AccountId: 011433970860
ContactId: 62638d91-de68-41bb-8ec4-1b062e790beb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 772599 ms
Total Talk Time (AGENT): 174105 ms
Total Talk Time (CUSTOMER): 342589 ms
Interruptions: 6
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/62638d91-de68-41bb-8ec4-1b062e790beb_20250212T13:07_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, this is [PII], and my last name first initial is [PII].
[AGENT][NEUTRAL] Spell your first name.
[CUSTOMER][NEUTRAL] Sure. My name is [PII]. It's spelled like [PII].
[AGENT][NEUTRAL] OK, and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, what's the policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] 2 24 2023.
[CUSTOMER][NEUTRAL] So, 017, sorry.
[CUSTOMER][NEUTRAL] Actually, you generally pay for limited benefits plan. 01773961 M as in Mary, L as in Lima, B as in Bravo.
[AGENT][NEUTRAL] What's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. Callback number is going to be [PII].
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure first name is.
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] was born on [PII].
[AGENT][NEUTRAL] OK. And what's the date of service in charge?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So, the service was render on [PII].
[CUSTOMER][NEUTRAL] With the total bill amount of $359 even.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I don't show that date of service on file um for this patient.
[AGENT][NEUTRAL] Hold on one second. I'm looking, I'm looking under the incorrect patient. Hold on a second.
[CUSTOMER][NEUTRAL] No claim on file?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it looks like we denied the claim for a copy of the major medical explanation of benefits.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Um, I show that this claim was received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] process [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 328-666-68
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, the policy effective date is [PII]. The policy lapsed [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] They denied for, could you please repeat the denial reason for me?
[AGENT][NEUTRAL] We need a copy of the major medical explanation of benefits.
[CUSTOMER][NEUTRAL] Major medical explanation of benefits.
[AGENT][NEUTRAL] The primary insurance.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Primary insurance, OK?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I have the mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the zip code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the timely filing limit?
[AGENT][NEGATIVE] To submit the claim there's no timely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Do you have a fax number?
[AGENT][NEUTRAL] And you can also check your
[AGENT][NEUTRAL] You can also check your status online at [PII]. The fax number is [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Attention to?
[AGENT][NEUTRAL] Claims.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can you please spell out your name for me from the documentation?
[AGENT][NEUTRAL] [PII] You'll use my name in today's date as reference for today's call. Any any other questions I could assist with today, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you, [PII] and I have uh
[CUSTOMER][NEUTRAL] Yeah, [PII], I have another 2 different members. Do you assist me with that?
[AGENT][NEUTRAL] OK, the next policy number?
[AGENT][NEUTRAL] And would you like for me to help you set up an online account to check your statuses?
[CUSTOMER][NEUTRAL] Sure one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Actually, uh, at the portal we requested access from the provider, but, uh, still we don't receive any.
[CUSTOMER][NEUTRAL] Update from the provider. We are waiting for the access.
[AGENT][NEUTRAL] Are don't you work for the provider's office?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm in the billing department of Cleveland Clinic Foundation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Next policy number is 310-2023.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Next policy number is 017.
[CUSTOMER][NEUTRAL] 19459
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Patient first name is
[CUSTOMER][NEUTRAL] [PII], and the last name is [PII]. was born on [PII].
[AGENT][NEUTRAL] Date of service and total charge.
[CUSTOMER][NEUTRAL] Sure, the service was rented on [PII] with the total bill amount of $774 even.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the policy number that you provided?
[CUSTOMER][NEUTRAL] Sure. Policy number is
[CUSTOMER][NEUTRAL] Actually, uh, I provide you 017.
[CUSTOMER][NEUTRAL] 19459
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] This claim was received [PII], processed [PII], and we need a copy of the itemized bill, the UV 92.
[CUSTOMER][NEUTRAL] [PII], right? Denial date?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And you denied for what, what information?
[AGENT][NEUTRAL] We need a copy of the itemized bill from the facility.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Itemized bill.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] UB 04.
[AGENT][NEUTRAL] The UB 92.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You'll be 92.
[CUSTOMER][NEUTRAL] You have the mailing address or fax number?
[AGENT][NEUTRAL] It's the same mailing address and fax number.
[CUSTOMER][NEUTRAL] And the timely filing limit?
[AGENT][NEUTRAL] It's the same as what I stated before.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. No timely filing limits.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Sure. Shall we move for the last member?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, the next policy or the last policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. 01773673961.
[AGENT][NEUTRAL] OK, that's the first policy number that you gave me.
[AGENT][NEUTRAL] And 2 with the patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's the same patient but a different date of service. I'm sorry.
[AGENT][NEUTRAL] The date of service?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] With the total bill amount $359 even.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] I needed a copy of the major medical explanation of benefits. The claim number is 3306232.
[CUSTOMER][NEUTRAL] 6322
[AGENT][NEUTRAL] Mhm. Received [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Mm sure one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The same mailing address and the fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions I can help out with today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh yes. Actually, I forgot to ask the claim number for the previous one, previous claim. Uh.
[AGENT][NEUTRAL] Which, which one? which state of service?
[CUSTOMER][NEUTRAL] For the date of service, [PII] for [PII] please.
[AGENT][NEUTRAL] OK, what's the policy number of the one that you're asking for?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. The policy number is
[CUSTOMER][NEUTRAL] 01719459.
[AGENT][NEUTRAL] Claim number is 347.
[AGENT][NEUTRAL] 0307.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, [PII], and uh thank you for your assistance today. Have a wonderful rest of the day, [PII]. And the reference number is your name and today's date, right?
[AGENT][POSITIVE] You're welcome. Thanks for calling APL.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for the information. Have a wonderful rest of the day.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Have a good day. You too.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.