AccountId: 011433970860
ContactId: d4d4dda3-b253-4f98-9217-d71afe047fed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380420 ms
Total Talk Time (AGENT): 153294 ms
Total Talk Time (CUSTOMER): 144755 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/d4d4dda3-b253-4f98-9217-d71afe047fed_20250425T19:08_UTC.wav
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[AGENT][POSITIVE] Good, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling from Cleveland Clinic, Coral Springs ASC to get a clarification of a denied claim. And could you please spell your name for me?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can you spell yours? You're welcome.
[CUSTOMER][POSITIVE] Thank you, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah, sure. My name is spelled as [PII]. First [PII] my last name is [PII].
[AGENT][NEUTRAL] OK, and the first initial to my last name [PII].
[CUSTOMER][POSITIVE] Thank you much, [PII].
[AGENT][NEUTRAL] You're welcome. And you said that you were needing to get clarification on a denied claim, is that correct?
[CUSTOMER][POSITIVE] Yes, you are right.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] My callback number is [PII] with the extension of [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy number that you're calling on behalf of?
[CUSTOMER][NEUTRAL] Uh, the member's policy number is 01930681.
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the information provided today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII], and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Bear with me just one second, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount is $2,818.45.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and do you already have this claim number, [PII], or do you also need the claim number?
[CUSTOMER][NEUTRAL] So, already I have the claim number. Also, I do have the EOB for this claim. So the claim number 353,532,280. Under this claim, the, the claim has been denied for and attachment is required to adjudicate this claim or missing explanation of benefits. It's stating like the primary UB is missing, I, right?
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] Uh, this states, according to the remark that I now see on this claim, it states benefits, and this is this specific remark that I'm going to read to you, Dineish is on page two of this claim. I mean of the of the explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It states benefits are payable.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Only if your major medical insurance provider provides benefits. If this claim is later paid by your major major medical insurance, please send the explanation of benefits showing benefits were paid.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, OK. So, it it requires the UOB for the primary from the primary insurance term, right? So the primary paid UOB needs, is it right?
[AGENT][NEUTRAL] If they paid on this claim, then yes, you would need to submit the explanation of benefits showing that benefits were paid.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, OK. So, primary has not been paid a single amount for this claim. They processed.
[AGENT][NEUTRAL] Yes, if there's no benefits, correct. If the major medical does not cover.
[AGENT][NEGATIVE] There would be no coverage on this policy either.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK. If primary doesn't pay, secondly also does not pay. I'm right.
[AGENT][POSITIVE] That is correct, right.
[CUSTOMER][NEUTRAL] Yeah, OK. Yeah, OK. So thank you very much. Could you please provide me a reference number?
[AGENT][NEUTRAL] Yes sir, you would actually use my name along with today's date and [PII] you may already have our website for our portal, but in the future if you were to need a copy of an explanation of benefits, you should be able to print one from our portal by going to secured.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yeah, OK, [PII]. Thank you for your assistance and have a great day. Happy weekend too. Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, well, I hope you a happy weekend to you as well, [PII], and if that is all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Uh-huh, bye bye.