AccountId: 011433970860
ContactId: 0cce9cc0-93d5-4df3-a77c-1e7a4fa96a1a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1193530 ms
Total Talk Time (AGENT): 403023 ms
Total Talk Time (CUSTOMER): 409365 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/0cce9cc0-93d5-4df3-a77c-1e7a4fa96a1a_20250519T16:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] on the care team. I've got an in uh provider on the line, um, checking on.
[CUSTOMER][NEUTRAL] A refund that was sent and then we reprocessed the claim, but I'm having a really difficult time following all this so I was gonna see if you could help her.
[AGENT][NEUTRAL] Certainly, who am I speaking with, uh, [PII]?
[AGENT][NEUTRAL] You said provider?
[CUSTOMER][NEUTRAL] Yes, um, so, yeah, provider is [PII], and let me give you the policy number, it's 131.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2696.
[AGENT][NEUTRAL] OK, let me pull that up real quick.
[AGENT][NEUTRAL] And the patient's info has been verified. Everything's been verified? OK, thank you.
[CUSTOMER][NEUTRAL] Yes, it has.
[AGENT][NEUTRAL] And do you have a callback number for [PII]?
[CUSTOMER][NEUTRAL] Uh, it's the one on the caller ID.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I'm sorry, you said that policy number 1, did I miss the number 13?
[AGENT][NEUTRAL] I have 2
[CUSTOMER][NEUTRAL] 131
[AGENT][NEUTRAL] Oh, uh-huh.
[CUSTOMER][NEUTRAL] 2696.
[AGENT][NEUTRAL] OK, sorry I missed that second one.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And it's for [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess the original claim, uh, this is for [PII].
[CUSTOMER][NEUTRAL] The original claim I guess we paid.
[AGENT][NEUTRAL] [PII]?
[AGENT][NEUTRAL] I'm sorry? OK.
[CUSTOMER][NEUTRAL] Yes, [PII], yeah, 2018, 731, um, original claim was 2209833.
[CUSTOMER][NEUTRAL] I guess we process the claim and overpaid, um.
[CUSTOMER][NEUTRAL] Uh, and so they sent a refund, but then there's a note in there that says we couldn't identify the refund.
[CUSTOMER][NEUTRAL] But I see the claim backed out and then it and then there's a reference to another claim but I can't figure out is I can't figure out what's going on exactly.
[AGENT][NEUTRAL] OK, so it's 1:30, 1:18.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm sorry, July. I'm sorry, July, goodness gracious, it's Monday.
[AGENT][NEGATIVE] OK, I was gonna say it's not coming up for me.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK got it alright so OK.
[AGENT][NEUTRAL] 7:31.
[AGENT][NEUTRAL] And so they're calling looking for payment?
[CUSTOMER][NEGATIVE] No, she's saying that they sent the refund, but then we sent the refund back to them.
[CUSTOMER][NEUTRAL] But then I
[CUSTOMER][NEUTRAL] I don't know why I it says we couldn't identify it.
[CUSTOMER][NEUTRAL] Um, per the notes and she has a letter, but then we, it looks like we process the claim again so I don't, I'm not understanding what's happening on the claim.
[CUSTOMER][NEGATIVE] I guess we've overpaid and she's just wanting to refund this back but we sent the refund back to her.
[CUSTOMER][NEUTRAL] Telling her to submit the EOB.
[CUSTOMER][NEUTRAL] But I, I, and again I can't, it looks like we've paid again on [PII].
[CUSTOMER][NEUTRAL] So I'm not, I'm confused on what's happening on the processing of it.
[AGENT][NEUTRAL] OK, might take a little bit of research, but you can go ahead and put her through, and it's [PII], is that right?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, let me see if she can provide me a little bit more detail so that I can figure out exactly what happened because.
[CUSTOMER][NEUTRAL] OK, that's
[AGENT][NEUTRAL] I'm seeing the same thing you are and it's a little bit confusing or a lot of it I should say.
[CUSTOMER][NEUTRAL] Yes, yeah.
[CUSTOMER][NEGATIVE] All right, I know that's why I'm like I can't, I don't understand what's happening.
[CUSTOMER][POSITIVE] OK, I'll get her on the line. I'll introduce you and then I'll release her, OK?
[AGENT][POSITIVE] Great thank you [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK [PII], I've got [PII] on the line she's gonna assist you, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi [PII], my name is [PII]. I'm on the claim support team and uh Ms. [PII] transferred you over to me to see if I can help you figure out exactly what's going on with this claim. So I understand we initially paid and then we.
[AGENT][NEGATIVE] We requested a refund.
[CUSTOMER][POSITIVE] I don't know, but we have refund the amount. Uh, I don't know, uh, whether you have re uh requested or not, but we have, uh, refunded the amount because we have already received the amount from United Healthcare and per checking that you guys are uh all payment, uh, we received. So again, uh, for checking, we have received the refunded amount back. So you guys want us to
[AGENT][NEUTRAL] Is that right?
[CUSTOMER][NEUTRAL] Uh, send it, uh, send refund or you guys will recoup the amount?
[AGENT][NEUTRAL] Well, generally we don't recoup um on on claims um if there's a refund due um.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Due to an overpayment, usually that overpayment is either sent back or you can uh process it. Are you showing a credit on their account for this patient?
[CUSTOMER][NEUTRAL] You can let him know
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] Uh, yes, I guess.
[AGENT][NEUTRAL] For this data service [PII], correct?
[CUSTOMER][NEUTRAL] It's July, yes, [PII], right.
[CUSTOMER][NEUTRAL] For the amount of $10,538.
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] $10,538?
[CUSTOMER][NEUTRAL] $7,538.21.
[AGENT][NEUTRAL] And 21 cents 10,538 and 21 cents, is that right?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so let me see if I can locate that amount on this claim.
[AGENT][NEUTRAL] And was this the hospital charges, is that right? the facility charge?
[CUSTOMER][NEUTRAL] I think uh let me check, let me check that you'll be sorry to inform.
[CUSTOMER][NEUTRAL] This is hospital charge.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And just give me a moment and I'm searching uh right now I'm searching our system to try to get that claim information.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] It was the charge amount uh.
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEUTRAL] What's the name of your facility, [PII]?
[CUSTOMER][NEUTRAL] OK. Uh, facility name is
[AGENT][NEUTRAL] The name
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] P F P S I V N N C.
[AGENT][NEUTRAL] OK, because I'm not showing that charge amount on here, so bear with me for just a moment. I'm showing a different charge amount the the the the the charges change?
[AGENT][NEUTRAL] That you know of?
[CUSTOMER][NEUTRAL] Uh, let me check that as well. Uh, did you check, uh, are you checking it like 7538.21?
[AGENT][NEUTRAL] Was there
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, I have a different charge amount for the facility charges for that data service, and I have the Hallandale Outpatient surgical Center. So like I said, that's why I think we're having a hard time finding this information because um.
[CUSTOMER][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] Uh, do you want claim number?
[AGENT][NEUTRAL] Yeah, what claim number do you show?
[CUSTOMER][NEUTRAL] The check?
[CUSTOMER][NEUTRAL] 2209833
[AGENT][NEUTRAL] 2209833
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you, let me check on that because the the um.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, I don't show that as a facility charge. I show it as a professional fee for the procedure code 229827.
[AGENT][NEUTRAL] Is the CPT code?
[CUSTOMER][NEUTRAL] Right, 298.
[AGENT][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Uh, see, I have CPT codes. Uh, yes. Let me give you all the CPT 29827, 29826, 29824, and 29823. This, uh, CPT code we have.
[AGENT][NEUTRAL] OK, got it, yep, and I see them all on that claim 2209833, and then I see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Then I see it was.
[AGENT][NEUTRAL] 227.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2460.
[AGENT][NEUTRAL] Just bear with me for one moment while I try to research this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It I
[CUSTOMER][NEUTRAL] No I'm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, I'm still checking on that just bear with me. I'm having to pull up um different um different claim information and because it was uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was and there was many charges for that data service so I'm just trying to track down the correct one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so the original claim, um, that was processed under the 2209833, I saw the charges were 7,53821, not 10,000, so did they change?
[CUSTOMER][NEUTRAL] That's what I'm saying, 7,538.21, sir.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And how much are you showing the overpayment is for this uh data service?
[CUSTOMER][POSITIVE] Uh, see, I can, uh, give you, uh, uh, CPT wise the payment which got overpaid for 29826, we refunded the amount, uh, but again, we received the refund, uh, uh, check for the amount of $1,076. And for 29827, again, uh, we refunded the amount and we received the amount of
[CUSTOMER][NEUTRAL] OK. OK, for the
[AGENT][NEUTRAL] So 1,076.
[CUSTOMER][NEUTRAL] Uh, yes, for the other CPT and for uh 29827, the amount is 647.37. We receive payment of 11784.30 cents.
[CUSTOMER][NEUTRAL] So you guys will recoup the amount or you want us to uh refund it?
[AGENT][NEUTRAL] Um, I would suggest you go ahead and send it in as a refund because we don't recoup generally, um, for these type of policies, if there's an overpayment, you can send the overpayment back to us or you can send it to the patient because um we're this is a supplemental uh benefit policy.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And it's actually um their policy is no longer active, but I don't show that there's any amount that's due back to us.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] They have um let me just check on something here.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, so they have a, a specific benefit amount that's paid out and we reached that maximum with this particular patient, but their policy is no longer active, so you can either send the refund back to us or you can send it directly to the to the insured to the patients.
[AGENT][NEUTRAL] Alright, does your facility do that or?
[CUSTOMER][NEUTRAL] OK. Uh, can you
[AGENT][NEGATIVE] Because we won't recoup that amount.
[CUSTOMER][NEUTRAL] I have to check. Can you please give me?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, we will refund it to you guys. Can you please provide me uh address?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Certainly.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] So the claims, uh, you would send the refund to our claims address and just put attention refund department.
[CUSTOMER][NEUTRAL] How did you get
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And that, that uh address is gonna be [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] And it's [PII].
[CUSTOMER][NEUTRAL] They're
[AGENT][NEUTRAL] And that's [PII], OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, fine, thank you. Can you please help me with reference number?
[AGENT][NEUTRAL] Certainly [PII], can you tell me again um so I can have it in my notes with the um overpayment amount?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, one for, see, I can't give you total number of, but I can give you, OK, let me check.
[CUSTOMER][NEUTRAL] The minimum.
[AGENT][NEUTRAL] I know you had told me 10076, but I just wanna.
[CUSTOMER][NEUTRAL] Insurance balance. 1,723. OK. Uh, here, uh, it is $1,723.37.
[AGENT][NEUTRAL] And that's the overpayment amount? OK.
[CUSTOMER][NEUTRAL] We gonna refund. Uh yes.
[AGENT][NEUTRAL] OK, and again that data service was 731-2018 and it was for those CPT codes that you uh provided to me um and the provider again was it looks like is it [PII], Doctor [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, yes, and uh date of service [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh, and it was TFPS, right? T, T like Tom, F like Frank, P like Paul, S like.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah it's
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] T as in Tango. F as in France. P as in Papa. S as in Sierra.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] TFPS.
[AGENT][NEUTRAL] Yep, TFPS got it, [PII]. OK. Your call reference number for today. You're gonna use my name and today's date, my first name [PII]
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] My last initial is [PII].
[AGENT][NEUTRAL] And then you use today's date. So my name and today's date. I'll go ahead and update the notes. [PII], did you have any other questions?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you so much, uh, for assisting. Thank you so much. Bye bye.
[AGENT][POSITIVE] You're welcome and thank you for calling API. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye bye.