AccountId: 011433970860
ContactId: 87c1dce4-4030-47a3-84b8-ad68eb9a869f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2096388 ms
Total Talk Time (AGENT): 386249 ms
Total Talk Time (CUSTOMER): 381316 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/87c1dce4-4030-47a3-84b8-ad68eb9a869f_20250605T15:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII] and I'm calling for the claim status. Could you please help on that?
[AGENT][NEUTRAL] Sure, I can help you with claim status, [PII]. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. The good callback number is [PII] the [PII] [PII].
[AGENT][NEUTRAL] Alright, and do you have the policy number with you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 024831110.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] So, like the patient's first name is [PII] and the last name is like [PII] and the date of birth is like [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh, sure, like, uh, the claim date of services like [PII] of 2024, uh, with the bill amount is like uh $29 even.
[AGENT][NEUTRAL] And I'm sorry, you said September what?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 2.
[AGENT][NEUTRAL] OK, give me just one moment to look that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what was the provider name or the hospital name?
[CUSTOMER][NEUTRAL] Uh, like it's like Cleveland Glen Foundation.
[AGENT][NEUTRAL] Did you say Cleveland Clinic?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, just wanted to make sure.
[AGENT][NEUTRAL] And give me just a moment.
[CUSTOMER][POSITIVE] Please take your time.
[AGENT][NEUTRAL] OK, I'm showing that we received that claim on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3530013.
[AGENT][NEUTRAL] And it looks like we paid $22.34.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, actually, like uh it was built within uh oh.
[CUSTOMER][NEUTRAL] Just $29 right? Uh, so it has been allowed on pay days like uh 22. $34 right? 29.
[CUSTOMER][NEUTRAL] I just paying 22. 34 minutes.
[AGENT][NEUTRAL] Yes, yes, sir.
[CUSTOMER][NEUTRAL] Uh, the remaining amount is like, uh, right, right, 6.66.
[AGENT][NEUTRAL] Yes, and we don't, um, we don't do patient responsibilities. That's not up to us, that's up to the provider.
[CUSTOMER][NEUTRAL] OK, and it was paid through EFTI check.
[AGENT][NEUTRAL] Let me look at when it was paid.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It looks like it was paid [PII].
[CUSTOMER][NEUTRAL] No, I'm asking about it was pay through check or EFT.
[AGENT][NEUTRAL] Oh, it's paid through check.
[CUSTOMER][NEUTRAL] Uh, what is the check number?
[AGENT][NEUTRAL] 201387.
[AGENT][NEUTRAL] 9
[CUSTOMER][NEUTRAL] OK. And may I know like uh what is uh like uh when was the cash date?
[AGENT][NEUTRAL] Uh, it looks like the check cleared on [PII].
[CUSTOMER][NEUTRAL] OK. And like uh it is a single check or bulk check?
[AGENT][NEUTRAL] It's a single check.
[CUSTOMER][NEUTRAL] What is the amount?
[AGENT][NEUTRAL] $22.34.
[CUSTOMER][NEUTRAL] And may I know to which address like uh the check has been sent, has been sent like a [PII], am I right?
[AGENT][NEUTRAL] I'm sorry, can you repeat the PO box?
[CUSTOMER][NEUTRAL] [PII]. Am I right?
[CUSTOMER][NEUTRAL] The check has been sent.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] No, sir. It was sent to somewhere else.
[CUSTOMER][NEUTRAL] OK, then could you please uh reissue the check details to this address please?
[AGENT][NEUTRAL] Uh, the address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, yeah, could you please reissue the check?
[AGENT][NEUTRAL] 021.
[AGENT][NEUTRAL] Uh, the check has already been cleared.
[CUSTOMER][NEUTRAL] No, no, no, could you please reissue the check?
[CUSTOMER][NEUTRAL] No, could you please just send uh like uh check details to this address, OK?
[AGENT][NEUTRAL] You want us to, I'm sorry, I'm just trying to understand, you want us to reissue the check?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Could you
[CUSTOMER][NEUTRAL] Yeah, could you please reissue the check details to this address?
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Oh, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, because the check has cleared, that means someone has already, um, processed the payment and received the payment. So I'm going to need to put, to put a request in.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] We sent the check to the, the address that was on the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, no, actually it's having a different address. So actually, like, uh it went to like incorrect address. OK. So just give me a minute. I'm checking my one more system. So you're saying like it's [PII], right?
[AGENT][NEUTRAL] That is not the, that is not the address that they put on the claim.
[CUSTOMER][NEUTRAL] Uh, yeah, then could you please, uh, yeah, just could you please send uh like uh check details to this new address.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify that no one has received the check, because the check is cleared.
[CUSTOMER][NEUTRAL] Yeah, I know that like it has been clear, OK. Just, could you please send the details to this address. OK, it's enough.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] So I'm not asking about the like uh to get the pay like uh to pay, like to pay again, OK? Just I'm asking like you the early payment has been paid, right? Just uh send the details to this address.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][POSITIVE] Sure, please take your time.
[AGENT][NEUTRAL] And can I get the address one more time?
[CUSTOMER][NEUTRAL] Sure it's like [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And may I know how many days we need to allow to reissue the check details?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][POSITIVE] Sure, please take your time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment while I put in a request to get that sent out.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Give me just one moment while I fill out the form to get it sent to get a request sent to you, OK?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And for the zip code, did you say [PII]- what was, what was after that?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. I'm almost done. Just give me one more moment.
[CUSTOMER][NEUTRAL] Uh, sure, like uh how many days we need to allow?
[AGENT][NEUTRAL] Um, you should expect it within 7 to 10 business days.
[CUSTOMER][POSITIVE] Thank you so much. And could you please provide the call reference number?
[AGENT][NEUTRAL] So we don't have call reference numbers?
[AGENT][NEUTRAL] But you can use my name.
[CUSTOMER][NEUTRAL] Can I use your name, [PII]?
[AGENT][NEUTRAL] [PII] and last initial [PII].
[AGENT][NEUTRAL] And then, uh, today's date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, there is like uh [PII] or [PII].
[CUSTOMER][NEUTRAL] Could you please go to the next thing?
[AGENT][NEUTRAL] OK. Give me just one moment.
[AGENT][NEUTRAL] And let me um enter my notes for this patient. Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Great. And what is the next policy number?
[CUSTOMER][NEUTRAL] Like the next policy number is like, and could you please send you through fax?
[CUSTOMER][NEUTRAL] The same you will be?
[AGENT][NEUTRAL] And what is your fax number?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] And may I know how many days you need to allow? Did you see the fax?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, I can send it in just a moment. Give me just a second while I pull that patient back up.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] Give me just a moment while I pull up that EOB.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And who is the attention for?
[CUSTOMER][NEUTRAL] Uh, so, like, uh, attention to, like you can mention [PII], my name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We use the patient's name.
[AGENT][NEUTRAL] OK, and the next policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, the next policy number is like uh
[CUSTOMER][NEUTRAL] 1669859 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] So, the patient's last name is [PII] and the last name is [PII] and the date of birth is like uh [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] So it's like [PII] with the bill amount it's like $336 even.
[AGENT][NEUTRAL] 336.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh, I'm sorry for that. Like, yeah, it's $336.
[AGENT][NEUTRAL] How much?
[CUSTOMER][NEUTRAL] 336
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the provider name? Or the hospital name?
[CUSTOMER][NEUTRAL] Uh, same, yeah, same, it's like Clule Foundation.
[AGENT][NEUTRAL] Looks like we received this claim on [PII].
[AGENT][NEUTRAL] We process the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 35.
[AGENT][NEUTRAL] 23519.
[AGENT][NEUTRAL] And give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] You said the total bill amount was $336?
[CUSTOMER][NEUTRAL] Yeah, or you can see like $70.
[AGENT][NEUTRAL] I'm not seeing that bill amount.
[CUSTOMER][NEUTRAL] So like not $336 you're not seeing.
[AGENT][NEUTRAL] No, I'm not seeing that bill amount.
[CUSTOMER][NEUTRAL] What about the $70?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] 70, let me see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not seeing one for $70.
[CUSTOMER][NEUTRAL] Then what about this claim number 3523519?
[AGENT][NEUTRAL] 352-351-9.
[CUSTOMER][NEUTRAL] What is the bill amount for this?
[AGENT][NEUTRAL] Yeah, I'm not seeing that bill amount.
[CUSTOMER][NEUTRAL] Yeah, what is the bill amount for?
[CUSTOMER][NEUTRAL] No, like what is the bill amount for this claim number? 352-3519?
[AGENT][NEUTRAL] I can't give you that. I'm sorry.
[CUSTOMER][NEUTRAL] No, no, no. See, like, if you're going to provide it, we like, uh, so we'll further the further step, OK. So we are not asking like any questions, right? So you're giving the claim number, it was on [PII].
[CUSTOMER][NEUTRAL] Yeah, we have submitted the [PII] with the bill amount of $336 even, but you're saying that there is no claim on file, right?
[AGENT][NEGATIVE] Not for that one, no.
[CUSTOMER][NEUTRAL] With that amount.
[CUSTOMER][NEUTRAL] And could you please provide the what is the TFL to resubmit this claim.
[AGENT][NEUTRAL] Did you want the fax number or the mailing address?
[CUSTOMER][NEUTRAL] No, I'm asking what is the TFL timely filing limit to resubmit this claim.
[AGENT][NEUTRAL] O[PII], I'm sorry, uh, there is no timely filing limit.
[CUSTOMER][NEUTRAL] OK, and uh submitting me has been the same, right? [PII].
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yeah, and what is the call reference number?
[CUSTOMER][NEUTRAL] Yeah, what is the call reference?
[AGENT][NEUTRAL] Uh, there is no call reference number, but you can use my name and last initial in today's date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Could you please go with the next member?
[AGENT][NEUTRAL] Uh, another patient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me just one moment to close this one out.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] At
[CUSTOMER][POSITIVE] God bless you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Give me one moment, I'm almost done.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and what is the next uh policy number?
[CUSTOMER][NEUTRAL] Sure, like 1284327. M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And to confirm that was 1284327?
[CUSTOMER][NEUTRAL] Yeah, M as in Mike.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] L as in Lima number 7.
[AGENT][NEUTRAL] And can I get you to verify the patient's name and date of birth for me?
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Sure, the patient's first name is like [PII] and the last name is like [PII] and the date of birth is like uh [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] In the data service.
[CUSTOMER][NEUTRAL] It's like 1008 of 2024 with the bill amount is like $481 even, or you can see like $100 even.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you said [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] I'm not showing a claim for that amount.
[CUSTOMER][NEUTRAL] So there is no claim on file for $481 and $100 right?
[AGENT][NEUTRAL] You said 481.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, what is the member affected it?
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, it looks like the effective date for this policy is [PII].
[CUSTOMER][NEUTRAL] Oh, still active, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Could you please go with the last claim?
[AGENT][NEUTRAL] Oh, with a different patient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me just one moment to close this one out.
[CUSTOMER][NEUTRAL] So
[AGENT][POSITIVE] Bless you.
[CUSTOMER][NEUTRAL] And did you have your like uh yeah, please go ahead. I'm sorry.
[AGENT][NEUTRAL] Oh, give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And the next policy number?
[CUSTOMER][NEUTRAL] The next policy number is 02462344 M as in Mike L as in Lima number 7.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] So the patient's first name is like [PII] and the last name is like [PII] and the date of birth is like [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] The claim data service is like uh [PII] with the build amount is like $937 even.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, it looks like we received this claim on [PII]. It was processed on this, uh, on the next day, [PII].
[AGENT][NEUTRAL] Claim number is 3589543.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like that claim was denied um let me see why.
[AGENT][NEUTRAL] Right, it looks like benefits payable under the certificate are limited to those outlined in the schedule of benefits, um, and this was not a covered loss under the plan. Therefore, no amount is payable for that expense.
[AGENT][NEUTRAL] So it was not a covered service.
[CUSTOMER][NEUTRAL] So you're studying this, yeah, this is not a call service under this patient, right?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] The service is not covered under this benefit plan for this patient, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. May I know why it has been not got under this patient?
[AGENT][NEUTRAL] Uh, it was not outlined in their policy certificate as a covered service, so we can't pay for services that aren't in their policy certificate.
[CUSTOMER][NEUTRAL] OK, so, like we need to be patient, uh, no, like, uh, so what are the pending amount, so it should be paid from the product or like uh the patient.
[CUSTOMER][POSITIVE] And be patient, right?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] We don't determine patient responsibility, that will be up to the provider.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Could you please provide the call reference number?
[CUSTOMER][POSITIVE] Oh, you already put it, yeah, thank you.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Yes sir, no call reference number, just my name and last initial and today's date.
[CUSTOMER][NEUTRAL] Yeah. May I know what is the type of the plan, the patient plan having?
[AGENT][NEUTRAL] Um, this is 2nd
[CUSTOMER][NEUTRAL] HMO PP or EPO?
[AGENT][NEUTRAL] Um, no, it's not PPO. It's just secondary gap insurance.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Great, thank you for calling [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] Yeah, thank you.