AccountId: 011433970860
ContactId: 5473f29a-8719-4e95-b855-a6f3efb7d970
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 919559 ms
Total Talk Time (AGENT): 221532 ms
Total Talk Time (CUSTOMER): 383097 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/5473f29a-8719-4e95-b855-a6f3efb7d970_20250218T18:25_UTC.wav
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[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 Cleveland Clinic to help check on our clients.
[AGENT][NEUTRAL] OK, [PII], I can help you with the claim. Uh, can I please get your callback number, sir?
[CUSTOMER][NEUTRAL] Uh sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Oh sure. Patient's name is, just a moment. It is [PII].
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII]. And patient's policy number is 01894931 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, let me look up that policy number real quick.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] Oh, sure. The date of service is [PII], uh, with the total charge amount, $2,076 2076.
[AGENT][NEUTRAL] OK, thank you sir and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Uh, sure, ma'am. After the primary, just a moment. Uh, I do see here that primary has, uh, yes, ma'am. Uh, they have it as a deductible. They processed it as deductible of $350.16.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So it's the same, yeah. Charge value is 2.
[AGENT][NEUTRAL] $350 160.
[AGENT][NEUTRAL] You said that was 350 or 200?
[CUSTOMER][NEUTRAL] That is a deductible, ma'am. Yeah.
[AGENT][NEUTRAL] Was that 350 or 250?
[CUSTOMER][NEUTRAL] The total charge on the claim is $2,076. The primary has processed it as a deductible, which is $350.16.
[AGENT][NEUTRAL] OK, thank you, and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Cleveland Clinic.
[AGENT][NEUTRAL] OK, thank you [PII]. I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me.
[AGENT][NEUTRAL] So looking on data service on this policy number 7-18 of 2024 and the amount of $20076 there's not a claim on file, but that policy was not active during that time, so I looked on the active policy number 249-6871.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And there is not a claim on file for that date of service.
[AGENT][NEUTRAL] For the amount that you have given me.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, sure, sure. Just a moment. Just, uh, let me pull up the information from my end, uh, just to verify. Um, just be on call, [PII]. Just, just be on call. I'm so sorry to put you on call here. Uh, let me check for the further details, yeah.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] But, yeah, by the way, how are you doing today, [PII]?
[AGENT][POSITIVE] I'm doing great. How about you, [PII]?
[CUSTOMER][POSITIVE] Uh, I'm doing so good. And just, just for
[CUSTOMER][NEUTRAL] Just so you know, I'm not [PII]. I'm [PII], and I do spell my name as [PII], [PII], and it, it's OK, it's OK.
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Oh, gosh, I'm so sorry, [PII]. I'm so sorry for giving you the wrong name. I apologize.
[CUSTOMER][POSITIVE] It's OK. Thank you. It's OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, so,
[CUSTOMER][NEUTRAL] Oh, just a moment. [PII]. So the date of service, [PII], am I right?
[AGENT][NEUTRAL] Right. That's the date you gave me, and there's not a.
[CUSTOMER][NEUTRAL] Yes. And
[CUSTOMER][NEUTRAL] Uh, uh, sure. There, there is no claim on file. And also there is a member ID that I'm having here as the policy ID is 01894931ML8. It's not active that you're saying, right?
[AGENT][NEUTRAL] Right, and, but there is an active policy number.
[CUSTOMER][NEUTRAL] Uh, sure, which is 249-687-1, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Oh, sure. Thank you so much. I will be having, we will be resubmitting the insurance. Yes, and may I know the timely filing limit?
[AGENT][NEGATIVE] We don't have one. There is no timely filing limit.
[CUSTOMER][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] Uh, sure. And may I know the policy effective and term date?
[AGENT][POSITIVE] Yes sir, let me give that to you real quick.
[AGENT][NEUTRAL] The effective date is [PII] and the policy is still active.
[CUSTOMER][POSITIVE] Oh, sure. Thank you so much. Uh, yup. Uh yeah. Uh, um, may I know the mailing address?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, sir. It's [PII]'s [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. Am I right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, sure, sure. [PII].
[CUSTOMER][NEUTRAL] [PII], yes. Um.
[CUSTOMER][POSITIVE] Uh, sure, sure. Thank you so much for that. Is there any payer ID for the electronic function, yeah.
[AGENT][NEUTRAL] Yes, it's 60.
[AGENT][NEUTRAL] Yes, it's 60801.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Oh, sure. Thank you, [PII]. Thank you so much for that. Yeah. Uh, just, uh, let me know whenever you're ready, we can move for the next member. I, I do have only one member for the day.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, we can go ahead and move on. What's the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh sure. My name is [PII]. [PII].
[CUSTOMER][NEUTRAL] The policy ID is 148427 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me pull his policy up real quick.
[CUSTOMER][NEUTRAL] 2151.
[AGENT][NEUTRAL] You said that policy number was 148427ML7.
[CUSTOMER][NEUTRAL] Policy number was
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK, we're missing some numbers. Do you have another number?
[CUSTOMER][NEUTRAL] Uh, I'm sorry. I will repeat it again. It is number 148427.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 7.
[AGENT][NEGATIVE] Yes, and that policy number is not pulling up. We're missing some digits.
[CUSTOMER][NEUTRAL] Oh, sure, ma'am. Because the claim was built with that policy number that I can see here. Or else, um, can I, can I help you with the patient's Social Security number?
[AGENT][POSITIVE] Yes, that would be beneficial. Thank you.
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] So, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me look him up real quick.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, let me give you the correct policy number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's 1484271.
[AGENT][NEUTRAL] ML 7.
[CUSTOMER][NEUTRAL] 148 EML7, sure.
[AGENT][NEUTRAL] There's a one on the end.
[AGENT][NEUTRAL] OK and then what is the um.
[CUSTOMER][NEUTRAL] So it is uh
[CUSTOMER][NEUTRAL] I'm, I'm sorry, sorry, sorry to interrupt you in the middle. It is 1484271 EML 7. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Yup. Sure. Thank you so much for that. Yeah.
[AGENT][NEUTRAL] You're welcome. And then what is the data service?
[CUSTOMER][NEUTRAL] Uh, sure. The date of service here I've got is uh [PII].
[AGENT][NEUTRAL] And the bill amount?
[CUSTOMER][NEUTRAL] $1,037 and even.
[AGENT][NEUTRAL] OK, and then what is the amount after primary paid their part?
[CUSTOMER][NEUTRAL] Uh, sure. Uh, after primary, they have, the primary has processed it as a deductible. And it is the same, the charges are the same. It is like $1,037. The deductible amount is $269.29.
[AGENT][NEUTRAL] OK, thank you. And the name of the facility, please?
[CUSTOMER][NEUTRAL] Uh, sure. Uh just a moment. The name of the facility is CCF Western Hospital. ED [PII]. It is [PII].
[AGENT][POSITIVE] OK, thank you so much. I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you [PII] this is [PII] back with you again. So looking at the data service for [PII] for [PII], there is not a claim on file for that date of service.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, sure, sure. Yup, I got it. So I'll be resubmitting the claim as well, the previous one, yeah.
[CUSTOMER][NEUTRAL] As well as the previous one, I will be resubmitting the claim for this one as well, yes, yeah. Uh, uh, is the mailing address and the payer ID are the same, right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, and there's no timely filing limit. Yeah, sure. And uh the correct policy number is 1484271 ML7. Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you, [PII]. I do appreciate your patience on the call. Yes, and you can give me the reference number now.
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Oh sure. Sure. Yeah.
[CUSTOMER][POSITIVE] It's OK, [PII]. Yeah. I wish you have a good day ahead. Bye.
[AGENT][POSITIVE] Thank you so much. You have a great day too, and thanks for calling APL. Bye-bye.