AccountId: 011433970860
ContactId: e072117b-ca39-4a02-8335-3d43495a6501
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308350 ms
Total Talk Time (AGENT): 136843 ms
Total Talk Time (CUSTOMER): 99609 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/e072117b-ca39-4a02-8335-3d43495a6501_20250225T16:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from the Cleveland Clinic. I'm calling to check uh members eligibility and benefits.
[AGENT][POSITIVE] Yeah, I can check eligibility and benefits for you. [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, that's going to be [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure, this member's policy number is 148427 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK, um, I'm sorry that was 14 uh excuse me, 148427.
[AGENT][NEUTRAL] Before the MLA
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK, so, um, we're actually missing some digits there, [PII], um, do you maybe have their social? I could search for them that way.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] I think we're missing one number.
[CUSTOMER][NEUTRAL] I'm looking at the ID card now.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, there is a number 1 [PII].
[AGENT][NEUTRAL] Uh, could you repeat the, um, the entire policy number as you see it on the card?
[CUSTOMER][NEUTRAL] Could you repeat
[CUSTOMER][NEUTRAL] Sure, that's 1484271 ML7.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, uh thank you for that and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying that. Uh, so this policy actually terminated [PII]. Uh, if you'll give me one moment, I'll see if they have one that's active. It might just be a different policy number.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm sure.
[AGENT][NEUTRAL] OK, they do have an active policy with us. Let me know when you're ready and I can give you that policy number.
[CUSTOMER][POSITIVE] I'm ready now.
[AGENT][NEUTRAL] OK, it is 02304093.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] What is the starting date for this policy?
[AGENT][NEUTRAL] Yes, effective date was [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And are we able to check uh benefits for this policy?
[AGENT][NEUTRAL] Sure, I, I will let you know if you're not aware that this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. And then of course, I will let you know verification of coverage is not a guarantee of payment for claims.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, so their outpatient benefits, uh, and their inpatient benefit, um, is $9000 max per calendar year, and if you'll give me one moment I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] I'm still there
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][POSITIVE] Thank you and is uh.
[CUSTOMER][NEUTRAL] Is there any amount for the coinsurance co-payment or deductible?
[AGENT][NEUTRAL] Um, it would come out of that $9000 if it were inpatient. It's $9000 and then if it's outpatient it's $9000 so it would go up to that maximum per calendar year.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] Mhm perfect.
[CUSTOMER][NEUTRAL] Does that apply as well for the out of pocket amount?
[AGENT][NEUTRAL] As long as major medical pays, it goes towards co-pay, deductible and co-insurance.
[CUSTOMER][POSITIVE] Mm perfect.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Are we able to confirm if uh referral is required for an office visit for this patient to see a specialist?
[AGENT][NEUTRAL] Referrals are not required. This plan is very dependent on major medicals, so it does not require any pre-authorization or referrals.
[CUSTOMER][POSITIVE] Perfect. And just to finish, may I have a reference number that I can use for this call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Last initial is [PII] And was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] That was actually all I needed for this call. Thank you very much. I hope and I hope you have a great day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Of course, thanks for calling APL. You too. Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.