AccountId: 011433970860
ContactId: 3dbb00d1-9eec-4d1f-a5bf-fc54af17bb07
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533510 ms
Total Talk Time (AGENT): 175236 ms
Total Talk Time (CUSTOMER): 206393 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/3dbb00d1-9eec-4d1f-a5bf-fc54af17bb07_20250605T17:12_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] Excuse me. This is [PII]. I have filed a, a claim back in, oh.
[CUSTOMER][NEUTRAL] I think it was in April.
[CUSTOMER][NEUTRAL] And so, after all the paperwork, paperwork was done, what happened was, instead of sending me the check, they sent it to the doctor.
[CUSTOMER][NEUTRAL] And I called the doctor, but he says that he doesn't have it.
[CUSTOMER][NEUTRAL] And I would like for somebody to help me with this.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can assist you with the status of that payment. Um, first, could I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now, could I get your policy number, please?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 02502437
[AGENT][NEUTRAL] And please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And please verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what's the date of service and bill charges on the claim you're calling about?
[CUSTOMER][NEUTRAL] The state of service was [PII] of this year.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I don't see the date here. Let me see.
[CUSTOMER][NEUTRAL] No, there's, there's no other date. um.
[AGENT][NEUTRAL] When you said the date was [PII], what are the bill charges?
[CUSTOMER][NEUTRAL] Uh, this is, uh,
[CUSTOMER][NEUTRAL] To refund me the money for the co-payment, which was $60.
[CUSTOMER][NEUTRAL] And then the reimbursement will be for $50.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Mhm. No problem.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that this payment was sent to the provider. It was sent to the provider on [PII] and I can give you the check number and I do show that the check is still outstanding. So they probably um have, if they have received it, they probably haven't entered it into their system yet.
[AGENT][NEUTRAL] Um, but I'm showing that it was sent to the on [PII], and I have the check number here if you need that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. What's the check number?
[AGENT][NEUTRAL] The check number is 204.
[AGENT][NEUTRAL] 7198 and it's for $50 even.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, right, I, I did call them yesterday, and, and I was on hold for a while while they were checking, and she assured me that they don't have the check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, do you know where they're sending the, the, the check from?
[AGENT][NEUTRAL] Um, I'm sure that it was sent to the.
[CUSTOMER][NEUTRAL] Because today is the [PII].
[AGENT][NEUTRAL] Yeah, I'm showing that it was sent to the address on the claim, and the address on the claim, um, where to send payments to is orthopedic Specialist of [PII] [PII].
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I, I meant where's the check coming from so I can on, let's figure out how long would it take to get here.
[AGENT][NEUTRAL] Oh, it's coming from um.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] What state?
[AGENT][NEUTRAL] Yeah, [PII]. It's coming from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um,
[CUSTOMER][NEGATIVE] I, I do, I do have to say I'm very upset about this because I was told that whoever makes the, the, the files the claim.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's the person that gets the check, and I did pay the $60 co-payment.
[CUSTOMER][NEGATIVE] And, and now, now I'm in kind of stuck here because I didn't get my refund and then the doctor says they don't have it.
[CUSTOMER][NEGATIVE] So, where does that leave me? I mean, if, if, at the end of the day, they claim that they never got the check, is there any way to escalate this, escalate this?
[AGENT][NEUTRAL] Um, one moment. I'm pulling the image to see um where did this claim come from because we can only go by who sends the claims, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine, that's fine. I did it myself online.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. Yes, ma'am. But I show a claim form from the provider's office. So did you get this claim form from your provider's office?
[CUSTOMER][NEUTRAL] No, I filled it out online.
[CUSTOMER][NEUTRAL] What I got what I got from, oh, you meant the, the provider asking what my, my insurance?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, yeah, I'm showing the 1500 form.
[AGENT][NEUTRAL] The health insurance claim form, the 1500 form for the office visit.
[CUSTOMER][NEUTRAL] I, I'm not sure what that is.
[CUSTOMER][NEGATIVE] I, I do know if it helps that I asked the doctor for the itemized bill and they send me something and I upload it on the website, and then I was told that's the wrong one. And then I had to call the doctor again and they sent me a second one, and that's what I uploaded.
[AGENT][NEUTRAL] OK. And I understand. OK, that's what happened. It looks like they sent you the 1500 form and these are claim forms that normally only comes from the doctor's office and that's why we ended up paying um the um provider because we thought.
[AGENT][NEUTRAL] That they submitted the claim because a 1500 form was uploaded.
[AGENT][NEUTRAL] So, but, yes, ma'am, that's.
[CUSTOMER][NEUTRAL] Oh, and that, that form, oh goodness, it's from the doctor, so it looked like it was coming from them, like they were filing the claim. Even, even though I was the one doing everything online. Oh.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Exactly. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Then what to do now?
[AGENT][POSITIVE] Well, they received, they received the payment. The check went to them, so, um, since you've already paid them, yeah, you can get with them, you have the check number, you can get with them and once the check clears, I guess, see if they could refund you your money.
[AGENT][NEUTRAL] Because the payment went to them. That's the check number I gave you.
[CUSTOMER][POSITIVE] Wow, that's.
[CUSTOMER][NEGATIVE] Yeah, I know, they gave me the wrong itemized form.
[CUSTOMER][NEUTRAL] Correct? Because the one that they gave me to upload is the one that is, is from them, like they, they're the ones filing the claim, not me.
[AGENT][NEUTRAL] Right. Yes, ma'am.
[CUSTOMER][POSITIVE] All right then. OK. I do, I do thank you for your time and your patience.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, no, thank you so much. You have a great day now.
[AGENT][POSITIVE] You do the same, so thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] OK, bye.