AccountId: 011433970860
ContactId: 04c2c71d-8329-4282-ac30-21ac7b30b945
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1254510 ms
Total Talk Time (AGENT): 429348 ms
Total Talk Time (CUSTOMER): 248481 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/04c2c71d-8329-4282-ac30-21ac7b30b945_20250520T13:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, I don't know if I got the right line, but we received a payment.
[CUSTOMER][NEUTRAL] From APL but we didn't build them so I'm just trying to figure out where this payment came from and why.
[AGENT][POSITIVE] OK. I can help you figure that out. I'm definitely sorry you received the payment you didn't bill for. Um, may I have your name and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII] and my number is [PII].
[CUSTOMER][NEUTRAL] 820
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And
[CUSTOMER][NEUTRAL] And I'm sorry, what did you say your name was?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then on the check, um, so wait, so do you have the explanation of benefits and the check or just the check?
[CUSTOMER][NEGATIVE] Uh, just to check, we don't even have this like in our insurance grid.
[AGENT][NEUTRAL] Oh, OK. Um, on the check, what's the check number? Let me try it that way.
[CUSTOMER][NEUTRAL] That is 2000.
[CUSTOMER][NEUTRAL] 170.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold? Is it it's in the amount of $20?
[CUSTOMER][NEUTRAL] Correct, yes, you can put me on hold.
[AGENT][NEUTRAL] OK, I found the check. OK, hold on one moment, thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, so I think I have all the information I need.
[AGENT][NEUTRAL] 93 2024.
[AGENT][NEUTRAL] Oh Lord,
[AGENT][NEUTRAL] Literally could be any of these.
[AGENT][NEUTRAL] be so convenient if they put the the number on there.
[AGENT][NEUTRAL] The claim number.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 69. Did I skip it?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] What?
[AGENT][POSITIVE] You know what, this is probably the easiest thing to do.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Was it sent to the wrong place.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. OK, so I found the claim and everything um that it came from.
[AGENT][NEUTRAL] And I pulled up the original documents.
[AGENT][NEUTRAL] So, where we sent it to is what's on the claim form, um.
[AGENT][NEUTRAL] Do you want me to like tell you what patient is for and then maybe look and see because I mean, it's a lot from you, from
[AGENT][NEUTRAL] Let me ask you this. Is this rehab clinics? Are you with rehab clinics?
[CUSTOMER][NEUTRAL] So that's one of our names. This clinic specifically is sports and orthopedic rehabilitation.
[AGENT][NEUTRAL] So, let me see.
[AGENT][NEUTRAL] Because we sent it to [PII]. That's the address on the claim form. Should it have gone somewhere else?
[CUSTOMER][NEUTRAL] Um, well, no, we.
[CUSTOMER][NEUTRAL] I don't we didn't bill this at all, so I just, I don't know where the payment came from and it has this patient's account number.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] like y'all attached the remittance and everything, the patient responsibility was $20. I, I, I don't know. I mean, from what was sent in, it looks like it was to y'all, it's correct.
[AGENT][NEUTRAL] But what do you mean you had a bill for it?
[CUSTOMER][NEUTRAL] Does it say how the claim?
[AGENT][NEUTRAL] Oh, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, we didn't, we didn't.
[CUSTOMER][NEUTRAL] Oh, I was just wondering if like you could see like did this come from the clinic like was it was the claim sent from this clinic?
[AGENT][NEUTRAL] Mhm. Um, OK, let me tell you what I have.
[AGENT][NEUTRAL] So it was submitted from the provider. We have um like the, so we received two pages. The first page is the health insurance claim form.
[AGENT][NEUTRAL] Um, there were a few from this date. Um, this was one of several.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] A a few from this date.
[AGENT][NEUTRAL] Mhm. So for September?
[CUSTOMER][NEUTRAL] So the same date of service?
[AGENT][NEUTRAL] Yes, uh, for [PII], because I had to go through each of them to find this check, to find the check, um.
[AGENT][NEUTRAL] And they were all from rehab clinics. So I was like, well, maybe we just sent them all to, we just sent them all to the wrong place, but
[AGENT][NEUTRAL] There's 12345678 payments that we made to y'all on [PII].
[AGENT][NEUTRAL] For this patient.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Can you see because this data service I'm looking at specifically is 723-2024 it that has the patient claim ID on it and that's the account that I'm working on, um, is that the same account number on the other?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see, this account number.
[AGENT][NEUTRAL] Let me see what this account number is.
[AGENT][NEUTRAL] 141.
[CUSTOMER][NEUTRAL] So the one on
[AGENT][NEUTRAL] Oh, go ahead, I can hear you still.
[CUSTOMER][NEUTRAL] Oh no, I was just making sure you saw the same account number as I did. It is the 141564916.
[AGENT][NEUTRAL] Wait a minute. Say that again.
[CUSTOMER][NEUTRAL] The patient account number on this um EOB I have is 141564916.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh wait, OK, hold on. So yours is 916. This shows 946. Let me look at the other ones.
[AGENT][NEUTRAL] Some
[AGENT][NEUTRAL] Yeah, all the ones that we have um that we paid out for [PII], I hope I didn't say that wrong because I'm not on the same screen, but the ones that we paid out on [PII], those all have patient account number [PII] and then it says 1516.
[CUSTOMER][NEUTRAL] OK, let me read that back to make sure I got it so the account number that you're showing is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Wait.
[AGENT][NEUTRAL] OK, so it's [PII] and then there's a space and 1516.
[CUSTOMER][NEUTRAL] OK, so it's
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So you're showing the the beginning is 141564.
[CUSTOMER][NEUTRAL] 946.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's a different account number and then what what was after the 946?
[AGENT][NEUTRAL] It's a space and then, well, OK, on, on the claim form it's a little star and then it says 1516.
[AGENT][NEUTRAL] And in our system it's just a space and then 1516.
[CUSTOMER][NEUTRAL] 1516.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I don't know.
[CUSTOMER][NEUTRAL] 415.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] 946.
[CUSTOMER][NEUTRAL] OK, now let me ask you, is this $20 payment that I'm investigating, is it for [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, this is for, is this the only person here. Hold on one second.
[CUSTOMER][NEUTRAL] Is it [PII]?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So that's funny.
[CUSTOMER][NEUTRAL] It has the wrong patient. I'm working with [PII]. This is the name that's on the EOB.
[AGENT][NEUTRAL] What's the, on the EOB wait, on primary EOB or ours?
[CUSTOMER][NEUTRAL] Yours.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] It says processed as primary.
[CUSTOMER][NEUTRAL] This claim number is 3,500,690.
[AGENT][NEUTRAL] Alright, hold on.
[AGENT][NEUTRAL] Um, OK, so that is the claim number on here.
[AGENT][NEUTRAL] But everything like the patient name and everything on the claim form that was sent in, well, let me check the remittance. Yeah, everything on our side.
[AGENT][NEUTRAL] Say [PII].
[CUSTOMER][NEUTRAL] Yes, I pulled up her account once you gave me.
[CUSTOMER][NEUTRAL] That number, so I'm showing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The data service 723-24 is missing a $20 payment and I think I found it on [PII]'s account.
[AGENT][NEUTRAL] 000, it was applied to the wrong account, OK.
[CUSTOMER][NEUTRAL] Um, are you able to send me?
[CUSTOMER][NEUTRAL] Yeah, but, but our EOB says, you know, [PII] has his ID and everything, so is it possible to get you to send me a copy of the correct EOB?
[AGENT][NEUTRAL] Wait a minute, it is, uh, I just want to make sure I'm following. So the EOB that you received from us shows the other, what's the other person's name, [PII]?
[CUSTOMER][NEUTRAL] Steven Montgomery.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me.
[CUSTOMER][NEGATIVE] I don't even think he has insurance with you guys.
[AGENT][NEUTRAL] Let me do it this way so I can look up the EOB. Hold on one second, 12345678.
[AGENT][NEUTRAL] 93.
[AGENT][NEUTRAL] And let me do it like this.
[AGENT][NEUTRAL] Sorry, I'm just trying to get everything in the same spot. I'm sorry.
[CUSTOMER][NEUTRAL] Oh no, you're fine.
[CUSTOMER][POSITIVE] I appreciate your help. This was a little bit of a mystery.
[AGENT][NEUTRAL] You're very welcome. OK, so this is it. So let me pull up the, is this the EP or the claim form.
[AGENT][NEUTRAL] It's coming up. I'm just trying to see if.
[AGENT][NEUTRAL] I, I thought I pulled up the EOB, but
[AGENT][NEUTRAL] It keeps giving me the claim form. Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] No, I don't mind, thank you.
[AGENT][NEUTRAL] OK, you're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] But I pulled, I need to pull it, oh Lord.
[AGENT][NEUTRAL] I don't think that's gonna have the same.
[AGENT][NEUTRAL] So I'm gonna have to go through each one.
[AGENT][NEGATIVE] Cause there's no
[AGENT][NEUTRAL] Oh, maybe we can suggest I'm not saying that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm looking for 690, so we only have the.
[AGENT][NEUTRAL] Once you see that claim number, if it's not 690, keep moving.
[AGENT][NEUTRAL] Nope.
[AGENT][NEUTRAL] Come on on base.
[AGENT][POSITIVE] [PII] is so good. Let me safe.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh [PII], and I was looking over there. Let me look at the other claim because that might have been what I needed and I was looking at policy and not claim number.
[AGENT][NEUTRAL] Let's see what happens. I'm looking for.
[AGENT][NEUTRAL] 0, OK, it wasn't it though.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] This is 93.
[AGENT][NEUTRAL] I don't know how they're going to.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 695.
[AGENT][NEUTRAL] What
[AGENT][POSITIVE] Well, this is so much easier when I can just click it and it pulls up.
[AGENT][NEUTRAL] How they fix it soon.
[AGENT][NEUTRAL] 369-0 come on.
[AGENT][NEUTRAL] Is there a quicker way to do this?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Unless there isn't one and I won't know.
[AGENT][NEUTRAL] Well, I will know cause I gotta go through each of them.
[AGENT][NEUTRAL] Wait, but you see them down there?
[AGENT][NEUTRAL] Wait a minute, it's a whole bunch on this day.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. OK, so I located the explanation of benefits. Um, what's a good fax number for you?
[CUSTOMER][NEUTRAL] That would be [PII].
[CUSTOMER][NEUTRAL] 629.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah it it'll come directly to my email.
[AGENT][NEUTRAL] OK, and it's [PII]?
[CUSTOMER][NEUTRAL] Yeah, no [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, so [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] All right, so I'm sending this over to you now. And was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that was it. Thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. Well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] Oh wait, do you give reference numbers?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome, [PII], and thanks for calling APL. I hope you have a great week.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.