AccountId: 011433970860
ContactId: 7d7ccfb0-6a83-496a-91f6-54dfaa9e7fad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470820 ms
Total Talk Time (AGENT): 130783 ms
Total Talk Time (CUSTOMER): 144622 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/7d7ccfb0-6a83-496a-91f6-54dfaa9e7fad_20250523T20:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon, thanks for calling APL. This is. May I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the providers I'll be checking on the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is again?
[AGENT][NEUTRAL] Ma'am, and your name is?
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] [PII]. My last initial [PII].
[AGENT][NEUTRAL] Spell that for me.
[AGENT][NEUTRAL] Uh, spell your name for me please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] Yeah. uh 01481848, M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yeah, [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah. The date of service is [PII]. Total charge amount is $221 even.
[AGENT][NEUTRAL] And what was the balance after primary process the claim?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I think 75.
[AGENT][NEUTRAL] And you said date of service was [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do not show we received that claim. Can you verify the address it was submitted to?
[CUSTOMER][NEUTRAL] Yes, the address is [PII] City. OK, uh [PII].
[AGENT][NEUTRAL] Uh, that is correct, and if you like, I can give you our fax number you can fax the claim.
[CUSTOMER][NEUTRAL] Yeah. And may I take two dates, please, member affect 2 dates.
[AGENT][NEUTRAL] Effective date [PII], the policy is active.
[CUSTOMER][NEUTRAL] [PII], right? Still active.
[AGENT][NEUTRAL] Of 28
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK. May I know this payer ID please?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. May I know this timely filing, please?
[AGENT][NEUTRAL] Uh, there isn't one.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEGATIVE] We don't have timely filing.
[CUSTOMER][NEGATIVE] No timely filing, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Uh, yeah, spell out your name, please?
[AGENT][NEUTRAL] [PII] last initial [PII]
[CUSTOMER][NEUTRAL] OK. Call reference number for this one. I have one more claim.
[AGENT][NEUTRAL] Well, you, well, we don't, well, you can use my name in today's date it's called reference and the next claim is it for the same patient or a different patient?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number is 02428173 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is um
[CUSTOMER][NEUTRAL] Yeah, [PII] and the date of birth is uh [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, the date of service is uh [PII]. Total charge amount is $78 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Name of the provider's office?
[CUSTOMER][NEUTRAL] Math, uh, Cleveland Clinic Foundation, Western Clinic.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I show that claim processed as service not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] 352-360-3.
[CUSTOMER][NEGATIVE] Claim received date and denied it.
[AGENT][NEUTRAL] Claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] OK. May I know this, this is patient responsibility or what?
[AGENT][NEUTRAL] We can't give patient responsibility. We can only verify how the claim was processed, which was service not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, this is provider plan or patient plan?
[AGENT][NEUTRAL] Per the patient's policy with our company.
[AGENT][NEUTRAL] Procedures in a doctor's office or clinic is not covered.
[CUSTOMER][NEUTRAL] Patient plan, right?
[CUSTOMER][NEUTRAL] I'm asking that uh this is patient plan or provider contract.
[AGENT][NEUTRAL] Ma'am, I just explained to you per the patient's policy with our company, it is not covered.
[CUSTOMER][NEUTRAL] OK. Patient plan is not covered, right?
[AGENT][NEUTRAL] OK, is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah, this, uh, then what I should do now, this $78 with the whole amount is patient responsibility or what?
[AGENT][NEUTRAL] As I stated, we cannot give patient responsibility. You have to contact the patient.
[CUSTOMER][POSITIVE] OK. Thank you so much. Thank you for providing this information. Have a great day. Bye-bye.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Thank you for calling APL. Bye.