AccountId: 011433970860
ContactId: 7cdf375a-f795-4854-b8d5-87c612bcc2a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 648739 ms
Total Talk Time (AGENT): 232913 ms
Total Talk Time (CUSTOMER): 259228 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/7cdf375a-f795-4854-b8d5-87c612bcc2a9_20250506T20:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, my name is [PII]. I'm calling with the provider's office, um, and I was calling to check on, um, a claim for a patient to see if you guys had received, uh, the check that we had mailed back since it was made out to a different doctor.
[AGENT][NEUTRAL] Yes ma'am, I can check that claim for you, Miss. What is your call back number just in case the call is disconnect.
[CUSTOMER][NEUTRAL] Uh yes, callback number it's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then may I please have the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh yes, name is uh [PII]. Date of birth is [PII]. Uh, the ID I have it's 02595679.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show [PII]'s policy number. Um, can you give me the date of service or do you even have the um claim number even?
[CUSTOMER][NEUTRAL] Uh, I don't have the claim number on me, but the data service is, uh, gonna be February 24th, 2025.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, let me look that up real quick, and what was the charge amount?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] A charge amount was $346.
[AGENT][NEUTRAL] Alright, I'm gonna put you on a hold while I look up this claim for us and I'll be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Miss [PII], can you please give me the name of the facility?
[CUSTOMER][NEUTRAL] Uh, yes, facility name is Dal Deov of Hefner.
[AGENT][NEUTRAL] OK, and what was the physician's name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Hm, I'm not finding the claim for um Mr. [PII] um I didn't find the claim on that data service. I only have one data service for for this member and.
[AGENT][NEUTRAL] It was for
[AGENT][NEUTRAL] [PII], but it wasn't that physician.
[AGENT][NEUTRAL] Let me keep looking.
[CUSTOMER][NEUTRAL] Yeah, that, that is one of the issues because we received because that is a data service with us, um, and we had received a payment for it, but the payment was made up to an [PII] of DDS but that's not one of our doctors and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, right.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm not quite sure how she even got attached to the claim, so um I was then told to um.
[CUSTOMER][NEUTRAL] Mail back out the claim to you guys and then once they received it they can process it under the correct provider and then send out the reissued check.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, alright, so what I'm gonna do is I'm gonna go ahead and transfer you now on over to the claims department so you can speak to a claims specialist about um getting the payment refunded back to you under the correct name.
[AGENT][NEUTRAL] So it's gonna be a quick hold while I transfer you on over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else, Ms. [PII], I can help with before I transfer you?
[CUSTOMER][NEUTRAL] No, that was all I needed.
[AGENT][NEUTRAL] OK, it's gonna be a brief hold. I'm gonna transfer you on over now thank you for calling APL.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], it's [PII]. You know, I'd transfer if I got home dingers.
[AGENT][NEUTRAL] I've got um
[CUSTOMER][NEUTRAL] Hi, sorry.
[AGENT][NEUTRAL] Hi, I've got Miss [PII] on the phone.
[AGENT][NEUTRAL] She is calling from provider's office. She is calling about policy number 259-567-9, and she's calling about claim number 3573265, and this is also in the notes um stating that the claim was paid to the wrong provider.
[AGENT][NEUTRAL] And they sent the check back because it was paid to the wrong provider and she's just calling to follow up to see when she's gonna get their money back paid to the correct provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And it's 3265, so we did get the check back. I don't see that it's been posted yet.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When the notes it says let's see.
[AGENT][NEUTRAL] It just says that um M [PII] said to send the check back in and then she needed to have the PPO changed with Carrington she needed to call Carrington.
[AGENT][NEGATIVE] But the claim she said was through us so they should get they should get their money back for the claim because it was filled out to the wrong provider.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] She's basically calling to follow up to see when they'll get their check.
[AGENT][NEUTRAL] To the correct provider.
[CUSTOMER][NEUTRAL] But she said that the check does is returned because I don't show that it's posted.
[AGENT][NEUTRAL] Yeah, she said it did return.
[CUSTOMER][NEUTRAL] Well I would have to probably say we'll reach out to the adjuster because I don't see first of all I don't see that the check has been voided.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me double check that.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] I'm not really sure.
[CUSTOMER][NEUTRAL] Yeah, I'm not sure what I'm not sure what to tell her.
[AGENT][NEUTRAL] Other than that we haven't.
[AGENT][NEUTRAL] Received the check yet?
[AGENT][NEUTRAL] And to give it some more time and I can tell her that.
[CUSTOMER][NEUTRAL] Yeah, because the check shows to be outstanding. So [PII]. I showed it paid, uh, payable to [PII] at Turp and DDS. The check is 2 for 249, um, but yeah, I don't see that it's been returned to us. So normally what happens when the check gets returned is that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I believe it's [PII] that handles the return mail with those checks, so then the check would be voided, so then it can be reissued. um, now as far as if it's been corrected, she did she say it's been corrected, the provider?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She hasn't, she hasn't said anything about that.
[CUSTOMER][NEGATIVE] She'll be returning the check that was on [PII], yeah, issued to the wrong provider once it reissued the F Rockwell Dental. I told him we hadn't.
[AGENT][NEUTRAL] I can get back to her.
[CUSTOMER][NEUTRAL] No, no, no, and it just says she's gonna contact [PII].
[CUSTOMER][NEUTRAL] And then she said she
[CUSTOMER][NEUTRAL] The adjuster told her she needed to call [PII] and have it set up that way.
[CUSTOMER][NEUTRAL] So I'm not sure if that's been done either but.
[AGENT][NEUTRAL] OK, so, so what do I?
[AGENT][NEUTRAL] Oh
[AGENT][NEGATIVE] What do I tell her? Just tell her that as of right now we're not showing that we have received the check?
[CUSTOMER][NEUTRAL] Basically, right, I don't show that the check's been received and is, is the issue with the um dentist being a PPO provider was that uh corrected with Carrington because they had told her on [PII] that she would need to call and I'm assuming they mean [PII] because that's what it says.
[AGENT][NEUTRAL] And did she call
[AGENT][NEUTRAL] Yes. OK. And if she has.
[CUSTOMER][NEUTRAL] She said the actual dentist is a PPO with Carrington and then they told her that she needed to call Carrington and have it set up that way. She said the bank wouldn't catch it with the dentist's name on it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so if she has further questions, I'll come back to you because I won't know how to answer those if she asks me anything else after I give her that.
[CUSTOMER][NEUTRAL] Do you want me to just take the call? I'll take the call, Tory, if you, if you'd like, um, it would be easier for you, yeah, that way we don't have to go back and forth. There we go.
[AGENT][NEUTRAL] Oh, OK. Yes. If you don't mind, that way we don't have to go back and forth.
[AGENT][NEUTRAL] For her. OK. All right, thanks, [PII].
[CUSTOMER][NEUTRAL] Because at this point I'm not sure what to tell her other than that, so yeah, go ahead and put her through and that callback number for her is that the one on the screen, the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] got it OK.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. Thanks, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.