AccountId: 011433970860
ContactId: 537272eb-a6e7-47fb-8c97-e0158895eb95
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 942640 ms
Total Talk Time (AGENT): 144069 ms
Total Talk Time (CUSTOMER): 444554 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/537272eb-a6e7-47fb-8c97-e0158895eb95_20250519T18:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, sir. My name is [PII], calling on behalf of provider office to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. The name of your spelling is [PII], is that right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Uh, thank you so much, sir. May I know if we can help you with the NPI or tax ID and member ID number or something else?
[AGENT][NEUTRAL] Uh, yeah, you just need to check on a claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What's the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, the patient policy number is 02497479.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the name is.
[CUSTOMER][NEUTRAL] [PII]. And the date of birth, [PII].
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] [PII] with the amount of $100 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] It looks like we did receive a claim for this state of service claim was received on [PII].
[CUSTOMER][NEUTRAL] Actually, uh, we received a payment from your end.
[CUSTOMER][NEUTRAL] If you want, I can help you with the claim number.
[AGENT][NEUTRAL] I have it here as far as the benefit payment. What did you need from that claim number?
[CUSTOMER][NEUTRAL] Yeah, the first thing I want to know whether you process this as a primary or secondary.
[AGENT][NEUTRAL] For the secondary.
[CUSTOMER][POSITIVE] Yeah, thank you so much. And one second, what I am seeing here means actually, here the primary initially paid $32.23 dollars 64 cents and they recoup that. And after that, they pay the $67.
[CUSTOMER][NEUTRAL] And 78 cents with no uh leftover. But here you covered that uh you pay $25 even. So may I know the reason for this payment?
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] I didn't see any uh leftover from the primary.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It says per office visit with this payment, this is the maximum benefit amount provided for the office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, actually,
[AGENT][NEUTRAL] So was it their co-pay? Did they have a $25 co-pay?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEGATIVE] No, actually, they didn't lift any co-pay. Primary didn't, uh, they didn't see any leftover from the primary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let me check what was submitted on the claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So it looks like when it was submitted this claim ending in 7119, it was submitted as a reconsideration. The total charge is showing $100.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Actually, we didn't expect to pay for this claim because there was no leftover from primary, so.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Is that anything to do?
[AGENT][NEUTRAL] No, I mean, at this, it's already the payment's already been issued to the provider, so, um, it, it's already been processed and paid and what we received showed that there was a charge amount of $100 so.
[CUSTOMER][NEGATIVE] To resolve this issue.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Just give me uh one minute of time so that I can check and let you know.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah thank you so much.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah, thank you for your patience. Actually, uh, we didn't see any leftover from the primary OB as I said earlier. And initially, what we are seeing is you paid 2 times for this claim. Actually, we didn't expect any payment from your end, but uh what I'm seeing here means uh we, you pay 2 times for this claim. Initially, you paid $10 and after that you paid $25.
[CUSTOMER][NEUTRAL] So, actually, we didn't expect any payment for this claim from your end because the payment covered the entire amount.
[CUSTOMER][NEUTRAL] So, is it possible to resolve these issues?
[AGENT][NEUTRAL] If the payment is an error, then the provider needs to dispose of the payment. The claim has already been processed and paid, so it was a reconsideration.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, whether, uh, yeah, thank you for that. Uh, may I know whether we, we have to void that amount or we have to recoup, uh, the amount, or we have to send back the amount?
[AGENT][NEUTRAL] If it's an error on that side, then yes, it would need to be returned.
[CUSTOMER][NEUTRAL] OK. That means you have to send refund, am I right? OK. So, let me confirm all the payment details one by one. So, just a minute, let me cross-check that, yeah.
[CUSTOMER][NEUTRAL] So, first, let me cross verify the payment details of $25 even. OK. So the paid amount is $25 even, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the claim number for this is 359-7119. Is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Yeah, thank you so much. And the CPT code paid was, what's the security code? Yeah.
[CUSTOMER][NEUTRAL] It's [PII]. Am I right?
[AGENT][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] Oh sorry, yeah, [PII]. Uh, and I want to know whether this payment is through check or the EFT?
[AGENT][NEUTRAL] Single check.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Single check, OK. Uh, the check number is 202042571. Is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Yeah, thank you so much and let me check payment, OK.
[CUSTOMER][NEUTRAL] Uh, is there any interest for this payment? Sorry, interest for this refund?
[AGENT][NEUTRAL] Any address, is that what you asked?
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] No, I, I'm asking, is there any interest uh for this uh refund?
[AGENT][NEUTRAL] Any interest?
[CUSTOMER][NEUTRAL] Yeah, interest means like um any amount will charge for this refund.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much and.
[CUSTOMER][NEUTRAL] Yeah. Uh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] May I know the amount that we need to be refunded, whether the entire amount or a particular portion of the amount?
[AGENT][NEUTRAL] If it was an error, then it would be the full amount.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Let me know.
[CUSTOMER][POSITIVE] Alright, thank you so much and
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. Uh, so let me cross verify the another payment. The, in the another time the paid amount was $10 even, am I right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, thank you so much. And the
[CUSTOMER][NEUTRAL] Claim number is
[CUSTOMER][NEUTRAL] 3562968. Is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the CPT code is [PII]. Is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, and the
[CUSTOMER][NEUTRAL] It is a single payment or uh sorry, it is a check or EFT payment?
[AGENT][NEUTRAL] Every single check.
[CUSTOMER][NEUTRAL] Yeah, it's a check payment and the check number is 2027403. Is that right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Could you help me with that refund address, refund mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You will work.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] OK, my city.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] My zip code is [PII]. Uh, after uh before [PII], is there any word will come?
[AGENT][NEUTRAL] No, it's just addressed to [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] [PII] my [PII].
[CUSTOMER][NEUTRAL] OK. OK, let me confirm. It's [PII] [PII]. Is that right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Yeah, thank you so much. And could you help me with your call reference number for this claim?
[AGENT][NEUTRAL] Call reference is my name with my last initial than today's date. My name is [PII], that's [PII] and then my last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Yeah. And uh today's date [PII], is that right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Yeah, thank you so much and thank you so much for your wonderful assistance for the day. Thank you. Have a great day, [PII].
[AGENT][NEUTRAL] You too, bye bye.
[CUSTOMER][NEUTRAL] Ma