AccountId: 011433970860
ContactId: 1db76e54-4b28-4c9f-9149-4f298aa7c75e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384049 ms
Total Talk Time (AGENT): 120727 ms
Total Talk Time (CUSTOMER): 170704 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/1db76e54-4b28-4c9f-9149-4f298aa7c75e_20250411T18:14_UTC.wav
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[CUSTOMER][NEUTRAL] I you.
[AGENT][NEUTRAL] Well, this is [PII]. How may I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling from Proda's office to check on a claim status.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with claim status. May I please get your callback number, ma'am, just in case the call is disconnected.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yeah, the call callback number [PII] and has an extension of [PII].
[CUSTOMER][NEUTRAL] No no I I.
[AGENT][NEUTRAL] OK, thank you very much, Ms. [PII]. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Oh, you said
[CUSTOMER][NEUTRAL] The patient's policy number will be 02518322 and the patient's name will be [PII] and the date of birth will be [PII].
[AGENT][POSITIVE] OK, let me pull that policy up for us real quick. Thank you for the information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh I'm.
[AGENT][NEUTRAL] OK, and may I please have the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, the date of service will be [PII] and the total charge amount will be $630 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Ah, it's $150.
[AGENT][NEUTRAL] Thank you. And may I please have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Name of the facility will be Cleveland Clinic Foundation.
[AGENT][NEUTRAL] OK. I'm gonna put you on a brief hold, Miss [PII], while I look up this claim for us and I will be right back.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][POSITIVE] Thank you. I appreciate it.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII].
[CUSTOMER][POSITIVE] Yeah, I'm here thank you.
[AGENT][NEUTRAL] So I'm looking on the data service of [PII], I do not find a claim on file for this member.
[CUSTOMER][NEUTRAL] Just you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. OK, so can I have the patient's effective date of coverages?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the policy terminated on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, I see the patient is active for the deed of service. Can we resubmit the claim?
[AGENT][NEUTRAL] Yes, you may.
[CUSTOMER][NEUTRAL] OK, can I have the timely filing limit to submit a claim?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK, uh, is there any, OK, I got that and the.
[CUSTOMER][NEUTRAL] Mailing address will be [PII]. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, um, for documentation purpose, can I know the corrected claims mailing address, mailing address and the timely filing limit?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For a corrected claim, you said?
[CUSTOMER][NEUTRAL] Mhm, yeah.
[AGENT][NEUTRAL] It's the same and the timely, there's no timely filing limit. If the claim is being corrected, then a letter will need to be sent as to why you want the claim corrected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, for appeals.
[AGENT][NEUTRAL] Appeals is 180 days from the date the claim was initially processed and it will also need a letter as to why you are appealing.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is that um mailing address will be the same for appeals?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK, could you please spell out your name for me?
[AGENT][NEUTRAL] Yes, it is [PII]
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] [PII], thank you so much, [PII], for your assistance. Have a great day ahead. Happy weekend to. Can I have the call reference number?
[AGENT][NEUTRAL] Yes, Ms. [PII], you can use my name and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And I hope you have a wonderful weekend too. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Um, no, thank you so much.
[AGENT][POSITIVE] You're very welcome. I thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Bye bye, ma'am.