AccountId: 011433970860
ContactId: 4a5fcc21-d339-42d1-9b6d-7518dfd6a942
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375480 ms
Total Talk Time (AGENT): 144928 ms
Total Talk Time (CUSTOMER): 123957 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/4a5fcc21-d339-42d1-9b6d-7518dfd6a942_20250225T16:34_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Northern All Surgeons and Superior calling in regards to a um claim that was sent to you guys date of service [PII] that was paid on.
[AGENT][NEUTRAL] OK, I'm sorry, you sound really, really low. You said you're calling for a claim status?
[CUSTOMER][NEUTRAL] Um, yes, we had already gotten paid on this claim, um, but there are some issues with it, so I'm wondering what we should do next if you can pull up these claims.
[AGENT][NEUTRAL] OK. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 1580719
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So there's claims that have been paid on and you have additional questions.
[CUSTOMER][NEUTRAL] Um, yes, so the charge amount was supposed to be $57 not $114.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how do you want to, will you send us a request for money back?
[AGENT][NEUTRAL] You, you charge for more than what it was and you just want to get the difference. You want us to request the difference, right? What's the claim number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Or the data service.
[CUSTOMER][NEUTRAL] The date of service is 10-25-24.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Dental
[AGENT][NEUTRAL] OK, so it was the actually the charge is 57, we were billed 114.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so you, um,
[AGENT][NEUTRAL] Asking if we should send a request for the difference between the 57 and the, the 114 is correct or 57 is correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] The 57 is correct.
[AGENT][POSITIVE] OK, that is correct.
[AGENT][NEUTRAL] OK 91.
[AGENT][NEUTRAL] All right, and [PII], do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm doing good. How about you?
[AGENT][POSITIVE] I'm doing good. I just have a quick question. A provider billed us for
[AGENT][NEGATIVE] $57 but it's, I'm sorry, for $114 but it should have been $57. She's asking me if we're gonna send her something to like get the difference.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So they
[AGENT][NEUTRAL] They, they
[AGENT][NEUTRAL] They billed us for more than what it was.
[CUSTOMER][NEUTRAL] They will have to submit a corrected bill. We can't do anything.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, submit a corrected claim.
[CUSTOMER][NEUTRAL] Yeah, they're gonna have to submit a corrected claim because we just can't assume.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] That what they're saying is right. OK.
[CUSTOMER][NEUTRAL] That's the total amount, right.
[AGENT][NEUTRAL] Alright, I'll let him know I was, I was like, oh, I don't think we send anything. OK, I just want to make sure.
[CUSTOMER][NEUTRAL] No, she's gonna have to surrender submit a corrected uh claim and then if that EOB shows 114, we're gonna have to have to correct the EOB with the total be a charge of 57.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. Alrighty, well, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Alright bye bye.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I just spoke to claims, um, you would just have to submit a corrected claim and we'll make the adjustment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you want me to submit a claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And attach that other EOB I would assume.
[AGENT][POSITIVE] The correct mhm correct.
[CUSTOMER][NEUTRAL] OK, and then say corrected claim at the bottom or?
[AGENT][NEUTRAL] Say that one more time, it went in and out and I heard corrected claim.
[CUSTOMER][NEUTRAL] So he want.
[CUSTOMER][NEUTRAL] So you want at the bottom corrected claim.
[AGENT][NEUTRAL] So like, oh, you can write it there if you like if um you don't have to, but you can.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Do you want a um.
[CUSTOMER][NEUTRAL] Can I get a call reference number?
[AGENT][NEUTRAL] Mhm. So there's no call reference number, but you can use my name in today's date, and that's [PII], and then today's date.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK sounds good thanks so much.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, just that.
[AGENT][POSITIVE] Alright, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you have a good day mm bye.
[AGENT][NEUTRAL] You too bye bye.