AccountId: 011433970860
ContactId: bc221010-f511-47bd-ac6f-c554cd610e4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273869 ms
Total Talk Time (AGENT): 95325 ms
Total Talk Time (CUSTOMER): 84050 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/bc221010-f511-47bd-ac6f-c554cd610e4b_20250225T16:27_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling. I'm sorry, good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, it's [PII] over at Cleveland Clinic. I wanna um verify eligibility for a patient.
[AGENT][NEUTRAL] OK, I can verify eligibility for you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and Ms. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] I got two different ones. Let's start out with the 02427782.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you, ma'am. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh sure that policy was effective [PII].
[AGENT][NEGATIVE] And it terminated on [PII]. I don't show any active coverage.
[CUSTOMER][NEUTRAL] OK, that's fine. Hold on, let me see what we got going on here so my data services while it was still open. OK, so that's the correct ID number for him?
[AGENT][NEUTRAL] Uh, that is the policy, yes, ma'am, for his medical plan.
[CUSTOMER][NEUTRAL] That I gave you
[CUSTOMER][NEUTRAL] Alright, is the group number 9464?
[AGENT][NEUTRAL] No, ma'am. Give me a moment.
[AGENT][NEUTRAL] Uh, it showed the group number was 70087.
[CUSTOMER][NEUTRAL] 70087 hold on a minute let me get that fixed up here.
[CUSTOMER][NEUTRAL] Alright, are you able to check on claims?
[AGENT][NEUTRAL] Sure. Uh, what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] That was [PII] for $517.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Let's see, and the name of the provider's office?
[CUSTOMER][NEUTRAL] Let me go back there. Let's see that was Akron General Medical Center.
[AGENT][NEUTRAL] Uh, see.
[AGENT][NEUTRAL] Uh, I don't show anything for the facility. So for the physician's office or the inpatient physician.
[CUSTOMER][NEUTRAL] That [PII].
[AGENT][NEUTRAL] OK let me pull up the.
[CUSTOMER][NEUTRAL] The Tricia [PII].
[AGENT][NEUTRAL] Uh, let me pull up the claim. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, [PII] is the provider. Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so we didn't receive payment on that claim, uh, what did we do wrong?
[AGENT][NEUTRAL] Well, the claim process is doctors and patient visits are not covered under the plan.
[CUSTOMER][NEUTRAL] So doctor and inpatient service is not covered?
[AGENT][NEUTRAL] No, just the doctor's inpatient visit is not covered. The patient had uh benefits for inpatient facility, just not for the physician's charged inpatient.
[CUSTOMER][NEUTRAL] So it doesn't cover physician charges?
[AGENT][NEUTRAL] Uh, not inpatient charges, so, ma'am.
[CUSTOMER][NEUTRAL] Because um
[CUSTOMER][NEUTRAL] Hold on a minute, let me see what this is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, I see it was an inpatient stay and it doesn't cover those physician charges got it right, so um do you use reference numbers for your phone calls?
[AGENT][NEUTRAL] Uh, we don't, but if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] OK, fantastic. Thank you so much for your time and your help. I appreciate it.
[AGENT][POSITIVE] Oh, you're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.