AccountId: 011433970860
ContactId: 9468e1a0-5809-4b79-b37c-8ccee137bfce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1245119 ms
Total Talk Time (AGENT): 325875 ms
Total Talk Time (CUSTOMER): 506493 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/9468e1a0-5809-4b79-b37c-8ccee137bfce_20250303T20:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, I'm calling her to see about my.
[AGENT][POSITIVE] OK, well, I can definitely help you with your claim. May I have a, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, the phone is breaking up. I missed your name. Can you repeat that for me, please?
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] No, I don't know that.
[AGENT][NEUTRAL] OK, I can search the policy with your social if you like.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] I'm sorry, I'm getting like every other number. The last thing I heard was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] I'm still missing it. It's very choppy. Can you, you want to try it one more time?
[CUSTOMER][NEUTRAL] Did you get it?
[AGENT][NEUTRAL] No, I didn't hear anything.
[CUSTOMER][NEUTRAL] Oh, I didn't
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And then can you repeat the name because I I didn't hear the name either.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm just waiting for the policy to populate. Hold on one moment.
[AGENT][NEUTRAL] It's kind of taking its time here. I apologize. Hold on one moment. Here we go. And um which policy is it for?
[CUSTOMER][NEUTRAL] Uh, the hospital.
[AGENT][NEUTRAL] OK, here we go.
[CUSTOMER][NEUTRAL] And stroke, there's two of them.
[AGENT][NEUTRAL] Do you have your stroke under your accident or your critical illness policy?
[CUSTOMER][NEUTRAL] Uh, critical illness.
[AGENT][NEUTRAL] I can look up
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment, let me pull those up.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Yeah, [PII], mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So,
[AGENT][NEUTRAL] This first claim here.
[AGENT][NEUTRAL] All right, so I have you pulled up and then what questions did you have?
[CUSTOMER][NEUTRAL] Alright, I was told I was waiting for the um.
[CUSTOMER][NEUTRAL] Detailed billing statement that y'all had mailed off for him and I wonder if it if it came in.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what the status of my claim is?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm looking on the Hustle indemnity one. So this one was asking for the itemized billing and
[AGENT][NEUTRAL] It looks like we received.
[AGENT][NEUTRAL] I'm flipping through screens. I'm sorry, hold on one moment.
[AGENT][NEUTRAL] So the claim was originally from January and then it looks like we received the documents, um, requested documents on [PII].
[AGENT][NEUTRAL] And on [PII], it was denied as a duplicate. So let me see what they sent in. Hold on one second.
[AGENT][NEUTRAL] Oh, I see. OK.
[AGENT][NEUTRAL] So the bill that was sent in, this is an itemized bill. This is the patient itemized bill though. So it only shows the treatment and the procedure codes. It's just basically showing you what you got done and what you paid for. We need the diagnosis codes which shows why you got all of this so that we can prove that it's medically necessary. So,
[AGENT][NEUTRAL] Um, all you'll need to do is, um, is this for, hold on, let me see, does it specify bill or EOB?
[AGENT][NEUTRAL] Yeah, so you're just gonna have to reach out to the Cleveland Clinic, let them know that you'll need you you're needing an itemized bill or universal bill, not the patient bill. We need their version of it, basically, because like yours only shows the diagnosis codes, it'll have, I'm sorry, the procedure codes, the one we're asking for has the diagnosis codes, procedure codes, and all the charges.
[CUSTOMER][NEUTRAL] Yeah well last time I talked to somebody in your office.
[CUSTOMER][NEUTRAL] They told me that because I'm having trouble with Cleveland Clinic.
[CUSTOMER][NEUTRAL] Mailing that the UBO4 form to me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Y'all's opposite down there.
[AGENT][NEUTRAL] Well, I mean, we sent them, yes, we sent them an well, let me double check before I say that.
[AGENT][NEUTRAL] Member calling check status of client see that pending.
[AGENT][NEUTRAL] I was gonna say now we will send the explanation of benefits, but because you filed the claim, it doesn't go to the provider, it's just um we we'll send the explanation of benefits to you. Um, the, uh, so I don't see anything that's been sent. I mean, I can reach out to them if you like and try to get the documents for you, but we typically would not call because we're a third party and with HIPA, they can't tell us anything anyway.
[AGENT][NEGATIVE] They can send it to us, but without you being on the phone, you know, they can't tell us anything.
[CUSTOMER][NEGATIVE] Yeah, because they're giving me a hard time about.
[CUSTOMER][NEUTRAL] Because this is the, I mean, I reached out to him 3 times.
[CUSTOMER][NEUTRAL] And 3 times they sent me.
[CUSTOMER][NEUTRAL] My personal medical records and I keep telling him I need a the UBO4, you know that the universal.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they keep sending me my personal.
[AGENT][NEUTRAL] So, let me do this. There is a number here down at the bottom of the, um, I'm just looking at the documents that were sent in. I see a customer service number for um Cleveland Clinic. If you don't mind, I can place you on a brief hold and call them on the other line.
[CUSTOMER][NEUTRAL] Yeah, that'll be fine.
[AGENT][NEUTRAL] OK, hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You have reached Cleveland Clinic billing customer service.
[CUSTOMER][NEUTRAL] Para espanol or prima elsiete.
[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] To speak with a customer service representative, press one to.
[CUSTOMER][NEUTRAL] To make a payment, press 1. To check the status of your financial application, press 2. To hear your balance or to receive an itemized statement, press 3.
[CUSTOMER][NEUTRAL] Please enter your billing account number without the E.
[CUSTOMER][NEUTRAL] Your billing account number starts with the letter E and can be found on the top right corner of your statement. Please enter all of the numbers after the letter E, then press the pound or hash key.
[CUSTOMER][NEUTRAL] If you do not have your billing account number, just press the pound or hash key.
[CUSTOMER][NEUTRAL] A customer service representative will need to assist you.
[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][POSITIVE] Hello, good afternoon. Thank you for calling customer service at Turland Clinic. My name is [PII]. Who do I have the pleasure of speaking with today?
[AGENT][NEUTRAL] Hey [PII], my name is [PII]. I'm calling from American Public Life. How are you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm good thank you for asking. How about you? How are you today?
[AGENT][POSITIVE] I'm doing well. Um, we have a mutual patient. She's on the line as
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] He's on the line as well. Um, I'm just trying to help him get the UBO4 or the itemized bill for a data service so that we can um continue processing the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, for this one, and sorry, uh, from what insurance are you calling again?
[AGENT][NEUTRAL] American Public Life.
[CUSTOMER][NEUTRAL] American.
[CUSTOMER][NEUTRAL] Do you have the uh patient's phone number?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Do you have a phone number?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] May I know the name and the uh date of birth, please?
[AGENT][NEUTRAL] [PII], date of.
[AGENT][NEUTRAL] Date of birth is [PII].
[CUSTOMER][POSITIVE] Thank you so much for that. And uh to verify the patient account, I also need the billing address, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] May I know the uh uh email address if you have one?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, for the email that you provided to me, [PII], it is not, uh, we have on file. Do you have the other email?
[AGENT][NEUTRAL] Mr. [PII], can you give her the other email?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] Thank you so much. Hi, [PII]. Good afternoon to you. How are you today?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's good to hear. And uh by the way, just wanna ask the consent, um, [PII], that are you OK to provide the information uh with [PII] regarding on your account? Are you OK with that?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So for this one, we can request the um UVL4. Um, may I know for what date of service is that?
[AGENT][NEUTRAL] Yes, hold on one second. Let me look at this all isn't.
[AGENT][NEUTRAL] Cleveland Clinic. Hold on one second.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Yeah, [PII], uh [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] I see. Let me check.
[CUSTOMER][NEUTRAL] [PII]. I see. Is that for the admission, um, [PII], at the Ribbon uh River Hospital? Yes.
[CUSTOMER][NEUTRAL] Yes. India, Indian River, I see.
[CUSTOMER][NEUTRAL] How do you do you receive your I, my, uh, your billing, uh,
[CUSTOMER][NEUTRAL] I mean your UBO form through mail or through email?
[AGENT][NEUTRAL] Are you sending it to the, to the insured or can you send it to us?
[CUSTOMER][NEUTRAL] We already sent it to you, um, I mean, we already sent the, the, uh, claim, uh to the insurance. Um,
[AGENT][NEUTRAL] The reason I'm calling is because, so the reason I'm calling is because we asked for a detailed itemized bill, we didn't receive it. So that's what I'm asking. Are you sending it to the patient or will you be sending it to us so that we can continue processing the claim?
[CUSTOMER][NEUTRAL] [PII] and
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, through the patient, uh, [PII].
[CUSTOMER][NEUTRAL] Yeah, email of the patient.
[CUSTOMER][NEUTRAL] Yeah sent it by mail because they tried to send it by.
[CUSTOMER][NEGATIVE] Email last time and I couldn't get into it.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Just a moment here.
[CUSTOMER][NEUTRAL] Via mail for your address that was verified earlier, [PII]?
[CUSTOMER][NEUTRAL] Excuse me, I didn't hear that.
[CUSTOMER][NEUTRAL] To your um billing address, which is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah. Hold on.
[CUSTOMER][NEUTRAL] Let me just put you on hold for both of you while um requesting the itemized statement.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Is your child struggling with pain from complex regional pain syndrome, chronic headaches, or some other type of chronic pain? Let us help you find effective answers. Schedule a half day evaluation for kids ages [PII] [PII] at our pediatric pain rehabilitation assessment clinic.
[CUSTOMER][NEUTRAL] You can meet with different specialists, get same-day recommendations, and see if our team is a good fit. For more information, please call [PII].
[CUSTOMER][NEUTRAL] When hip or knee pain limits your ability to perform daily activities or stops you from enjoying doing the things you love, it's time to seek medical advice. If you are experiencing joint pain, we have you covered. Make an appointment with an orthopedic specialist by visiting [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] This heart month, put your health first. Avoiding tobacco usage, getting enough sleep, and managing stress can all help improve your heart health. Learn more ways to stay heart healthy. Subscribe to Love Your Heart, a free monthly email newsletter from Cleveland Clinic experts. Sign up at [PII].
[CUSTOMER][NEUTRAL] Life is busy and it can be hard to make time for your health. MyChart offers many options to manage your care online, including the ability to choose the types of communications you receive from Cleveland Clinic. Access your secure MyChart account and use communication preferences to opt in or out of receiving email, text, mobile, telephone, and mail messages. You can also adjust your preferences by message type, such as appointment reminders or billing notifications.
[CUSTOMER][NEUTRAL] Hello, [PII] and uh [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you for patiently waiting and I do apologize for the long wait. So for this one, I already request to um send the uh UBO4 for the data service [PII].
[CUSTOMER][NEUTRAL] And you will receive uh it, uh, [PII], through your uh through your mail. And once you receive it, uh you can uh resubmit that, or you can submit that, uh, you bill for to your insurance, OK?
[CUSTOMER][NEUTRAL] Alright, did you say 26? I'd be [PII]. UBO4 [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, that's it.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][POSITIVE] You're welcome. And is there anything else um I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[CUSTOMER][NEUTRAL] OK. By the way, [PII], do you have your, uh, do you have a reference number?
[AGENT][NEUTRAL] Um, there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much for that one. And uh is there anything else I can help you with for both of you?
[AGENT][POSITIVE] No, that's it. Well thank you very much.
[CUSTOMER][POSITIVE] You're welcome, [PII] and [PII], and thank you for choosing Cleveland Clinic. Have a great day for both of you. Bye for now. Thank you. All right, thank you. Bye.
[AGENT][NEUTRAL] You too. Bye bye.
[AGENT][NEUTRAL] OK, hello, Mr. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, as soon as I get it I have it faxed to you.
[AGENT][NEUTRAL] Alrighty. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] All right you too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] But