AccountId: 011433970860
ContactId: 405bfb0d-bfca-4493-91cd-970c1d4f032d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 909770 ms
Total Talk Time (AGENT): 179303 ms
Total Talk Time (CUSTOMER): 171718 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=-1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/405bfb0d-bfca-4493-91cd-970c1d4f032d_20250307T15:41_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office regarding the claim status.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with claim status. Can I please get your callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, so the patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] And what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, so the policy number is.
[CUSTOMER][NEUTRAL] It's 01912859.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lion, 8.
[AGENT][NEUTRAL] OK, let me look up that policy for us real quick.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK, I have [PII] pulled up. Can you please give me the date of service of the claim?
[CUSTOMER][NEUTRAL] Yeah, definitely [PII].
[AGENT][NEUTRAL] [PII] or [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and what is the charge amount?
[CUSTOMER][NEUTRAL] Yeah, OK, the charge amount is $1,162 even.
[AGENT][NEUTRAL] OK and then can you give me the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] So the primary was billed for $1,162 with patient responsibility, but I can see that, uh, American Public Life also process for the same charges, which is $1,162.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling for Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's Holy Cross Hospital.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you and I will be right back.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Ms. [PII], you mentioned that APL was billed already for this claim. Do you have a claim number? Because I am not finding the claim in the amount that you have given me.
[CUSTOMER][NEUTRAL] OK, so the claim number for American Public Life is 32773009.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'm gonna look that up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 1912859.
[AGENT][NEUTRAL] Paid
[AGENT][NEUTRAL] 7562.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you [PII] for holding for me so I did find the claim that you gave me 327-7309.
[AGENT][NEUTRAL] The claim has been paid, let me give you the check number.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] The check number is 11775623.
[AGENT][NEUTRAL] The check was issued.
[AGENT][NEUTRAL] On [PII] and the amount of $310.
[AGENT][NEUTRAL] And the check was cashed on.
[AGENT][NEUTRAL] For [PII].
[CUSTOMER][NEUTRAL] OK, so I can see that.
[CUSTOMER][NEUTRAL] A ABMed health plan initially applied patient responsibility of $310 which was paid by secondary, which is uh American Public Life. Later, primary reprocessed and applied patient responsibility of $80. But the secondary didn't process for that.
[CUSTOMER][NEGATIVE] As the second it needs to recoup the initial payment which is causing an overpayment.
[AGENT][NEGATIVE] It's causing an overpayment you said.
[CUSTOMER][NEUTRAL] As a present the page.
[CUSTOMER][NEUTRAL] Yeah, it's an overpayment on the claim.
[AGENT][NEUTRAL] From us
[CUSTOMER][NEUTRAL] Yes, as the primary we process for the patient responsibility of $80.
[CUSTOMER][NEGATIVE] But the secondly did not reprocess as it paid for the.
[CUSTOMER][NEUTRAL] Primary initial patient responsibility.
[AGENT][NEUTRAL] OK, so let me get um,
[AGENT][NEUTRAL] Make sure that we have your a good call back number for you because what I'll need to do is let the claims department know that they have an overpayment on this claim and they will have to contact you about the overpayment.
[CUSTOMER][NEUTRAL] OK, so can you send the claim for the process?
[CUSTOMER][NEUTRAL] Do you cook the appointment.
[AGENT][NEUTRAL] You want me to send you the claim to reprocess?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] But we overpaid it.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Why would we process it again if we paid it already and it was paid more than it should have been?
[CUSTOMER][NEUTRAL] To, yeah, to recoup the payment.
[AGENT][NEUTRAL] OK, so what I'm gonna need to do is get your good call back number and let the claims department call you back about this claim. Is this number that you gave me [PII] a good number to call you back on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm gonna put you on a hold while I request that call back and I'll be right back.
[CUSTOMER][NEUTRAL] Before that, can I, may I know your name please?
[AGENT][NEUTRAL] Yes, my name is [PII]
[CUSTOMER][NEUTRAL] And the last initial?
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And may I know the phone number of that department?
[AGENT][NEUTRAL] It's the same number that you called.
[CUSTOMER][NEUTRAL] Yeah, OK, could you please.
[CUSTOMER][NEUTRAL] Do that.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me [PII]. I've got that request in for you to get a call back within 24 hours.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the call reference?
[AGENT][NEUTRAL] Yes, you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for the information. It was great talking to you. Have a great day. Bye bye.
[AGENT][POSITIVE] You too, [PII]ss [PII] you have a wonderful weekend and thanks for calling APL bye bye ma'am.