AccountId: 011433970860
ContactId: 6e5c359a-b3fa-4233-85a6-8d37cc10d644
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400760 ms
Total Talk Time (AGENT): 183196 ms
Total Talk Time (CUSTOMER): 121914 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/6e5c359a-b3fa-4233-85a6-8d37cc10d644_20250210T14:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] So, um, just, uh, I have a member, um, I'm calling from Cleveland Clinic to verify coverage, but this is life insurance, like if something happened to him, correct?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, no, ma'am, we offer different types of, we offer all types of workplace benefits. Mhm.
[CUSTOMER][NEUTRAL] It's not medical.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so, um, I'm just calling to verify um coverage for the patient.
[AGENT][NEUTRAL] OK, so you need eligibility and benefit information, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and [PII], what is your callback number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 558-9940.
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Uh, that is 01887403. Oops.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] But that's the mother though information. I don't know how it works, but yeah.
[AGENT][NEUTRAL] OK, so just
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], how do you spell your first name?
[CUSTOMER][NEUTRAL] Wait, I, I gave you the.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I gave you the wrong number ID number. Can I give you a number number? I'm sorry.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEGATIVE] Yeah, that's the wrong number.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK. All right.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] 0101887403ML
[CUSTOMER][NEUTRAL] That's I mean ML 7. I'm sorry, I'm gonna repeat it again, why?
[AGENT][NEUTRAL] So, that's the same
[AGENT][NEUTRAL] That's the same one you just gave me.
[CUSTOMER][NEUTRAL] Oh, I thought I gave you subscriber number. OK. So maybe the email wasn't on there in the [PII], so I guess maybe so, yeah.
[AGENT][NEUTRAL] OK. Right, just a moment.
[AGENT][NEUTRAL] And information [PII] that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Eango, I guess it [PII] Date of birth [PII].
[AGENT][NEUTRAL] OK, one moment. And what was the first name again? I'm so sorry.
[CUSTOMER][NEUTRAL] [PII], I think that's how you say it.
[AGENT][POSITIVE] OK. All right. Thank you.
[CUSTOMER][POSITIVE] Mhm you're welcome.
[AGENT][NEUTRAL] OK, so I do show he is a dependent on the supplemental policy, [PII], and it is the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Oh well, he's in our emergency, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, that, that should be fine, I guess. This is a supplement.
[AGENT][NEUTRAL] This is a supplemental policy to their major medical insurance that helps with co-pays, deductibles, and co-insurance amounts of coverage services.
[AGENT][NEUTRAL] So at this time, you're needing outpatient. You said he's in the emergency room?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so one moment.
[AGENT][NEUTRAL] OK, so on this supplemental policy, the outpatient benefit maximum is $1000 per covered person per calendar year for covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient, excuse me, no outpatient emergency room deductible per cover person per occurrence.
[CUSTOMER][NEUTRAL] OK, so he's still, he's good, correct? Is that what you're saying, um, that language I don't understand.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So he's OK. Yeah, so I should be OK.
[AGENT][NEUTRAL] He's eligible, yes. Now, when you all get ready to file the claim with us for review, we must have a also receive a copy of the primary insurance company's explanation of benefits as well for review.
[CUSTOMER][NEUTRAL] OK, OK, alright.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal as well, [PII] in which you should be able to check claim status and have access to our EOB and that website is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Am
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, OK, so I'll go ahead and um verify this. Is there a reference number that I can put down on here?
[AGENT][NEUTRAL] You would use my name along with today's date.
[CUSTOMER][NEUTRAL] And what did you say your name? Can I get the spelling of your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And your last initial?
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] [PII].
[CUSTOMER][POSITIVE] OK, all right, thank you for that.
[AGENT][POSITIVE] Well, you are certainly very welcome and is there anything else that I can help you with this morning [PII]?
[CUSTOMER][POSITIVE] No, that's that's it. Thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Uh, thank you. Bye-bye.