AccountId: 011433970860
ContactId: ae7334ea-39fc-4bbb-bc29-9f8493980455
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396450 ms
Total Talk Time (AGENT): 125488 ms
Total Talk Time (CUSTOMER): 174445 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/ae7334ea-39fc-4bbb-bc29-9f8493980455_20250319T12:45_UTC.wav
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[AGENT][POSITIVE] Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm calling from provider's office. I have to know the claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. Thank you for asking. How are you today?
[CUSTOMER][POSITIVE] Yeah, I'm great thank you for asking and uh could you please spell your name?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And [PII], what is a good callback number, please?
[CUSTOMER][POSITIVE] Thank you for that, uh, yeah, sure, thank you for that, [PII], and my callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. [PII], what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, sure, the policy number 01480079 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, sure, it's uh the patient name is uh.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] All right, thank you. And [PII], it would be my pleasure to assist you with that claim status. Do you have a data service or claim number?
[CUSTOMER][NEUTRAL] Yeah, sure, I have both. Uh, the date of service is [PII].
[CUSTOMER][NEUTRAL] Mm claim number 3458694.
[AGENT][NEUTRAL] And what is the name of the facility, please?
[CUSTOMER][NEUTRAL] Mm just a moment, um, it's Holy Cross Hospital.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I'm just pulling everything up, give me just one moment if you don't mind.
[CUSTOMER][POSITIVE] Yeah, sure, take your time, [PII]. No problem.
[AGENT][NEUTRAL] I'm just checking on this for you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do have that claim pulled up.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number 3458694 and that was received on [PII] and processed on [PII] with a payment of $1,742.59.
[CUSTOMER][NEUTRAL] OK, uh, are you the primary insurance, right, uh, sorry, I mean, uh, secondary insurance, right, uh.
[AGENT][NEUTRAL] Yes
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, thank you for that. And uh could you please uh help me with that on that [PII] actually later you paid $1,742.59. Later we received a payment of $581.82.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I get the claim number 34590007.
[AGENT][NEUTRAL] O for
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please check that? uh.
[AGENT][NEUTRAL] Yeah, I'm seeing that payment as well.
[CUSTOMER][NEUTRAL] OK, um, may I know the reason for that? I paid, uh, uh, twice.
[CUSTOMER][NEUTRAL] Because the primary applied PR was $1,742.59 initially that was paid by you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Insurance and later you paid $581.82.
[AGENT][NEUTRAL] Yeah, let me check that. Hang on just a second.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] I am checking I'm pulling the claim up to see looks like that might have been paid in error, but I'm checking on it.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] What I'm going to do, [PII], is I'm going to send this back to the adjusters to review.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so they may, um, they may need to send out a refund request if there's an overpayment.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] OK, uh, are you going to, uh, send for review for the equipment of 5 $81.82 dollars 80 cents?
[AGENT][NEUTRAL] Yes sir, yes sir, that would be the one I'm sending back for review, um, and if there is an overpayment, they will send a refund letter.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] To Holy Cross Hospital refund request.
[CUSTOMER][NEUTRAL] OK, if, uh, OK, thank you for that. How many days it will take to, uh, for the review, uh.
[AGENT][NEUTRAL] I would give it, um, about 7 to 10 days.
[CUSTOMER][NEUTRAL] Is it a business days or calendar days?
[AGENT][NEUTRAL] Business days, please, sir.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you for that and uh could you please help me with the call reference, uh.
[AGENT][NEUTRAL] The call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Mm, OK, just a moment.
[CUSTOMER][POSITIVE] OK, thank you for that and uh.
[CUSTOMER][NEUTRAL] I have two more claims, OK. In those claims, what happened is we received, uh, we received two payments overpayment, so we received a, uh, a refund letter, but it was on [PII]. So can we directly refund to your address in the listed in the letter?
[AGENT][POSITIVE] Yes, that would be fine.
[CUSTOMER][POSITIVE] OK, thank you for that. Uh, thank you for helping me through the call, [PII]. You have a nice day.
[AGENT][POSITIVE] I hope you have a wonderful day as well, [PII]. It was my pleasure to assist you and thank you for calling APL.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yeah you too bye bye.
[AGENT][NEUTRAL] Bye bye.