AccountId: 011433970860
ContactId: c35b6724-41b4-4457-80bf-36ca8a998787
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311220 ms
Total Talk Time (AGENT): 143432 ms
Total Talk Time (CUSTOMER): 115556 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/c35b6724-41b4-4457-80bf-36ca8a998787_20250403T17:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Yes, I just want to know the status of my claim.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I please get your name and your policy number?
[CUSTOMER][NEUTRAL] Sure, it's my name is [PII], and the policy number would be my group number or my benefit cert number.
[AGENT][NEUTRAL] Cert number.
[CUSTOMER][NEUTRAL] Sure number in-house, in in hospital or outpatient?
[AGENT][NEUTRAL] Either one will work.
[CUSTOMER][NEUTRAL] OK, it's 02476599 ML 7.
[AGENT][NEUTRAL] OK, let me look up your policy real quick.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] All right, Ms. [PII], um, can you please give me your callback number just in case the call gets disconnected, I'll be able to call you right back.
[CUSTOMER][POSITIVE] Oh excellent [PII].
[AGENT][NEUTRAL] OK, thank you very much. And then I'll need for you to please uh verify your policy. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Address is [PII]. Email address is [PII] My last name [PII].
[AGENT][NEUTRAL] OK, and then the number that you gave me to call you back on, is that your cell phone number?
[CUSTOMER][NEUTRAL] Well I finish.
[CUSTOMER][NEUTRAL] Yes, it is, uh huh.
[AGENT][POSITIVE] OK, thank you very much. All right.
[AGENT][NEUTRAL] So I do show that there was a claim, um, and the claim is for yourself, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I do show there was a claim reported on [PII], um, let me look and see what it says.
[AGENT][NEUTRAL] It was for the Cleveland Clinic?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, let's keep.
[CUSTOMER][NEUTRAL] Outpatient surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let's look.
[AGENT][NEUTRAL] Give me just a second while I pull it up.
[AGENT][NEUTRAL] OK, so the claim um is in process, but there's some more information that we need.
[AGENT][NEUTRAL] We need to have the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I thought I sent that explanation benefits. I thought I sent that already.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, that's what it's asking for. It looks like the claim was reprocessed. Um, it was originally sent in on, uh, [PII].
[AGENT][NEUTRAL] And then it was reprocessed on [PII] and it's still asking for the same information that we need the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Yes, it, it, it, um, explanation, I asked for it from my HR and that's what they gave me and that's what I provided. It was a description regarding copays.
[CUSTOMER][NEUTRAL] And out of pocket.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And what the um in inpatient cost wouldn't that be the explanation of benefits?
[AGENT][NEUTRAL] No, ma'am, the explanation of benefits comes from your primary insurance, so your major medical insurance carrier have to get it from them.
[CUSTOMER][NEUTRAL] OK. OK. Oh, OK.
[CUSTOMER][NEUTRAL] OK, alright, OK. Explanation of benefits that's what you need.
[AGENT][NEUTRAL] Right that shows where they um the the part that they paid, it'll show everything that they paid explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, OK, because I thought that the, the, the, um, receipt that I got paying the um the copay shows what they they paid.
[AGENT][NEUTRAL] The itemized statement. No, ma'am, that's the itemized statement. That's a different form.
[CUSTOMER][NEUTRAL] That didn't show that?
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] OK. Explanation of benefits. Thank you.
[AGENT][NEUTRAL] And once we that we can um finish processing the claim.
[CUSTOMER][POSITIVE] OK, explanation of benefits from my primary. Thank you very much.
[AGENT][POSITIVE] You're so very welcome. Is there anything else, um, Ms. [PII] I can help you with?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] No, that'd be all. Thank you.
[AGENT][POSITIVE] You're welcome. You have a good day and thanks for calling ATL.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] OK, you, bye bye.