AccountId: 011433970860
ContactId: 6bfba8d7-fdad-4932-952e-369558fd0559
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 716510 ms
Total Talk Time (AGENT): 165500 ms
Total Talk Time (CUSTOMER): 319009 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/6bfba8d7-fdad-4932-952e-369558fd0559_20250117T13:27_UTC.wav
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[AGENT][POSITIVE] Good, thank you for calling IPL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. I'm calling regarding um a claim that I submitted um that was actually paid to the provider instead of being directed to me because I had already paid the bill and I wanna know how that could be rectified.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, 02102761.
[AGENT][NEUTRAL] OK, can you give it to me one more time, please?
[CUSTOMER][NEUTRAL] Mhm 02102761.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what's your date of birth, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] Mhm [PII], [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII], and
[AGENT][NEUTRAL] You were wanting to know if we paid the provider.
[AGENT][NEGATIVE] How you could get that money back.
[CUSTOMER][NEUTRAL] Yeah, so, um.
[CUSTOMER][NEUTRAL] Mhm. Because it was a, a claim that was submitted and it was paid when I got the um EOB it said that it was paid to the provider. Um, a check was sent to the provider, but then I resubmitted um uh receipt that I actually paid that claim since last year, um, I the invoice, and, um, so I wanted to know how that would be, because, you know, the provider was paid by me directly.
[CUSTOMER][NEUTRAL] So, I don't know why the claim was, OK. The date of service is um [PII].
[AGENT][NEUTRAL] OK. What date?
[CUSTOMER][NEUTRAL] And if I could find.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you know what procedure code it was for, because I have a lot for that data service.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah let me see if I could try to get in here.
[CUSTOMER][NEUTRAL] Um, because the lasting procedure.
[AGENT][NEUTRAL] Or how much the bill was or?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is it a um on this last EOB it says um OVSWS.
[CUSTOMER][NEUTRAL] Is that one?
[AGENT][NEUTRAL] I'm not sure.
[CUSTOMER][NEUTRAL] O V S W I mean, I mean O V S V S.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] What doctor was it for? Let me see if I can find it.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I'm trying to find.
[CUSTOMER][NEUTRAL] Uh, the claim num is would the claim number help?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, it's 355-1598.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, OK, so yeah, this has all the procedures on here.
[AGENT][NEUTRAL] Hold on just a second.
[AGENT][NEUTRAL] OK, it's because that doctor filed the claim first and when we get the EOB in, we have to pay the doctor on that one cause they filed it. Let's see when they filed it.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 323.
[AGENT][NEUTRAL] Yeah, they filed that one back in 17-1724.
[AGENT][NEUTRAL] They had a benefit assigned to them on it. So when we got the EOB we had to pay them.
[CUSTOMER][NEUTRAL] Mm, OK, that's weird because I've, so I resubmitted a claim um some evidence on that one because I've already paid them. I already I paid them and I sent the receipts on this, um, to show that the bill was paid.
[CUSTOMER][NEUTRAL] So that's, I didn't, I didn't see a claim in there for them at all before this.
[AGENT][NEUTRAL] There was a claim on claim number 3483323 that they filed back in.
[AGENT][NEUTRAL] 7:17 to 24.
[CUSTOMER][NEGATIVE] Well, I don't know. So basically I have to contact them then because I've overpaid, so when I resubmitted the um because I, I paid the whole bill, so I just need to contact them because um APL can't do anything now because the, I didn't see that claim pending.
[AGENT][NEUTRAL] Right, cause they sent in.
[AGENT][NEUTRAL] They sent in that benefit of assignment. Hold on, let me pull up that claim.
[AGENT][NEUTRAL] Yeah, when they send in a benefit of of assignment on there, we have to pay them by law.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that was done, you said 7:17 of 24?
[AGENT][NEUTRAL] 24, uh-huh, when they send it in.
[AGENT][NEUTRAL] Hold on just a second, I'm trying to get the limb up.
[CUSTOMER][NEGATIVE] I don't even have that one on there.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Yeah, they had a signment accepted on it, yes, so we had to pay them.
[CUSTOMER][NEUTRAL] You said 3483323, that was the claim number.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] Oh OK, now I'm seeing it in here, but so it was never paid on it wasn't paid at that point, um.
[AGENT][NEUTRAL] Because they didn't send in the EOB.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Alright, well I guess I'll have to try to contact them because they received, they would have um.
[AGENT][NEUTRAL] Double payment, yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm, OK, and just to clarify, let's see here the um.
[CUSTOMER][NEUTRAL] Oh OK, well that was sent out on um
[CUSTOMER][NEUTRAL] 114 so I guess I'll.
[CUSTOMER][NEUTRAL] Give it a minute.
[CUSTOMER][NEUTRAL] Um, so that they contact their billing department then that was sent out 114. The check was um.
[CUSTOMER][NEUTRAL] Ending 748
[CUSTOMER][NEUTRAL] For the 122, 42.
[AGENT][NEUTRAL] That I paid the provider, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'll give you that information. It is check number 2022748.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm. OK, I'm just looking at the UBEOB.
[AGENT][NEUTRAL] Uh, let me see when it was paid.
[AGENT][NEUTRAL] Yes, it's 122, 42.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm, because it was, I guess when I send the EOB when I submitted my claim that it, it triggered that um process.
[AGENT][NEUTRAL] Back to that claim, yeah, because they had a uh assignment on the previous claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Oh, all right, well, I'll contact them. So while I have you on the phone, may I, um, can I ask a question? Um, through my employer, we were told that specialists, um, specialist visits were covered under this policy, but every time I submit a claim for um that it kept, it keeps telling me that office visits are not covered. It which is the correct, you know.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] I know that my like primary care visit is not covered, but like specialists um when we go to any specialist, it's supposed to cover like co-pays and stuff like that.
[AGENT][NEUTRAL] No, ma'am. It's not covered.
[CUSTOMER][NEUTRAL] Oh, that's what we were informed.
[AGENT][NEUTRAL] Office visits are not covered, no, ma'am. If you have any services done in the doctor's office, like injections, X-rays, or anything like that, now it's covered, but the actual office visit itself is not covered.
[CUSTOMER][NEGATIVE] It's not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The co-pay for the office visit is not covered. Mm, OK, that's um so I'll have to find a child.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, cause when I, when we changed insurances and the co-pay went up and they were and um uh you know, HR was like, well, don't worry about it because, you know, that it's covered with your gap, so it doesn't matter what the co-pay is. I'm like, well, that's not what I'm getting now because every time I submit a claim, it's saying that co-pay is not covered. So I'll have to talk to them and, and let them know they give you wrong information.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It's just for that office, is it?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, well thank you very much. You're very helpful.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, that should do it for today.
[AGENT][POSITIVE] Thank you, Ms. [PII] for calling APL. You have a good day.
[CUSTOMER][POSITIVE] OK, thank you too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.