AccountId: 011433970860
ContactId: 25903da9-386d-4cb7-ba44-b8b388fd421c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1026989 ms
Total Talk Time (AGENT): 218082 ms
Total Talk Time (CUSTOMER): 206732 ms
Interruptions: 5
Overall Sentiment: AGENT=1.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/25903da9-386d-4cb7-ba44-b8b388fd421c_20250109T14:51_UTC.wav
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[AGENT][POSITIVE] Good Morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], I'm calling from and uh.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, good morning, uh, [PII]. My name is [PII]. I'm calling from provider's office and I want to discuss a claim with you today.
[AGENT][POSITIVE] [PII], it would be a pleasure to discuss a claim with you today. What is a good callback number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Uh yes. Uh, the policy number is 01832184.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] This patient's name is [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] We actually have her listed with a different last name.
[CUSTOMER][NEUTRAL] Let me find, please hold on one second.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] Is it the [PII]?
[AGENT][NEUTRAL] Yes sir, that is what we have on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the claim number or the data service for that claim?
[CUSTOMER][NEUTRAL] Yes, I have the date of service, uh.
[CUSTOMER][NEUTRAL] And I also have the claim number. Let me give you the date of service first. It is April 17, 2024.
[AGENT][NEUTRAL] Bear with me just one moment. My system is.
[AGENT][NEUTRAL] And you said April.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] All right, thank you, sir.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right. And what, what's the claim number?
[CUSTOMER][NEUTRAL] Is the claim number is 34537557.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And the facility name?
[CUSTOMER][NEUTRAL] Name of the facility is Previa Medical Group.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I do have that claim pulled up. How can I help you?
[CUSTOMER][NEUTRAL] OK. Uh, so this claim is paid $5.75 because the primary had left the patient responsibility of that amount initially. However, later, the primary insurance went ahead and reprocessed the claim and left no patient responsibility. So this $5.75 that you paid, it is showing as an overpayment to us now.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like you sent in another claim. I'm going to see if that has that updated EOB with it. Bear with me just one second.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] Now we can request a refund on that if we have that updated EOB or you can send just send the amount back to us.
[CUSTOMER][NEUTRAL] Sure. Uh, so whatever is best suited for you and for us, but first, you can check if you have received that updated UOB please.
[AGENT][NEUTRAL] But let me
[AGENT][NEUTRAL] Yeah, I'm checking on this claim. Yeah, that's what I'm doing right now. Bear with me just one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] No problem at all.
[AGENT][NEGATIVE] We do have that information. Looks like it was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can send this back for.
[CUSTOMER][NEUTRAL] Yes, and the claim number ending in 2184, right?
[AGENT][NEUTRAL] Well, hang on just a second. Let me look at the COV again.
[AGENT][NEUTRAL] Uh, the claim number ending in.
[CUSTOMER][NEUTRAL] 7967, I guess.
[AGENT][NEUTRAL] That's correct, yeah, that's the one I'm looking at. Give me just one second, let me review this again. I apologize.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, would you like
[AGENT][NEUTRAL] For me to send this to our claims department to send a refund request.
[CUSTOMER][NEUTRAL] Um, or what is the other option if you will send it back for a refund department or a claim department to send a refund request or can I send you a refund now?
[AGENT][NEUTRAL] You certainly can. That can be just sent with that updated EOB.
[CUSTOMER][NEUTRAL] OK. Uh, I will do that then, uh.
[AGENT][NEUTRAL] And you don't have to send anything else but the EOB and the claim number.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Absolutely. You can then give me the refund address where I can send you a refund check.
[AGENT][NEUTRAL] Um, that would go to.
[AGENT][NEUTRAL] Let me give you the correct address.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm looking that up, bear with me just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just want to verify that, so bear with me just one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] I appreciate your patience.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] [PII], thank you for your patience. I'm still checking on that address. I want to make sure I give you the correct refund address.
[CUSTOMER][POSITIVE] OK, no problem. Absolutely fine.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sing.
[CUSTOMER][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hey [PII], just a super quick question. Do you know if refund checks from a provider come to the claims address, the [PII]?
[CUSTOMER][NEUTRAL] Now that's of course, I have not, I'm not sure if they do or not cause [PII], cause when when we get them, [PII] send them to us, so I, I don't wanna tell you a story.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just gonna, I'm just gonna give the provider that address. They'll, they'll have to route it somewhere. I've been trying to find out for about 10 minutes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I can ask him and then I can send you a message on Team.
[AGENT][NEUTRAL] No, that's fine.
[AGENT][NEUTRAL] That's fine. I'll find out later. I just I was thinking maybe somebody sends a refund letter might know, but I'll just give them the claims address.
[CUSTOMER][NEUTRAL] But let me see, I just got a I just did a refund letter. Let me see what's the address on there because I um.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I know we just put an email we put an address on there for them to send it over to like send it back to us, let me see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Open it up and see.
[CUSTOMER][NEUTRAL] It's just [PII], so it's the claim's address. It's the address that's on my refund letter.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Perfect. Thank you so much.
[CUSTOMER][POSITIVE] You're welcome, [PII]. Have a good day.
[AGENT][POSITIVE] You have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][POSITIVE] OK, thank you for your patience, [PII]. The correct address to send a refund to is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] And again if you would put that updated EOB showing that um they reprocessed paid in full.
[CUSTOMER][NEUTRAL] Sure. And uh what it will be attention to?
[AGENT][NEGATIVE] Refunds.
[AGENT][NEGATIVE] Claims refunds department.
[CUSTOMER][NEGATIVE] Claims refund department.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Understood. Uh, thank you so much. So the refund address is uh APL [PII]. Attention claims refund department.
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK. Wonderful. Thank you very much, [PII]. That will be all for today. I will do the refund uh processing as soon as I can and hopefully this issue will be resolved then. Thank you very much. What will be the reference number for this?
[AGENT][NEUTRAL] Yes, sir. It's been.
[AGENT][POSITIVE] The reference number is my name and today's date, and I spell my name [PII], and it has been such a pleasure to assist you with that claim information today, [PII]. Thank you for calling APL and I hope you have a lovely day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.