AccountId: 011433970860
ContactId: 49cdd48f-c5cb-4cb9-9f24-8c90de11ecbe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 792119 ms
Total Talk Time (AGENT): 201301 ms
Total Talk Time (CUSTOMER): 547601 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/49cdd48f-c5cb-4cb9-9f24-8c90de11ecbe_20250212T18:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII] from Cleveland Clinic, uh, billing department. I do have a patient here on the line with me and we're checking about her eligibility for a specific date of service.
[AGENT][NEUTRAL] OK, I can um help you with eligibility, Ms. [PII]. What is your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, it is, um, direct line [PII].
[AGENT][NEUTRAL] [PII] and uh [PII] you said?
[CUSTOMER][POSITIVE] Yeah, yes, correct.
[AGENT][NEUTRAL] OK thank you what's the patient's name?
[CUSTOMER][NEUTRAL] Um, patient's name is [PII].
[AGENT][NEUTRAL] And what's Ms. [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And then what is [PII]'s policy number, please?
[CUSTOMER][NEUTRAL] Uh, phone number on file. Let me check here. 95 0 policy. Um, she provided 02, I'm sorry, 02550.
[AGENT][NEUTRAL] No, policy, policy number.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] 885 M for Mary, L for Lima, number 7.
[AGENT][NEUTRAL] Number OK let me pull in her policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me make sure I've got it correct. 0255085.
[AGENT][NEUTRAL] ML 7
[CUSTOMER][NEUTRAL] Um, no, it's 0885.
[AGENT][NEUTRAL] 885 at the end. OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. Let me pull that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I've got Ms. [PII]. Um, her effective date of her policy is [PII]. Her policy is active.
[CUSTOMER][NEUTRAL] As of now, OK, got it here. and Ms. [PII] is asking to connect her over as well with a representative. I'm not sure what is the reason why, um, can I add her over?
[AGENT][POSITIVE] Yes, I can, I can help her.
[CUSTOMER][NEUTRAL] Uh-huh, OK, OK.
[AGENT][NEUTRAL] And if I can't, I can find somebody who can.
[CUSTOMER][NEUTRAL] Yeah. OK. All right. One moment here.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] Hello [PII], thank you for patiently waiting. Uh, we already have [PII] here on the line and she's she already provided your eligibility, um, information for your date of service here and then do you have additional questions because you uh requested a while ago to be connected with them.
[CUSTOMER][POSITIVE] That if we have any questions, you, you, yes we do. My mom is actually helping me, um, she might have a question, um.
[CUSTOMER][NEUTRAL] Here, here she is. OK, so because we don't understand how this secondary policy works, um, because we've now given the information to Cleveland Clinic and um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII] is on the line as well. Um, it's [PII].
[CUSTOMER][NEUTRAL] Uh, I'm sorry, sorry, um, so does now that Cleveland Clinic has the secondary policy on file, will it be necessary for [PII] to show her.
[CUSTOMER][NEUTRAL] Eligibility every time she goes to the clinic urgent care, um, to the doctor's visit, what, what happens now as to we she didn't know that she was supposed to.
[CUSTOMER][NEUTRAL] She forgot every time to give this card number, so can you explain that or be be make us knowledgeable about what happens now?
[CUSTOMER][NEUTRAL] Or what do we have to go back to all the doctors and give them the secondary information?
[AGENT][NEUTRAL] We always instruct our insured and this is [PII], we always instruct our insured to carry their card with them and every time they go to a visit to bring both cards so that the office has both um policies for them. Now it's up to the individual um facility to decide if they're going to request it every time.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I don't know how the individual facilities uh keep up with policies for their patients because we're the insurance company and we just provide the insurance benefits, but I would say yes, bring your card with you every time you go to the doctor, that way you have it.
[CUSTOMER][POSITIVE] OK, now, [PII] has been to several doctors at Cleveland in the past month, months, uh, of this year, and she has this benefit.
[CUSTOMER][NEUTRAL] Should you, what do you advise her to do at this point?
[CUSTOMER][NEUTRAL] Uh, go back to each doctor Cleveland Clinic, you might have some information on this because you're, we're talking to Cleveland billing. Uh, what do you advise [PII] to do? Yeah, so what I can do advise to [PII], um, since she has different.
[CUSTOMER][NEUTRAL] Um, policy number here. Uh, she stated a while ago, it's different from in hospitals and our hospital, uh, policy. Um, she might also bring the card to let us know if uh we will bill the in-hospital or the out the hospital, um, policy. But if you want, I can note here that the patient does have
[CUSTOMER][NEUTRAL] Different policy number depends on the service that she, she's going to have for the Cleveland Clinic. No, in the past we're talking about her past, the past, yeah, that's so on the card.
[CUSTOMER][NEUTRAL] Mhm. All right. And then, uh, for the past.
[CUSTOMER][POSITIVE] Yes, um, I can.
[CUSTOMER][NEGATIVE] you're breaking up you're breaking up a little bit.
[CUSTOMER][NEUTRAL] Um, how about now?
[CUSTOMER][NEUTRAL] I think I can hear you now.
[CUSTOMER][NEUTRAL] I'm sorry for that. Maybe that's the connection. Um, yeah, so I can, um, request for the past date of service [PII], which is the activity date to be added here on file. Sorry ma'am, you're breaking up again you're breaking up again. I don't know why this is happening.
[CUSTOMER][NEUTRAL] Um. Hello.
[CUSTOMER][NEUTRAL] Yeah, I'm still here.
[CUSTOMER][NEUTRAL] OK, yeah, it wasn't hold on. I don't know she has the information how many doctors she's been to. I don't know, maybe she can tell you. I don't remember how many doctors I've been to in the last.
[CUSTOMER][NEUTRAL] Since the beginning of January, um, I don't remember, so I don't know what my mother is talking about. I've been to the, I know I've been to, I've been to a bunch of doctors, but I cannot remember everybody I've been to in the last two months.
[CUSTOMER][NEUTRAL] OK. I mean, I, I would think that you guys would have that on your billing there, um, mainly I'm concerned about the billing from the ER in the hospital.
[CUSTOMER][NEUTRAL] Um, is there any way to like.
[CUSTOMER][NEUTRAL] Apply this to that in retroactively apply that? Yes, I can still add it as secondary for your date of service, um, [PII]. Um, do you have your other policy number so I can request it as well here?
[CUSTOMER][NEUTRAL] Yes ma'am, you mean the outpatient benefits certification number? Yes, OK, the outpatient benefits certification number is 025.
[CUSTOMER][NEUTRAL] Um, 508.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 85.
[CUSTOMER][NEUTRAL] ML 8.
[CUSTOMER][NEUTRAL] OK. And then, uh, for Tari from the um insurance, may I ask, is this, uh, can I have the effective date as well for the outpatient policy? Is it the same?
[AGENT][NEUTRAL] Yeah. Yes, it's the same. So in, on our side.
[CUSTOMER][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] Both for outpatient and inpatient, um, on her on her numbers on her policy number, the ML 7 stands for inpatient and the ML 8 stands for outpatient, but the policy number is the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's perfect, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh, OK. OK, got it now. Um, just in case, the claim's mailing address, is it the same for both?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you want me to verify that with you?
[CUSTOMER][NEUTRAL] OK. Can I have that, please?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] Yes, it's [PII]. That's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] We also have a payer ID number.
[AGENT][NEUTRAL] For electronic claims that is 60801.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And just to uh let you know we do not have a timely filing limit. So as long as uh Ms. [PII] was covered on her policy, the date of service, there's no um timely filing limit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, that's, that's perfect.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's perfect here. One moment, let me add that info here.
[CUSTOMER][NEUTRAL] 248,950. OK, um, I guess that's the info that I'll be needing today. I'm sorry, do I have a call reference number for my documentation?
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[CUSTOMER][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] OK, so [PII] and then [PII] and then [PII], do you have additional questions to the representative?
[CUSTOMER][NEUTRAL] Um, do you need my the group number as well, or do you have that?
[CUSTOMER][NEUTRAL] Oh let me check here.
[AGENT][NEUTRAL] I have it. The group numbers.
[CUSTOMER][NEUTRAL] Yeah. Do we have, mhm.
[AGENT][NEUTRAL] You wanna just verify group number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] 231 43.
[CUSTOMER][NEUTRAL] Just like
[AGENT][NEUTRAL] Nova Southeastern University.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Can you.
[CUSTOMER][NEUTRAL] OK, got it here. And then how about the fax number, the I was just about to say the fax number, yeah. Mhm.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] All right, thank you. I guess I got the info that I'll be needing. And then, uh, [PII], just stay on the line because I need to um fill out the form here, OK?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'm going to leave um Ms. [PII] and Ms. [PII]. You guys have a blessed day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Oh so you're filling out a form?
[CUSTOMER][NEUTRAL] Uh-huh
[CUSTOMER][POSITIVE] Yeah thank you.
[AGENT][NEUTRAL] Bye bye.