AccountId: 011433970860
ContactId: 3c5c46d3-a9b2-4d7f-8a34-c4052252f5f5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 464160 ms
Total Talk Time (AGENT): 237434 ms
Total Talk Time (CUSTOMER): 215541 ms
Interruptions: 4
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/3c5c46d3-a9b2-4d7f-8a34-c4052252f5f5_20241231T16:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], good morning. My name's [PII]. I'm calling you this morning from Cleveland Clinic Hospitals Foundation here in [PII]. I do have a patient on my back line. Um, she gave me, um, some insurance information, and I'm calling to verify that this is medical insurance that's being billed. Can you help me with that, please?
[AGENT][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] OK, [PII], so you're needing to verify eligibility and get benefit information on a member?
[CUSTOMER][POSITIVE] Yes. Yes, please.
[AGENT][NEUTRAL] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 01663504
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And [PII] any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, so in our system, we show her as [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she is the subscriber on the supplemental policy.
[AGENT][NEUTRAL] This supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] So this is medical inpatient, outpatient or.
[CUSTOMER][NEUTRAL] Combination of all of the above.
[AGENT][NEUTRAL] Yes, and this is a this is a supplemental policy to her primary um excuse me, primary health care insurance that helps with co-pays, deductibles, and co-insurance amounts of covered services.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Mhm. You're welcome.
[CUSTOMER][NEUTRAL] Now she, she gave me a group number of 22967, is that correct?
[AGENT][POSITIVE] That is correct. Mhm, it is.
[CUSTOMER][NEUTRAL] Her insurance ID number 01663504, is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] What is the claim's mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] How about a phone number for claims please?
[AGENT][NEUTRAL] The same number you called?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] She is a subscriber. She owns this insurance, correct?
[AGENT][NEUTRAL] She is the subscriber.
[CUSTOMER][NEUTRAL] And you have her listed as [PII], correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, no. [PII].
[CUSTOMER][NEUTRAL] How do you have her listed?
[AGENT][NEUTRAL] Again, [PII].
[CUSTOMER][NEUTRAL] OK, I'm gonna take a look to make sure we have this correct in our system.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And may I take your name and a call reference number?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Spell your name for accuracy.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you. Today's date, yes, ma'am.
[AGENT][NEUTRAL] And [PII], mhm. And again, this is a supplemental policy. This policy only has benefits for inpatient hospitalization.
[CUSTOMER][NEUTRAL] I will put that down inpatient hospital only, correct?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me see. I have everything covered. I'm gonna have to take a look at all these claims that she has.
[AGENT][NEUTRAL] And when the, oh, I'm so sorry, go ahead. I did not mean to overtake you. Go ahead.
[CUSTOMER][NEUTRAL] Because I do believe she.
[CUSTOMER][NEUTRAL] No, you're OK.
[CUSTOMER][NEUTRAL] That's OK. I do believe she's not aware of her policy and how it works.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I have to check to see what she has inpatient hospitalization only. Got you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Do not think any of these charges will apply now. [PII], thank you so much for all of your help. I'll be able to go ahead and further assist.
[AGENT][POSITIVE] Yes, and you're certainly welcome.
[AGENT][NEUTRAL] And if you do end up submitting, if there are claims submitted [PII] to APL for review, we would have to also uh receive a copy of the primary insurance company's explanation of benefits for review as well.
[AGENT][NEUTRAL] And then we do have we do have a portal once the claim has been processed by APL in which claim status can be checked and you would have access to the.
[CUSTOMER][NEUTRAL] Understood.
[AGENT][NEUTRAL] of benefits and that portal website is [PII].
[CUSTOMER][NEUTRAL] [PII], thank you. Looking at these charges, I do not believe we will be submitting in any claims whatsoever.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] She did indicate to me on the call that um the insurance she has will pay for all co-pays, etc. but she's not understanding inpatient hospital.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, and this particular plan that her employer opted to go with, um, does not have outpatient benefits. Most of the, um, I mean, a lot of them, I'll say most, a lot of the Medin, the supplemental policies do have outpatient benefits, but this one does not.
[CUSTOMER][NEUTRAL] Understood understood. I'm going to review all of these claims once again just to take a look, um, majority of them so far as I'm speaking to, none of this is going to apply.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So I have her on my back line. I will have this conversation with her and actually do you have a problem with me bringing her into this call? I don't think I'll be able to that's OK. I will explain if she needs to further she could contact your business directly but yes um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, she can call us if she has any further questions or you um I, I don't have a problem with you conferencing her in.
[AGENT][NEUTRAL] But did you say can?
[CUSTOMER][NEUTRAL] I don't think I can at this time the way I called you. I just have her on the back line hold that's fine. I'm going to go through this with her and.
[AGENT][NEUTRAL] 00, I.
[AGENT][NEUTRAL] Ah, OK.
[CUSTOMER][NEUTRAL] Advise her, so thank you for this information. None of these claims qualify.
[AGENT][NEUTRAL] Well, you are
[AGENT][POSITIVE] Uh, OK. Well, if that is OK, mm, OK. Well, if, if you have any other questions, just please feel free to give us a call back and we'll be more than happy to help you. Otherwise, [PII] I hope you have a wonderful day and a very happy New Year.
[CUSTOMER][NEGATIVE] So unfortunately.
[CUSTOMER][POSITIVE] Happy [PII] to you as well, [PII]. I hope you have a great day and thank you for your assistance. Greatly appreciate it.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you. Absolutely. It was my pleasure. It was my pleasure.
[CUSTOMER][NEUTRAL] Bye now.
[AGENT][NEUTRAL] OK, bye-bye.