AccountId: 011433970860
ContactId: 83de129d-a72c-48eb-bd0a-3dacea5e4333
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 492320 ms
Total Talk Time (AGENT): 259146 ms
Total Talk Time (CUSTOMER): 225221 ms
Interruptions: 6
Overall Sentiment: AGENT=-0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/83de129d-a72c-48eb-bd0a-3dacea5e4333_20250311T18:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII], and I have a quick question. Um, I had recently, um, had an ultrasound done, and what happened is I, they, they billed me or they charged me ahead of time before I even had the procedure and then when I went to the hospital, I gave them my gap insurance information they billed the insurance and gap both so you guys paid the insurance $500 and the $500 should have came to me.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So I just called the hospital and got them they said that they verified that there was a $500 credit on file, but they can't refund it to me they have to refund it back to you, so you can refund, so you can send it to me.
[AGENT][NEUTRAL] OK, well go ahead, [PII], and give me your policy number.
[CUSTOMER][NEUTRAL] That makes any sense.
[CUSTOMER][NEGATIVE] Sure, um, blah blah bah where my policy number go oh crap.
[AGENT][NEUTRAL] Can be your certificate number.
[CUSTOMER][NEUTRAL] Uh, policy number I have. OK, it's 02585874.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alrighty, [PII], thank you for that information. Now, while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] All right, [PII], thanks for all that information. Now, what is uh your date of birth and your address for me, please, ma'am?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] And my address is [PII].
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. OK, so what date of service is this bill from?
[CUSTOMER][NEUTRAL] This is from [PII].
[AGENT][NEUTRAL] Alright, let me get that bill pulled up. Let's see.
[AGENT][NEUTRAL] Alright, let me pull a copy of this claim up. Let's see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] My system's a little slow so bear with me, [PII].
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, let's see. Alright, I do say the claim Melbourne Regional Medical Center.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, yeah, I do see that you have a $500 per calendar day benefit. Yeah, and the allowable was $539 and we paid $500 but I do show this hospital sent this claim in a signed, so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I cannot ask for a refund. Yeah.
[CUSTOMER][NEUTRAL] I know, I
[AGENT][NEGATIVE] I can't legally ask for a refund. They sent it in a sign for us to pay them.
[CUSTOMER][NEUTRAL] Well, no, that.
[CUSTOMER][NEUTRAL] They, they
[CUSTOMER][NEGATIVE] I understand and I told him I said you double billed. I said you billed me and then you went ahead and build my secondary insurance, which you shouldn't have done.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I said you should have let me file that claim.
[AGENT][NEUTRAL] Yeah, because you could have right that way because if you had already paid it, we could have paid you, but this bill is a sign, so yeah, so legally.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] So what do I do now? Because they're telling me that that's the only way I can get a refund is if you request a refund and they gave me a fax number and an email address.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, I tell you what, [PII], I'm, I don't know. Legally I can't ask for the refund because they send it in a sign, so we have to honor their assignment of benefit, but what I can do, do you have a name who you spoke with at that hospital? I can call the hospital.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I mean, I, I called the billing department. I didn't call the hospital, so I called the billing department and I believe her name was Precious. I'm not even 100% sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you
[AGENT][NEUTRAL] Alright, well, do you tell me the number that you actually called for that. Do you have it?
[CUSTOMER][NEUTRAL] OK, yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the thing is, is everything is under Stewart, um.
[CUSTOMER][NEUTRAL] Associates or Stewart uh Medical.
[CUSTOMER][NEUTRAL] I know that it's Melbourne Regional, but it's under Stewart Medical is the is the organization.
[AGENT][NEUTRAL] Alright I'm writing this down.
[AGENT][NEUTRAL] OK, yeah, because at this point, I mean, I, I, I, I don't think I can send him a refund letter because our claim is paid correctly, but what I can do, like I said, is call this billing office and speak with someone about the $500 and tell them that, I mean legally, you know, we have to honor their assignment because they send it in a sign, so either they're gonna have to mail the check back to me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I can pay you, but they have to gonna have to give me authorization to do that.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, otherwise I just, yeah, I need to send it back.
[CUSTOMER][NEUTRAL] Right, but that's what they're, that's what that's what they told me is that you guys have to request the refund to be sent back to you.
[AGENT][NEUTRAL] Yeah, and I don't know that I can, but.
[CUSTOMER][NEGATIVE] Because they're, they're showing an over they're, they're showing a uh overage of $500 on my account.
[AGENT][NEGATIVE] Yeah, and I'm not understanding if you paid that why they can't send it to you. I'm not understanding because I sent their claim in, yeah, um, so, mhm, yeah, I'm not really understanding. I've never heard of that.
[CUSTOMER][NEGATIVE] I don't understand it either.
[CUSTOMER][NEUTRAL] And the thing is that
[CUSTOMER][NEGATIVE] And the, the sad thing is is that I told them I said you, you followed you filed a fraudulent claim with my secondary insurance. I said you should have never filed a claim. You guys were paid in full.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I said so now there's $500 of credit on my account. I said if I wasn't smart enough to ask for it, you guys would just have $500.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It would still be, yeah, yeah, and I definitely yeah you have to keep up with every little thing nowadays, but um I will make a phone call though um it might be a day or two before I get an answer, but I tell you what, once I find out what I can do legally.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I can call you back, [PII] and let you know, but I don't because I'm not sure they're gonna let me do a refund letter. This claim was paid correctly here, so, um, I'm not seeing that maybe not happen. Like I said, I will reach out to the hospital and explain that they sent this claim in assigned.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So they're gonna have to, they're gonna have to give you the money back. Yeah, that's up to them, but I will reach out to them and, and let them know the situation now, [PII], OK.
[CUSTOMER][POSITIVE] Right, I got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] OK, so how long should I wait before I follow up with somebody if I don't hear nothing?
[AGENT][NEUTRAL] Uh, probably, let's see, um, at least give me the Friday.
[CUSTOMER][NEUTRAL] Because this has been a couple week process already.
[CUSTOMER][NEUTRAL] OK, alright, I will.
[AGENT][NEUTRAL] Yeah, yeah, and if not, yeah, call back or if I, or if you don't hear back from me. Now my name is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And I, and I can call you back at this number you left me [PII].
[CUSTOMER][NEUTRAL] All right, my dear.
[CUSTOMER][NEUTRAL] Yes, that's my cell phone. Mhm.
[AGENT][NEUTRAL] OK, OK, alright, well just let me do some digging and some research, [PII] and find out, you know, what I can do for you, OK?
[CUSTOMER][NEUTRAL] OK, while I have you on the phone though, um, and now I just recently had surgery, um, on the [PII] and [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any way I can put a block on my account so they're not allowed to bill you?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] So I can file my own claim?
[AGENT][NEUTRAL] No ma'am. You can call them and tell them you want a copy of your bill and maybe send it in, try to get it in before they do.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Right, that's what I'm doing, so, yeah.
[AGENT][NEUTRAL] But I can't, yeah, I can't block him from billing legally. No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, but, OK, well, [PII], let me do some, some digging in and I will let you know something, OK?
[CUSTOMER][NEUTRAL] Got you. OK, my dear.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Thank you so much I appreciate it.
[AGENT][POSITIVE] Yes, ma'am. You're so welcome, [PII]. No problem, and you have a great rest of your day. Mhm. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][POSITIVE] You too thanks bye bye.