AccountId: 011433970860
ContactId: ab57795a-ccdd-45ff-b2f4-4e6a2db70994
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 459640 ms
Total Talk Time (AGENT): 122204 ms
Total Talk Time (CUSTOMER): 116771 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/ab57795a-ccdd-45ff-b2f4-4e6a2db70994_20250604T17:16_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII] how can I assist you today?
[CUSTOMER][NEUTRAL] Good afternoon. Um, this is [PII].
[CUSTOMER][NEUTRAL] And this is about a claim that I filed, and supposedly it was paid.
[CUSTOMER][NEUTRAL] But I haven't, excuse me, I haven't received the check or it's not in the bank.
[AGENT][POSITIVE] OK, I'll be happy to assist, [PII], if I can get a good callback number for you.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] I should memorize this number.
[CUSTOMER][NEUTRAL] Let me see. It is 02502437.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, can you repeat that policy number for me?
[CUSTOMER][NEUTRAL] Sure. It's 02, I'm sorry. It's uh yeah, 02502437.
[AGENT][NEUTRAL] Yeah and your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And if you can verify the email address for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the date of service for the claim?
[CUSTOMER][NEUTRAL] It was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you submitted the claim? OK, yeah.
[CUSTOMER][NEUTRAL] I did.
[AGENT][NEUTRAL] OK, because it looks like payment went to.
[AGENT][NEUTRAL] Directly to the provider.
[AGENT][NEUTRAL] There was a
[CUSTOMER][NEUTRAL] Oh God.
[AGENT][NEUTRAL] $50 payment that went to orthopedic specialists.
[CUSTOMER][NEUTRAL] How is that even possible when I'm the one that filed the claim?
[AGENT][NEUTRAL] Oh, OK, so I don't know why they.
[AGENT][NEUTRAL] One moment, let me see.
[AGENT][NEUTRAL] Oh, OK, on the claim form that you sent.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It had an assignment in box 27, except assignment, it was checked, yes.
[AGENT][NEUTRAL] Of that, um, claim form. That means the payment comes to the provider. If it had been checked, no.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The payment, so that's what it was, it was that this that that box.
[AGENT][NEUTRAL] Was checked and um in the on the claim form that you sent to us but if you've already paid them just contact them to let them know that um when they get the payment they can either send it back to us.
[AGENT][NEUTRAL] To devoid and reissue to you or they can just give you the, you know.
[AGENT][NEUTRAL] Um, give the money to you, so.
[CUSTOMER][NEGATIVE] This is really, really upsetting. It is, it is.
[CUSTOMER][NEUTRAL] Because I did all this online and it took me, well, we're in June.
[CUSTOMER][NEUTRAL] It started in March.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, but by law if that box is checked on that claim form you sent, we have to pay the provider.
[CUSTOMER][NEUTRAL] OK, I was told whoever files the claim, that's where the money's gonna go to. I don't really remember the box. Mhm.
[AGENT][NEUTRAL] And that's true.
[AGENT][NEUTRAL] Had you not sent that, that form, that uh claim form that you sent?
[AGENT][NEUTRAL] Um, had that, had that not been checked, if you hadn't sent that, then, you know, if you had other documentation and you probably provided that because we needed the actually, the medical record had the diagnosis, but that's what made her, when she processed the claim, she had to pay the provider because there was an an an assignment of benefits to the provider on that claim form.
[CUSTOMER][NEGATIVE] Well, seriously, not, nothing against you. I know you're only doing your job, but it's, it's, it's so frustrating, and this, this new website too doesn't help much. I haven't been able to see what what's going on or anything. It is really, really disappointing because God knows how long is it gonna take me for them to tell me that I paid 60 and I'm only getting 50. So, this is, this is really, really, really upsetting.
[CUSTOMER][NEUTRAL] All right, let me, um, let me reach out to them and, and see.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] OK. I'm so sorry.
[CUSTOMER][NEUTRAL] It's OK. It's not your fault. It's not. Have a good day.
[AGENT][POSITIVE] You too, thank you for calling bye bye.
[CUSTOMER][NEUTRAL] Bye bye. Bye.