AccountId: 011433970860
ContactId: 18a9dc09-4122-470b-ab59-9eaa5a3036ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 168009 ms
Total Talk Time (AGENT): 51781 ms
Total Talk Time (CUSTOMER): 104680 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/18a9dc09-4122-470b-ab59-9eaa5a3036ff_20250617T20:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], it's [PII] on the care team. Um, I, I'm only calling because, uh, we have an insured who requested a call back, um, on a claim issue, and I'm a little bit confused on, um, what to do so.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is 206-9775.
[AGENT][NEUTRAL] On a brook
[CUSTOMER][NEUTRAL] Uh, Felipe, yeah.
[CUSTOMER][NEUTRAL] So I guess what happened is uh if you look at the notes claim 3599392.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so she submitted this. She already paid the provider. She submitted this to get reimbursed, but because she submitted the CMS 1500 and there's a slight amount of benefits, we paid the provider. So I guess I was unclear. I see the note I guess is that Roxy.
[AGENT][NEUTRAL] Yeah, it is.
[CUSTOMER][NEUTRAL] Um, no, yeah, she said somebody left a message and said they were gonna work it out between us and the provider, but I don't know if that sounds accurate like if we.
[CUSTOMER][NEUTRAL] If the provider's been overpaid they should just refund the patient right? um but she's saying she's, she doesn't wanna call them because she thinks it's gonna be hard to get the money back from them and I was trying to explain, well if you've ever if if they've been overpaid.
[CUSTOMER][NEGATIVE] Then they should refund the money.
[AGENT][NEUTRAL] Right, they should. And she's saying she filed a claim? Let me look at this document.
[CUSTOMER][NEUTRAL] I just like
[CUSTOMER][NEUTRAL] Yeah, she said she filed it like.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] That says claim from billing department and.
[CUSTOMER][NEUTRAL] A claim to claims department from billing department so I've.
[CUSTOMER][NEUTRAL] This shows it's from the provider.
[AGENT][NEUTRAL] Yeah, it does. It says from Homestead Diagnostic Center.
[CUSTOMER][NEUTRAL] Right, so I don't, I don't know what those.
[AGENT][NEUTRAL] Yeah, it has our information, American Public Life. They, they did check assignment of benefits.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah. It, yeah, it, yeah, she needs to talk with the provider about it because they submitted the claim. It came from them. They listed assignment of benefits. So she would need to discuss that with them as far as them refunding her, the 16576.
[CUSTOMER][NEUTRAL] OK, so she really needs to call them and.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. That's what I thought. I just wanted to make sure I didn't think that we, we really started calling them and trying to work it all out. We just process according. OK, perfect. Thank you so much, [PII]. I appreciate you.
[AGENT][NEUTRAL] Yeah. Mhm. Yeah.
[AGENT][NEUTRAL] Yeah. Mhm.
[AGENT][POSITIVE] Mhm. You're welcome.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] Mm bye.