AccountId: 011433970860
ContactId: 10f2e1fd-a9fd-4559-9606-677a25f668e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530340 ms
Total Talk Time (AGENT): 97184 ms
Total Talk Time (CUSTOMER): 192524 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/10f2e1fd-a9fd-4559-9606-677a25f668e2_20250425T19:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is
[AGENT][NEUTRAL] How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'm calling regarding um a claim um that my client received and it said it was an additional payment that the first payment was sent to her, so I'm calling to find out what it was because she doesn't recall.
[AGENT][NEUTRAL] OK, may I have your name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And are you the provider, agent?
[CUSTOMER][NEUTRAL] The broker.
[AGENT][NEUTRAL] Bro
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I please have a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 56,700.
[AGENT][NEUTRAL] member's name and date of birth?
[CUSTOMER][NEUTRAL] And I have a claim number as well.
[CUSTOMER][NEUTRAL] Her name is [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Are you still there, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes. Did you hear her date of birth? [PII].
[AGENT][NEUTRAL] Date of birth, please?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I please have either the claim number or the date of service?
[CUSTOMER][NEUTRAL] Um, claim number 358-830-5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know there was a payment that was just sent for 1265 77.
[CUSTOMER][NEUTRAL] But then it said,
[CUSTOMER][NEUTRAL] The benefits have previously been underpaid. This is the additional amount due. Benefits for the service were previously paid to the insured.
[CUSTOMER][NEUTRAL] So I guess I just wanna see how much was.
[CUSTOMER][NEUTRAL] was sent to her and when to see if she
[CUSTOMER][NEUTRAL] Recalls.
[AGENT][NEUTRAL] OK, I'm not seeing any documentation.
[AGENT][NEUTRAL] For me to speak with you on her policy. I don't see your name listed on here.
[CUSTOMER][NEUTRAL] I call all the time, almost every week.
[CUSTOMER][NEUTRAL] I can give you any information you want about her.
[CUSTOMER][POSITIVE] As with all my clients I've never had an issue calling APL to assist my clients with their.
[AGENT][NEUTRAL] OK, so I did pull that claim up and that payment actually went to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, the 1265 77.
[CUSTOMER][NEUTRAL] But if you look at the notes on the explanation of benefits, it says benefits for these services were previously paid to the insured.
[CUSTOMER][NEUTRAL] This payment represents the additional amount due for data service 2624.
[CUSTOMER][NEUTRAL] So she's questioning as to what was the amount that was sent to her because she doesn't recall getting a check from APL for that claim.
[CUSTOMER][NEUTRAL] And for that claim in question, she had um
[CUSTOMER][NEUTRAL] She had a balance due of 2137.
[AGENT][NEUTRAL] OK, I do see that we did make a payment to the insured. Let me pull that claim up.
[CUSTOMER][NEUTRAL] That she doesn't remember.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So for that claim, that claim was processed in [PII].
[AGENT][NEUTRAL] Which is [PII], so that payment was already submitted to the insured at that time.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what was the amount that was sent to her?
[AGENT][NEUTRAL] It was a total amount of $2,667.27.
[CUSTOMER][NEUTRAL] 2,067 24.
[AGENT][NEUTRAL] 200
[CUSTOMER][NEUTRAL] It must have included
[AGENT][NEUTRAL] $667.27. This is probably additional.
[AGENT][NEUTRAL] Yes, there is.
[AGENT][NEUTRAL] The facility bill that is listed on here and then there's a some physician bills for that data service that was also received and this was submitted in by the broker.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so I'll have to look back, so I submitted it in April.
[CUSTOMER][NEUTRAL] And you paid her 2,667 24. So with this 12.
[CUSTOMER][NEUTRAL] Let me see what it was 1260.
[CUSTOMER][NEUTRAL] Right, with the 1265 77 it completes the total that she's done. So it's not just for the facility. That's why it also includes the physicians from the surgery.
[AGENT][NEUTRAL] Yes, the total amount that we paid to her in April of 24. Yes.
[CUSTOMER][NEUTRAL] I did the surgery.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And, and
[CUSTOMER][NEUTRAL] Can you tell if that check was cashed or no, or she's gonna have to look back?
[CUSTOMER][NEUTRAL] To see if she cashed it.
[CUSTOMER][NEGATIVE] Because I don't know how you get a check for almost $3000.
[AGENT][NEUTRAL] Yes, the check was cash [PII] or [PII], I mean [PII].
[CUSTOMER][NEUTRAL] So check was cash on [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, let me reach out to her.
[CUSTOMER][NEUTRAL] I'll let her know.
[CUSTOMER][POSITIVE] That she should have paid the doctor's hospital in. OK. Thank you so much for your help today.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that's it. Have a great weekend. Take care. Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Thanks mhm bye bye.