AccountId: 011433970860
ContactId: af892712-1e6a-4703-ba40-f70294926785
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295239 ms
Total Talk Time (AGENT): 114569 ms
Total Talk Time (CUSTOMER): 125251 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/af892712-1e6a-4703-ba40-f70294926785_20250428T20:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from Cleveland Clinic. I was calling on one of your members, um.
[CUSTOMER][NEUTRAL] To get verification of eligibility on their insurance.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need to go callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 0244.
[CUSTOMER][NEUTRAL] Um, 6323 ML 8.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII] And her date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Outpatient, um, let me make sure, hold on, let me make.
[AGENT][NEUTRAL] OK, for
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The one of them might be.
[CUSTOMER][NEUTRAL] Inpatient. No, that's still outpatient. Yeah, all outpatient.
[AGENT][NEUTRAL] OK. For outpatient, we cover up to 7500 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] She, she was very confusing. She called a couple of people before us and I think they thought you were like a just like a Aflac insurance.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] But you're you're someone that we can bill correct?
[AGENT][NEUTRAL] Um, yes, ma'am. We're secondary gap insurance. Um, once you build the primary insurance, you'll send the primary, it'll be OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, that's what I thought.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Yeah, so I think she was a little confused by this, so, well, actually she confused me, but I think I
[CUSTOMER][NEUTRAL] I think I got it now. And can I have um your
[CUSTOMER][NEUTRAL] Mailing address for the claims.
[AGENT][NEUTRAL] Um, yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the um
[AGENT][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] and this [PII] good number.
[CUSTOMER][NEUTRAL] Is there any fax number?
[AGENT][NEUTRAL] Um, yes, the fax claims, the fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and please attention it to the claims department.
[AGENT][NEUTRAL] And we also have a pair ID.
[CUSTOMER][NEUTRAL] You also have a what?
[AGENT][NEUTRAL] A pair ID for EDI claims.
[CUSTOMER][NEUTRAL] Oh payer ID OK and that is?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. And you said this is effective [PII]?
[CUSTOMER][NEUTRAL] And how about is there any group number?
[AGENT][NEUTRAL] Um, yes, the group number is 19698.
[CUSTOMER][NEUTRAL] OK. All right. And last thing I just need is if there is a reference number for the call.
[AGENT][NEUTRAL] Yes, ma'am. So the reference number, you can use my name and today's date. My name is [PII] um it's spelled [PII] Last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's it. Um thank you so much for your help today.
[AGENT][POSITIVE] OK, thank you, [PII], for calling APL. You have a great rest of your day. Bye.
[CUSTOMER][NEUTRAL] You too. Bye bye.
[AGENT][POSITIVE] Thank you.