AccountId: 011433970860
ContactId: 056c0406-441b-4e38-994d-f16d0bc882bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316459 ms
Total Talk Time (AGENT): 186480 ms
Total Talk Time (CUSTOMER): 110790 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/056c0406-441b-4e38-994d-f16d0bc882bd_20250131T16:03_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] in the care team. I've got um Miss [PII] on the phone. She is with the provider's office of Spine Hospital of Louisiana.
[CUSTOMER][NEUTRAL] She is calling because back in [PII], she said that we should have requested a refund for claim number 3346543.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In the amount of $571.57 and the check number is 18060007.
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Policy, you you've got it pulled up?
[AGENT][NEUTRAL] Um, yeah, I do. Uh.
[CUSTOMER][POSITIVE] OK, OK, cool.
[CUSTOMER][POSITIVE] Alright well I'm gonna go ahead and release the call and let you speak with her because she wants to make sure that we get our money back.
[AGENT][POSITIVE] Oh, OK. OK, thank you. Yeah, I can.
[CUSTOMER][POSITIVE] OK. You're welcome. Bye-bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] [PII], this is [PII]. Yes, [PII], this is [PII] in the claims department. I'm just looking up the claim, uh, that [PII] sent to me here, so I'm just
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] OK. For [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you're saying that you sent us something asking us for a refund, is that, is that correct or?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] We spoke with someone on [PII], someone named [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And, and she advised us, she stated she has submitted a refund request, told us to allow 7 to 10 business days.
[CUSTOMER][NEGATIVE] And we never heard anything else, never got a refund request that or anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what we did, they submitted it to us. Um, we did receive something uh on [PII].
[AGENT][NEUTRAL] Uh, it looks like there was a lady named [PII] who contacted us, uh, and said that, uh, you know, said that this claim was, was, uh, overpaid. Um, so what, what, uh, what we did was we, we went, uh, we did a review of it let me see if I can't pull up the.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we did a review of the, of the claim and uh it looks like it was paid as far as the um
[AGENT][NEUTRAL] As the explanation of benefits uh we we're concerned, uh, what the explanation benefits that were submitted to us now normally we have something like this if it's, if it is something that is uh a request for a refund, um.
[AGENT][NEUTRAL] Generally we have a, we have a different uh ELB one that maybe they adjudicated the the claim. I don't know, um, but we were looking through this and we couldn't find where it was overpaid. So there was um a payment of 46757 um there was a payment of um.
[AGENT][NEUTRAL] Let's see what else. $102.
[AGENT][NEUTRAL] And then everything else was paid in full by the, by the uh uh insurance company. So what we, uh, we just don't have anything that shows that there was an overpayment. Uh, so it looks like the, the deductible co-payment or co-insurance was in fact $571.57. So we did get that, that uh notice to, to review it, um.
[AGENT][NEUTRAL] But uh we didn't have, we.
[CUSTOMER][NEUTRAL] But you guys are not primary. The primary had paid.
[AGENT][POSITIVE] Right, yes, we should.
[CUSTOMER][NEUTRAL] You're not primary, yeah, that was the thing.
[AGENT][NEUTRAL] No, we're the secondary. Yeah, so the, the primary, it looks like the paid to the provider by the primary was $725.43. But what they did was they put towards a deductible co-payment or co-insurance that $571.57 which normally we would be paying. Now, um, if you want [PII], I'd be glad to send you a copy of this. I can send it to you, uh, fax you a copy or email you a copy of the EOB that we received, um, but that's, uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The EOB from where? From United.
[AGENT][NEUTRAL] Once we
[AGENT][NEUTRAL] Uh, yeah, that's what we go by. We go by the.
[CUSTOMER][NEUTRAL] We have United ELB already.
[AGENT][POSITIVE] Oh, good. OK.
[AGENT][NEUTRAL] Well, that's what, uh, that's what we went by was the uh United EOB that um
[CUSTOMER][NEUTRAL] So you don't find that that this is overpaid. OK, well, we'll just keep the money then.
[AGENT][NEUTRAL] No, ma'am, I don't, yeah. OK, yeah, yeah, we don't show that it's overpaid at all. We did review it, but uh there was nothing to indicate that it was, uh, that it was overpaid.
[CUSTOMER][NEUTRAL] All right then.
[CUSTOMER][NEUTRAL] OK, all right, well thank you and your name was [PII]?
[AGENT][NEUTRAL] Uh, my name is [PII]. Yes, and the, um, reference for today will be my name and today's date.
[CUSTOMER][POSITIVE] All right, Ms. [PII], thank you very much.
[AGENT][POSITIVE] OK, thanks for contacting AP have a good.
[CUSTOMER][POSITIVE] Alrighty