AccountId: 011433970860
ContactId: 54e3a4dd-f4c2-43ca-99ac-019a78aabe94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 433730 ms
Total Talk Time (AGENT): 149369 ms
Total Talk Time (CUSTOMER): 186235 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/54e3a4dd-f4c2-43ca-99ac-019a78aabe94_20250310T17:06_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], it's [PII]. How are you?
[AGENT][POSITIVE] Oh, I'm good how are you?
[CUSTOMER][NEUTRAL] I'm OK, thank you. So I have a provider's office on the line and it's regarding policy 1912866 and it's for part one, Mr. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The lady I'm speaking with, her name is [PII].
[CUSTOMER][NEUTRAL] And her callback number, [PII] is [PII].
[CUSTOMER][NEUTRAL] And the claim number that she gave me was 328-719-7 for data service 322023 for him for 2500.
[CUSTOMER][NEUTRAL] So we initially paid the 250 on the claim, the original claim, however, the primary insurance came back and there was an adjustment.
[CUSTOMER][NEGATIVE] And they have sent the new explanation of benefits to us twice and those last two claims have been denied as a duplicate.
[CUSTOMER][NEUTRAL] Because she's trying to find out because she says that you know we overpaid on the claim at this point.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can we
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Give me 1 2nd to pull that information up.
[CUSTOMER][NEUTRAL] Yeah, sure. Uh-huh, sure.
[AGENT][NEUTRAL] One
[AGENT][NEUTRAL] 6
[AGENT][NEGATIVE] Come on, get your fingers together.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEGATIVE] Nobody probably didn't wanna request a refund. They ain't request a refunds, Lord [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] One second, I'm pulling it up.
[CUSTOMER][NEUTRAL] Uh, OK. I just didn't wanna do a hub ticket since they submitted it twice.
[CUSTOMER][NEUTRAL] And it's an old claim.
[CUSTOMER][NEUTRAL] I wasn't sure, you know.
[AGENT][NEUTRAL] Oh yeah, we, yeah, let's see when was your process? [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And then again, they submitted it twice since then, but it just keeps getting denied as a duplicate.
[AGENT][NEUTRAL] Right there.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 1 2nd 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, you're fine.
[CUSTOMER][POSITIVE] And she's really nice, so that's helpful.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Not that we don't treat everybody the day, but, you know, some of them are a little.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEGATIVE] Hard to deal with.
[AGENT][NEUTRAL] So 36,790.
[AGENT][NEUTRAL] And da da da.
[AGENT][NEUTRAL] I'm sick. I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 377 21. Let me look at the other one because I don't see where we would.
[AGENT][NEUTRAL] I'm about to get my dog
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] OK, now I see it.
[AGENT][NEUTRAL] OK, yeah. We, we need to request a refund. Do you want me to tell her or you're just gonna do a request?
[CUSTOMER][NEUTRAL] It doesn't matter, just, um,
[CUSTOMER][NEUTRAL] Do you want me to just tell her that we'll process it with a request for the refund to be?
[CUSTOMER][NEGATIVE] I mean, it doesn't, I'll do whatever.
[AGENT][NEUTRAL] Yeah, you can, you can do a hub request and uh.
[AGENT][NEUTRAL] Let me see if the same person processed the claim.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Probably not.
[AGENT][NEUTRAL] 356711
[AGENT][NEUTRAL] Two different people
[AGENT][NEUTRAL] Uh, [PII] processed the first.
[AGENT][NEUTRAL] So it would go, it would come to her, but you know what.
[CUSTOMER][NEUTRAL] But we are assigned it, we don't assign it to anyone, so.
[AGENT][NEUTRAL] OK, but you know what, send her over and then I'll just send it to [PII] for [PII] to uh do it.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh, OK, so you do want me to transfer you?
[AGENT][NEUTRAL] Yeah, go ahead and transfer so you don't have to do a her request and then somebody gotta.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Figure that
[CUSTOMER][NEUTRAL] OK, well, OK.
[CUSTOMER][POSITIVE] Well, all righty, I can do that then. So, um, I appreciate you taking a look at this and helping me with this one or helping her. OK, [PII], well I have, I hope you do too. Thank you so much. All right, bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All righty.
[AGENT][POSITIVE] No problem [PII], have a great rest of your day.
[AGENT][NEUTRAL] All right, bye bye
[CUSTOMER][NEUTRAL] I will stop there. What was what was that?
[AGENT][POSITIVE] Good afternoon thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Golden Orthopedics, and um I was calling regarding a claim um that was paid and we just had a little bit of an issue with.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, uh, she, uh, is the [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] And she said it was for claim number 3287197 where we paid $250 and it looks like it was reprocessed by the major medical and so we should have issued an overpay, I mean a refund request for that amount.
[CUSTOMER][NEUTRAL] Yes, that is true, yes, and we sent that information a couple times, but it just kind of denies as a duplicate instead.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK, alright, so, uh, I did look at that information and verify that you know there is a lesser amount that was owed and so we will uh take the steps to go ahead and try to get a refund request letter out to you. Uh, is there a fax number that we can fax that letter over to?
[CUSTOMER][POSITIVE] Yeah, great, yeah that'd be great um fax number is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 203-088-2
[AGENT][NEUTRAL] 0882 and does it need to come to anyone's attention?
[CUSTOMER][NEUTRAL] Um, you can just not specifically, but you could put to me on that's fine. It'll come right to me.
[AGENT][NEUTRAL] OK, and can you, can you spell that for me please?
[CUSTOMER][NEUTRAL] Sure, it's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, alrighty, thank you for that information, [PII].
[AGENT][POSITIVE] And I'll go ahead and get that refund request uh faxed over to you shortly.
[CUSTOMER][POSITIVE] OK perfect I really appreciate your help with this.
[AGENT][POSITIVE] No problem, is there anything else I can help you with on today?
[CUSTOMER][NEUTRAL] Uh, nope, that'll be it.
[AGENT][POSITIVE] OK, well thanks for calling APL you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you so much.
[AGENT][NEUTRAL] All right, bye bye.
[CUSTOMER][NEUTRAL] Mhm bye.