AccountId: 011433970860
ContactId: 00b894db-9839-4906-860e-cd5fdabc40e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261589 ms
Total Talk Time (AGENT): 101674 ms
Total Talk Time (CUSTOMER): 113206 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/00b894db-9839-4906-860e-cd5fdabc40e1_20250331T20:02_UTC.wav
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[AGENT][NEUTRAL] Well, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Hi, this is [PII] from I need to check eligibility for a patient.
[AGENT][NEUTRAL] OK, I can help you with eligibility, [PII]. Can I please get your callback number?
[CUSTOMER][NEUTRAL] OK, I can help you with eligibility. [PII]. Can I please get your callback number? Sure, it's [PII] with an extension which is [PII].
[AGENT][NEUTRAL] Thank you, sir. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] in the
[CUSTOMER][NEUTRAL] Alright, let's start with the policy number which is 01792009 M as in Mike L as in Larry number 8.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Her name is [PII].
[CUSTOMER][NEUTRAL] And her date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the name of the facility you're calling from, [PII]?
[CUSTOMER][NEUTRAL] Why
[CUSTOMER][NEUTRAL] Cleveland Clinic Hospital.
[AGENT][NEUTRAL] OK, let me pull up this policy.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, I do see that [PII] does have an active policy, and the effective date of the policy is [PII].
[CUSTOMER][NEUTRAL] You say that [PII] does have an active policy.
[CUSTOMER][NEUTRAL] And see if that's.
[CUSTOMER][NEUTRAL] Alright, got it. So the reason I'm calling is because she's scheduled to have an office visit with um, um, specialist, specialty is orthopedics, and so I need to check if she requires a referral or something and to see if we are in network for her to go to to her appointment.
[AGENT][NEUTRAL] OK, uh, and this is just to verify her benefits. It's not a guarantee of payment. She has, um, let me see if she has office visits on her policy.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] She does not require referral and there's no network.
[CUSTOMER][NEUTRAL] My
[AGENT][NEUTRAL] Not
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] Primary
[CUSTOMER][NEUTRAL] Oh, sorry, you're, you're breaking up a little. Can you repeat that?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Did you hear me?
[CUSTOMER][NEUTRAL] Yeah, I'm here uh yeah I can hear you now. Sorry, you were saying?
[AGENT][NEUTRAL] OK, so yes, sir.
[AGENT][NEUTRAL] I was saying that she does not need to have authorization. This is not her major medical insurance.
[CUSTOMER][NEUTRAL] But I mean
[AGENT][NEUTRAL] So no authorization is needed, but I'm gonna look to see if she does have office visits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it and I want you're looking for that. Are you, are you able to check what her major medical insurance is because I don't have that information file.
[CUSTOMER][NEUTRAL] So I may need to call them.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Yes, what I'll do is let me check this real quick and then we'll go move on to that and I'll be able to help you that way, um.
[CUSTOMER][NEUTRAL] Sure, I have.
[AGENT][NEUTRAL] OK, office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let's look and see what her major medical is.
[AGENT][NEUTRAL] Her major medical is [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Alright, I will call them in that case then, but, uh, thank you so much for the information provided for me today. You got a call reference number?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, sir, you can use my name, [PII]
[CUSTOMER][POSITIVE] Yes sir, you can
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] Alright awesome then thank you so much for the help today [PII] and have a good one.
[AGENT][POSITIVE] Thank you, [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] That will be all. Thank you so much.
[AGENT][POSITIVE] Thank you you have a good day and thanks for calling APL.
[CUSTOMER][NEUTRAL] For the second of those.
[CUSTOMER][NEUTRAL] Bye bye.