AccountId: 011433970860
ContactId: 1938f54a-f037-44ba-bca0-8b64c7bae72b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 809510 ms
Total Talk Time (AGENT): 216777 ms
Total Talk Time (CUSTOMER): 280440 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/1938f54a-f037-44ba-bca0-8b64c7bae72b_20250519T16:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, [PII] here. I'm calling from Toto office to check on claim status.
[AGENT][NEUTRAL] Hey, I can help you with claim status. Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Uh, [PII], and my callback number it is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, my policy number it is.
[CUSTOMER][NEUTRAL] 131269.
[CUSTOMER][NEUTRAL] 6, sorry, uh let me repeat. 1312696 M L as in Lima, 7.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] Day of service [PII] uh sorry, [PII]. And total charge, ma'am.
[CUSTOMER][NEUTRAL] $7,538 even.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, what I'm sorry, what was the bill amount?
[CUSTOMER][NEUTRAL] The amount is $7,538. 21 cents.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is this a facility claim or a physician claim?
[CUSTOMER][POSITIVE] Uh, this is facility claim and for checking that uh claim got paid by United Healthcare and also American Public Life is, uh, paying this claim. We refunded the amount, again, we got the refund amount. So you guys this amount to be refunded back or you will uh recoup the amount?
[AGENT][NEUTRAL] Um, so do you have the claim number?
[CUSTOMER][NEUTRAL] Uh yes, I do have and the claim number is, hold on.
[CUSTOMER][NEUTRAL] I don't know
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] of
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hey man.
[AGENT][NEUTRAL] Were you able to locate the claim number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm in the.
[CUSTOMER][NEUTRAL] Uh yes, 2209833.
[CUSTOMER][NEUTRAL] Do you want a check number as well?
[AGENT][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 1260484
[AGENT][NEUTRAL] OK, and so you're saying that we, we overpaid, is that right?
[CUSTOMER][NEUTRAL] Uh, see, we already, uh, like we have received payment from United Healthcare, um, for checking, uh, American Life Insurance is also paying the claim. You guys are paying as a primary or secondary?
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][POSITIVE] OK. Uh, so, uh, United Healthcare have paid for a single CPT I'm talking about 29826. Uh, we receive payment of 1,0076. And same amount has been paid by American Public Life Insurance Company for the CPT 29826. And when we refunded the amount, again, we received the refund amount back.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, um, let me read in here.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, so you, you refunded the amount and we sent it back to you?
[CUSTOMER][POSITIVE] Yes. They received a refund letter as well from you guys.
[AGENT][NEUTRAL] Do you know what it stated?
[CUSTOMER][NEUTRAL] Uh, here is certain that we have received your refund amount of 3,418.72 cents. and the check number 005175068 made payable to American Public Life Insurance. At this time, we are unable to accept and process the refund due to insufficient information. Therefore, we are refunding the refund.
[CUSTOMER][NEUTRAL] So what information do you require? please provide us a copy of explanation of benefit from APL.
[CUSTOMER][NEUTRAL] American public life.
[CUSTOMER][NEUTRAL] Its search of the OK. 6.
[AGENT][NEUTRAL] Well, I see it refunded. Let me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And just
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] And credit she's getting out, she would ask me to send.
[AGENT][NEGATIVE] EOB shows the insured has 0 responsibility to request a refund.
[CUSTOMER][NEUTRAL] Look
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It looks like we did apply the refund because I show it backed out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but, uh, why.
[AGENT][NEUTRAL] And we
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh, no, no, you go ahead.
[AGENT][NEUTRAL] We we applied the refund, but then we reprocessed the claim. I'm having trouble following what's going on. So, um, do you mind if I get you over to our claims department and they'll be able to help you with this?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Ferring.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Thank you for calling ATL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey, [PII], it's [PII] on the care team. I've got an uh provider on the line, um, checking on
[AGENT][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.
[CUSTOMER][NEUTRAL] Certainly, who am I speaking with, uh, [PII]?
[AGENT][NEUTRAL] Yes, um, so, yeah, provider is [PII], and let me give you the policy number. It's 131.
[CUSTOMER][NEUTRAL] You said provider?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2696.
[CUSTOMER][NEUTRAL] OK, let me pull that up real quick.
[CUSTOMER][NEUTRAL] And the patient's info has been verified. Everything's been verified.
[AGENT][NEUTRAL] Yes, it has.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And do you have a callback number for [PII]?
[AGENT][NEUTRAL] Uh, it's the one on the caller ID.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I'm sorry, you said that policy number 1, did I miss the number [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I have 2
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, sorry I missed that second one.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And it's for [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I guess the original claim, uh, this is for [PII].
[AGENT][NEUTRAL] The original claim I guess we paid.
[CUSTOMER][NEUTRAL] 2018?
[AGENT][NEUTRAL] Yes, [PII]. Yeah, [PII], 731. Um, the original claim was 2209833.
[CUSTOMER][NEUTRAL] I'm sorry? OK.
[AGENT][NEUTRAL] I guess we process the claim and overpaid, um.
[AGENT][NEUTRAL] Uh, and so they sent a refund, but then there's a note in there that says we couldn't identify the refund.
[AGENT][NEUTRAL] But I see the claim backed out and then 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.
[CUSTOMER][NEUTRAL] OK, so it's 1:30, 1:18.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, July, I'm sorry, [PII]. Goodness gracious, it's Monday.
[CUSTOMER][NEGATIVE] OK, I'm gonna say it's not coming up for me.
[AGENT][NEUTRAL] Oh wait.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK got it alright so OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And so they're calling looking for payment.
[AGENT][NEGATIVE] No, she's saying that they sent the refund, but then we sent the refund back to them.
[AGENT][NEUTRAL] But then I
[AGENT][NEUTRAL] I don't know why I it says we couldn't identify it.
[AGENT][NEUTRAL] Um, per the notes, and she has a letter, but then we, it looks like we processed the claim again, so I don't, I'm not understanding what's happening on the claim.
[AGENT][NEGATIVE] I guess we've overpaid and she's just wanting to refund this back, but we sent the refund back to her.
[AGENT][NEUTRAL] Telling her to submit the EOB.
[AGENT][NEUTRAL] But I, I, and again, I can't, it looks like we've paid again on [PII].
[AGENT][NEUTRAL] So I'm not, I'm confused on what's happening on the processing of it.
[CUSTOMER][NEUTRAL] OK, it might take a little bit of research, but you can go ahead and put her through, and it's [PII], is that right?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][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.
[AGENT][NEUTRAL] OK, that's.
[CUSTOMER][NEUTRAL] I'm seeing the same thing you are and it's a little bit confusing or a lot of it I should say.
[AGENT][NEUTRAL] It is, yeah.
[AGENT][NEGATIVE] All right, I know, that's why I'm like, I can't, I don't understand what's happening.
[AGENT][POSITIVE] OK, I'll get her on the line. I'll introduce you and then I'll release her, OK?
[CUSTOMER][POSITIVE] Great thank you [PII].
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] OK, [PII], I've got [PII] on the line. She's gonna assist you, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.