AccountId: 011433970860
ContactId: 00080449-4b90-428d-a5f1-347492953121
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332279 ms
Total Talk Time (AGENT): 100451 ms
Total Talk Time (CUSTOMER): 193191 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/00080449-4b90-428d-a5f1-347492953121_20250210T16:37_UTC.wav
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[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling ATL.
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII]. I'm calling from the provider's office. I'm inquiring about the claim information for the member.
[AGENT][NEUTRAL] I'm sorry we were needing to check on a claim.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yep, and that's gonna be [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] 0.
[CUSTOMER][NEUTRAL] Um, sure. And the policy number is gonna be uh.
[CUSTOMER][NEUTRAL] 018.
[CUSTOMER][NEUTRAL] 16843 M as in Mary, L as in Lima number 8.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Name, uh, the insurance name is saying that it's gonna be a Cleveland Clinic, Florida Hospital.
[AGENT][NEUTRAL] OK, what was the name and date of birth for the patient? sorry.
[CUSTOMER][NEUTRAL] Uh, the name is gonna be uh, [PII].
[CUSTOMER][NEUTRAL] And the birth date is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Um, servicing date is gonna be [PII]. Charge amount uh $41,273.05.
[AGENT][POSITIVE] OK, got it thank you one moment please.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm sorry, [PII], what did you say the name of the uh provider's office was?
[CUSTOMER][NEUTRAL] Uh, Cleveland Clinic, Florida.
[AGENT][NEUTRAL] OK, and was that remaining balance after major medical paid was that $65?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Mm, OK. Medicaid paid and balance amount is not $65 actually. That's totally uh $2430.22.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] how long ago?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So excuse me, we did receive this claim.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] Uh, we were unable to pay a benefit as there are no benefits payable for chemotherapy or radiation therapy when administered in a physician's office or an outpatient facility.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. uh, for which, uh,
[AGENT][NEUTRAL] If you'd like, I can send you a copy of this EOD, [PII].
[CUSTOMER][NEUTRAL] Uh, which you will be, ma'am?
[AGENT][NEUTRAL] Um, this EOB with the Deal reason.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you want me to send that to you?
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] Uh, it is 349-672-0.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you're saying that uh under the radiology therapy, you're saying, right?
[AGENT][NEUTRAL] Yes, uh, so no benefits were payable for chemotherapy or radiation therapy when it's administered in a physician's office or an outpatient facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so only the.
[CUSTOMER][NEUTRAL] OK, so you're saying that uh the bill service is not being covered, right?
[AGENT][NEGATIVE] Right, uh, this policy is unable to pay this benefit.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK. So if, if this is, if this is not payable means it is the, the responsibility goes the member's responsibility, so the amount goes to the right.
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. So, OK, uh, this is the, this, this service is not payable under which benefits, ma'am. This is provide benefits or the patient plan.
[AGENT][NEUTRAL] Under this patient's plan.
[CUSTOMER][POSITIVE] Another business plan. Got it. Thank you so much for this information came to be here, ma'am. And OK. And uh you said uh your, your name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. And thank you so much for this information you brought me here. And uh may I get your reference for the, uh, nothing else, [PII]. Thank you so much for asking that. And may I get your reference?
[AGENT][NEUTRAL] Yeah, was there anything else I can help you with?
[AGENT][NEUTRAL] A reference number would just be my first name, last initial, and today's date, uh, so my last initial is A.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. OK. Thank you, [PII], for this information, going here and have a nice day, ma'am. Thank you. Thank you, ma'am. Bye.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Yeah, thanks for calling APL you too bye bye.
[AGENT][NEUTRAL] Bye bye.