AccountId: 011433970860
ContactId: 0478cf54-bfcf-4d61-ae58-c345a27285da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 462750 ms
Total Talk Time (AGENT): 160137 ms
Total Talk Time (CUSTOMER): 131899 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/0478cf54-bfcf-4d61-ae58-c345a27285da_20250417T14:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office for claim status.
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] So it's 01480079 M as in Mike, L as in Lime.
[CUSTOMER][NEUTRAL] 8
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct line.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. May I have the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] It's $3,885 even.
[AGENT][NEUTRAL] 3,885.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. One moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This process under claim number 3459007 looks like a benefit amount of $581.82 processed to the provider.
[AGENT][NEUTRAL] This claim processed on [PII].
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] I have a specific question on the claim. So, I do have the claim number.
[CUSTOMER][NEUTRAL] Uh, which is 3458694.
[AGENT][NEUTRAL] 8694.
[CUSTOMER][NEUTRAL] Yes. 3458694.
[AGENT][NEUTRAL] Let me get that pulled up one moment.
[CUSTOMER][NEUTRAL] And by the way, may I know your name, please?
[AGENT][NEUTRAL] [PII] Last initial is [PII]
[CUSTOMER][POSITIVE] Thanks for that.
[AGENT][NEUTRAL] You're welcome, one moment.
[AGENT][NEUTRAL] Just waiting on the claim to load one moment.
[AGENT][NEUTRAL] It looks like this paid a benefit amount of $1,742.59.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] To [PII], just waiting on it to load.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like they both was the same date of service.
[AGENT][NEUTRAL] Did the primary insurance reconsider the claim?
[CUSTOMER][NEUTRAL] Yes. So the primary insurance applied patient responsibility of $1,742.59. So, later, American Public Life process a secondary and paid that patient responsibility, paid the primary patient responsibility. But why did American Public Life again paid with $581.82 on [PII], which is causing an overpayment on the claim.
[AGENT][NEUTRAL] OK, so what I'll do is I'll send this claim over for review, and if they overpaid it, then they'll send a refund request.
[CUSTOMER][NEUTRAL] OK, so how many days will it take for review and uh sending for refund request?
[AGENT][NEUTRAL] The review can take anywhere from 7 to 10 business days and then they'll send out the um letter requesting a refund.
[CUSTOMER][NEUTRAL] OK, 7 to 10 business days, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you so much for the information. It was great talking to you. Can I have the callerence for this?
[AGENT][NEUTRAL] Yes, it will be my name which is [PII]. Last initial is.
[CUSTOMER][NEUTRAL] And before that,
[CUSTOMER][NEUTRAL] Yeah, before that, just a second. Actually, uh, as I see that we are um we already took the call on [PII] and the rep said that um it will take 7 to 10 business days and we have crossed that business days, but we didn't get any.
[CUSTOMER][NEUTRAL] Information on this.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][POSITIVE] Sorry for that.
[AGENT][NEUTRAL] And I do show that someone called on [PII], so I'll make sure that note as well because I'm not seeing anything in our system.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] We do show.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Someone is reviewing it, so it is under review right now.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Yes, so it looks like it is under review for 58182.
[AGENT][NEUTRAL] So they are working on it.
[CUSTOMER][NEUTRAL] Yes. So, how many days will it take for the review to complete?
[AGENT][NEUTRAL] I'll send this over now because it should have been reviewed. I'll send it over now and see what they can do on that one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we need to allow some more time. Is that right?
[AGENT][POSITIVE] So, I am sending mine over today. Mine will take 7 to 10, not necessarily that long, but hopefully they can get it out today.
[CUSTOMER][NEUTRAL] OK, 7 to 10 business days.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Thank you for that. So the callerence will be your name and the date, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] OK, thank you so much for the information.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye.
[AGENT][POSITIVE] [PII], you're so welcome, and thank you for calling American Public Life. Have a great day. Bye-bye.