AccountId: 011433970860
ContactId: 21154270-9654-4758-b9ea-6c4772b45530
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250869 ms
Total Talk Time (AGENT): 135627 ms
Total Talk Time (CUSTOMER): 90514 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/21154270-9654-4758-b9ea-6c4772b45530_20250123T15:29_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? this is Cleveland Clinic registration. I'm calling to check verification for the insurance for patient seen at the emergency department. Do you have a moment to help me to do that?
[AGENT][NEUTRAL] Absolutely, so you need eligibility and benefits, is that right?
[CUSTOMER][POSITIVE] Yes, it is right.
[AGENT][NEUTRAL] OK, go ahead and and um I'm sorry, can you tell me your first name?
[CUSTOMER][NEUTRAL] [PII] And your first name, too?
[AGENT][NEUTRAL] It's [PII], yeah, can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. The patient member ID number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 01791985. M as in Mary, L as in Larry, 7.
[AGENT][NEUTRAL] OK, and [PII], go ahead and and provide me your callback number in case we get disconnected during the call and I can call you back please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I'm sorry, can you tell me the name of the facility or provider's office?
[CUSTOMER][NEUTRAL] Clander Clinic emergency department.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Got you. OK, thank you so much. Just give me one moment to pull up that patient ID.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I please have you verify the patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have her date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, great, thank you, just give me one moment to pull up this uh eligibility information and just to let you know it is a verification of their coverage only and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The policy is active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Right, that's their effective date. The policy is currently active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said they were seen in the emergency department, were they admitted or just seen in the ER in the emergency room?
[CUSTOMER][NEUTRAL] No, now, the patient is seen as the emergency department. I don't have any more information.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] OK, alright, just verifying that it's outpatient benefits that you're needing, um, just to let you know this policy again is a it is a supplemental medical expense plan, so we're secondary to major medical.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now this policy will work hand in hand to cover co-insurance and or deductible amounts for services covered under the plan.
[AGENT][NEUTRAL] Now they do have an outpatient benefit maximum.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And, go ahead.
[AGENT][NEUTRAL] And that, that uh
[AGENT][NEUTRAL] That the outpatient benefit max is $500 per covered person and it's per calendar day so they're allowed up to that $500 benefit up to $500 and that would uh include that emergency room uh outpatient benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And what is the confirmation for our call right now?
[AGENT][NEUTRAL] Uh, [PII], you would use my name in today's date, [PII] is the last initial and then today's date.
[CUSTOMER][NEUTRAL] Today's date.
[CUSTOMER][NEUTRAL] OK. What is your initial? Sorry, I didn't hear you well.
[AGENT][POSITIVE] L like love.
[CUSTOMER][POSITIVE] Labs. OK, thank you.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Did you have any other questions? Did you need to verify the mailing address?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I.
[CUSTOMER][POSITIVE] No, everything is up to date. Thank you and have a great day. Bye.
[AGENT][POSITIVE] Thank you [PII] thank you for calling API. Have a great day bye bye.
[CUSTOMER][NEUTRAL] You too. Bye. Bye.