AccountId: 011433970860
ContactId: 58c186a1-37f3-46be-8c0d-984758b2b44d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212229 ms
Total Talk Time (AGENT): 80915 ms
Total Talk Time (CUSTOMER): 81803 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/58c186a1-37f3-46be-8c0d-984758b2b44d_20250410T15:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, hi. Uh, this is [PII]. I'm calling from the provider's office. Uh, I'm inquiring about the claim information for the member.
[AGENT][NEUTRAL] But you said you're calling to check claim status?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, I can assist you with that information. What's the policy number?
[CUSTOMER][NEUTRAL] And the policy number is gonna be 02465911 M as in Mary, L as in Lima, B as in Bravo. I'm sorry, uh M as in M as in Mary, L as in Lima, and 8. That's not a B, sorry.
[AGENT][NEUTRAL] What's a good call back?
[AGENT][NEUTRAL] OK, all right, and what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, that's gonna be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Ma'am, the patient is gonna be uh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, that's OK. The name of the patient is gonna be [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] And the birth of, sorry, [PII].
[AGENT][NEUTRAL] Alright, thanks for that information. What's the date of service of the claim?
[CUSTOMER][NEUTRAL] The service is gonna be on [PII].
[AGENT][NEUTRAL] And what's the total charge?
[CUSTOMER][NEUTRAL] This has been under the total charge amount of $136 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the name of the facility?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The name of the facility?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh, this has been under for under Florida Hospital.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Is it Florida Hospital or is it Cleveland Clinic?
[AGENT][NEUTRAL] Florida.
[CUSTOMER][NEUTRAL] This is Cleveland Clinic Florida Hospital, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I showed that this claim was received.
[AGENT][NEUTRAL] On [PII], processed [PII], there was no payment made um on this claim, and the reason being that benefits are only payable if your major medical in or the major medical insurance provides a benefit, so it looks like the major medical denied that charge and when that happens, the APL policy does not cover the charges either.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. These charges not covered under which policy? Are the member benefits or the uh provider benefits, I'm sorry.
[AGENT][NEUTRAL] It's gonna be the patient's policy.
[CUSTOMER][NEUTRAL] OK, so the status cover. Thank you. And, and sorry, I didn't get your name and the insured.
[AGENT][NEUTRAL] You'll use my name in today's date as your reference, [PII], first initial and last name is [PII], and you can also check status on our online service center at [PII]. And [PII], did you have any other questions?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Uh, nothing else, [PII]. Thank you so much for asking that and have a wonderful day, ma'am. Thank you.
[AGENT][POSITIVE] Oh, you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Yeah.