AccountId: 011433970860
ContactId: 38f4962a-00e5-4a95-aaf8-2412f94cac75
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1922800 ms
Total Talk Time (AGENT): 873562 ms
Total Talk Time (CUSTOMER): 648975 ms
Interruptions: 9
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/38f4962a-00e5-4a95-aaf8-2412f94cac75_20250415T20:17_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm calling um.
[AGENT][NEUTRAL] I'm sorry, I can't hear you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, OK, I'm, I'm, I say I'm calling because I need to talk to whoever issued a check for your dinner.
[AGENT][NEUTRAL] You're needing to speak to someone, OK, are you the insured or are you calling on behalf of a of a provider's office?
[CUSTOMER][NEUTRAL] I'm calling on behalf of myself. What it is, I have uh
[CUSTOMER][NEGATIVE] I had filed my insurance, I mean my dental office claimed they could not, they send a check in to you all, y'all did not answer and they gave y'all a whole month, and y'all didn't answer. So I asked them, I said, can you send that information to me and I'll fax it in to them. They told me yes. So, I got it and I faxed it in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And when I faxed it in, I called you out to ask you, have you received my fax? And y'all say yes. And when y'all see my fax, I said, well, I said, since y'all received my fax, who do y'all send the text to? Because I'm the one that's doing it and you told, whoever it was told me, the one that uh send the fax in, that's who we send the check to. So, last week I received two papers saying that y'all sent me the check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Check the text, but you send them to the to the dentist's office.
[CUSTOMER][NEUTRAL] And, and then the dentist's office, I called them and asked them and they said, oh we haven't received anything yet. So a few minutes ago they called me and said, oh we received it, but we have to hold it. We can't send it to you right now, and all this kind of stuff, you know, I'm just wondering what's going on with all this.
[AGENT][NEUTRAL] OK, so yes ma'am, so you have a question on the claim that was processed and payment was issued to the provider, is that correct?
[CUSTOMER][NEGATIVE] Yes, because it's supposed to, they told me when I called that detect them, it's to me because I'm the one that uh faxed it in to you all. But then in the end he got faxed it on to his company.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so yeah
[AGENT][NEUTRAL] OK, so yes, ma'am, I can help you, uh, well, who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] The name is [PII].
[AGENT][NEUTRAL] [PII], is your last name, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 774
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And your policy number, please?
[CUSTOMER][NEUTRAL] I don't have the policy number right now. Let me look at.
[AGENT][NEUTRAL] And is the insurance in your name, the policy in your name, Ms. [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Just everything is in my name. I've had this insurance 20 years.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is your full social security number if you don't have your policy number, I can try and look it up that way.
[CUSTOMER][NEUTRAL] Wait a minute, I'm getting, I'm getting it, but I'm trying to find the number for the uh.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Credit bill what is something called people.
[CUSTOMER][NEGATIVE] Better Business, that's what I'm trying to find the number for. Let me see, let me find this because this is, this, this shit don't make sense. I don't have money like that.
[CUSTOMER][NEUTRAL] Let me see the power.
[CUSTOMER][NEUTRAL] Let me give you my number, my social security number. I don't see that letter.
[AGENT][NEUTRAL] OK. That'll be fine.
[CUSTOMER][NEGATIVE] I'm about to put it somewhere else. My bad. I can't even find my letter [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. One moment while I look up your information.
[CUSTOMER][NEUTRAL] Having this all of these years and no problem now I need to talk.
[AGENT][NEUTRAL] OK, Ms. [PII], any information that I provide for you today will be a verification of benefits and not a guarantee of payment. I will need to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you, one of them is the same as the one that you gave me. We do have also a different number with a different um.
[CUSTOMER][NEUTRAL] No, I told him it supposed take it off. That's the old number. Like I say, I've been with y'all about 20 years, so that's an old number.
[AGENT][NEUTRAL] I can remember
[AGENT][NEUTRAL] OK, do you remember what that number was, Miss [PII]? The old number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, and the last piece of information to verify is your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying your information. And what is the date of service, Ms. [PII], that you're calling about?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I told you I couldn't find that letter. I'm trying to find the letter.
[CUSTOMER][NEUTRAL] Except the gun thinking it was not going.
[CUSTOMER][NEUTRAL] [PII] or something like that. They uh.
[CUSTOMER][NEUTRAL] [PII], I don't remember exactly what it is.
[CUSTOMER][NEUTRAL] I picked the letter and I had it but I can't, I can't remember.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. I'm
[CUSTOMER][NEUTRAL] But y'all send me a check. Y'all sent me two checks, so all that information is there.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right, we have a lot of claims on file for you, Miss Miss [PII] and we have a lot of claims on file for you, so for me to look at the one that you're saying we sent the payment to the provider, I just need to know what the date of service was so I can locate that claim.
[CUSTOMER][NEUTRAL] And for one thing, I called, I called.
[CUSTOMER][NEUTRAL] But you, y'all don't go by dates the last claim that was filed because uh that was all been filed since then.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] No ma'am, the last claim on file was paid to you.
[CUSTOMER][NEUTRAL] With what?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What happened?
[AGENT][NEUTRAL] The last claim that was processed, the last two claims were paid to you.
[CUSTOMER][NEUTRAL] And what day was that?
[AGENT][NEUTRAL] 9 for a data service 92.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 2024.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] 24.
[AGENT][NEUTRAL] And the, uh-huh, and the other day the service was for 12 6.
[CUSTOMER][NEUTRAL] And we'll get
[CUSTOMER][NEUTRAL] What was the amount you sent for that?
[AGENT][NEUTRAL] For which data service?
[CUSTOMER][NEUTRAL] For the one you say 924.
[AGENT][NEUTRAL] Yes, ma'am. That was for $403.
[CUSTOMER][NEUTRAL] $403 and you said it to me?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] This claim, you probably haven't received it because it was just issued on [PII], so it would not have gone out until at least the [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] But, but what about the one?
[AGENT][NEGATIVE] So that was on Friday, so it wouldn't have been even mailed out until yesterday because it went through our nightly processing on the [PII] which is Friday night and obviously we're not open over the weekend.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, when I was talking to somebody on the phone, they told me I was gonna receive a call then.
[CUSTOMER][NEUTRAL] And then uh
[CUSTOMER][NEGATIVE] Cause I, I called them to ask them why was the check not sent to me after I called them. I called your company, and they specifically told me that the check was gonna come to me and it was two checks that were sent to me. I'm trying to find, I'm trying to find those letters cause there's two checks that were sent to me, a total of, hold on, $800 and something dollars.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] With the total
[AGENT][NEGATIVE] Two separate claims and they were both processed on [PII] so they wouldn't have been mailed out to you until even yesterday.
[CUSTOMER][NEUTRAL] But it, yeah.
[AGENT][NEUTRAL] One was for data service [PII] and the other one was, uh, let's see, for.
[CUSTOMER][NEUTRAL] Right, but yeah.
[AGENT][NEUTRAL] Um, one second.
[AGENT][NEUTRAL] And the other one was for dates of service back in [PII], [PII].
[CUSTOMER][NEUTRAL] And, and how much was the amount y'all sent me?
[AGENT][NEUTRAL] 652 on the one claim for your [PII] data service and 403 for the [PII] data service.
[CUSTOMER][NEUTRAL] And those two checks were sent, when were those sent out?
[AGENT][NEGATIVE] They would have been mailed out yesterday.
[CUSTOMER][NEUTRAL] Could you give me your name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And Miss, I mean, Ms. [PII], did you use the internet very much?
[AGENT][NEUTRAL] And I'm asking that because we have a portal that I would be happy to email you the user guide for so you could set up your profile and that would give you access to your claims that are on file and your explanation of benefits for each of those claims.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, could you give me that then?
[AGENT][NEUTRAL] Uh-huh, I'll be happy to email that to you, and I'll do that in just a moment to that email that we verified and the email that you will receive from me, Ms. [PII] is gonna come from care team.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] [PII] and I will put APL in the subject line for you so that that's easy to recognize.
[CUSTOMER][NEUTRAL] OK, wait a minute. King.
[AGENT][NEUTRAL] Uh-huh, [PII] [PII].
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] [PII]. OK.
[AGENT][NEUTRAL] [PII], yes ma'am, and I will put APL online service center in the subject line of that email so that you can recognize that.
[CUSTOMER][NEUTRAL] Right. Well, OK then I'll look that up because this is, but then when I called the dentist, but the dentist's office called me and they told me that they have a check from you all.
[CUSTOMER][NEUTRAL] And, and the check that they have from you all is the same one that you all had sent me telling me that y'all gave them.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] OK. How much did they say their check is for?
[CUSTOMER][NEUTRAL] 1 is a 3.
[CUSTOMER][NEUTRAL] 3 something and the other one is for 8, no, 3 and uh 5.
[CUSTOMER][NEUTRAL] But she told me and now they have $889.
[CUSTOMER][NEUTRAL] And check for me, but
[CUSTOMER][NEUTRAL] I can't get it till they go over that thing and see because they said they filed with the secondary insurance and uh the secondary insurance, they haven't heard from them.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they gonna take that.
[AGENT][NEUTRAL] Give me just a moment to look at something, Miss um [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, because they gave me that information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] It is right and you definitely sound like that.
[AGENT][NEUTRAL] OK, so we received, OK, so we received a claim from your provider also.
[AGENT][NEUTRAL] For a data service in December, but their billed amount was different than the claim that we processed for payment to you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So how much they were?
[AGENT][NEUTRAL] We sent a payment to them for $350 for data service 126.
[AGENT][NEUTRAL] And then let me look at one other thing.
[AGENT][NEUTRAL] OK, let me, um, bear with me just a moment, Ms. [PII].
[CUSTOMER][NEUTRAL] I had that stuff up.
[AGENT][NEUTRAL] OK, so bear with me just a moment. OK, so it looks like we've received claims for the 126 data service from the provider as well, not your 92 or 920 rather. I'm sorry, but we did from the provider. Now what I can do is.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] I can connect you over with another division to look at how this was processed because again we issued payment to you.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Which should have been mailed out on yesterday?
[AGENT][NEUTRAL] Oh no, wait, give me just a moment. I'm getting crossed up here. Hold on Missten in just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you for your patience, Ms. [PII], while I'm looking at this information.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Really
[AGENT][NEUTRAL] OK, Miss [PII], so what I can do is I can transfer you over to one of the claims examiners to further look at this claim with you to see why payment was issued to you and to the provider, but it was on different claims.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] But for the same data service.
[CUSTOMER][NEUTRAL] OK, this one you're saying that it's it and uh.
[AGENT][NEUTRAL] It appears that we issued payment to you and to the provider for both the same dates of service for the [PII] day of service.
[CUSTOMER][NEUTRAL] The [PII] something different.
[AGENT][NEUTRAL] But I would have to connect you with someone else who could look at that claim with you to determine why that was done. I'm not sure about that.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] And, and, and see was it, was it cash because I didn't receive a check from you all.
[AGENT][NEUTRAL] No, ma'am, you wouldn't have yet because it was just mailed on yesterday.
[CUSTOMER][NEUTRAL] So, I'm talking about, you said back in uh.
[AGENT][NEUTRAL] No ma'am, we didn't re yeah but we didn't res OK we received a claim.
[CUSTOMER][NEUTRAL] The first one you say.
[AGENT][NEUTRAL] For a data service of [PII], OK, but we did not receive, yes and we didn't receive that claim until [PII] of this year.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] That's what I did.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We also received a separate claim on [PII] for 126.
[AGENT][NEUTRAL] 2024 data service and on both of those two claims they're the ones that we issue payment to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we had also received a claim from the provider on [PII] for that same December data service.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, and y'all pay them for that?
[AGENT][NEUTRAL] And that's, yes, ma'am, but I cannot tell you why we did that. I mean, I'm, I, I can't see that information. I would have to have one of the examiners to look at the claim.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] With you on that.
[CUSTOMER][NEUTRAL] OK, so they.
[CUSTOMER][NEUTRAL] They gonna talk to
[AGENT][NEUTRAL] Yes ma'am I can connect you with someone and when I do I will explain to them the scenario of and give them the information you will not have to re verify anything I will let them know that that has been done and um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then I have also emailed you that user guide that I was telling you about, so you should have that in your inbox. If for any reason you don't see it in your inbox you may want to check your junk or spam folder if we've not emailed you before because it might would go there but I don't really think it will um.
[CUSTOMER][NEUTRAL] All
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] And then if you need any help setting up your profile you could call us back and we'd be happy to help you with that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, let, let me see because I'm looking.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, is there anything else that I could try and help you with there, Ms. [PII] before I connect you over?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Let me see, I'm gonna, I wanna see did I received it.
[CUSTOMER][POSITIVE] Cool.
[AGENT][NEUTRAL] What do you mean, I'm sorry, what do you mean if you received it?
[CUSTOMER][NEUTRAL] I check the email.
[AGENT][NEUTRAL] Oh, OK. I'm sorry. OK.
[CUSTOMER][NEUTRAL] OK, I don't see. This is oh, care team, yes, the first one I.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, I have that.
[AGENT][POSITIVE] OK, good. Well, I'm glad you received it. So again, Ms. [PII], before I transfer you over, is there anything else I can help you with?
[CUSTOMER][POSITIVE] That's it. Thank you, ma'am.
[AGENT][POSITIVE] Yes, ma'am. You're welcome and thank you for calling APL. I hope you have a very nice evening.
[CUSTOMER][POSITIVE] Thank you, ma'am. You as well.
[AGENT][POSITIVE] Uh, yes, ma'am. Thank you very much. So one moment, please.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII].
[CUSTOMER][NEUTRAL] Hello [PII].
[AGENT][NEUTRAL] How are you?
[CUSTOMER][POSITIVE] I'm doing well how are you?
[AGENT][NEUTRAL] Mm, um, OK.
[AGENT][POSITIVE] I'm all right. Hm. So I have an, well, I have an insured on the line who was very hot initially, but she's calmed down.
[CUSTOMER][NEUTRAL] What's going on?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sort of. I mean, she has. Um, the policy number is 604575.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Miss [PII].
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And she's fully verified. Mhm.
[CUSTOMER][NEUTRAL] Let me pull this up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All righty.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] As you can see, if you look on Amtrak, the two most recent claims processed on [PII] with payment to her, OK? And obviously the checks probably were not mailed until yesterday because of the weekend.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so first off, she was calling because she's was hot that
[AGENT][NEUTRAL] She had called and been told that we didn't have the claims from the provider and that she could submit them and payment would be issued to her.
[AGENT][NEUTRAL] Well, if you will notice, the two claims that were processed on the [PII].
[AGENT][NEUTRAL] And payment was issued to the provider, which they have told her they received the money.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Is for the same data service as what she submitted.
[AGENT][NEUTRAL] So we it appears we have issued payment to the provider and to her.
[AGENT][NEUTRAL] For the [PII] data service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now
[CUSTOMER][NEUTRAL] I guess this is dental, right?
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] It sure is.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Because I don't even know how to advance on the screen. I don't, I don't know nothing about dental. I gotta be honest.
[AGENT][NEUTRAL] Uh, I understand.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] They said they closed the key down Monday, so now, you know, here we are.
[AGENT][NEUTRAL] We're trying to get, you know, all their calls are coming to us and then we have to transfer to the claims support.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] But the question really is, you know, well why did we pay her and them and, you know.
[AGENT][NEUTRAL] And the paid amount to her is different than the paid amount to the doc, but both of those claims for the provider or for the same data service. It's just two separate claims, but
[AGENT][NEUTRAL] We paid them 350 and 539, we paid her 652.
[CUSTOMER][NEUTRAL] Yeah and I'm seeing there's a note in here from Ms. [PII] I think she's dental new claim.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, pay the insured request refund for from from provider.
[CUSTOMER][NEUTRAL] Apparently she called about this on [PII] as well.
[CUSTOMER][NEGATIVE] Insured called about claims. Both claims were paid to provider insured say they should have been paid to her because she's the one that submitted them.
[CUSTOMER][NEUTRAL] And then we sent a help request to ask the insured and then apparently [PII], uh.
[CUSTOMER][NEUTRAL] I'm assuming that she reviewed the hub request because she's saying that they need to request a refund from the provider.
[AGENT][NEUTRAL] So has that been done?
[AGENT][NEUTRAL] I can't tell that that's been requested.
[CUSTOMER][NEUTRAL] Um, I
[AGENT][NEUTRAL] And if that is the case, then
[CUSTOMER][NEGATIVE] It doesn't look
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, it doesn't look like it at this point, but to be honest, like I said, I don't even, uh, I'm not sure how to read the screen for dental at all, and I'm sorry, but I don't, I was not made aware that the dental calls were coming to us as well, to be honest, I, I don't, and I'm not saying that, you know, I'm just saying that that we were not informed.
[AGENT][NEUTRAL] Oh yeah, I understand. No.
[CUSTOMER][NEUTRAL] So I have no clue about dental and I have no idea how to read the screens even, um, according to what I see as far as from a claim standpoint, I don't see where the refund has been requested. I just see where that it was noted that she has to request a refund from the provider because the claim should have went to the insured.
[AGENT][NEUTRAL] I understand, [PII].
[AGENT][NEUTRAL] OK, so I'm just.
[AGENT][NEUTRAL] And what I'm gonna do is I'm just gonna tell that.
[AGENT][NEGATIVE] She, I'm not even gonna transfer Miss [PII]. I'm gonna tell her that we will be processing a refund request from the provider.
[AGENT][NEUTRAL] And then I will send another hub.
[CUSTOMER][NEUTRAL] If you'd like, you can transfer her [PII]. I don't want you to.
[AGENT][NEUTRAL] Well, I mean if I mean if you wanna tell her that I mean we're essentially gonna tell her and you know and then I guess another hub ticket would have to be created to make sure that this because I don't know that process as far as.
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] Uh, making sure the refund was requested. I don't know how anything about that.
[CUSTOMER][NEUTRAL] Yeah, that would just be like you said another help request and then we'd have to assign it to the adjuster to make sure that um she you know request that refund because I don't see where it's been initiated. I just see where it's been noted, so that's what that would be the process I would think mhm.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, well, I can just tell her that. I'll just tell her that we were going to be requesting a refund from the provider. I will send a hub ticket to claims for research, I guess I'll put it under research to see if the refund has been requested.
[CUSTOMER][NEUTRAL] And and she's also, and you said yes, and you also said that she said we're paying that we pay the provider more than she got?
[AGENT][NEUTRAL] Well, we did. I'm looking, I mean, I don't, I don't.
[AGENT][NEUTRAL] If you, if you notice the benefit on her claim paid to her, I don't know, but they gave her the bill amounts. Mm, I mean, they gave her the amount of the checks they have, but said they couldn't release them to her because they were in a whole like had to hold them for X number of time first.
[CUSTOMER][NEUTRAL] Now, that
[AGENT][NEGATIVE] What a mess.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] And I don't know how the system, see, I don't know.
[CUSTOMER][NEUTRAL] I mean, I, I don't honestly, I don't know how that could have even happened if you were, they were already benefits were paid without the overriding the system to double pay a service because you know.
[AGENT][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] That should not the system should not allow you to do that unless like I said it was overridden so.
[AGENT][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] I don't know.
[CUSTOMER][NEGATIVE] What a mess it is a mess. You are right.
[AGENT][NEUTRAL] OK, so let me just
[CUSTOMER][NEUTRAL] Um, so yeah, that's.
[AGENT][NEGATIVE] I'm just gonna tell her that's what I'm gonna do and then somebody else can research it and call her back.
[CUSTOMER][NEUTRAL] That's what I would do.
[CUSTOMER][NEUTRAL] Yeah, because at this point, like I said, if I'll get the hub, I'm on late tonight, so I'll get the hub request and then I'll assign it to the adjuster and ask her to review it and explain what what's going on.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect. OK, thank you so much, [PII].
[CUSTOMER][NEUTRAL] Have the yeah.
[CUSTOMER][POSITIVE] You're welcome, [PII] any time.
[AGENT][MIXED] Uh yeah, I, I do. I appreciate it, but yeah, I'm not gonna really, yeah, I'm not gonna transfer her to you. I can tell her all that and do the hub ticket.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thanks, [PII]. OK.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][POSITIVE] Thanks, [PII]. You're welcome. Bye bye.
[AGENT][POSITIVE] You're welcome. Thank you too. Bye bye.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is still [PII]. Thank you for your patience. OK, so instead of transferring you, I'm going to send a request to have one of the examiners to look at this because I can tell that apparently we are going to be requesting a refund from the provider.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] For the overpayment.
[AGENT][NEUTRAL] For this state of service, but I don't, that's so that's what I'm going to be sending a request for.
[CUSTOMER][NEUTRAL] To them.
[AGENT][NEUTRAL] To see if that has been done yet.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] For those two claims that we sent payment to them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause I see where you had spoken with um with someone last week about it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Yes ma'am. I can see where they documented that we were going to be requesting a refund from the provider so I'm going to send a request to verify that that has been done or that has been initiated and if you would like I can ask someone to give you a call back once that has been done and that will probably be, you know, maybe tomorrow if not tomorrow it should be by Thursday.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Could it be by Thursday?
[CUSTOMER][NEUTRAL] Tomorrow I'm having a proced tomorrow I'm having a procedure. I had a procedure.
[AGENT][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am, I can
[AGENT][NEUTRAL] Well, I can
[CUSTOMER][NEUTRAL] I'm gonna have anesthesia now.
[AGENT][NEUTRAL] Oh, yes, I understand. No talking when you've been under anesthesia. Or not for me anyway. So, yes, ma'am, I can just, I can put that in the note that, um, you will not be available tomorrow and ask if someone could please call you on Thursday.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, that'd be great.
[AGENT][NEUTRAL] OK. Well, is there anything else at the moment, Ms. [PII], that I can help you with?
[CUSTOMER][NEGATIVE] No, ma'am. You just, these people got me so upset.
[AGENT][NEUTRAL] Well, don't be upset. We're gonna get this, but your payment, your payments for you, the claims have been mailed to you and then we're going to, according to the notes that I'm reading, we will be requesting a refund from the provider.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now again, you know, you're gonna probably, it'll probably take a week or so for you with the mail service to get your checks. So you know, if you haven't received your payments within about 10 business days, then you can give us a call back, but they are en route to you to the address that we verified with each other.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK, thank you, ma'am.
[AGENT][POSITIVE] All right. Well, you're welcome. So again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] No, ma'am. God bless you, ma'am.
[AGENT][POSITIVE] Well, thank you, Ms. [PII], and I'm praying that everything goes well for you and your procedure tomorrow.
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you, ma'am.
[AGENT][POSITIVE] Alright well have a nice evening, yes ma'am and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][NEUTRAL] Ah, [PII].