminate it was, uh, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, well that explains it, doesn't it? So let me ask.
[CUSTOMER][NEUTRAL] I wish they let me see if I can um I'm gonna I'm gonna see if I have another um because I've, I'm, I've come across a um a couple of these that I'm having to call at each time so I, I wanna see if um there's another one that you could maybe um.
[AGENT][POSITIVE] All righty.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh thank you. Do you wanna, yeah, um, yeah, just checking, um, uh, these are old, some of these, uh, so I need to get them out of my work here, so I'm just needing to know what the denial reason is besides not covered because I, yeah.
[AGENT][NEUTRAL] Just check, yeah.
[AGENT][POSITIVE] Understandable.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, so this one
[CUSTOMER][NEGATIVE] I don't think this one doesn't even show who it is, um, give me just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you are APL, so I'm trying to, yeah, because I've come across a couple of those and then I'm like, you know what, instead of like calling every 5 minutes, how about if I just.
[AGENT][NEUTRAL] All at once, sure.
[CUSTOMER][NEGATIVE] Right, yeah, right, I mean, I'm working on so many denials that that it doesn't make sense for me to keep um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, OK, well, of course, when I'm not calling or when I'm not calling, then I'm seeing a lot or when I'm calling, of course when I'm not, oh, here's another one.
[CUSTOMER][NEUTRAL] Um, no, and, and you know what?
[AGENT][NEUTRAL] It's a day, it's been a day. I, I understand. It has been a day.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Girl, listen, it's Wednesday. I'm just dying for Friday.
[AGENT][NEGATIVE] It is Wednesday. I've got Friday vibes and I'm so disappointed when I realized it's Wednesday, so.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEGATIVE] Me too. No, me too, me too. I was like, I thought, oh my gosh, I need like it, you know, how they are, they're the worst because I'm just trying to get through this day. So I'm just like, just I'm, yeah, I'm waiting for Friday because I'm sure like you, like you and I, we have challenges throughout the day and we, you know, we're not retired. I, I know. My mom, my mom's always telling me, listen, you're not retired, you're gonna have challenges every day. I'm like, I know.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] We just have to do the best we can, so uh.
[AGENT][NEUTRAL] That's it.
[CUSTOMER][POSITIVE] I'm glad I got you though because you're, you're, you're lifting my mood here because my, I was really down and you're making me giggle, so this this is helping my day.
[AGENT][POSITIVE] Oh, I'm so glad to hear that.
[CUSTOMER][NEUTRAL] Yes, yes, yes, yes, you're like brightening my, um, yeah.
[AGENT][NEUTRAL] Sometimes that's all it takes. I get, I know what you mean though. Sometimes it's all it takes is a friendly tone.
[AGENT][POSITIVE] So many people are just about the business boom boom and come on smile a little bit.
[CUSTOMER][POSITIVE] Yes ma'am, absolutely.
[CUSTOMER][POSITIVE] I know everybody's just like, you know, it's not that serious it's so robotic and just so technical, you know we all have to we're all in this together. We all we gotta do our bit, right?
[AGENT][POSITIVE] Yes, exactly.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, little bits and they make a big difference.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][POSITIVE] Yes, huge difference, thank you. um, I think I found another one. I think it's gonna be this is.
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] OK, if you've got the claim number you can just give me that that'll be fine.
[CUSTOMER][POSITIVE] Awesome, that's perfect. OK, so it shows pull up the EOB. OK, it's 344-2457.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And it should be, uh-huh.
[CUSTOMER][NEUTRAL] Yeah, it should be [PII]. Let me write this name down so I don't get my patients mixed up.
[AGENT][NEUTRAL] [PII] and then uh if you have her date of birth please.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, sure, sure, it's [PII].
[AGENT][NEUTRAL] OK, so this one is active, so let's see what this reason is.
[CUSTOMER][NEUTRAL] 5
[AGENT][NEUTRAL] OK, this one, we were unable to pay a benefit of office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] And this is yeah.
[CUSTOMER][NEUTRAL] Got you and that's for um [PII] data service, is that what you're looking at as well?
[AGENT][NEUTRAL] OK that's make sure, yeah, [PII], yes.
[CUSTOMER][NEUTRAL] OK, so, um, what, what, what, what am I, I'm sorry, office visit is not covered?
[AGENT][NEUTRAL] Under this policy, right, so we were just unable to pay a benefit.
[CUSTOMER][NEUTRAL] OK, let me do that non-covered under policy. OK, and so what, so this is an office visit if it's not covered, what kind of policy does she have since, uh, since she's just a, it's just a medical, you know, bill really outpatient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, so this one, this policy is a, it's a secondary medical policy and it is considered, you know, the supplemental.
[AGENT][NEUTRAL] So it's designed to help with a co-pay deductible coinsurance after major medical pays, um, but of course it does have its own policy of what is and is not covered. And so for this particular one it doesn't cover office visits. They're not all like this. um, some of them would cover visits, some only cover treatment received in office, but this particular one just doesn't cover office visits.
[CUSTOMER][NEUTRAL] Mm, OK, um, alright, so let me see if I can get a tertiary on her and push it to that. If not, then it'll be patient responsibility. Let me see if I could find another one here. Oh, actually, um, and you know what, [PII], this is my fault. I'm not getting call reference numbers from you. Is there a call reference number?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh no, that's perfectly fine. Um, so for anyone that we check it would be the same, uh, so it would just be my uh first name, last initial, and today's date, uh, so my name is spelled [PII]
[CUSTOMER][POSITIVE] Perfect. And then today's date, OK, no, I'll take it. That works perfect. Let me see today's date. OK, let me see if I've got one more here for you. Um, I'm seeing a lot of commercials on my end and, um, American Public Lives. Look at that [PII]. OK, I've got one. How many can you do for me? These are all pretty easy. I have to get them off my books, so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Oh yeah, no worries, um, however many you've got we can do it.
[CUSTOMER][POSITIVE] Ah, you're the best. You are the best. Let me write this down for this one.
[CUSTOMER][POSITIVE] You are. Oh my gosh, you have no idea. You are my, you are my superhero for the day, for sure.
[AGENT][POSITIVE] Oh, I'm so happy to hear that.
[CUSTOMER][NEUTRAL] Yes, of course, no, I mean that. Alright, um, OK, uh, you're welcome. Are you ready for the next number?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Oh, claim number you want claim number, yes. Um.
[AGENT][NEUTRAL] Sure that'd probably just be quicker that's fine.
[CUSTOMER][NEUTRAL] OK, [PII], um, OK, this is gonna be 3442564.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII], uh huh, it's [PII] for [PII].
[CUSTOMER][NEGATIVE] I'll write this down and it says non covered as well.
[AGENT][NEUTRAL] OK. And then, uh, if you would, can I get [PII]'s, uh, date of birth, please?
[CUSTOMER][NEUTRAL] Oh yeah, yeah, I'm sorry, it's gonna be uh January thank you [PII], so it looks like the um yeah it looks like it was a partial paid so there was one CPT code that denied it was $18. Yeah, I just need to know the reason for that.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes. OK. Yeah. All right. Give me just a moment, let's take a look.
[AGENT][NEUTRAL] OK, so this one states that uh Venny puncture is not covered under this policy as the denial reason.
[CUSTOMER][NEUTRAL] OK, it looks like this.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Got you. Vinny puncture not covered under policy, good enough. OK, I'll write that down. Yeah, I just gotta get it. These are so old, so our managers are like, you guys, you've got some old AR you gotta work. So I'm just trying to trying to get yeah.
[AGENT][POSITIVE] Uh, no, I get it. And no, and it's, you know, we can knock them out. We'll, we'll, we'll get them taken care of. Don't worry.
[CUSTOMER][POSITIVE] Oh thank you. You're the best. OK, cool. I got, yeah, I got 3 of my working so far. OK, moving on. Let's see. Uh, I know, right? I it's these gold little nuggets that means a lot, um.
[AGENT][POSITIVE] Uh, it'll, yeah, and it'll be even better once you get them all, and they'll be all done. That'll be a great feeling.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] I'm so excited. yes, and yeah, because my, my, my work you like it's so, I mean it's padded, it's really, it's a lot. So there's a lot of like little insurances I got it.
[AGENT][NEUTRAL] Oh, I can imagine.
[CUSTOMER][POSITIVE] Yeah, it's 10 it's this one I think it has like over 1000, but I, if I can get like a, if I can grab like, mhm, yeah, and this is one work you girl. This is one so if I can get like a I know it's it this is, this is my life story. But if I could get like a handful from like a same carrier, you know, then it would be like a batch I could get, yeah, and that's my goal.
[AGENT][NEUTRAL] Dang.
[AGENT][POSITIVE] Wow.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][NEUTRAL] Yeah, so that, that is definitely, um, and I'm just eyeballing the ones that say um um non-covered because your EOBs for some reason they come across as just non-covered like I don't even have an adjustment code that I can use because noncovered is not one of my codes that I can um I don't think we I know isn't it? It's odd it is odd, yeah, we're.
[AGENT][NEUTRAL] That's odd.
[AGENT][NEUTRAL] Yeah, so if I were to pull up the, if I were to pull up the EOB, it states the reason at the very, very bottom. So I'm wondering if maybe it could like cut off or it doesn't send maybe like the second sheet or something like that.
[CUSTOMER][NEUTRAL] Let me see, let me scroll down this ELB um.
[CUSTOMER][NEUTRAL] Uh, no, it just says, no, I'm scrolling all the way down. It says, um, reason code description 96, you know, like I guess because we have those in seats or arcs and it has $96 for non-covered charges $45. That's it. So it's like, yeah, I know, yeah, and, and it's like, well, what do you mean by non coverage? So of course it's not.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Weird. OK, well.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I think it's just our, I think it's my system. I think it's limited to what it can actually um um upload or whatever or download from um the payers. So whenever it comes across something, I don't know why. So this is why, and it makes it hard for us because when it says non covered there's a whole, the whole host of reasons. I mean it could be non yes.
[AGENT][NEUTRAL] Well, sure.
[AGENT][NEUTRAL] And then no wonder it just piles up, yeah.
[CUSTOMER][POSITIVE] That, that, that's why, that's exactly why it piles up because the non cover that we have to, uh huh, it is, it lands in my lap and I gotta work it because I gotta find out what the non covered means so that I can use the correct. Mhm. Yes, ma'am, um, and I'm still scrolling bear with me here. I'm trying to learn a lot of these that are like thank you. I'm just hitting the ones that are like um because so far you've helped me with what 3 or 4 that's that is awesome.
[AGENT][POSITIVE] Makes sense. Yeah.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] No, you're perfectly fine.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Uh, we got 3, we got 3.
[CUSTOMER][NEUTRAL] 33. OK, we got 3. So if I can grab, um, yeah, because a lot of these like if I'm getting ones that do say duplicate or not covered because it's termed or we need primary insurance EOB stuff like that then I don't have to like call. I can pull up on the provider web or I can um but for some reason all the all the all the um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, the public, well, I don't know why, but it just says every single one of these they would say non-covered. That's it. But then there's other ones that are noncovered and it's not you guys, which is why I'm just kind of trying to go past through these because they're not, they're like Oscar, they're like, yeah, it's they're they're, they're Medica they're not you so I'm trying to find the ones that say.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Oh my goodness, I don't think I'm gonna come across watch the minute I get off the phone, I'll be like, oh my gosh, they're coming.
[AGENT][POSITIVE] I find more. No, you're fine. I'm not, I don't, we're not terribly busy. Um, this is, it is literally my job, [PII], so you take your time. I'm here to help.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, you're so nice. I have other payers telling me, yeah, I can only help you with 2, or I'm only, uh, we can, we can only spend 20 minutes per customer or whatever. So, so this is unusual for me. You're, yeah, this is, this is really, uh, this is unusual for me for you to be like, oh no, go ahead, take your time. I'm like, oh my gosh, this is like you're like heaven sent. You're my, um, hero for, for the day. This is definitely unusual for me. I can tell you that much.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] That's the thing that's my job, you know, all you'd have to do, you just have to call right back anyway so I might as well go ahead and help you now.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] That is so true, isn't it? I would just have to call back anyway, kind of like what I was doing earlier when I was calling multiple times and then I'm like, you know what?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It, yeah.
[CUSTOMER][NEGATIVE] Yeah, cause I was like coming across so many and I'm like, why am I calling every 5 minutes when I can say hey, can you look up? In fact, you were able to look up 3 for me, so I don't know why. Sometimes my little light doesn't come on until after I've suffered and it's like.
[AGENT][POSITIVE] But you just explained briefly how much you've got to deal with, so I think that's completely understandable.
[CUSTOMER][NEGATIVE] I know, right? And then you know it's like I, I do have to remind myself and go, [PII], you're a dummy. Why didn't you just ask for this one and that one? OK, so.
[AGENT][NEGATIVE] No, not dumb. It's overwhelmed and scatterbrained.
[CUSTOMER][MIXED] Yes, that's me, but yes, oh, you're so nice, but no, this, this job kind of makes you a little bit scattered brain actually, and it really it is overwhelming. It really, yeah, because there's, it's so like, and there's so many pairers out there, you know, so, um, it, it, it, I have like EODs from all over and a lot of them, see, I've got one that great American life, not quite public, but great American life. So.
[AGENT][NEGATIVE] Definitely not them.
[AGENT][NEUTRAL] Exactly, I, yeah.
[AGENT][NEUTRAL] Oh, there's others, there's so many like the, um, that start with American and we get so many wrong wrong calls because they think that we're somebody else because all of them sound so similar.
[CUSTOMER][NEUTRAL] Oh my goodness, that I, you know, I believe that. And then there and then you have your mom and pops, you know, they are like, well, I don't know, I like literally there's not even a website you can't even register for a log in because there literally is not even, yeah, so, so we do, we do American Public Life, oh yay, look at this, um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I've got 10, this one actually has, um, it says non cover screening in conjunction with routine that might be a bundle. um, OK, so this one is, I'm gonna give you the claim oh it doesn't have a, it doesn't have a claim number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me give you the um.
[AGENT][NEUTRAL] Oh, that's OK. Uh, do you have the policy? That's fine.
[CUSTOMER][NEUTRAL] Yeah, let me see if I can pull up OK and this might not be you guys. I hope it is, but it's, if not, let me know it's 0.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, oh, OK, 02132359.
[AGENT][NEUTRAL] OK, that sounds like one of our policy numbers. What was the name and date of birth for the number?
[CUSTOMER][NEUTRAL] I'm gonna write this down.
[CUSTOMER][NEUTRAL] OK, so this one is [PII].
[CUSTOMER][NEUTRAL] Uh, bars neck, um, [PII]. She's all of [PII] old.
[AGENT][NEUTRAL] Got it. OK, yeah, uh, so that is one of ours and I do see her on there. um, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, so this one is gonna be [PII] for $173.
[AGENT][NEUTRAL] OK. Give me just a moment. Let me check on this.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I coverage screening in conjunction with your team. Hmm.
[CUSTOMER][NEUTRAL] That is outpatient.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh yeah I was vomiting outpatient. So this is an outpatient visit.
[AGENT][NEUTRAL] There we go. OK, yes, so this one is the same as the previous where um office visits are not covered.
[AGENT][NEUTRAL] So we were unable to pay that benefit and did you need that claim number, [PII]?
[CUSTOMER][NEUTRAL] Mm, gotcha.
[CUSTOMER][POSITIVE] Yeah, I do actually thank you. Let me write this down claim number, OK, I'm ready.
[AGENT][NEUTRAL] Yeah, let me know when you're ready.
[AGENT][NEUTRAL] OK, it is 346-562-5.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 625. Perfect. The office visit a non-covered benefit under the policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, under policy, what kind of policy does she have, by the way? This is just as a mother.
[AGENT][NEUTRAL] This is the same as that other one. It's that secondary medical, um, that's more supplemental.
[CUSTOMER][NEUTRAL] Uh, uh, uh, uh, uh, got you, got you, got you. OK, supplement, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I've got 4 out of my books, um.
[CUSTOMER][NEUTRAL] Let me see here.
[AGENT][POSITIVE] Making progress.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] Some of these, I don't.
[CUSTOMER][NEGATIVE] It just says claims. I'm like, well, that's not a carrier. I don't know what carrier claims, but you know sometimes our front desk people if they don't, I don't know why they, they just name it whatever if they can't find.
[AGENT][NEUTRAL] Oh, just to put a label on there?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yep, just to put a label to get it out the door because sometimes it'll hit a snag because our system the way it works, it's like, man, you gotta tell me, are you Blue Cross? Is this web TPA? Is it who is this?
[AGENT][NEUTRAL] Oh, so if it's one of those random ones, yeah.
[CUSTOMER][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] Yep, and it's a required field. So if we can't put like a United Aetna Blue Cross, and it's a required field, sometimes they'll just put commercial or claims. So they just, yeah, mhm, our system's kind of funny if we use Epic, so, um, I can't even identify half of these, so I don't know. I'll have to look at the ID card and see if I can get a phone number. Mm, yeah, I, no, we have to, yeah, we have this was a Philadelphia American Life. Oh my gosh, you're right, there's a lot of American life.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][POSITIVE] No kidding.
[CUSTOMER][NEUTRAL] Um, this is Philadelphia American, yeah, there's so many Medicare. Oh, why is Medicare under?
[CUSTOMER][NEUTRAL] No, that's not it.
[CUSTOMER][NEUTRAL] Oh, OK. Oh, Medicare, Medicaid, that's not you.
[CUSTOMER][NEUTRAL] Um, come on, come on, come on, come on, EOB.
[CUSTOMER][NEGATIVE] Some of these they just don't even have a label at all. I don't know how they're able to get these. This, this is why these are all denied and they're coming into my deal as a denied claim because it cannot literally identify and it doesn't know why, but mhm and that's.
[AGENT][NEGATIVE] 00, that's even more frustrating.
[CUSTOMER][NEUTRAL] It really is actually and then for our posting team if they can't identify a denial, what they can instead of like being able to adjust it off and and use a code for adjustment, they send it over to the denial team and that's when it lands in my lap and then now we have to call or dig to find out why it denied so we either appeal it.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You get that fun job of sorting all that. Oh my gosh.
[CUSTOMER][MIXED] Yeah, it's, oh yeah, fun, fun stuff what what I get. So it either if I can appeal it then it's appealable I can appeal it, but if not like in your case what you're telling me with the policies and stuff, I still have to call to find out or mhm yeah and that's why these are all.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Well, yeah, getting an exact answer as to why, yeah.
[CUSTOMER][NEGATIVE] Yeah. So now you feel my pain, you understand why?
[AGENT][POSITIVE] I, man, I did before but it just keeps growing.
[CUSTOMER][NEUTRAL] I girl, I know it's, but you know it's, it's job security though, right? I mean it's, it's just kinda.
[AGENT][POSITIVE] It is, and I, I bet your day goes by pretty fast and then.
[CUSTOMER][NEUTRAL] Oh yeah for sure and some of these, they go pretty fast if it's like if I have a uh a log in a user ID like if I, if I'm logged in and I can start knocking out like a whole bunch of them, um, especially if it's like a, yeah, especially if it's like a term plan because then it's, it's a default to patient because if it's term plan then it's essentially self pay, um, but the non-covered ones are the, yeah, but the non-covered, I tell you what, those are the ones where we have to dig because we don't know what the.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Uncovered is and we are not, we're not like it yeah and my system is not equipped to just adjust something off of yeah noncovered because if the, the revenue people are like yeah they're like we're not covered for what though? I need to know why we're not covered, you know what I.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Exactly, right. Well, and that it makes sense, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm, because it could be a lot of different reasons like you just given me for different, you know, like they're all different varieties.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Terminated, just not covered, not under the policy, yeah.
[CUSTOMER][NEUTRAL] Yeah, so, and I get it.
[CUSTOMER][NEUTRAL] Yep, exactly. Or sometimes if it's a baby and they're not enrolled, that could happen too. It's like, well, the mother never enrolled the child. There's so many reasons you've seen it all, yeah, you, I'm sure you come across so many, um, but yeah, this is why.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh yeah, so, so many that I'd need help even interpret and like I'll try to tell them I'm like what does that mean? Like, ah, you know, good question.
[AGENT][NEUTRAL] Well let me find out.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] A variety. I tell you what, but yeah, this is why, and bear with me, I'm clicking on every single one of these for, um, I'm looking for oh American public, uh, you're so nice. I cannot believe how lucky I am.
[AGENT][NEUTRAL] You are fine.
[AGENT][NEUTRAL] Got one?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Oh, and then this one I might need a um a claim number because it doesn't look like it has one either. OK, so uh let me see, let me scroll all the way down here. OK, so here's the ID number. Um it is 02047329. And this is um [PII] date of birth.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII], and then what was the date of service, please?
[CUSTOMER][NEUTRAL] Yeah, sure, um, uh, [PII] $220 even, and you're probably gonna tell me the same thing because yeah it looks like you guys are secondary to United on this one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, this is secondary, but we will double check for good measure. Let's see because again some of these uh secondaries do cover office visits.
[CUSTOMER][NEUTRAL] Uh, OK, got you.
[AGENT][NEUTRAL] I'm surprised sometimes. Let's see.
[CUSTOMER][NEUTRAL] Yeah, and this one is um payment, oh it doesn't tell me what it is.
[CUSTOMER][NEUTRAL] Is it not oh injection and it is outpatient. Oh, it's outpatient visit and injection so but denied um $2220 I guess that's both of them.
[CUSTOMER][NEGATIVE] Yeah, they both denied
[AGENT][NEUTRAL] Was this, um, let's see. Did it have uh multiple procedure codes?
[CUSTOMER][NEUTRAL] Yeah, let me pull up the, the HCA. 00 yeah, OK, so.
[CUSTOMER][NEUTRAL] Um, it looks like I've got 4 on here, so.
[AGENT][NEUTRAL] 4, OK, OK, cool. I found it. Uh, I was just wanting to make sure. OK, so yes, office visits are not covered and then.
[CUSTOMER][NEUTRAL] I have not
[AGENT][NEUTRAL] The services are not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, is that per policy or is it, um,
[AGENT][NEUTRAL] Again that varies so some of them do cover treatment received in office. This particular one does not look like office visits or treatment in office are covered.
[AGENT][NEUTRAL] And I do have that, uh, claim number for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, let me, let me, OK, first, let me put treatment in office, not covered. OK, so is this something that we can appeal with medical records or is this something that, I mean that in the water.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It's simply not covered under their policy, unfortunately. It does not cover office visits or treatment received in office.
[CUSTOMER][NEGATIVE] Oh, under the policy, OK, so there's no benefit for this. So, so it's dead in the water. We can't appeal it. I mean, it's not gonna do basically, OK, so this.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I'm gonna say you could, but
[CUSTOMER][NEGATIVE] It's you're I know you're like yeah you could you could try, but it's not gonna go anywhere because the policy is gonna.
[AGENT][NEUTRAL] You've got enough to do.
[CUSTOMER][NEUTRAL] Yeah, yeah, exactly, um, and then, oh let me write, OK, so claim and number OK, I'm ready for the claim number.
[AGENT][NEUTRAL] Yes, it is 34.
[AGENT][NEUTRAL] 37,110.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, claim number. All right. So, that's one more of my books here of uh out of my work here.
[AGENT][NEUTRAL] There we go, we've knocked out 5.
[CUSTOMER][NEUTRAL] Yes, OK, I've got another one here and it all it says is APL, but I'm guessing that might let me see, yeah, I think it's you because I'm seeing a pattern of, um, numbers, um, OK, so the number, I don't, it doesn't have an I I'm gonna need a claim number. I don't know why some of these are coming across without claim number. Um, this one is gonna be thank you. uh, 000, here it is 020. I was like where is it? Um, 020.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] 99852. And this is [PII]. I'm gonna write this down. [PII] and then [PII] OK. This one, her date of birth is [PII] and
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] Uh, OK, and then [PII] for $333 even dollars and it's not covered. Uh-huh. It looks like this is also Secondary United it looks like.
[AGENT][NEUTRAL] 333. OK.
[AGENT][POSITIVE] Got it. All right.
[AGENT][NEUTRAL] Yeah, this is secondary as well. Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There we are. OK, this one has quite a few items on it, so I'm guessing it's probably gonna be the same as the other.
[AGENT][NEUTRAL] Yes, so office visits are not covered and then the service uh.
[AGENT][NEUTRAL] When performed in a doctor's office or clinic is not covered.
[CUSTOMER][NEUTRAL] Wow, what kind of policies are these? My gosh, the premium must be low.
[AGENT][NEUTRAL] They're really different, um, and some of these are a bit older. Most of the newer variants of these policies offer quite a bit more, um, but I'm telling you, every single one is different on the benefit amounts, how the benefits are paid, and then what is and isn't covered.
[CUSTOMER][NEUTRAL] Hm, is this something that the patients can appeal though? Could would they be able to reach out to you and say, listen, I've got this policy, can you, could they, could they do that if we can't do it for them?
[AGENT][NEUTRAL] No, I mean, they could, again, they could, but it is in the per the policy, office visits and treatment received in office are not covered.
[CUSTOMER][NEGATIVE] They can't
[CUSTOMER][NEGATIVE] OK, well, if it's a non-covered benefit, they're not gonna, they're they're, they're just gonna hit a brick wall anyway, huh, because, uh, OK, got you, because I know for, for me like if my, if, if, if a, if a clinic or doctor's visit or something got denied, then I reach out to my own, you know, my own insurance because.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I can either try to fill my I can fill out a form for disputes, but it's like you said, if it's not covered, it's not the policy if there's no benefit, there's no benefit. So my insurance will tell me, I mean you can dispute all you want and fill out a form, but if it's non-covered, we're not gonna cover it. That's all I mean you have to purchase a different type of policy, yeah, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Exactly. And most of the time, like ones like these, they could be, most of the time the benefits lie with um like surgical benefits or uh emergency room or hospital kind of environment instead of office visits.
[CUSTOMER][NEUTRAL] Oh God.
[CUSTOMER][NEGATIVE] Oh, you know, that makes sense. OK. Um, and they don't even probably will have like urgent care either, huh? The some, some of these problems are so limited like they probably won't even have, like I know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Some, yeah, and it, it really depends.
[CUSTOMER][NEUTRAL] OK, hm, well, so, oh, and then the claim number for this one.
[AGENT][NEUTRAL] Oh, yes.
[AGENT][NEUTRAL] Yeah, it is uh 343-696-6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect. OK, let me put a line to that. And then, yeah, you're right, this does have a lot of items on the HCA here. It looks like several CPPs. Goodness, that's too bad. But you know, it's a secondary. A lot of them are just kind of like, well, I don't wanna have to purchase two. We can get it. Yeah, I get it because you wanna, you, you know, if you're paying United a premium, you don't wanna have to go and like I'm paying everybody premium, you know, and I get it, so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Supplemental, yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But at least they'll have, you know, like coverages for like ER or like, you know, like you said, emergency surgery or something and sometimes that's that's important, you know, I mean, you wanna be.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Well, and that's what this plan really helps, and that's what most people like is that it helps with the co-pays and deductibles. So most of those bigger things like um United, they'll usually take care of uh their customers when it comes to like office visits and such, you know, wellness benefits, but the bigger things, that's where, you know, sometimes these deductibles can be, you know, 400 to $5000.
[CUSTOMER][NEUTRAL] Yeah, I see. So the, OK, I see what you're saying. So the benefits would be to help cover their deductible and and copays and all that. So they, so some of these, the, OK, so if it says non-covered and it's um office visit, it's because it's not a deductible or co-pay or anything like that, is that right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Not a covered benefit for that particular policy, yeah.
[CUSTOMER][NEUTRAL] 0000 OK, got you, got you, got you.
[AGENT][NEGATIVE] That's very confusing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is kind of it really is, yeah, but you know there's so many um you know different um carriers with different guidelines and policies and so sometimes it's just really not I'm getting a lot of timely filing here oh my goodness, OK, I'm, I'm trying to breeze through and bear with me, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] What is this one? You've already gotten a lot knocked out for like, my gosh, I, it's, it's, you're helping me a lot here. Um, and a lot of it is, it's, no, you are, you are, you, you have no idea. You, this means a lot. This is like making my day because if I can, if I can get a lot out of my work here and, and, and kind of bring the volume down a little bit, especially if it's like quick, yeah, and it's quick and easy cause you're just like, yeah, not covered because of this or whatever, then.
[AGENT][POSITIVE] Well, I'm glad that's what, that's what we do.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][POSITIVE] That helps me determine and use the correct adjustment code.
[AGENT][POSITIVE] Right, and that's, that is literally my job is, you know, callers coming in asking why did this deny or whatever then that's my job so yeah, I'm happy to help.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, awesome. Yes, absolutely. But you do it with such good like spirits and you're like, you're, you're just like, oh yeah, sure, OK, like some people are so like they're just done, you know, so it kind of, kind of, kind of, it transmits a little bit because it's.
[AGENT][NEUTRAL] I know.
[AGENT][POSITIVE] I, I understand, but I've been on the opposite end of that too many times and like I said before, sometimes just a friendly attitude can make such a huge difference.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][POSITIVE] Oh yeah, a huge, huge, huge, like it, it can go a long way. You're right, because like even today I've had, um, I've had a really trying day today and I've had computer issues. I've already been on the phone with IT and then I talked to you and literally I'm giggling. I'm like, oh my gosh, this is my first giggle of the day.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] I'm so glad.
[AGENT][NEGATIVE] Because that's, I mean, your job sounds frustrating enough. A computer problems to that. I probably throw it through the window.
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Yeah, oh my God, yeah, and you know we're remote, so we rely on our, um, computers and like, you know, yeah, so, so if I have to call IT or whatever the case is and it's like well we'll have to open a ticket and nobody can get to you until 24 hours, then I'm like, well I'm on productivity because I'm remote, you know, so if I get anything done, yeah, then my numbers look awful because then my managers are like, what were you doing? you know and then.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Yeah, so they want accountability. I totally get it. They want accountability and so I can't, so yeah, this day has just been one of those. So I've had a frown on my forehead like all day and then I talked to you and I'm like, holy cow, I just had my first gig all day and it's [PII]. It's after lunch, so I don't know this should have started my, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][MIXED] Oh, that's awful. I mean, I'm so glad I could help with it, but I'm sorry you've had such a bad day. I sure hope that with all of this, especially that it turns around for you.
[CUSTOMER][POSITIVE] Well, so far it has already because you've helped me knock out like a batch versus one trickle here and there and you literally like you made me giggle. I mean that's like a feat for today because I'm not like I'm like.
[AGENT][POSITIVE] Oh, I'm glad.
[CUSTOMER][NEUTRAL] So that's that is my first and I'm like, my gosh, well, I should have called and talked to her, you know, if you would have kicked off my day with all this, I would have been in better spirits, to be honest, and not awful, but like, yeah, sometimes, yeah, it's, it is what it is. It's our day. That's it's what happens. So, um, I think.
[AGENT][NEUTRAL] I know what you mean.
[AGENT][POSITIVE] It'll get better. It will get better.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Thank you. I, I, I, I love your attitude. I love your spirit, and I, you know, it's encouraging. I think it, you know, it's good when, when you can be encouraged, you know what I mean? It's just, it's, it's very uplifting for sure. In international benefits, that's not.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Well, I'm glad.
[CUSTOMER][POSITIVE] Yeah thank you um and I'm running across let me see, uh, and, and, and you know, and I promise you as we're talking I'm not just like I'm staring at the screen I'm literally um.
[AGENT][NEUTRAL] No, you're OK.
[AGENT][POSITIVE] You're all right.
[CUSTOMER][POSITIVE] I'm, I'm scrolling. Thank you. I'm scrolling past a bunch of these that are like units and things that are not, you know, so I'm scrolling past and this work you has a ton. So if I can knock out as many, uh, as you know, I can with, I even have Kaiser Permanent Permanente. Why would I have Kaiser? They don't cover Oklahoma. Um, so Kaiser, uh, yeah, I feel sorry for these patients. They're not.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] These are not gonna get covered.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, I'm not sure why that says that's Medicare.
[CUSTOMER][NEUTRAL] Just so I don't know why it says APL, but it's just Medicare when I open it and some of these are really, you really have to like um.
[CUSTOMER][NEUTRAL] Um, you really have to, um, what's the word, you know, like really kinda, um.
[AGENT][NEUTRAL] Dissect
[CUSTOMER][NEUTRAL] You, you do, you do, you know, there's a lot of, there's a lot of, yes, a lot of dissecting and a lot of really just deciphering and, and kind of like.
[AGENT][NEUTRAL] But it sounds like, like investigating extreme.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Making sure it all matches up, yeah.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Yeah, so, um, and there's a ton here that are that looks like they might be, um, APL, which is why I am like thinking.
[CUSTOMER][NEUTRAL] I'm I'm opening each one to make sure.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I wonder why I wish it just came out and if you know if I could sort my work queue to say APL, but it's not you guys are hidden under um I think it's labeled commercial on my end so the commercial could be an umbrella for like a ton of stuff.
[AGENT][NEUTRAL] Anyone
[AGENT][NEUTRAL] Oh man.
[CUSTOMER][NEGATIVE] Any, anyone, anyone, yeah, I had, I just came across one that says evolutions, not familiar with evolutions, but that's um under commercial and that's not helping me so um.
[CUSTOMER][NEUTRAL] Because I, I am able to sort, but if I can sort and if you guys would have like if you appeared as APL or or American but you know, on my end then at least I, I would be able to, I would be able to sort accordingly but yeah it's, it's, it's so hard to like.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can't be that easy, can it?
[CUSTOMER][NEUTRAL] No, of course not, it's too easy, right? Yeah, why would it be, yeah, why not? Why make it? I mean, you know, I have to think, right? Med mutual. OK, that's not.
[AGENT][NEUTRAL] Of course not.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Lots of commercials I need. I'm coming across every single one that's not Atlantic coast. Look at all of these and then the minute I get off the phone with you, I'll be like, well, look at all of these APL, APL, APL. So that's why I'm holding you hostage.
[AGENT][POSITIVE] That's OK. That's OK. No, that's, that's perfectly fine. You've got me for at least another half hour and then I gotta go pick up my kiddo, but even if we're not done by then, if you'd like, I can, I can always give you a call right back.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Oh my gosh, you are so awesome. Like who does that?
[AGENT][NEUTRAL] Me
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I know you're like me cause you're lucky.
[AGENT][POSITIVE] No, I mean, honestly, I will say um I can't speak for everyone, of course, but everybody on my team are they're all great, you know I mean sometimes we've all got our days but um they're all really great so if you happen to call back and you don't get me uh you are going to get someone who's gonna help you out, I promise.
[CUSTOMER][NEUTRAL] No, I am.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Oh, I love it. Then, you know, then I wish I could like work with you guys because it sounds like it's a very healthy environment over there.
[AGENT][POSITIVE] It's very everybody's really positive and yeah it's it's a great team and we're all remote too so it can be a little bit difficult, you know, but.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's got its challenges for sure.
[AGENT][POSITIVE] It does, but, you know, it allows me to take care of my kid though, so.
[CUSTOMER][NEUTRAL] Um
[AGENT][POSITIVE] I don't have to worry about daycares or babysitters, so that's a big plus.
[CUSTOMER][POSITIVE] Absolutely, absolutely.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] It's a huge plus when you have, yeah, when you because daycare is not cheap at all, so.
[AGENT][NEGATIVE] Oh, that's so expensive. Oh my goodness, that is so expensive.
[CUSTOMER][NEGATIVE] Oh ri ridiculous ridiculous. So if you can keep kiddos at home and you know just be a mama for them and and not put them in strangers, you know, um, yeah for sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Oh yeah, that's another thing. I hear so many horror stories.
[CUSTOMER][NEUTRAL] That's how
[CUSTOMER][NEGATIVE] Oh, girl, yeah, no, it's hard to, it's hard to even really, you know, focus sometimes when you're thinking about your kids out there and, and you're like, well, who's taking care of my kids, right? I mean, I'm not taking care of.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Even just letting him go to school, honestly, it can be super scary with all the stuff you just see in school.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Yes, I, I agreed. It, it is scary for parents, you know, with the kids in school, you never know. Oh my gosh, so many, especially nowadays for some reason our society's just gotten worse with.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Oh, I know, it's crazy, but luckily, he's got a really good teacher and she'll text me and she's really good with communication, so that makes me feel a lot better.
[CUSTOMER][NEUTRAL] Yes, that helps. That is a plus. Uh, oh, I, I came across another one. Yay, look at this. I have a, I have a, a claim number. All right, [PII]. Conquest. Here is, uh, um, claim number is gonna be 3338493. Write this down. [PII], and it is [PII]. It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, all right.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] Um, da da da da da, uh, oh, this is old. [PII].
[AGENT][NEUTRAL] Not many. Oh yeah, it is.
[AGENT][NEUTRAL] OK, let's see. I bet this one is an office visit. Let's see.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, she, this is actually a secondary to United. OK, so this is.
[AGENT][NEUTRAL] Yeah, sure is.
[AGENT][NEUTRAL] Yes, so this one, office visit it's not covered.
[CUSTOMER][NEUTRAL] Wow, so this is, we're coming across a lot of similarities among these patients. So office visit not covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So this.
[CUSTOMER][NEGATIVE] Um, so it's not, so I'm just gonna put no benefits under policy, yes?
[AGENT][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] No,
[CUSTOMER][NEUTRAL] OK, OK, under policy that will be my AR note no policy, no benefits in the policy. OK, I think I might be able to pull off a um.
[CUSTOMER][NEUTRAL] Uh, an adjustment code for that one as well.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] There's another one. No, that's not you. That's Cigna. Why is Cigna in the commercial? Some of these are so weird. Like I don't know Cigna is not, I don't know why. Sigma is a common, common. I don't know why they would have that hidden under their com, but you know it's, it's like, again, it's sometimes the front desk, they don't, they can't locate it. I don't know why they, yeah, why they're being labeled um off like.
[AGENT][NEGATIVE] Oh gosh, no.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, and everybody's human and even the computers, you know, there's mistakes possible everywhere.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] And you have that fun job of going through and correcting all of it.
[CUSTOMER][NEUTRAL] Sure, yeah.
[CUSTOMER][NEUTRAL] That's what happens because it ends up in my lap and I have to figure out what happened because it may not even be actually like well no it's not it's not, it's not a non-brand commercial it's actually Cigna, so I have to fix it. So but you know it's like I said it's job security for a lot of these it's the reason why we're here so that we can get these claims out like, yeah, because we want clean claims, you know, so um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, sure.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Sometimes, yeah, and sometimes we have people that are, um, you know, they're, they're, they're new and they have no experience so they um they, but you know, and they don't ask questions sometimes and so and it kinda hurts the, the claim sometimes because yeah, it's, it's either like not uh you know, just the training maybe it's lacking a look at this claims PO Box 5010.
[AGENT][NEUTRAL] Um, yes.
[CUSTOMER][NEUTRAL] That's the name of the company claims.
[AGENT][NEUTRAL] Claims. Oh, so maybe they were right.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][POSITIVE] That's hilarious.
[CUSTOMER][NEUTRAL] I'm telling you, I am telling you I'm telling you, [PII], that's, yeah, that's, I mean they, they don't label, yeah, and so they call it claims PO Box something something something or like it'll be the heading is claims claims.
[AGENT][POSITIVE] That is so funny.
[AGENT][NEUTRAL] In other words, um, you handle this.
[CUSTOMER][NEUTRAL] Yes, pretty much, pretty much it's past the buck type of thing and then when it decides.
[AGENT][NEUTRAL] Right, that's what it seems like.
[CUSTOMER][NEUTRAL] Yeah, that literally that's what it is and then it's past the b and then when it denies then of course you know they're like, well we have our denial team that works all of it, but you know we all have to, you know, kind of make an effort, right? I mean.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We don't know, we wanna, we wanna, we want, we want clean claims and we wanna get them paid and we don't need a work you that has 10,000 claims.
[AGENT][NEUTRAL] Mhm. Cohesiveness, yeah.
[CUSTOMER][NEUTRAL] Yeah, see, look at this one commercial insurance [PII]. I'm not really quite sure.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][POSITIVE] Yeah, there's so there's a lot of, OK, I think I might have hit the last one here for you, um, OK, here's my last, um, Med mutual. Nope, so that concludes my APL. So I got every APL out of this for you. Oh my goodness, so.
[AGENT][POSITIVE] Yay.
[AGENT][POSITIVE] Well, that's a good chunk, I think.
[CUSTOMER][MIXED] It's, it's a nice little chunk because I, I mean, I wish I had more to to, you know, because you have been such a trooper, but if I can get like a huge bull out of.
[AGENT][POSITIVE] I don't know and it's been an absolute pleasure speaking with you, [PII].
[CUSTOMER][NEUTRAL] Oh, thank you. No, it's for me too because my gosh, I giggled like 2 or 3 times. I had to wipe tears a couple of times, so the.
[AGENT][POSITIVE] Good.
[CUSTOMER][POSITIVE] That's the first. That's, that's a blessing, right? It's a huge blessing. So I'm very, I'm grateful for that. So I think I got everything, [PII]. You're so thank you so much for you think you're so patient and just, just so kind. Thank you. I appreciate that.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Absolutely nothing to thank me for. Like I said, it has been an absolute pleasure, [PII]. Anytime, I mean it.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Uh, you're the best. Hopefully I get you again next time because I've got 20 more work cues, so when I get into some of those, I might, I might call yeah.
[AGENT][NEUTRAL] I don't mind. I do not mind.
[CUSTOMER][NEUTRAL] Yeah, as you're like, you're like, well, [PII], as long as it's not where I have to like go get my kiddos. So, but yeah.
[AGENT][NEUTRAL] No, yeah, that's fine.
[CUSTOMER][POSITIVE] Alright, well thanks [PII] so much.
[AGENT][POSITIVE] Well, I sure hope you have a great rest of your day and that the weekend comes for you soon.
[CUSTOMER][POSITIVE] Thank you. You're so sweet. Thanks for the giggles. I appreciate it. I, I for the help.
[AGENT][NEUTRAL] Oh, anytime.
[CUSTOMER][POSITIVE] All right, well I'll talk to you later you have a great evening.
[AGENT][POSITIVE] You too, [PII]. Thank you. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.