AccountId: 011433970860
ContactId: 75a2018f-7279-4454-842b-4016ea4a9403
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 574780 ms
Total Talk Time (AGENT): 277636 ms
Total Talk Time (CUSTOMER): 156489 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/75a2018f-7279-4454-842b-4016ea4a9403_20250505T17:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I'm calling to find out the status of a claim.
[AGENT][NEUTRAL] OK, I can help you with the same status. May I please
[CUSTOMER][NEUTRAL] I, I, I don't know if you're, sorry.
[CUSTOMER][NEUTRAL] Go ahead, I'm sorry.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That's OK. I can help you with client status. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII], [PII]. Policy number is
[CUSTOMER][NEUTRAL] 255-088-888
[AGENT][NEUTRAL] OK, let me look that up real quick. So you are the um member that is insured, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Ms. [PII].
[AGENT][NEUTRAL] I'm gonna need for you to please verify your policy. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] My, my date of birth?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you hear me?
[AGENT][POSITIVE] Thank you, ma'am. And then what is your
[CUSTOMER][NEUTRAL] Kind of. You're, you're, you're breaking up a little bit.
[AGENT][NEUTRAL] I'm sorry, I'm sorry, let me see if I can, uh, correct that for us real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and can you please give me your address, phone number and email address that we have on the policy for you, Ms. [PII]?
[CUSTOMER][NEUTRAL] [PII], [PII]. And what was the other one?
[AGENT][NEUTRAL] Your phone number? I'm showing it's the same number that you gave me for call back we're disconnected is, is that correct? That's your current cell phone?
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] OK. Thank you, Ms. [PII].
[AGENT][POSITIVE] Awesome, thank you so much for verifying your policy for me. How can I help you with your claim?
[CUSTOMER][NEUTRAL] I put it, OK, so I had a surgery done in January. The hospital put a claim. It was denied because of, I guess, of lack of documentation. I put the claim in myself thinking that any reimbursement would come to me, but then it was sent to the hospital because I guess I originally gave them permission to request a reimbursement.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the reimbursement went to the hospital, but then the hospital, I just spoke to them and they told me that they sent it back to you guys on March, I'm sorry, [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Oh OK well let me look and see the last time a claim was paid.
[AGENT][NEUTRAL] And see what the remarks on that.
[CUSTOMER][NEUTRAL] And you guys sent me a text recently also from the system. It looks like it was system generated like somebody submitted something to APR for for me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check real quick. Let me look in the notes and also to see if the check is cleared or not.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] What was the check amount for, do you know?
[CUSTOMER][NEUTRAL] 3000
[AGENT][NEUTRAL] OK, I do show the check number 2034761.
[AGENT][NEUTRAL] And the amount of $3000 was sent to HCA Florida JFK Hospital.
[AGENT][NEUTRAL] And the check did did clear the bank. They cashed it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me see if I've received anything back from them if they sent it in again.
[AGENT][NEUTRAL] And then they repro OK so I do see that.
[AGENT][NEUTRAL] A refund of $3000 was received for claim 357955. Let me write that down.
[AGENT][NEUTRAL] And then they reprocessed the claim.
[AGENT][NEUTRAL] Under 359-685-6, so let me look at that claim status for you real quick and see how it's going.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, they do show that they, the refund was received. So you're stating that this payment should have gone to you and not them, is that correct?
[CUSTOMER][NEUTRAL] Yes, the balance was that I, I paid out of my pocket was $3000 something dollars, which I submitted my, my EOB and and uh whatever it's called, UB40 UB04 to you guys and like that that's why the the refund was processed, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what I'm gonna do is I'm gonna transfer you on over to the claims department so you can speak to a claims specialist about this so that um we can see what the next step will be as far as getting you paid rather than the hospital since they returned the claim, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, ma'am. You're so welcome. It's gonna be a brief hold while I transfer you.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi [PII], it's [PII] in the care team.
[AGENT][NEUTRAL] I've got um Miss [PII] on the phone. Let me give you her policy number it's 255-088-8.
[AGENT][NEUTRAL] And she's been verified.
[AGENT][NEUTRAL] So she was calling about um claim number 3579555 was paid $3000 to the facility with check number 2034761.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The facility sent the check back to us because or or sent us a refund because the $3000 from what the insured is saying should have been paid to her.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And so I looked and I saw that um they replaced the claim number I just gave you with this new 1 359-6856.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it says refund was received and no further action is needed, but the insured wants to know when is she gonna be getting her $3000 that should have been paid to her originally that the.
[AGENT][NEUTRAL] Facility refunded us she's on the other line.
[CUSTOMER][NEUTRAL] OK, let me.
[AGENT][NEGATIVE] And I can't see anything in the notes that states that a check was sent to her.
[AGENT][NEUTRAL] For the payment.
[CUSTOMER][NEUTRAL] OK, so what I'm gonna do at this point is I'll go ahead and, and, uh, you can transfer her and I'm gonna send an inquiry to.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, the adjuster and just see if she's reprocessing that amount. She sent that out put that note in on 52, but I don't see any further updates, so yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. That's the same thing I.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] We see too OK.
[CUSTOMER][NEUTRAL] And what's her call back number to?
[AGENT][NEUTRAL] All right, [PII].
[AGENT][NEUTRAL] Oh, her callback number is the one she's calling from yeah it's [PII].
[CUSTOMER][NEUTRAL] Do you have her call back?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You can go ahead and transfer her when you're ready, bless you.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] OK, thanks, [PII]. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] You're welcome [PII].