AccountId: 011433970860
ContactId: 7bef10b2-0680-4fcb-a624-8c6ed283c757
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1379479 ms
Total Talk Time (AGENT): 427602 ms
Total Talk Time (CUSTOMER): 567510 ms
Interruptions: 7
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/7bef10b2-0680-4fcb-a624-8c6ed283c757_20250109T21:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with the care team. How you doing?
[AGENT][POSITIVE] I'm good, [PII]. How are you doing?
[CUSTOMER][POSITIVE] Hey, I'm doing great and I have a feeling that maybe I should have like looked up the someone's little digits and.
[CUSTOMER][NEUTRAL] Called somebody. I have no idea what I'm doing, um.
[CUSTOMER][NEUTRAL] Hey, I have a claim and it looks like we paid it twice and we put it under somebody else's name the second time we paid it.
[AGENT][NEUTRAL] OK, what is the policy number?
[CUSTOMER][NEUTRAL] Policy number is 2,443,500.
[AGENT][NEUTRAL] OK, and for which part?
[CUSTOMER][NEUTRAL] Alright, I'm looking at part 3 and part 4. there's the same claim under both names.
[CUSTOMER][NEUTRAL] I think I don't actually I feel really confident in what I'm saying, but I do not process claims so that's why I called.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] No problem, just waiting on my computer.
[AGENT][NEUTRAL] OK, part 3 and part 4.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And I have both claim numbers when you're ready, but no rush because you know we're both paid by the hour.
[AGENT][NEUTRAL] Correct, thank you. So what's your claim number for part 3?
[CUSTOMER][NEUTRAL] OK, the claim number for part three is 3534537.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this one should be the correct claim like the claim matches the insured's name on this one.
[AGENT][NEUTRAL] OK, that's for [PII], OK, and the other claim number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yep, uh, for part four, the claim number is 352-450-6.
[AGENT][NEUTRAL] OK, so about the same dates of service.
[AGENT][NEUTRAL] OK, OK, I have that pulled up. OK, so, OK, so you're saying that they are one is processed incorrectly under the wrong part's name, is that correct?
[CUSTOMER][NEUTRAL] Yes, when I went into OnBase and I pulled up the claim, the claim name is [PII], and they're the same dates of service, same diagnosis codes, same CPT codes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK, so someone processed it incorrectly. OK, let me look here.
[AGENT][NEUTRAL] OK, so since you've already gone to on base, which one is it processed incorrectly? The one for [PII]? OK, so that's processed it correctly.
[CUSTOMER][NEUTRAL] The 506 mhm yeah, [PII]'s name on the file and or on the claim but his name on the policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, interesting, OK.
[CUSTOMER][NEUTRAL] The reason I pulled it up was because I thought the providers were pulling one over and submitting two claims, you know what I mean?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I was just like, oh I'm gonna flag that first.
[AGENT][NEUTRAL] OK, so these are process but two separate, uh, different, um, examiners. OK, so, OK, um, well, we will have to.
[AGENT][NEUTRAL] Request a refund just to make sure so OK so you have a provider on the phone?
[CUSTOMER][NEUTRAL] I do have a provider on the phone and she just wants like further information on what she needs to do.
[AGENT][NEUTRAL] OK, and what is her name, please?
[CUSTOMER][MIXED] Her name is [PII], and she is so sweet, but her background noise is really loud.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, do you have a callback number for [PII] or is it the number on the screen? OK.
[CUSTOMER][NEUTRAL] I do. It is not, oh, you know what? It is the number on the screen. Yeah, the same. And I'm so sorry, I should have taken this down, but what was your name? [PII].
[AGENT][POSITIVE] OK awesome.
[AGENT][NEUTRAL] My name is
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, it came back to me.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do you mind if I introduce you when we join calls?
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] I do not mind at all. [PII], go right ahead.
[CUSTOMER][NEUTRAL] And then do you mind if I listen in just so I can, I wanna be prepared, you know what I mean if I get this again.
[AGENT][NEUTRAL] Well, let me first pull up the claim, but just to go off what you said, the one that'll pay correctly is the 453 7.
[CUSTOMER][NEUTRAL] Yes, and then the incorrect one is the 506.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 12 9 24374.
[AGENT][NEUTRAL] And it processed under part 4, but it should also be part 3, is that correct?
[CUSTOMER][NEUTRAL] Yes, it is, it belongs to part 3 and it's the same claim we just paid.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so we are gonna have to request it. OK, so this process. Give me one second. 028.
[AGENT][NEUTRAL] 20.
[AGENT][NEUTRAL] 600 we have 1 pages.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me first get my
[AGENT][NEUTRAL] On base up, give me one sec.
[CUSTOMER][POSITIVE] Take your time. I'm in a rush.
[AGENT][NEUTRAL] 1234.
[CUSTOMER][NEUTRAL] I mean once you hit 5:30 I'll be in a rush, but like we got time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, come on.
[AGENT][NEUTRAL] OK, so so is processed on [PII] and that has cleared. OK, I have to request that.
[AGENT][NEUTRAL] And here we go this is for [PII]. OK, so that's good for [PII], OK.
[AGENT][NEUTRAL] So that is for for you, OK, so what we'll actually, OK, I'm ready, go ahead.
[CUSTOMER][POSITIVE] OK, I'm gonna join I'll introduce you and then I'll be quiet.
[CUSTOMER][NEUTRAL] Hi Miss [PII], are you still there with us?
[CUSTOMER][POSITIVE] Hey [PII], hey, thank you so much for your patience. I have [PII] on the phone and she's with our claims team. She's gonna take the call over from here, but she should be able to provide you further direction, OK.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so could you please help me with the call reference number? Oh, you got you. Um, my call reference number was [PII], first initial last name, [PII] in today's date.
[CUSTOMER][NEUTRAL] Uh, could you please repeat that for me, please? Yeah, you betcha. It's [PII]
[CUSTOMER][NEUTRAL] [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] [PII], hi, hi, my name is [PII].
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for.
[AGENT][NEUTRAL] Can you hear me? Hi. OK. Hi, [PII].
[AGENT][NEUTRAL] Yes, Ms. [PII] gave me all the information. It appears that we processed a claim twice.
[AGENT][NEUTRAL] And we will have to do since the check, yes, since the check has cleared, we will have to request a refund in the amount of $78.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. OK. May I place the call on hold for a couple of minutes, please, [PII]?
[AGENT][NEUTRAL] OK, go ahead, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Thank you for being on hold, [PII], and uh could you please repeat that information for me?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Certainly.
[AGENT][NEUTRAL] We process it a claimed twice for the same participant for the same member and that claim processed incorrectly as 352-4506.
[AGENT][NEGATIVE] We will have to request a refund in the amount of $78 because that is what we paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you made both of the payments, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And you are ready to refund the $78 even, right?
[AGENT][NEUTRAL] A request will be sent?
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] For a refund of $78.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Would you need that claim information just for your documentation as to which one I will be, well, excuse me, which one the adjuster will be requesting the refund? Would you need that claim number?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Or do you have the, oh, OK.
[AGENT][NEUTRAL] OK. Are you ready for the claim number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yes, I'm ready for the claim number.
[AGENT][NEUTRAL] OK, the claim number is 352-4506.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now would you also need that check number as well for your documentation?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, the
[AGENT][NEUTRAL] Check, OK, the check number shows 2,011,190.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the claim number ends with 506 is.
[CUSTOMER][NEUTRAL] Correct. And the claim number ends with 537 is.
[CUSTOMER][NEUTRAL] You will refund $78 from this one, right? The claim number that ends with 573.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, we will request a refund from the claim number that ends in 506.
[CUSTOMER][NEUTRAL] OK. So the refund is happening in this, the, in the claim number that is 506.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. So what about the next one?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What about the next claim number that ends with 537?
[CUSTOMER][NEUTRAL] Because actually we made payment, uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um, uh, that was my bad. The claim number that ends with 537 is correct and uh you will, you are ready to refund $78 in the claim number that ends with 506. Is that right?
[AGENT][NEUTRAL] I'm sorry, you will, excuse me, the provider will refund us the amount of $78.
[CUSTOMER][POSITIVE] OK. I'm so sorry that.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. I have a few more questions. Could you please help me with that also?
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes. Am I audible?
[AGENT][NEUTRAL] Yes, I, I can hear you. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it possible for take back from your side?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is it possible for a take back?
[AGENT][NEUTRAL] What is a take back?
[CUSTOMER][NEGATIVE] Um, it takes back from your side instead of refund.
[AGENT][NEUTRAL] No, we paid the claim incorrectly, so we've paid this particular twice actually.
[AGENT][NEUTRAL] And we need to um a refund on this particular claim, yes.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] It is not possible for equipment, right?
[AGENT][NEGATIVE] We will be requesting a refund in the amount of $78 for for claim number ending in 506. The claim was paid incorrectly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh the reason for the incurrect payment is you made.
[CUSTOMER][NEGATIVE] Payment twice incorrectly, right?
[AGENT][POSITIVE] That is correct. The payment was actually the plan was
[CUSTOMER][NEUTRAL] I.
[AGENT][NEGATIVE] Filed in a different participant's name so therefore again we will have to request a refund.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Because we have already paid that for that particular date of service for this particular member which is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim is processed as primary, right?
[AGENT][NEUTRAL] No, we are secondary.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] OK, I'm sorry, sorry, uh, claim is processed as secondary and uh it is not possible for uh recruitment from your side, right?
[AGENT][NEUTRAL] A secondary account. It's OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] We will be requesting a refund in the amount of $78.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And uh may I know the refund mailing address, please?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, the refund mailing address.
[AGENT][NEUTRAL] We will send a letter to the provider of service for the refund, so we will be sending a letter of a refund request to the provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And the refund amount is $78 right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] $28 even, right? OK. And will there be any interest applied?
[AGENT][NEUTRAL] I'm not certain if any interest will be applied.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEGATIVE] OK, so no interested.
[CUSTOMER][NEUTRAL] And the CPT code for this payment is 36416 and 99213 and 85025. Is that right?
[AGENT][NEUTRAL] Those are the procedure codes listed on the claim form.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That was that, uh, that is what I met and uh the paid amount is.
[CUSTOMER][NEUTRAL] $78 even and uh
[AGENT][NEUTRAL] The payment
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And the payment number is 2015833.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] And it is
[AGENT][NEUTRAL] I'm so sorry, can you repeat? I'm sorry, [PII], can you repeat that information and.
[CUSTOMER][NEUTRAL] OK, the, the payment number is 2015833, right?
[AGENT][NEUTRAL] Are you asking me what the check number was? Is that what you're asking me?
[CUSTOMER][NEUTRAL] Uh, the mode of payment is via EFT, right? And it is a single EFT?
[AGENT][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] No, the mode of payment was, no, the mode of payment was a single paper check and that check number is 24 was 2,011,190.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But actually checking up on the check number, that is the participant name is [PII].
[AGENT][NEUTRAL] That is correct and the claim was processed correctly in his name so again we will be requesting that refund in the amount of $78.
[CUSTOMER][NEUTRAL] OK. So you only have that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the payment number is 2,011,190, right? And uh
[CUSTOMER][NEUTRAL] It is the transaction is via check. It is a single check.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And could you please provide the amount also?
[AGENT][NEUTRAL] We paid $78.
[AGENT][NEUTRAL] 78.00 was paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], is there anything else I can assist you with?
[AGENT][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] Yes, I'm here. I have a few more questions, please. Uh, could you help me?
[AGENT][NEUTRAL] OK, anything else I can help you?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yes, yes. OK, so.
[CUSTOMER][NEUTRAL] Uh, could you, uh, please provide the time frame for the equipment?
[AGENT][NEUTRAL] For the refund request, um, I would have to send a request to the adjuster who processed the claim. Please allow at least 5 to 7 business days. It may be sooner, but please allow at least 5 to 7 business days for processing.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] OK. OK. And the amount is $78 even and there is no interest applied, right?
[AGENT][NEUTRAL] Again, I'm sorry, [PII], I'm not sure if any interest will be applied. I do not know that at this moment, but definitely we will be requesting that refund of $78.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So could you please help me with your call reference number also?
[AGENT][NEUTRAL] Um, we do not provide call reference numbers. You can use my name [PII], that is [PII]
[AGENT][NEUTRAL] My last initial is [PII], and today's date please, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for your assistance. Have a great day, [PII].
[AGENT][POSITIVE] And you as well and thank you so much [PII] for calling APL. Take care bye.
[CUSTOMER][POSITIVE] Thank you so much. Bye-bye.
[AGENT][NEUTRAL] Mm