AccountId: 011433970860
ContactId: 41b82618-e3b5-48af-8359-6956e2c5fcb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 475160 ms
Total Talk Time (AGENT): 186084 ms
Total Talk Time (CUSTOMER): 238491 ms
Interruptions: 4
Overall Sentiment: AGENT=-0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/41b82618-e3b5-48af-8359-6956e2c5fcb1_20250415T20:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII].
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] How are you?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][NEUTRAL] Mm, um, I'm OK.
[CUSTOMER][NEUTRAL] I'm all right. Mm. So I have an, well, I have an insured on the line who was very hot.
[AGENT][NEUTRAL] What's going on?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Initially, but she's calmed down.
[CUSTOMER][NEUTRAL] Sort of, I mean she has, um, the policy number is 604.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 575.
[CUSTOMER][NEUTRAL] Ms. [PII].
[AGENT][NEUTRAL] OK, one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull that up.
[CUSTOMER][NEUTRAL] And she's fully verified. Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] As you can see, if you look on them track, and 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.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so first off, she was calling because she's was hot that
[CUSTOMER][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. Well, if you will notice the two claims that were processed on the [PII].
[CUSTOMER][NEUTRAL] And payment was issued to the provider, which they have told her they received the money.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Is for the same data service as what she submitted.
[CUSTOMER][NEUTRAL] So we did it appears we have issued payment to the provider and to her.
[CUSTOMER][NEUTRAL] For the 12 6 2024 data service?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] I guess this is dental, right?
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It sure is.
[AGENT][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.
[CUSTOMER][NEUTRAL] Uh, I understand.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] They said they closed the key down Monday. So now, you know, here we are.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] We're take it, you know, all their calls are coming to us and then we have to transfer to the claims support.
[CUSTOMER][NEUTRAL] But the question really is, you know, well why did we pay her and them and, you know.
[CUSTOMER][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 services just two separate claims, but.
[CUSTOMER][NEUTRAL] We pay them 350 and 539 we paid her 652.
[AGENT][NEUTRAL] Yeah, and I'm seeing there's a note in here from Ms. [PII], I think she's dental new claim.
[AGENT][NEUTRAL] Uh, pay the insured request refund for from from provider.
[AGENT][NEUTRAL] Apparently she called about this on [PII] as well.
[AGENT][NEGATIVE] Insured calls 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.
[AGENT][NEUTRAL] And then we sent a help request to ask the insured and then apparently [PII], uh.
[AGENT][NEUTRAL] I'm assuming that she reviewed the hub request because she's saying that they need to request a refund from the provider.
[CUSTOMER][NEUTRAL] So has that been done?
[AGENT][NEUTRAL] Um, I
[CUSTOMER][NEUTRAL] I can't tell that that's been requested.
[AGENT][NEGATIVE] It doesn't look
[CUSTOMER][NEUTRAL] And if that is the case, then
[AGENT][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.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 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.
[CUSTOMER][NEUTRAL] Oh yeah. I understand. No.
[AGENT][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.
[CUSTOMER][NEUTRAL] I understand, [PII].
[CUSTOMER][NEUTRAL] OK, so I'm just
[CUSTOMER][NEGATIVE] Then what I'm gonna do is I'm just gonna tell that to 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] If you'd like, you can transfer her [PII]. I don't want you to, you know.
[CUSTOMER][NEUTRAL] And then I will send another hub.
[CUSTOMER][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] Uh, making sure the refund was requested. I don't know how anything about that.
[AGENT][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 not[PII], so that's what that would be the process I would think, mhm.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][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.
[AGENT][NEUTRAL] And, and she's also, and you said yes. And you also said that she said we're paying that we paid the provider more than she got?
[CUSTOMER][NEUTRAL] Well, we did. I'm looking, I mean, I don't, I don't.
[AGENT][NEUTRAL] Now, that
[CUSTOMER][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 so 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][NEGATIVE] What a mess.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I don't know how the system, see, I don't know.
[CUSTOMER][NEUTRAL] But
[AGENT][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.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] That should not the system should not allow you to do that unless like I said it was overridden, so.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEGATIVE] What a mess it is a mess. You are right.
[AGENT][NEUTRAL] Um, so yeah, that's.
[CUSTOMER][NEUTRAL] OK, so let me just
[CUSTOMER][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.
[AGENT][NEUTRAL] That's what I would do.
[AGENT][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.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Have the yeah.
[CUSTOMER][POSITIVE] Perfect. OK, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome, [PII], anytime.
[CUSTOMER][MIXED] Uh yeah, I, I do. I appreciate it, but yeah, I'm not gonna really, yeah, I'm not gonna transfer to you. I can tell her all that and do the hard ticket.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK, thanks, [PII]. OK.
[AGENT][POSITIVE] Thanks, [PII]. You're welcome. Bye bye.
[CUSTOMER][POSITIVE] You're welcome. Thank you too. Bye-bye.