AccountId: 011433970860
ContactId: cb3ab2c2-897e-4829-9294-4ebbac9bbeaf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 439359 ms
Total Talk Time (AGENT): 96449 ms
Total Talk Time (CUSTOMER): 103573 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/cb3ab2c2-897e-4829-9294-4ebbac9bbeaf_20250626T15:37_UTC.wav
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[AGENT][NEUTRAL] For calling APO this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have a callback number for you, [PII], and the policy number?
[CUSTOMER][NEUTRAL] Callback number is [PII] extension 5952.
[CUSTOMER][NEUTRAL] Member ID is 022.
[CUSTOMER][NEUTRAL] 86183.
[AGENT][NEUTRAL] Give me that policy number one more time.
[CUSTOMER][NEUTRAL] 02286183
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And you're calling to check the status of a claim for what date of service, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. What is your procedure called?
[CUSTOMER][NEUTRAL] Procedure code is 96372 and J 3420.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] 963-72.
[AGENT][NEUTRAL] The claim was received [PII]. It was processed [PII]. There was a payment of
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] $25 made on that claim?
[CUSTOMER][NEUTRAL] It was exactly $25.26.
[AGENT][POSITIVE] Mhm, that's correct, which was the benefit maximum.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, so we received a refund request letter from the insurance, American Public Life, and I believe they accidentally requested the incorrect refund amount because the actual overpayment was for just $15 for CBD 96372.
[AGENT][NEUTRAL] Give me one moment. Do you have that claim number for the refund letter?
[CUSTOMER][NEUTRAL] But the refund letter is
[CUSTOMER][NEUTRAL] Yeah, one moment.
[CUSTOMER][NEUTRAL] So, claim number is 355.
[AGENT][NEUTRAL] I found it.
[CUSTOMER][NEUTRAL] 2077.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I place you on a brief hold?
[AGENT][POSITIVE] Well I research this. Thank you. I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Why the refund.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for holding. I apologize for the inconvenience. So it looks like the original claim, there was only $10.26 made on that claim.
[CUSTOMER][NEUTRAL] Yes, so the overpayment should be $15 correct?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] But the refund letter we received is requesting a refund of 1526.
[AGENT][NEUTRAL] It is.
[AGENT][NEUTRAL] OK, so I'm gonna send this to the adjuster for review so that the corrections can be made.
[AGENT][NEUTRAL] In regards to this?
[AGENT][NEUTRAL] And an updated refund letter would be.
[CUSTOMER][NEUTRAL] And once they
[CUSTOMER][POSITIVE] Easy, easy.
[AGENT][NEUTRAL] Sent out.
[CUSTOMER][NEUTRAL] Letter
[CUSTOMER][NEUTRAL] And is there any turn around time for that?
[AGENT][NEUTRAL] Um, no, there is no turnaround time because I'm not sure. I have, there's a process. I have to send this over to the adjuster. The adjuster will have to research and then it'll go from there.
[CUSTOMER][NEUTRAL] OK, got it. May I know the call reference?
[AGENT][NEUTRAL] We don't provide those, [PII]. You can use my name in today's date as a reference.
[CUSTOMER][POSITIVE] OK thank you have a great day bye.
[AGENT][POSITIVE] Thanks for calling APL and you have a great one as well. Bye bye.