AccountId: 011433970860
ContactId: de3e51ea-72f4-4347-9168-5a3a3dc04d9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345950 ms
Total Talk Time (AGENT): 126057 ms
Total Talk Time (CUSTOMER): 106458 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/de3e51ea-72f4-4347-9168-5a3a3dc04d9b_20250603T13:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with Cleveland Clinic. I'm trying to get some information on a claim.
[AGENT][NEUTRAL] OK, I can help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, sure, it's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] I have 02280066.
[CUSTOMER][NEUTRAL] M as in Mary. L as in Lima 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] 13125 $2,921.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so we received this claim 3 times.
[AGENT][NEUTRAL] Um, OK, so did you want the original or?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] So I guess go ahead with the original because every time that we get an EOB from you guys it's saying.
[AGENT][NEUTRAL] A different reason.
[CUSTOMER][NEUTRAL] That it is pending review and we are not receiving actual like status on it um but at one point we did see that you guys did request that primary EOB which we did submit and then it was denied as a duplicate.
[AGENT][NEUTRAL] OK, so there's one in.
[CUSTOMER][NEUTRAL] I just need to see if it was even processed.
[AGENT][NEUTRAL] So what, so here's the thing, that, so she doesn't have an active policy with us right now. The policy, um, this policy terminated, hold on one second, terminated on [PII]. So that first claim that came in, that's the one that was denied for the explanation of benefits, but the second one was denied saying it was um services were rendered after coverage was terminated. Did you need that explanation of benefit?
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] If you could send that, that would be great.
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Uh, let me get the, are you able to email it?
[AGENT][NEUTRAL] Um, let me check. I believe I can. Hold on one second.
[CUSTOMER][NEUTRAL] OK, yeah, that would just be it'll come directly to me then, otherwise it kind of goes through all the loops.
[AGENT][NEUTRAL] OK, I hold on one second provider.
[AGENT][NEUTRAL] OK, we can only fax or mail it.
[CUSTOMER][NEUTRAL] OK, uh, that's fine. Let me get the fax number. One second.
[AGENT][POSITIVE] OK, take your time.
[CUSTOMER][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] Uh, they've changed it on so many times. Hold on.
[AGENT][POSITIVE] Mhm. Take your time.
[CUSTOMER][NEUTRAL] OK [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's [PII]?
[CUSTOMER][POSITIVE] Yeah, go ahead with that one that'll work.
[AGENT][NEUTRAL] OK. Well, I'm sending this over to you now, and this is, you want the one that shows the um services were rendered after coverage was terminated, the second one?
[CUSTOMER][POSITIVE] Yes, yep, exactly.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and can you actually give me the date that that was denied and then also the claim number just so when I have it in my notes.
[AGENT][NEUTRAL] Oh, sure, hold on one second.
[AGENT][NEUTRAL] OK, so it was received on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 5230.
[AGENT][NEUTRAL] And on [PII], it was denied um because the policy is no longer active.
[CUSTOMER][POSITIVE] OK awesome and then um do you guys do call reference numbers?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Awesome thank you so much for your help I appreciate it.
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Nope, that is it.
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Mm.