AccountId: 011433970860
ContactId: 6ade8af8-6ab6-4094-a336-0cfeecdd39bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 810380 ms
Total Talk Time (AGENT): 212473 ms
Total Talk Time (CUSTOMER): 344682 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/6ade8af8-6ab6-4094-a336-0cfeecdd39bf_20250529T19:09_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, hello, and, uh, uh, this is [PII] from the customer service at the Cleveland Clinic Foundation. So I'm calling in here for today to verify about the, um, your policyholder, um, eligibility for this, uh, date of service.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the eligibility. And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, I'm sorry, we don't have any extension, uh, I'm sorry, your name is [PII], right?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] [PII], OK, uh, we don't have, uh, an extension, but you may call us back at [PII].
[CUSTOMER][NEUTRAL] And the policy number we I have here on there on my end is 01260490.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, number 7.
[CUSTOMER][NEUTRAL] The name is [PII].
[AGENT][NEUTRAL] And can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So for [PII], I'm not showing the policy um is active. Um, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] So for this
[AGENT][NEUTRAL] Trying to see.
[AGENT][NEUTRAL] And this ended. Hold on one moment.
[CUSTOMER][NEUTRAL] So the one
[AGENT][NEUTRAL] OK, so [PII], um, it was active up until, hold on one second.
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] And there were no other active policies with APL since then for [PII]?
[AGENT][NEUTRAL] Um, I'm gonna double check this one, yeah.
[AGENT][NEUTRAL] There were no other policies active for him.
[CUSTOMER][NEUTRAL] OK, um, just only [PII]?
[CUSTOMER][NEUTRAL] Uh, just only [PII].
[AGENT][NEUTRAL] So this
[AGENT][NEUTRAL] That's when it terminated, yes.
[CUSTOMER][NEUTRAL] Oh, it was terminated. Uh, when was the, um, the start date of the plan?
[AGENT][NEUTRAL] OK, so for [PII], the policy became active on [PII].?
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] And it terminated.
[CUSTOMER][NEUTRAL] And it ended on [PII].
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes, it, I'm sorry, it ended on [PII], is that correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, um, for this one, and, um, I do have the patient here on the other line, um, is it OK if I conference the call so so that, uh.
[CUSTOMER][NEUTRAL] They would know
[CUSTOMER][NEGATIVE] The status because they want to bill us this um outstanding balance.
[AGENT][NEUTRAL] Um, sure, you can connect them. What are you wanting me to tell them what I just told you?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK, I can um relay that to the patient if you, if you can. Go ahead, sure.
[CUSTOMER][NEUTRAL] OK, um, yeah, I'm sorry, uh, the, the caller for today is also the, uh, [PII]. It's uh the matter. OK, yeah, I'll conference the call. I'm sorry.
[CUSTOMER][POSITIVE] Um, hello [PII]. So thank you so much for holding. I have, um, [PII] here from the American Public Life Insurance, and she can uh ver uh.
[CUSTOMER][NEUTRAL] Speak with you regarding about your eligibility of your son. OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Alright, um, hi, so this is [PII] with APL. So he called asking me for the eligibility um for your son, um, but the policy is, it is a single parent, but the only people that are um covered are you and [PII], if I'm saying that correctly.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Can you check on their uh account number maybe I gave you the wrong group number because he has a policy of by himself. Can you try 17847?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] 17847 is the group number.
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] You're saying he has his own individual policy under the group?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, he has his, his own policy correct because he's an adult.
[AGENT][NEUTRAL] OK, hold on one second.
[CUSTOMER][NEUTRAL] She's not my dependent.
[AGENT][NEUTRAL] OK, so, OK, so for his policy by himself, yes, he has a policy. So,
[AGENT][NEUTRAL] [PII], are you needing the eligibility for this policy, the active policy?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] OK, so the policy number is 213.
[AGENT][NEUTRAL] 7475.
[AGENT][NEUTRAL] And it's been active since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Until.
[CUSTOMER][POSITIVE] Until present, I'm sorry.
[AGENT][NEUTRAL] I don't understand the question. Can you repeat that, please?
[CUSTOMER][NEUTRAL] So the start, um, the beginning of the plan for 2137475 is [PII] and when is the end of the uh plan date?
[AGENT][NEUTRAL] There's no termination date?
[AGENT][NEUTRAL] It's still active?
[CUSTOMER][NEUTRAL] There is no OK until present, OK.
[CUSTOMER][NEUTRAL] OK, let me check here, um, so I just want, so that is the correct, uh, policy number, right, uh, 213-7475.
[AGENT][POSITIVE] Yes, the policy number I just provided. That's correct.
[CUSTOMER][NEUTRAL] OK, and for this one, and uh, I'm sorry, uh can you stay on the line for me let me try to rebuild this give me a moment here, but I gave you, I'm sorry, I think I gave you the wrong group number it's, it's on the [PII].
[AGENT][POSITIVE] No, no, it's, it's, it's correct.
[AGENT][POSITIVE] Yeah, you, yes, that's correct.
[CUSTOMER][NEUTRAL] It's correct? OK.
[CUSTOMER][NEUTRAL] Policy number, uh, yeah, give me a moment here, OK? Can you stay on the line.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, I'm so
[CUSTOMER][NEUTRAL] Uh, I'm sorry, a quick question.
[CUSTOMER][NEUTRAL] Um, and uh
[CUSTOMER][NEUTRAL] Um, even though you're out of network, you would still, uh, be secondary insurance, right? You would still, um, take care of the left charges. Yes, I'm sorry, you can go, OK, go ahead.
[AGENT][NEUTRAL] Hold on one second. Let me.
[AGENT][NEUTRAL] Let me pull up the.
[AGENT][NEUTRAL] So there's no network for this policy. This is a secondary policy. So we, we apply to the co-pay, deductible and co-insurance of covered charges after primary.
[AGENT][NEUTRAL] And primary um for.
[CUSTOMER][NEUTRAL] Oh, OK, OK, that would be.
[CUSTOMER][POSITIVE] OK, yes, go ahead, I'm sorry.
[AGENT][NEUTRAL] Primary for this insurance is United Healthcare.
[CUSTOMER][NEUTRAL] OK, so you would cover the uh what was left by the United Healthcare. OK, um, can I have your call reference number for today? Yeah, I'll be.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, we won't cover what's left. We only apply to the co-pay, deductible and co-insurance after United Healthcare of covered charges.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, yes, of cover charges. OK, yeah, can I have your call reference number for today?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Today's date is, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, let me just.
[CUSTOMER][NEUTRAL] Uh, update the patient's account here, OK, for the secondary.
[CUSTOMER][NEUTRAL] Give me a moment here.
[CUSTOMER][NEUTRAL] And a
[CUSTOMER][NEUTRAL] And it's a lot of accounts. Can you stay on the line for me.
[CUSTOMER][NEUTRAL] So OK, yes.
[CUSTOMER][NEUTRAL] Um, and, uh, uh.
[CUSTOMER][NEUTRAL] American public life.
[CUSTOMER][NEUTRAL] And a secondary insurance.
[CUSTOMER][NEUTRAL] Effective date is January until present of [PII].
[CUSTOMER][NEUTRAL] Uh, member ID is 2137475.
[CUSTOMER][NEUTRAL] Um, the group number 178, what was it again? I'm sorry.
[AGENT][NEUTRAL] 17847.
[CUSTOMER][NEUTRAL] 17847
[CUSTOMER][NEUTRAL] Um, can I have your claim address [PII] [PII].
[AGENT][NEUTRAL] Sure, it's PO Box 248.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]. The zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, [PII] Oklahoma OK [PII].
[CUSTOMER][NEUTRAL] OK, uh, do you have your phone number, ma'am?
[AGENT][NEUTRAL] Our phone number?
[CUSTOMER][NEUTRAL] Uh, you need the phone number?
[CUSTOMER][NEUTRAL] Yes [PII] mhm.
[AGENT][NEUTRAL] As in like a customer service number or like a fax number?
[CUSTOMER][NEUTRAL] Uh, yes, your customer service and also the fax number.
[AGENT][NEUTRAL] Our phone number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Our fax number is [PII].
[CUSTOMER][NEUTRAL] OK, and the fax number?
[AGENT][NEUTRAL] Our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK perfect so um yeah that would be all, um, [PII], thank you so much for this wonderful information, ma'am. Yeah, we are going to update uh [PII]'s um account here so that we can uh rebuild it, I'm sorry, submit this claim to you as the secondary insurance of the patient.
[CUSTOMER][NEUTRAL] Right, it's uh [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh the last name is [PII].
[CUSTOMER][NEUTRAL] Um, hello, [PII].
[AGENT][NEUTRAL] As I'm here,
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Yes, uh, that would be all, ma'am thank you so much for this information.
[CUSTOMER][POSITIVE] OK [PII] thank you so much.
[AGENT][POSITIVE] All right, thanks for calling APL. You all have a great day.
[CUSTOMER][NEUTRAL] OK, do you still need me on the phone now?
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Um, yes, [PII], I still need you on the.