AccountId: 011433970860
ContactId: e20ef6ef-e262-4c83-a139-60a8ab428e38
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 405869 ms
Total Talk Time (AGENT): 78772 ms
Total Talk Time (CUSTOMER): 254927 ms
Interruptions: 4
Overall Sentiment: AGENT=1.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/e20ef6ef-e262-4c83-a139-60a8ab428e38_20250610T17:38_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling American Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with Legacy Financial. I'm the agent for a member that has gap insurance with you all, and I have a question in regards to a claim that he submitted online for reimbursement. I have all of his information for you.
[AGENT][NEUTRAL] OK. And what was the agency name?
[CUSTOMER][NEUTRAL] Legacy Financial Consulting.
[AGENT][NEUTRAL] OK, and may I have a callback number?
[CUSTOMER][NEUTRAL] Absolutely [PII].
[AGENT][NEUTRAL] And the policy number.
[CUSTOMER][NEUTRAL] It is 246-223-6.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Members's name and date of birth?
[CUSTOMER][NEUTRAL] His name is [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] And you were calling in for a status of a claim?
[CUSTOMER][POSITIVE] Well, he received a check he submitted um several um claims through the um APL member portal. I, I helped him over the phone to submit them um he had paid out of pocket for um PT uh physical therapy sessions he had forgotten completely about the APL so he submitted.
[CUSTOMER][NEUTRAL] The EOB's, um, the claim reports and the, uh, proof of payment for several dates of service with the, with the provider and he just received a check but.
[CUSTOMER][NEUTRAL] He was only reimbursed for two dates of service. The others indicate comment one which says paid to provider. So I wanted to I wanted to just get clarification if it was paid to the provider before he submitted this in or as a result of him submitting the claim.
[AGENT][NEUTRAL] Do you have a date of service?
[CUSTOMER][NEUTRAL] I do. I have several. Um, the first is [PII].
[AGENT][NEUTRAL] Is that the one that was saying denied pay to the provider?
[CUSTOMER][NEUTRAL] There's several, but yes, that's one of the ones that says paid to provider not denied but processed and was paid to the provider.
[AGENT][NEUTRAL] And what was the date of service again?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I want to see just how uh because they number one they overcharged him. Let's start with that um and then they were their medical insurance clearly stated what the copay was and they had overcharged him $20 already, so he was already speaking to them about getting reimbursed all those overchargements, but if.
[CUSTOMER][NEUTRAL] If they've already processed to the gap and collected from him, I, I just want clarification so we know how to go about.
[CUSTOMER][NEUTRAL] Dealing with them.
[AGENT][NEUTRAL] So if you leave the denial stating that it was paid to the provider that they then if it's stating that.
[CUSTOMER][NEUTRAL] on the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] From the reading of it, it says.
[AGENT][NEGATIVE] The policy benefit for the listed dates of service have been paid directly to the provider of services, so that meant it was previously paid to that provider, so that's a denial.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] To the provider, so it, OK, OK, so is there a way to know what day they were what day they were uh the provider was paid?
[AGENT][NEUTRAL] I can't give the information for the provider claim.
[CUSTOMER][NEUTRAL] I just want as much information to.
[CUSTOMER][NEUTRAL] Oh, you cannot give information to the propriety. OK, so basically all of those that say one that were already paid towards to the provider before he even submitted the reimbursement, basically is what you're saying, correct?
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, and you all will be able, he should be able to go out there and check any payments listed on the secured portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, even if he's not the one that submitted it, because I know sometimes if, if, um, I don't know if every, OK, so this is already, OK, I'm gonna have him go into the mineral portal because I have a feeling these people have triple dipped now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they were previously paid OK.
[CUSTOMER][POSITIVE] Wow, OK.
[CUSTOMER][NEUTRAL] Um, OK. And then I have a, um,
[CUSTOMER][NEUTRAL] OK, I'm gonna go ahead then and and let him know so that we could check the member portal then and see if he could see more.
[CUSTOMER][NEUTRAL] Uh, detailed information and that way he can speak to the provider.
[AGENT][POSITIVE] Yes, he will be able to.
[CUSTOMER][POSITIVE] OK, [PII], thank you so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead, he will be able to know what claim was paid from the provider or even to him. He will have on that portal. He will be able to access all that.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll have a look because when when I when we were doing the reimbursements they were not showing, so maybe they since then they have I don't know, it's very weird.
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][POSITIVE] These, these, uh, offices are fabulous. All right, [PII], thank you so much for your help. I appreciate it. Is there a reference number that I oh no, I think with you guys it's just first name and date of birth and the date of the today's date, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, [PII], can I get the first initial of your last name if you don't mind?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] All right. Wonderful. Thank you, [PII].
[CUSTOMER][POSITIVE] No, that's it. Thank you so much. I appreciate your help. Have a great day and um good rest of your week. Absolutely, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Thank you for calling American Public Life.
[AGENT][NEUTRAL] Same to you. Bye-bye.