AccountId: 011433970860
ContactId: a883a9c5-4071-46cf-99d6-50e1279b50c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 670140 ms
Total Talk Time (AGENT): 154537 ms
Total Talk Time (CUSTOMER): 257012 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/a883a9c5-4071-46cf-99d6-50e1279b50c7_20250213T20:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, [PII], I am checking, uh, I got some questions about a claim.
[AGENT][NEUTRAL] OK, can I get your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] That would be.
[CUSTOMER][NEUTRAL] 02300109.
[AGENT][NEUTRAL] OK. Are you the policyholder or calling on behalf of the provider's office?
[CUSTOMER][NEUTRAL] Provider facility.
[AGENT][NEUTRAL] And the phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm, what's the date of service and total charge of the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For 3, for $13,297.18.
[AGENT][NEUTRAL] OK, we're just checking the status of this claim.
[CUSTOMER][NEUTRAL] Well, yeah, yeah, exactly I mean you guys made a payment but I got questions.
[AGENT][NEUTRAL] OK, about the payment. Give me one second, let me pull that up, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What's the patient's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] Uh, that would be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What do you have the claim number, [PII]?
[CUSTOMER][NEUTRAL] 355.
[CUSTOMER][NEUTRAL] 1237.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so the policy that that claim is under is 230.
[AGENT][NEUTRAL] And it's for a different patient as well.
[AGENT][NEUTRAL] You gave me 2. Yeah.
[CUSTOMER][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] What, what, what claim number did you hear me say?
[AGENT][NEUTRAL] You gave me 355-1237?
[CUSTOMER][NEUTRAL] Oh, you're right. That is not the right one. I apologize. There's a lot of patients on this thing. I, yes, it's more than one patient on this.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, or maybe it's not. I, I think what it is is this patient is a dependent on the policy. I'm pretty sure that's what it is.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] She's not the policy holder that's the problem she is like a let me because this is the right right claim number unless we posted it to the wrong account.
[AGENT][NEUTRAL] Maybe, let me look, hold on.
[CUSTOMER][NEUTRAL] But it says the insured, the insured is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the claimant is [PII]. So apparently, uh.
[CUSTOMER][NEUTRAL] I don't know what that means apparently I have no idea.
[AGENT][NEUTRAL] What's [PII]'s date of birth?
[CUSTOMER][NEGATIVE] I, I don't even know what's going on right now. You gotta excuse me for a second. I just ran into a problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because that's not [PII] name, you feel me?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, so let me just, why is the name different? That's the question I have right now. Let me check something.
[AGENT][NEUTRAL] Ma'am, it looks like it was posted to the incorrect patient because I see the payment under [PII].
[CUSTOMER][NEUTRAL] Well you guys made the payment, yeah, but I'm just saying you guys posted it to it because you put the account number that we build on the UBO4 on this ELB, you feel me?
[AGENT][NEUTRAL] But the
[CUSTOMER][NEUTRAL] We posted based on the data service and the patient account number.
[AGENT][NEUTRAL] Mhm. And what is the patient account number that you see?
[CUSTOMER][NEUTRAL] And that's
[CUSTOMER][NEUTRAL] [PII] and that is uh.
[CUSTOMER][NEUTRAL] [PII]'s account number.
[CUSTOMER][NEUTRAL] And her date of service as stated earlier is [PII] and the ID number that I provided you uh comes from.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]'s ID card.
[CUSTOMER][NEUTRAL] Uh, let me see, one, what is it? Give me one second. I wanna make sure. I believe that's I can't see where we got it anywhere else, but let me just double check.
[CUSTOMER][NEUTRAL] See what ID card we got here. Let's see.
[CUSTOMER][NEUTRAL] What? What is this? uh.
[CUSTOMER][NEGATIVE] Oh man, you guys are giving away money, huh? Is that what's going on?
[AGENT][NEUTRAL] No, I don't think so.
[CUSTOMER][NEUTRAL] I'm trying to figure this one out. I haven't gotten to the conclusion yet. You, I don't know, man.
[AGENT][NEUTRAL] Yeah, and I do, I pulled up the UBL4 and it is for [PII].
[AGENT][NEUTRAL] And you gave me policy 2300109. Give me a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh man, I hope I didn't jeopardize our payment. We like the payment, we want more, but we don't object to them, you know what I'm saying, right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Has that check been cashed?
[CUSTOMER][NEUTRAL] I'll give you two guesses and the first one don't count. How about that, you know what I'm saying?
[AGENT][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of course, it was cashed.
[AGENT][NEUTRAL] Yeah. Yeah.
[CUSTOMER][NEUTRAL] Yeah, man, that's like, uh, that's the first thing we do.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Give me 1 2nd, please.
[CUSTOMER][NEUTRAL] [PII], wow.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEGATIVE] Man, I can't even find that, uh, a McGee on her account, not a distant relative, a cousin, nothing.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see, give me 1 2nd.
[CUSTOMER][NEUTRAL] Oh man.
[AGENT][NEUTRAL] What we will do, um.
[AGENT][NEUTRAL] Is I'm gonna have to request that this one be reprocessed.
[AGENT][NEUTRAL] Under in month, so they're gonna be seeking a refund for the 1363.11.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I guess you guys uh.
[CUSTOMER][NEUTRAL] Let me ask you a couple questions whenever you get a free moment, [PII].
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] When did you guys receive our claim?
[AGENT][NEUTRAL] This claim was received.
[AGENT][NEUTRAL] On [PII], processed on [PII].
[CUSTOMER][NEGATIVE] OK, so it was for the claim number that I gave you, but it was the wrong patient.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, so I'll just put a note, uh, as to your analysis and we'll wait and let you guys have a second go at it. Is there anything you need from me?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, I'm gonna have to forward it to the appropriate area to get the correction made um and to send out a refund letter to your location.
[AGENT][NEUTRAL] Um, and then get it processed under the correct, um, patient.
[CUSTOMER][NEUTRAL] Do you need me to stay on the phone while you do what you gotta do?
[AGENT][NEUTRAL] Oh no, no, no, this will probably take anywhere I'm gonna say 5 to 7 business days.
[CUSTOMER][NEUTRAL] No I just meant making your request in your system because.
[AGENT][NEUTRAL] No, you don't have to.
[CUSTOMER][NEGATIVE] Uh, yeah, uh, do you have a reference number for me? I feel kind of useless right now.
[AGENT][NEUTRAL] Mhm. You'll use
[AGENT][NEUTRAL] You'll use my name in today's status.
[AGENT][NEUTRAL] As a reference for you.
[CUSTOMER][NEUTRAL] That is not the outcome I was looking for, just for the record, OK?
[AGENT][NEUTRAL] You'll use my name in today's date as reference um for today's call.
[CUSTOMER][POSITIVE] OK, but you, you know what they say it is what it is, you know what I mean, so I will talk to you guys later. Thank you so much.
[AGENT][NEUTRAL] It is what it is.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome and thanks for calling APM.
[CUSTOMER][NEUTRAL] You said 7, you said it should take.
[AGENT][NEUTRAL] allow 5 to 75 to 7 business days.
[CUSTOMER][NEUTRAL] How long do you say 7 to 14 business days? 5 to 7.
[CUSTOMER][POSITIVE] OK, thank you very much have a great rest of your day.
[AGENT][POSITIVE] OK, you too, [PII], thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Bye.