AccountId: 011433970860
ContactId: 93650213-dd3a-43e3-8e38-51e56d60a1f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 435609 ms
Total Talk Time (AGENT): 163078 ms
Total Talk Time (CUSTOMER): 155862 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/93650213-dd3a-43e3-8e38-51e56d60a1f8_20250307T16:47_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office regarding the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, OK, yeah, it's 01912859 ML 8.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] What was the last four digits?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're calling for claim status. Uh, what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] OK, so the date of service is [PII].
[CUSTOMER][NEUTRAL] And the bill charges are $1,162 even.
[AGENT][NEUTRAL] And you said the data server is 113 of 23?
[CUSTOMER][NEUTRAL] And may I know your
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I apologize, he's gonna ask me?
[CUSTOMER][NEUTRAL] Yeah, may I know your name, please?
[AGENT][NEUTRAL] Sure, it's [PII]. And give me one moment. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yes, as the primary insurance process and applied patient responsibility of $80 but we have the payment from.
[CUSTOMER][NEUTRAL] Uh, American Public Life, which is paid for the initial patient responsibility due to that there is an overpayment on the claim.
[AGENT][NEUTRAL] OK. Well, uh, do you have the amount showing that we paid?
[CUSTOMER][NEUTRAL] Yes, it's $310.
[AGENT][NEUTRAL] OK. And
[AGENT][NEUTRAL] Do you happen to have a claim number?
[CUSTOMER][NEUTRAL] Yeah, I have the claim number. It's shall I go with the claim number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, OK, it's 327-730-09.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh looks like we paid 3:10. Give me one moment.
[CUSTOMER][POSITIVE] No problem, take your time.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Well, part of the explanation of benefits we received, that's the amount they had under for the patient's deductible and co-pay.
[AGENT][NEUTRAL] So that's the reason why we paid 310. So did the primary insurance reprocess the claim?
[CUSTOMER][POSITIVE] Yes, it's reprocessed and applied patient responsibility of $80 even.
[AGENT][NEUTRAL] OK, then we will need a copy of that EOB showing that the primary had reprocessed the claim because per the information we received, it shows that they applied the 310.
[CUSTOMER][NEUTRAL] I have the claim number of the primary process.
[AGENT][NEUTRAL] OK, then if you can submit that to us and just uh submit a letter or statement saying that there's an overpayment uh overpayment and submit that EOB along with it, that way they can request an over the overpaid amount, but per what we were initially received, that's what it shows.
[CUSTOMER][NEUTRAL] 5 minute message yeah.
[CUSTOMER][NEUTRAL] OK, so to recoup the over payment we need to submit the EOP copy of the primary UOP deposit EOP, right?
[AGENT][NEUTRAL] Correct. You must submit the EOB showing that the primary had repriced the claim and also submit a statement or submit a letter stating that the primary reprocessed the claim and then there was an overpayment. That way, one of our examiners can send a request for overpaid amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so uh we need to send the OB.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you please say?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So, uh, how we need to send the copy of the UB, uh, will you provide the fax, yeah.
[AGENT][POSITIVE] Yes, you will need it.
[AGENT][NEUTRAL] Sure. Our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, it's [PII]. Can I also have the refund address before ending the call?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, just a second.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] And last digits
[AGENT][NEUTRAL] For the zip code [PII].
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] Thank you so much for that. Yeah, so, uh, we need to send the copy of the UB with the statement as primaryly processed and applied the patient responsibility. We need to, uh, mention all those things and we need to fax the UB, right.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, perfect. Uh, can I get the call reference?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you so much for the information. It was great talking to you. Have a great day. Bye bye.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye.