AccountId: 011433970860
ContactId: 30e69e01-d38b-48a7-a984-497a0470e219
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 761559 ms
Total Talk Time (AGENT): 298048 ms
Total Talk Time (CUSTOMER): 313566 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/30e69e01-d38b-48a7-a984-497a0470e219_20250617T20:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, good afternoon. Um, I was calling because I wanted to check the status of a claim. Um, do you prefer that I give you the claim number or I believe I have here my policy number.
[AGENT][NEUTRAL] Uh, yes, I can take your policy number.
[CUSTOMER][NEUTRAL] Um, it is 02069775.
[AGENT][NEUTRAL] OK. Can I get your first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, my name is [PII], and my birthday is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And can you verify your address and your email address for me?
[CUSTOMER][NEUTRAL] Sure. [PII]. Uh, email, right? Email. Uh, I didn't know, I don't remember you said email or phone number. I'm sorry. Uh, the email is [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] But you're
[AGENT][NEUTRAL] OK, and then lastly, a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And was it a claim for yourself?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Um, do you have the claim number?
[CUSTOMER][NEUTRAL] I do. Uh, it is 359-939-2.
[AGENT][NEUTRAL] OK, uh, it looks like on this claim, uh, we made a payment for
[AGENT][NEUTRAL] To the provider for 16576.
[CUSTOMER][NEUTRAL] Right, and I had called, um, I wanna say it was, uh, sometime last week, I got a call back from, I guess like a claims supervisor.
[CUSTOMER][NEUTRAL] Um, because when I had called last time for an update, they, it was explained to me that the payment was sent to the diagnostic center, but I already have paid that. So when I called, I said I filed a claim to get reimbursed, and then when she looked into it, she goes, oh, the payment was issued to them and not to you. So she put in a call for me to get a call back from the uh supervisor.
[CUSTOMER][NEUTRAL] Which I did and then I spoke to her and I explained everything and then I believe uh if I remember correctly they told me that they hadn't reached out to the Homestead diagnostic and that they were gonna figure out about that payment and then I was gonna get a call back or something and um that's why I wanted to call and check in to see if there's any any progress. I, I, I don't know what's the status now.
[AGENT][NEUTRAL] OK, um, let me see.
[AGENT][NEUTRAL] Uh, looks like we had pulled the information that we received.
[AGENT][NEUTRAL] Um, the claim had assignment of benefits, which means we're we can pay the provider.
[AGENT][NEUTRAL] And that's why it was paid to the provider. We left a message with contact information.
[AGENT][NEUTRAL] Um, did you receive a voicemail back from us or?
[CUSTOMER][NEUTRAL] Uh, I, I got a voicemail of the supervisor reaching out to me, so I called, I called back and then that was the update that I got that I guess you guys were making contact with Homestead Diagnostics.
[AGENT][NEUTRAL] OK. Um, let me see.
[AGENT][NEUTRAL] So are, so you said you paid them or will they not refund you? Is that what the issue is or?
[CUSTOMER][NEUTRAL] Uh, when I originally got the service, the MRI, I did pay and after they filed the claim and I got my receipt and my explanation of benefits, I filed a claim with you guys.
[CUSTOMER][NEGATIVE] And then the way that the, the claim was processed, you got the, you guys sent the money to them instead of sending it to me, and that's kind of where I'm at right now. Am I supposed to reach out to Homestead Diagnostics to have them give me this money because, I mean, I don't see how they're gonna do that.
[AGENT][NEUTRAL] Um, well, I mean they can't.
[CUSTOMER][NEUTRAL] Are, are they, do they become like responsible, oh sorry, go ahead.
[AGENT][NEUTRAL] Um, well, they can't, if they, if you've overpaid, they have to refund you, um, they can't keep the money. Um, let me see.
[AGENT][NEUTRAL] I think that's the
[CUSTOMER][NEUTRAL] Well, I don't think I overpaid. I, I just think that APL sent the reimbursement.
[AGENT][NEUTRAL] Well, that that
[CUSTOMER][NEUTRAL] To them when it should have come to me.
[AGENT][NEUTRAL] That's, that's what I meant. So if you've paid them and then they've received a payment from us too, then they've been overpaid and then they would refund the money. Um, so let's see, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But like, how do I go about that? Because if I call them, like I don't, you know, I don't see this kind of going smoothly.
[AGENT][NEUTRAL] Yeah, I understand. Sure.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] You know, you know what I'm saying? Like, I get it, like if they refund it to the, to the, the, the company that paid them, then I see that more kind of working out through like an accounting type of way.
[AGENT][NEUTRAL] Um, let me, uh, let me check something real quick. Can I place you on a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL, this is [PII]. How can I help you?
[AGENT][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.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] Uh, policy number is 206-9775.
[CUSTOMER][NEUTRAL] On a [PII]
[AGENT][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] So I guess what happened is, uh, if you look at the notes, claim 3599392.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][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 side amount of benefits, we paid the provider. So, I guess I was unclear. I see the note, I guess is that Roxy?
[CUSTOMER][NEUTRAL] Yeah, it is.
[AGENT][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
[AGENT][NEUTRAL] If the provider's been overpaid, they should just refund the patient, right? Um, but she's saying she's, she doesn't want to 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.
[AGENT][NEGATIVE] Then they should refund the money.
[CUSTOMER][NEUTRAL] Right, they should, and she's saying she filed a claim? Let me look at this document.
[AGENT][NEUTRAL] Just like
[AGENT][NEUTRAL] Yeah, she said she filed it and like.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] That says claim from billing department and.
[AGENT][NEUTRAL] to claims department from billing department, so I've
[AGENT][NEUTRAL] This shows it's from the provider.
[CUSTOMER][NEUTRAL] Yeah, it does. It says from Homestead Diagnostic Center.
[AGENT][NEUTRAL] Right, so I don't, I don't know what the.
[CUSTOMER][NEUTRAL] Yup, it has our information, American Public Life. They, they did check assignment of benefits.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so she really needs to call them and.
[CUSTOMER][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.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, perfect. That's what I thought. I just wanted to make sure I didn't think that we, we really got in calling them and trying to work it all out. We just process according. OK, perfect. Thank you so much, [PII]. I appreciate you.
[CUSTOMER][NEUTRAL] Yeah. Mhm. Yeah.
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye.
[AGENT][NEUTRAL] OK, so sorry about that. Well, I think so part of the problem is that they submitted the claim to us too and we received it and that's why we paid it to them. So, um, they shouldn't have an issue refunding you. There, there shouldn't be any issue, um, because now they've been overpaid um you paid them, we paid them, and then they should owe you back.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Um, because they're not, they don't typically refund us, so they refund the patient.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is this the, I'm looking here at uh the letter that I got, um, and it refers to, uh, forgive me, I don't know what PROC means is that procedure?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I guess, I guess my question is when I go to ask them to be refunded, this is this the proof that they were paid this check number 2043467?
[AGENT][POSITIVE] Yes, that's correct. Yep.
[AGENT][NEUTRAL] And then you'll have proof of your.
[CUSTOMER][NEUTRAL] OK, because I have my receipt that I paid them.
[AGENT][NEUTRAL] Yeah, so they should, they should show that on their records. Let me see, let me give you one more bit of information. Let me see if they've cashed the check. Hold on one moment.
[AGENT][NEUTRAL] That will help too, um.
[CUSTOMER][NEUTRAL] Yeah, and I, I was gonna mention, I think it's weird that they also filed a claim with you guys, because when I went to get the procedure done, I didn't share my APL.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Like policy with them. I just did my regular healthcare.
[AGENT][NEUTRAL] Well, so this policy is, is very popular, um, and they may have just called us to see if you have the um um policy that happens a lot, so, um, let me see.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] They did cash the check. They cashed it on [PII].
[AGENT][NEUTRAL] You can also use that information for them.
[CUSTOMER][NEUTRAL] And it was a check number that I just that I had read over.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All right, I guess I'll try. It's just, um, not to sound mean or anything, but um when I call that diagnostic center, um,
[CUSTOMER][NEUTRAL] You know, I feel like I don't get very far.
[AGENT][POSITIVE] Well, if you have any issues at all you can ask them if they will, you can ask them to call us too on a 3 way um but like I said, usually, usually they won't refund us they'll refund you um because I ran into this for myself personally too where I paid and my insurance paid and then they'll refund me back um so um if you have any issues at all just ask if they'll give us a call on a three way line and then we can.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Verify, you know, that they've cashed their check and that they're overpaid.
[CUSTOMER][POSITIVE] Alright, alright, I appreciate it um alright I'll go ahead and try and if anything I'll reach back out.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well, thanks for calling APL. I hope you have a good afternoon.
[CUSTOMER][POSITIVE] Same to you. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you.