AccountId: 011433970860
ContactId: 66fa130c-2b41-46d8-a228-c8f5bb87549c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 689859 ms
Total Talk Time (AGENT): 181341 ms
Total Talk Time (CUSTOMER): 163904 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/66fa130c-2b41-46d8-a228-c8f5bb87549c_20250213T17:07_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, sorry. This is [PII], and my last name first initial is [PII].
[AGENT][NEUTRAL] Hi, and you can you repeat your first name for me?
[CUSTOMER][NEUTRAL] Sure. Sure. It's [PII].
[AGENT][POSITIVE] OK, thank you so much. I appreciate that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your um call back number [PII]?
[CUSTOMER][NEUTRAL] Sure. My callback number is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] And how can I help you today?
[CUSTOMER][NEUTRAL] To check claim status.
[AGENT][NEUTRAL] OK, I can help you with the claim status. Can you please give me the patient's name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient first name is [PII], and the last name is [PII].
[AGENT][NEUTRAL] OK. And what's the patient's date of birth?
[CUSTOMER][NEUTRAL] [PII], sorry, [PII].
[AGENT][NEUTRAL] Thank you. And what's the patient's policy number?
[CUSTOMER][NEUTRAL] 01635006 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[AGENT][NEUTRAL] OK and then what is the data service?
[CUSTOMER][NEUTRAL] Sure, the service was rended on [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $679 even.
[AGENT][NEUTRAL] OK and you said that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $679 even.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Sure. Cleveland Clinic Foundation.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up that claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] Come on [PII], come on if you're coming. I gotta work.
[AGENT][NEUTRAL] OK, I've got the um claim status for you [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the claim number is 3286008.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me get the received date for you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, the claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] The claim was denied because we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And also the fax number?
[CUSTOMER][NEUTRAL] And the mailing address?
[AGENT][NEUTRAL] The fax number?
[AGENT][NEUTRAL] Yes sir, fax number is [PII].
[AGENT][NEUTRAL] The claim's mailing address.
[CUSTOMER][NEUTRAL] Attention to
[AGENT][NEUTRAL] Claims
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim's mailing address is [PII].
[CUSTOMER][NEUTRAL] And then, go ahead.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mm [PII].
[CUSTOMER][NEUTRAL] May I know the timely filing limits?
[AGENT][NEUTRAL] We do not have one.
[CUSTOMER][POSITIVE] Thank you for the time and I have another one different number. Do you assist me with that?
[AGENT][NEUTRAL] You have another one that's a different member you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the member's name?
[CUSTOMER][NEUTRAL] Sure. And the first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] OK, and what is the date of birth?
[CUSTOMER][NEUTRAL] I was born on [PII].
[AGENT][NEUTRAL] And the policy number, please.
[CUSTOMER][NEUTRAL] Sure, 028, 022.
[CUSTOMER][NEUTRAL] 80064 M as in Mary, L as in Lima, [PII].
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] Sure. The service was ended on [PII].
[CUSTOMER][NEUTRAL] With the total bill amount of $679 even.
[AGENT][NEUTRAL] OK, and what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] A phone checking.
[CUSTOMER][NEUTRAL] Primary applies towards deductible of $185.15 and they allowed $185.15.
[AGENT][NEUTRAL] OK, thank you. And the name of the facility?
[CUSTOMER][NEUTRAL] Sure, the facility name is Cleveland Clinic Foundation.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again while I look up this one for you and I'll be right back.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I'm back. I've got this claim status for you the claim number is 3274443.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We received it on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And processed it on [PII] and it was denied for the same reason we need the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the information is the same as for the previous claim?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Sure, ma'am. Could you please spell out your name for me for my document issue?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] And the last name first initial, [PII].
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Thank you, [PII]. May I know the reference number for our conversation?
[AGENT][NEUTRAL] Yes sir, you can use my name in today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for your assistance today. Have a wonderful rest of the day, [PII].
[AGENT][POSITIVE] Thank you so much. You also, thanks for calling APL. You take care.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.