AccountId: 011433970860
ContactId: 6f339e80-fc08-4ebf-8e34-ecd811b81094
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1298260 ms
Total Talk Time (AGENT): 331697 ms
Total Talk Time (CUSTOMER): 228759 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/6f339e80-fc08-4ebf-8e34-ecd811b81094_20250514T18:26_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office office uh to check status of the claim.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. May I have a callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh yeah, it is [PII].
[AGENT][NEUTRAL] [PII] and may I have um the name of the facility you're calling from for my notes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's Cleveland Clinic, Florida.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm, OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, just one second. Uh, it is 02166993.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh the patient's first name is [PII]. The last name is [PII], [PII] The date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And um may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, it is [PII] and the amount is $3,314 even.
[AGENT][NEUTRAL] [PII], the amount of $3,314 even. Is that correct?
[CUSTOMER][POSITIVE] Yes, perfectly.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK, for future, you can check claim status online through our website at [PII] and that's just optional. And let me pull this ELB OK, one moment.
[AGENT][NEUTRAL] OK, I'm still waiting on the UOB.
[AGENT][NEUTRAL] All right, looks like we processed the claim on [PII], and we send a benefit amount of $1,359.18.
[AGENT][NEUTRAL] To the provider?
[CUSTOMER][NEUTRAL] It's like uh the amount is paid.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] No, my. OK. Can I know when it was paid, uh, the check number and everything, the paid information?
[AGENT][NEUTRAL] Sure. Uh, the checking date is [PII], which is the process date. The check number.
[AGENT][NEUTRAL] It's 1869304. Again, that's 1869304. It was a paper check, single check, the amount $1,359.18.
[CUSTOMER][NEUTRAL] Just 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Can I know, it, it is a single check, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Paid and check number, uh OK. Uh, can I know to which address it has been paid?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much uh for that information.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Uh, and just one second.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have one more claim. Can you please assist me?
[AGENT][NEUTRAL] OK, is it for the same member or different member?
[CUSTOMER][NEUTRAL] Oh, for the different member?
[AGENT][NEUTRAL] Oh, OK. Let me go ahead and make a note on this one, OK? One moment.
[CUSTOMER][NEUTRAL] Yes. And also before that, can I get your name and the reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date. My name is [PII], that's [PII]. Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. Do you need the claim number, Miss [PII]?
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][NEUTRAL] OK, the claim number for this one is let's see, go back to it.
[AGENT][NEUTRAL] OK, um, 349-5102.
[CUSTOMER][POSITIVE] Uh, thank you so much.
[AGENT][NEUTRAL] You're welcome and bear with me just one more minute, I'm finalizing my note.
[CUSTOMER][NEUTRAL] uh
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK. What is the next policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, just one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02483108.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Let me give you
[CUSTOMER][NEUTRAL] The first name is [PII]. The last name I'll spell, it is [PII] The date of birth is um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] No, I
[CUSTOMER][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] The total, total charge amount is $536 even.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, let me pull this EOB.
[CUSTOMER][NEUTRAL] I'm really sorry, I forgot to ask uh about the previous claim. Can I know the clear date?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, I'll have to go back to that one to get that information. Bear with me just a minute. Let me pull the information on this one, OK? Or do you mind holding for me?
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding being impatiently. OK, um, OK, so on the previous one, I checked on the check number and it looks like it's still outstanding.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] For the new one for [PII].
[AGENT][NEUTRAL] And we process the claim on [PII] and we also send a benefit amount on this one for $188.21.
[AGENT][NEUTRAL] Um, the check number on this one is 1869284.
[AGENT][NEUTRAL] It's also a single check, a paper check?
[AGENT][POSITIVE] And it's still outstanding as well.
[AGENT][NEUTRAL] And the claim number on this one is.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][POSITIVE] It's still, the check's still outstanding.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 16
[AGENT][POSITIVE] Yes, the checks still outstanding.
[CUSTOMER][NEUTRAL] As pending, so there is no clear date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number on this one for [PII] is 349-5258.
[CUSTOMER][POSITIVE] OK. Thank you so so much. And uh I have uh one more uh
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, this, can you, uh, sorry, one more thing. Can you please assist me?
[AGENT][NEUTRAL] OK, is it a different member or the same in a member?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, it's for a different member.
[AGENT][NEUTRAL] I'm sorry, you said the same or different?
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Different, OK. Bear with me just a minute. Let me finalize it all on this one. You don't need any other information on this one, Miss [PII]?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh hello?
[AGENT][NEUTRAL] Yes, um, yeah, it's gonna be one more minute. I'm finalizing my note, OK?
[CUSTOMER][NEUTRAL] on the previous notes here, you're telling that a clear date is pending, right? So can I know why still it is pending?
[AGENT][NEUTRAL] I'm sorry, can you repeat? You, you was coming in and out. Can you repeat?
[CUSTOMER][NEUTRAL] You said previously the check clear date is pending, right? For the previous payment?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sir, can I know why it is still pending?
[AGENT][NEGATIVE] It's not, it's not cleared. It's not pending. We send the check out. It's just not cleared. I don't see a clear date.
[CUSTOMER][NEUTRAL] Is there any specific reason for taking a long time?
[AGENT][NEUTRAL] I'm not sure. We already sent the check, so I'm not sure what happened to the check if they received it or not, but uh it's, it's still showing outstanding in our site, so it's not, it's not giving me a clear date.
[CUSTOMER][POSITIVE] OK, thank you. Can we go for the next one?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. Uh, what is the next policy?
[CUSTOMER][NEUTRAL] Uh, the next policy is, uh,
[CUSTOMER][NEUTRAL] 2,473,050.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the name and date of birth?
[CUSTOMER][NEUTRAL] [PII] is the first name, [PII] is the last name. The date of birth is [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the amount is $724 even.
[AGENT][NEUTRAL] I'm sorry, I didn't get the amount. 700 and how much?
[CUSTOMER][NEUTRAL] $24.
[AGENT][NEUTRAL] 724. OK, and that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me pull the EOB on this one, OK? One moment.
[AGENT][NEUTRAL] OK, so it looks like this one was processed on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that benefits are payable only if major medical insurance provides benefits.
[CUSTOMER][NEUTRAL] OK. If, if, uh, any other primary insurance paid, then it will be paid by secondary.
[AGENT][NEUTRAL] Correct. We, we pay if the major medical pays. We are secondary.
[CUSTOMER][POSITIVE] OK. Thank you so much. Can I have the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 352-553-5.
[CUSTOMER][POSITIVE] Thank you so much for that information and uh hope you're having a great day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Mm. No. Thank you so very much.
[AGENT][POSITIVE] Thank you. You're welcome and thank you for calling APL. Have a good day.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.