AccountId: 011433970860
ContactId: 784a736c-ac71-4c13-8427-ef94edc81b00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2487639 ms
Total Talk Time (AGENT): 620114 ms
Total Talk Time (CUSTOMER): 1301261 ms
Interruptions: 7
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/784a736c-ac71-4c13-8427-ef94edc81b00_20250620T15:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling. I'm following up on a claim I submitted and trying to get information that you all need.
[CUSTOMER][NEUTRAL] From the hospital where her son had services and I have, so what info do you need to look it up? I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, it's OK. Um, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, uh, good phone number [PII] and then, uh, let's see, policy number.
[CUSTOMER][NEUTRAL] Not my member number, right?
[AGENT][NEUTRAL] Right, um, it should start with a 01 or 02.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bear with me, sorry.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Oh, OK, here it is right, uh 02599625.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Uh, my date of birth is [PII].
[CUSTOMER][NEUTRAL] Mailing address [PII], and then did you need email too or?
[CUSTOMER][NEUTRAL] Sorry, post it on.
[CUSTOMER][NEUTRAL] I'm sorry, did you need an email too?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah, now I can hear you. It went out. Can you hear me? Hello?
[AGENT][NEUTRAL] Oh, I was saying yes ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] OK, email address you need?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um,
[AGENT][NEUTRAL] You said it's for your son?
[CUSTOMER][NEUTRAL] Yes, from Cleveland Clinic emergency room visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have the um date of service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Actually,
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] [PII]. OK. And just for the call again, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I'm waiting for it to come up now. I apologize for the wait.
[CUSTOMER][NEUTRAL] Oh, that's OK. I just, I talked on [PII]. I talked to someone at your company and she said we needed that you needed the diagnosis code while all the tests.
[CUSTOMER][NEUTRAL] They were on the bill we're listed that I um faxed or I mean um scanned and emailed to you all and uh the particular form a UB 04.
[AGENT][NEUTRAL] Oh, you're saying you sent it in already?
[CUSTOMER][NEGATIVE] No, so I, I had sent in all the claim information with the, the codes that Cleveland Clinic gave me. This was back in April, but then I hadn't heard anything, so I called, talked to someone on the [PII]. She said we actually need the diagnosis code. It's not on the bill that I had sent to you all.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's she said I we need form UB04 so I emailed Cleveland Clinic um on the [PII] and said we need this form for our insurance company and they emailed back and said we apologize for the inconvenience. Unfortunately we are unable to provide the UB 0-04 form at this time. The reason for this is that we can only issue the claim form after your insurance has been processed and the invoice has been created.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEGATIVE] I know. I, I don't understand it.
[AGENT][NEUTRAL] What's the, who, what's the, this is a hospital?
[CUSTOMER][NEUTRAL] Yeah, Cleveland Clinic in [PII], like the big Cleveland Clinic.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Wait a minute. Can you read that one more time?
[CUSTOMER][NEUTRAL] Yeah, let me go back because now I, I had given them our card when we went to the ER.
[CUSTOMER][NEGATIVE] And now they're asking for more. So the beginning of the response is we apologize unfortunately we're unable to provide the UB.
[CUSTOMER][NEUTRAL] Z0 form and I have a screenshot of all this. I can email it um for your records if you need it. The reason for this is that we can only issue the claim form after your insurance has been processed and the invoice has been created as per your request.
[AGENT][NEUTRAL] Wait, OK, hold on.
[AGENT][NEUTRAL] We can only issue the claim form after the insurance has been processed. We can
[CUSTOMER][NEUTRAL] Right, so then it says now the 2nd page.
[CUSTOMER][NEGATIVE] They're asking for my insurance again.
[CUSTOMER][NEUTRAL] We can provide an itemized statement which I already have already I already sent it to you.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So they said please respond to this request with the insurance name effective date which I'd already given all of them that but all they're saying is that they can provide is an itemized statement which I think you already have because I sent it to you which wasn't enough. You needed the diagnosis code.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] So there's 2 things here. So, and if we have a phone number I can call them with you on the line, but there's 2 things. So it sounds like for part of it sounds like they didn't put the insurance on file when you gave it to them.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Right. OK.
[AGENT][NEUTRAL] If the claim there's no invoice to wait for, that's how you were able to file the claim because the invoices are out, um.
[CUSTOMER][NEUTRAL] Right, very.
[CUSTOMER][NEUTRAL] Right, exactly, and, and we've already started to pay on it monthly because it was $11,000.
[AGENT][NEUTRAL] Right, and we're just asking for their version of the bill. They don't have the insurance on file, so they're saying we can't we can't present the UBO4 because we need to file it with insurance, which makes sense because you filed this claim, not them. OK, now I get that. Um, do you want me to talk to somebody? I don't.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But they said they wouldn't, well, maybe because uh um an initial conversation when I first called back in April.
[CUSTOMER][NEUTRAL] To try and get the diagnosis code which I thought I was getting but I was just getting it for each little itemized thing, the woman said.
[CUSTOMER][NEUTRAL] Then I talked to a Cleveland clinic she said we don't do business with your insurance company.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which is why we didn't submit the bill.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] And so
[AGENT][NEUTRAL] We don't do business with your insurance company because it's uh, yeah, I, I need more, um, I don't mind if you want me to speak to somebody, I can call them on the other line.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, the in the email response they it says uh an [PII] number but it's with her um.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] It's for uh.
[CUSTOMER][NEUTRAL] It's for um financial assistance paying your bills, so that wouldn't be the right one, would it?
[AGENT][NEUTRAL] Right. Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, should I look up, uh, let me look them up and just see if I got it.
[CUSTOMER][NEGATIVE] No other um doctor's officer has ever given me so much trouble.
[AGENT][NEUTRAL] I'm wondering if it's because it's a hostile indemnity policy, but that shouldn't.
[CUSTOMER][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] That, that doesn't that shouldn't matter. Yeah, it sounds I'm gonna ask some more questions because I, well, first, why don't you deal with uh what what is that? What is that? I'm thinking while I'm speaking, um, so yeah, I need to figure out what that means and then
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Right, right, that's fine.
[AGENT][NEGATIVE] Why they can't provide us with a copy of the bill to pay.
[CUSTOMER][NEGATIVE] Right, well, they provided a copy which I forwarded to you, but it didn't. The woman who I spoke to on the [PII] said it didn't have a diagnosis code, so it didn't say that he, what our son had was the a C. diff infection, which was why they um did all the medications, um, scans, blah blah blah. But they didn't put that on the bill.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She said
[CUSTOMER][NEUTRAL] That I they had sent me and that I had forwarded um to you all.
[AGENT][NEUTRAL] To us
[CUSTOMER][NEUTRAL] It just uh had a uh.
[CUSTOMER][NEUTRAL] Reference number and then just detailed account.
[CUSTOMER][NEUTRAL] Uh, IV therapy laboratory, laboratory, uh, tomographic scan, blah, blah, blah, emergency room, but she said there wasn't.
[AGENT][NEGATIVE] See, this is not OK, yes, this is not a, I just pulled up the documents and they know this. This is not a UBO4. This is just
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know how you pull up the patient account and it's like an overview.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Right, right, of all the things that are done and how much each thing costs.
[AGENT][NEUTRAL] Exactly. This is, that just, this is for you. We need, OK, let me see if on here, I got, I'm clear now, hold on one second.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] I'm looking through here to see if I can find the number.
[CUSTOMER][NEUTRAL] Cause I did.
[CUSTOMER][NEUTRAL] I did submit the hospital indemnity and everyday solutions claim form from APL um.
[CUSTOMER][NEUTRAL] But that was for your purposes so I don't think that's not um let me see if there's a phone number.
[AGENT][NEUTRAL] Yeah, from um what you submitted, from what they gave you, I mean, you submitted it correctly. It's just
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] They this
[CUSTOMER][NEGATIVE] They didn't have the right info.
[AGENT][NEUTRAL] Um, and they know that this is not the bills that are submitted for claims. This is kind of like
[AGENT][NEUTRAL] Your patient copy of.
[AGENT][NEGATIVE] was old.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Um, I don't see a, um,
[AGENT][NEUTRAL] Number here, this is probably the fax number.
[CUSTOMER][NEUTRAL] I have a main number I'm looking at on their website.
[AGENT][NEUTRAL] Oh, well, we can take that. I can start from there. What's the main, what's the number you have?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Alright, and do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Not at all. Thank you so much.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You have reached the Cleveland Clinic Florida Appointment Center.
[CUSTOMER][NEUTRAL] Para continuing espanol pre siete.
[CUSTOMER][NEUTRAL] If this is a medical emergency, please hang up and dial [PII] or proceed to the nearest emergency department.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This call may be monitored or recorded.
[CUSTOMER][NEUTRAL] If you would like to participate in a brief survey at the end of your call, please remain on the line. After the agent hangs up, you will be connected to the survey.
[CUSTOMER][NEUTRAL] I see it. So do you put everything because.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] but yeah I'm just grabbing. I have one last thing and uh I was gonna ask you.
[AGENT][NEUTRAL] I'm on the line, I guess I'm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Nobody came to the line. I just hear them.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Morning. Thank you for calling the Cleveland Clinic appointment Center. This is [PII]. How I can assist you?
[AGENT][NEUTRAL] Hi, [PII]. Um, my name is [PII]. I'm calling from American Public Life. Is there a way you can transfer me to billing?
[CUSTOMER][POSITIVE] Oh yes, definitely I can switch over now. Something else that I can assist you with?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Is this just for like appointment setting or?
[CUSTOMER][NEUTRAL] This is appointment center, yes.
[AGENT][POSITIVE] OK, yeah, um, just billing that's all. Thank you.
[CUSTOMER][POSITIVE] Alright, and thanks again for choosing Cleveland Clinic. I hope you have a wonderful day. Please hold on for me.
[AGENT][POSITIVE] Alright, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] You have reached the Cleveland Clinic Florida Patient Financial Advocate department.
[CUSTOMER][NEUTRAL] If this is a medical emergency, please hang up and dial [PII] or proceed to the nearest emergency department.
[CUSTOMER][NEUTRAL] This call may be monitored or recorded.
[CUSTOMER][NEUTRAL] If you have questions regarding the Cleveland Clinic's co-pay policy, press [PII]. All others please remain on the line.
[CUSTOMER][NEUTRAL] To speak with a patient financial advocate before your appointment date about an estimate, or if you have financial clearance questions prior to your appointment date, press [PII].
[CUSTOMER][NEUTRAL] To speak with a customer service representative about billing questions for completed dates of service that appear on your billing statement, press [PII]. To make a payment.
[CUSTOMER][NEUTRAL] If you need financial assistance, please stay on the line and a member of customer service will assist you or go to [PII].
[CUSTOMER][POSITIVE] Thank you for calling customer service at Cleveland Clinic.
[CUSTOMER][POSITIVE] My name is [PII], and who do I have the pleasure of speaking with today?
[AGENT][NEUTRAL] Hi, [PII]. My name is [PII]. How are you?
[CUSTOMER][POSITIVE] I'm doing well [PII] how are you doing?
[AGENT][NEUTRAL] I'm doing good. Um, I just need some assistance with a mutual patient. I'm calling from American Public Life, the patient is on the line as well, or policyholder is on the line. Um, what do you need any information from me or you want me to tell you what's going on?
[CUSTOMER][NEUTRAL] You can tell me the nature of the call and I'll get the patient's information as well.
[AGENT][NEUTRAL] OK. Um, so basically there's a claim here, um, that we are trying to process. We're needing the UBO4 so that we can get the diagnosis codes, um, what was presented to the patient as an itemized bill is kind of just like a
[AGENT][NEUTRAL] It just says outstanding balances and it just shows what the patient owes and it has CPT codes on it, but we need the diagnosis to prove why not what.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I have an MRN if you need it.
[CUSTOMER][POSITIVE] Yeah thank you.
[AGENT][NEUTRAL] OK, um, it's 910-774-53.
[CUSTOMER][NEUTRAL] OK, for [PII], what's his date of birth and home address?
[AGENT][NEUTRAL] Hold on one second.
[CUSTOMER][NEUTRAL] I am hi this is his mother [PII]. I, I can give that to you. His date of birth is [PII].
[CUSTOMER][NEUTRAL] And home address [PII].
[CUSTOMER][NEUTRAL] OK and the phone number and email on the account.
[CUSTOMER][NEUTRAL] Mhm. [PII]. Email [PII].
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] And is there a specific data service you guys are calling about?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Yes, [PII], mhm.
[AGENT][NEUTRAL] Of this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I don't and you're calling from an insurance company?
[AGENT][NEUTRAL] Yes, American Public Life.
[CUSTOMER][NEUTRAL] Yes, so what what what's happening is we got this bill for $11,000.
[CUSTOMER][NEUTRAL] And I um submitted the claim because uh Cleveland Clinic did not and so I've been working on this since March.
[CUSTOMER][NEGATIVE] And unfortunately just I had and I had um tried twice to get the UB40 code again this week on the [PII]. I sent an email.
[CUSTOMER][NEUTRAL] Asking for it or son did and the response I received um in his chart was that we cannot.
[CUSTOMER][NEUTRAL] Uh, we are unable, we're sorry, but we're unable to provide the UV 04 form at this time.
[CUSTOMER][NEUTRAL] The reason for this, I don't know if you have you probably have access to the all the information on this chart of the emails so I, I, which I, we, I just don't understand.
[CUSTOMER][NEGATIVE] Why the Cleveland Clinic can't provide that.
[CUSTOMER][NEUTRAL] UB 044.
[CUSTOMER][NEUTRAL] For the insurance company.
[CUSTOMER][NEUTRAL] So the reason for this is that we can only issue the claim form after your insurance has been processed and the invoice has been created as per your request.
[AGENT][NEGATIVE] Yeah, I don't understand that part.
[CUSTOMER][NEUTRAL] We can provide an itemized for your account if you please respond to this request.
[CUSTOMER][NEUTRAL] We did provide all the insurance I, when we took our son to the ER at Cleveland Clinic, and so I don't understand that.
[CUSTOMER][NEUTRAL] Is that because I did get an itemized bill.
[CUSTOMER][NEUTRAL] For 11,000 something, um, 11,278.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I, I, I'm confused by that. I just don't understand so thank you for helping.
[CUSTOMER][NEUTRAL] Is it a kind of insurance that's not.
[CUSTOMER][NEUTRAL] Maybe it's not one that's in network with the clinic because sometimes if there's like these they call them.
[CUSTOMER][NEUTRAL] Call these here it's one even if it's not networked.
[AGENT][NEUTRAL] Wait, but I don'ts. OK, hold on one second. I just have a question. I'm sorry. So the, so, so that I just want to make sure I understand. So the policy, the policy is a hospital indemnity policy, so it's not a major medical insurance policy, but even if you all won't bill to us, you still have a, you have a bill. You have the UBO4 or the
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEGATIVE] Well, you're a hospital, so the UBO4. Why? I don't understand why that can't be submitted to insurance.
[AGENT][NEUTRAL] So we can pay a claim.
[CUSTOMER][NEUTRAL] Even if it's out of network.
[AGENT][NEUTRAL] Well, there's no network
[CUSTOMER][NEUTRAL] I don't know what kind of insurance this is. It's no network because it's like a third party like it's not a medical insurance because I know they call it something else like a reference base. There we go, reference base, but they know they don't like.
[AGENT][NEUTRAL] No, this isn't that type of policy. This is just a hospital indemnity policy, so it's a limited medical policy. So she has like a, they have like a list, a big list of things that will cover and how much we will pay to it and anything outside of that won't be covered. But regardless, there has to, the hospital has to have a bill for the data service.
[CUSTOMER][NEUTRAL] Oh it's not.
[AGENT][NEUTRAL] And, you know, she received the itemized bill for the, for the 11,000, so there's a bill, we just need the hospital's version that has the diagnosis code, procedure code, the charges.
[CUSTOMER][NEUTRAL] Mhm. With the diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just give me one moment OK?
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Oh thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hold on one moment for me, um, [PII], OK?
[CUSTOMER][POSITIVE] You, you bet absolutely thank you so much.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] I know. I don't know. Is there, is there a um
[AGENT][NEUTRAL] Oh [PII].
[CUSTOMER][NEUTRAL] Yeah, what's the insurance called again? No, it's OK. What's the insurance called again?
[AGENT][POSITIVE] Sorry about that, y'all.
[AGENT][NEUTRAL] The insurance company is American Public Life. The product is a hospital indemnity plan.
[CUSTOMER][NEUTRAL] We work
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK, because I
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, I think.
[CUSTOMER][NEUTRAL] Let me just check here.
[CUSTOMER][NEUTRAL] Let's go ahead and update the insurance.
[CUSTOMER][NEUTRAL] On here they had a.
[CUSTOMER][NEUTRAL] Because it's not on the account I'll wait to hear back from the work lead just to make sure.
[CUSTOMER][NEUTRAL] And do you have um.
[CUSTOMER][NEUTRAL] The claim number not the claim number, the uh here we go, yeah, yeah.
[AGENT][NEUTRAL] Policy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What is your name and reference number?
[AGENT][NEUTRAL] What is my name or reference number for the call?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I need all that for the updated insurance.
[AGENT][NEUTRAL] OK, so my name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's no call reference number, um, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the claim address?
[AGENT][NEUTRAL] PO Box 248.
[CUSTOMER][NEUTRAL] One minute PO box.
[AGENT][NEUTRAL] Not, oh OK.
[CUSTOMER][NEUTRAL] To PO box was it again?
[AGENT][NEUTRAL] PO Box 248.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, what's the zip code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK the phone number?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I was getting ready to give you the claims number. I'm sorry, 855.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 256
[CUSTOMER][NEUTRAL] Har
[AGENT][NEUTRAL] 8606 and it's 800, I'm sorry, 1800256-8606.
[CUSTOMER][NEUTRAL] So [PII] what's after that?
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] Oh wait a second, sorry, so 1-800.
[AGENT][NEGATIVE] I gave it to you wrong.
[CUSTOMER][NEUTRAL] That's OK, 1-800.
[AGENT][NEUTRAL] Mhm. 256.
[AGENT][NEUTRAL] 8606.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect and then.
[CUSTOMER][NEUTRAL] Do you have a fax number if applicable?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, subscriber's name?
[AGENT][NEUTRAL] [PII], sorry if I said that wrong, [PII].
[CUSTOMER][NEUTRAL] [PII], no, that's OK.
[CUSTOMER][NEUTRAL] Yes, [PII] and then [PII] is [PII]
[AGENT][NEUTRAL] And we have a payer ID as well if you need it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, let me.
[CUSTOMER][NEUTRAL] OK, let me get back to it. I was just talking to the work week. We, we haven't heard of your company before, but we were like, as long as it's medical, the clinic will be happy to send the bill.
[AGENT][NEUTRAL] Right, it's definitely medical.
[CUSTOMER][POSITIVE] Um, thank you.
[CUSTOMER][NEUTRAL] As long as it's medical, we'll send it over there. I just wanted to check because I've never heard of it and there is like this reference based payer thing like when people will use like church funds to try to pay and it gets a little we that's different that's when they have to give the claim to the patient yes alright and so what's the social security number for the um.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Like for assistance and stuff.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], what's your social security number?
[CUSTOMER][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] OK, and subscriber's date of birth.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Right, what is the relationship to the subscriber? Are you the parent, parent, right? Yes, I, and the, uh, it's our son who had the services.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK, and let me just make sure.
[CUSTOMER][NEUTRAL] Um, and everything will update the insurance do check the claim and see was previously processed, um.
[CUSTOMER][NEUTRAL] And again it is called.
[AGENT][NEUTRAL] The insurance company?
[CUSTOMER][NEUTRAL] American public life, no, I got it. I had to copy and paste. I wrote it down somewhere and so I went back to it.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK, American Public life.
[CUSTOMER][NEUTRAL] OK and then what we need as well.
[CUSTOMER][NEUTRAL] For this insurance is what is the.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Trying to find where to put the the patients.
[CUSTOMER][NEUTRAL] Oh here it is.
[CUSTOMER][NEUTRAL] The ID number, the member ID.
[AGENT][NEUTRAL] It's 259.
[AGENT][NEUTRAL] 962 5.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Effective date
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And well I guess you'll have to see the claim first so not sure if the patient will have a responsibility or not, but we'll get for them sent over to you um.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] You, it's kind of choppy. Can you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah, so
[CUSTOMER][NEUTRAL] As far as the patient have a responsibility, won't, yeah, of course we won't know that yet until it gets processed with the insurance, but do allow for 30 business days for, uh, this is for the patient for to see any updates on the accounts because typically that turnaround once it gets to the insurance company is typically just say 30 business days so but it'll get sent out today. OK.
[CUSTOMER][NEUTRAL] OK, OK, um, and then I just have a quick question, [PII] again, um, because we've been trying to make a monthly payment, a minimum to try and not because like get bad credit, um, so can I pause those payments or
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I won't get a letter from Cleveland Clinic that says we're sending you to the claims court or whatever.
[CUSTOMER][NEUTRAL] Is she gone?
[AGENT][NEUTRAL] No, no, I think she's still here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] Oh, OK, I just didn't hear anything, so.
[CUSTOMER][NEUTRAL] Oh, I thought you were asking.
[AGENT][NEUTRAL] It was kind of choppy. I thought we lost you.
[CUSTOMER][NEUTRAL] No, I was asking you actually.
[CUSTOMER][POSITIVE] Yeah, that's OK. I was asking you what's your name from Cleveland Clinic? Uh, [PII], sorry, I was like I'm [PII], OK, that's OK. No, [PII], thank you, you've been so helpful. No, I just want to make sure because we're trying to make minimum payments.
[CUSTOMER][NEGATIVE] Monthly, um, and I just wondered if, if I pause it until this gets resolved, I just don't wanna get a letter from Cleveland Clinic that says we're sending you to claims.
[CUSTOMER][NEUTRAL] So I'll give you just kind of the general like Cleveland Clinic policy and this is just helpful to know is that the Cleveland Clinic they don't typically don't put anything on hold right? However they do give patients like 4 months, you know, 4 to 5 months to make payments, put on a payment plan before something would go on a collection, so you're the account would have to be delinquent for 4 months.
[CUSTOMER][NEUTRAL] OK, so with that move forward how you like, but I can't as an employee say don't, you know, like, so I'm just gonna give you the you can make whatever decisions best for you. Alright. And is there anything else I can help with today?
[CUSTOMER][POSITIVE] No, no, thank you so much. So we're all clear you are able to submit what APL needs.
[AGENT][NEUTRAL] Wait, wait, I'm sorry. Hold on. I just have a quick question. I'm sorry.
[AGENT][NEGATIVE] Is so I had that, had this been billed to us and there was like no payment or something and she received the bill and didn't.
[CUSTOMER][NEUTRAL] No, please.
[AGENT][NEGATIVE] You know, had the 4 months, that would make sense, but because insurance has never been billed, why how
[AGENT][NEUTRAL] How can she be?
[AGENT][NEUTRAL] Required to pay the bill if insurance hasn't processed everything yet.
[CUSTOMER][NEUTRAL] So basically that's one of the policies of Clevelandun.
[AGENT][NEUTRAL] Will she be reimbursed?
[CUSTOMER][NEUTRAL] Of course, of course, so basically this is like with most companies as soon as you sign those papers when you go in for your appointments, they you're on on the hook as a um consumer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's how they get because like even if people don't have insurance let's say they get a denial and they won't pay the patient's still responsible whoever rendered the service is gonna be responsible. That's just how those documents go mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] OK, as long as she'll be reimbursed for any.
[CUSTOMER][NEUTRAL] But so that's how they get reimbursed if we gonna yeah you'll absolutely get reimbursed once you know everything gets processed, but that's how they're able to bill him in the first place is because whoever rendered the service regardless of insurance.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yep you sign those papers.
[CUSTOMER][POSITIVE] Alrighty, is there anything else I can help with today?
[AGENT][NEUTRAL] OK, that's understood.
[AGENT][POSITIVE] No, that's it. Thank you so much for helping us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You're welcome, thank you for choosing Cleveland. You're welcome. Have a great rest of your day and thanks for choosing Cleveland Clinic. Alright, bye bye.
[AGENT][NEUTRAL] All right, you too. Hold on one moment, Ms. [PII].
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] I will, I will.
[AGENT][NEUTRAL] OK, so we got that taken care of. They're sending the claim over. I just want to make sure that you were going, there was a way to get your money back. That's all I was trying to get to.
[CUSTOMER][POSITIVE] I know, thank you so much. Oh my goodness. You've been a rock star. I'm, I cannot thank you enough because like I said, this has been going on.
[CUSTOMER][NEGATIVE] Since February. Back and forth and, and they have been so difficult and you have taken it. I mean, I just can't thank you enough for taking the time and getting on the phone with them and everything because I wasn't having any luck as you can see from, you know, getting letters sorry we can't provide it. So, and I've never been able to get a person there. So, I, I, you are a rock star. I mean, can I, where can I send a, a big
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm like, what?
[CUSTOMER][POSITIVE] Thank you. Your APL you're so lucky to have and I wanna write um an email or whatever I need to do to to commend you.
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Well, I, we don't have like surveys or anything, but I can get my supervisor for you if you'd like to speak with Ms. [PII].
[CUSTOMER][NEUTRAL] Is there somewhere someone I can.
[CUSTOMER][POSITIVE] Yes, I'd be I would love to.
[AGENT][NEUTRAL] OK. Well, before I get her on the line, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, my only question is, so what do you think? Should I make a note to follow up with you all in 1 month or 2 weeks to make sure that Cleveland Clinic does indeed.
[CUSTOMER][NEUTRAL] Submit it and you receive it or what do you what do you advise next step yeah.
[AGENT][NEUTRAL] Submit it.
[AGENT][NEUTRAL] OK, so let me ask you this first. When you get your, um, when you submit claims, do you get like a text message that says, hey, we received the claim, it's in processing or did you receive anything like that with the other claims?
[CUSTOMER][NEUTRAL] Um, I
[CUSTOMER][NEUTRAL] I received a letter, so the most recent letter in the mail, yeah, and it just said we received a claim on your policy and a review of the claim is started. In some cases additional info must be must be requested from your provider. Thank you for trusting APL with your insurance needs. And so then I get that letter. That's the second one I've gotten, so then I call, I received.
[AGENT][NEUTRAL] Letter
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And so that's why I called in again on the [PII] and said, OK, I don't understand because I thought I got all the info from [PII] but I didn't get the right stuff so.
[AGENT][NEUTRAL] So you will, um, so you'll get the letter again, so that, I mean, you can call however often you like, but you will get the letter um to let you know, hey, we've received this claim and then that that'll, that's how you'll know it's here, but um you can call, you can call whenever if you want to check, um, that's what we're here for.
[CUSTOMER][NEUTRAL] I get the letter
[CUSTOMER][NEUTRAL] Trigger
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] OK, alright, well thank you so much and yes please, I'd love to um give you my commendations of your amazing work to your supervisor.
[AGENT][POSITIVE] Well, thank you. I appreciate you, Ms. [PII]. Well, thank you for calling APL. I hope you have a great weekend and hold on one moment while I get um Miss [PII] for you, OK. Thank you.
[CUSTOMER][POSITIVE] I hope you do too.
[CUSTOMER][POSITIVE] Oh, OK, perfect. Thanks so much.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Whoa.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, so she's in a meeting, but I'm gonna transfer you to her voicemail and she'll get it. Um, all right. Hold on one moment, OK?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][POSITIVE] OK, thank you, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Hello, you've reached the desk of [PII] in the American Public Life Administration area. I'm currently away from my desk, but please leave your name, telephone number, and a brief message to indicate how I can help you. Your call is very much appreciated. Thanks and have a great day.
[CUSTOMER][NEUTRAL] Please leave a message after the tone. When you have finished, please hang up or press the pound key for more options.
[CUSTOMER][POSITIVE] Hi [PII], this is [PII] calling on [PII], and I just got off the phone, um, with [PII], and she was just phenomenal and is the first one who, um, I've been dealing with at your company who's just uh really solved my issue which has been going on with Cleveland Clinic Emerge um Hospital in [PII].
[CUSTOMER][POSITIVE] Since um March and I've had many phone calls and trying to get the information that you all needed from Cleveland Clinic and they wouldn't provide it and she said, let's call them together today and we did and she got um the right person to talk to and and hopefully this claim um will be moving forward thanks to her efforts. I just wanted to leave you a message because I, I, she was just absolutely phenomenal.
[CUSTOMER][POSITIVE] And uh you are a great company and blessed to have her um and I can't thank you enough for all our help and again this is [PII] and my member ID is 683-539-721 so you can see all the back and forth that I've been dealing with with Cleveland Clinic and um I think that [PII] solved it today. So thank you so much. Have a fabulous day and weekend. Bye bye.