AccountId: 011433970860
ContactId: 8538b185-446b-4d75-98df-6cdf5bcdec3a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244479 ms
Total Talk Time (AGENT): 100894 ms
Total Talk Time (CUSTOMER): 81562 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/8538b185-446b-4d75-98df-6cdf5bcdec3a_20250116T13:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. I'm [PII] from the Cleveland Clinic. I am calling to verify a benefits and eligibility.
[AGENT][NEUTRAL] OK. And you said that you're calling from a clinic, so is this for an office visit?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] 95 um policy number will be.
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 71736
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. Could you give me the last four digits again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII] for that information. So we're checking the eligibility dates and uh the office visit benefit, is that correct?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Alright, so the policy effective date is [PII]. Uh, this policy is active at this time.
[AGENT][NEUTRAL] And for the office visit benefit, this policy will cover up to up to $50 per day.
[AGENT][NEUTRAL] A maximum of 4, excuse me, 4 days per calendar year.
[AGENT][NEUTRAL] And the information provided is verification, not a guarantee of payment, and currently I don't show any of those uh visits used.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] By any chance, uh,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] The like.
[CUSTOMER][NEUTRAL] Is the insurance in network by any chance?
[AGENT][NEUTRAL] So the uh network of contracted providers is multi plan. Are you familiar with multi plan?
[CUSTOMER][NEUTRAL] Um, of course, but OK, it is multi-plan. What happened if we are on the network with multi plan? Is there any way for us to apply for a gap exception?
[AGENT][NEUTRAL] Uh, no, it wouldn't be considered a gap exception. I mean we could still consider a benefit, um, and then you can also contact multiplan to verify if you're part of their con you know, network of contracted providers. We don't have a list of their providers.
[AGENT][NEUTRAL] Um, but I can give you their phone number if you would like.
[CUSTOMER][NEUTRAL] No, that's why I'm trying to explain. We are out of network. We already know that we.
[AGENT][NEUTRAL] Oh, you're not. Oh, OK. Gotcha. OK.
[CUSTOMER][NEUTRAL] We are not, yes, so.
[AGENT][NEUTRAL] OK. So you can go ahead and
[CUSTOMER][NEUTRAL] What happened in that case? Does patient have out of network coverage?
[AGENT][NEUTRAL] It's not technically considered out of network coverage. Uh, we can, um, offer a benefit, but it will not be discounted.
[CUSTOMER][NEUTRAL] That's what I try to say.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you can still the proprietor's office can still receive a benefit if there's an assignment of benefits on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you provide me with those?
[CUSTOMER][NEUTRAL] Benefits also?
[AGENT][POSITIVE] Yeah, it's the benefits that I just gave you $50 per day.
[AGENT][NEUTRAL] Up to 4 days per calendar year?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you very much and take care.