AccountId: 011433970860
ContactId: e11267e3-5e7e-4965-8591-7e413e37c980
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455440 ms
Total Talk Time (AGENT): 199835 ms
Total Talk Time (CUSTOMER): 195506 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/e11267e3-5e7e-4965-8591-7e413e37c980_20250318T14:57_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, [PII].
[CUSTOMER][NEUTRAL] My name is [PII], and I'm calling for uh Cleveland Clinic Hospital to check on the claim status.
[AGENT][POSITIVE] It would be my pleasure to assist you and I apologize. Can you spell your name for documentation, please?
[CUSTOMER][NEUTRAL] So, [PII].
[AGENT][POSITIVE] Thank you, [PII], and what is a good callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the policy number is 024.
[CUSTOMER][NEUTRAL] 83108.
[AGENT][NEUTRAL] And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] It is uh [PII] and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you, [PII]. And I understand you're needing claim status for [PII] and it would be a pleasure to assist you with that claim status. What is the date of service, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the bill amount?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The total bill amount, uh,
[CUSTOMER][NEUTRAL] $373 even, 373.
[AGENT][NEUTRAL] And what is the name of the facility?
[CUSTOMER][NEUTRAL] The facility name is the Cleveland Clinic, Florida.
[AGENT][NEUTRAL] Thank you, [PII], I'm showing that we received that claim on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Claim was processed on [PII]. This claim is pending for the primary EOB. We are secondary to the policyholder's major medical.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] OK. May I know who is the primary insurance for this number?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We have Allstate listed as their primary.
[CUSTOMER][NEUTRAL] For Hall state.
[AGENT][NEUTRAL] That's correct. Allstate. I don't have that policy information. You would need to contact the patient for that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you do not have the uh
[CUSTOMER][NEUTRAL] Information, right, for regarding the uh
[CUSTOMER][NEUTRAL] Allstate.
[AGENT][NEUTRAL] That's correct. You would need to contact the patient for that information.
[CUSTOMER][NEUTRAL] OK, may I know how long it will take for uh to submit the uh UV?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For the primary?
[AGENT][NEUTRAL] So that would depend on the primary. That's a different company. I don't, I don't, I just don't know how long they take.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So you'll need to file the claim with Allstate.
[AGENT][NEUTRAL] And then when you get that EOB back from Allstate, then you would submit the claim back to us for reprocessing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's the Allstate, right? uh Allstate, correct?
[AGENT][POSITIVE] That's correct. A L L S T A T E, Allstate.
[CUSTOMER][NEUTRAL] OK. One second. Let me check in our insurance card also because I could see some primary insurance that is Cigna OAPTPA, the third-party administrator. Just to confirm that whether it is Allstate or different.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so you do not have the Allstate information, right? OK, I'm also not.
[AGENT][NEUTRAL] We do not
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] [PII], for the next one, the last name for a different number?
[AGENT][POSITIVE] For a different member, I would be happy to help you with that. Bear with me just one second.
[CUSTOMER][NEUTRAL] Sure. And uh could you please spell out your name for my documentation?
[AGENT][NEUTRAL] Sure, it's [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And the first initial of the last name is [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the reference number will be my name and today's date.
[AGENT][NEUTRAL] And the reference number is the same for the call.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, [PII]. Thank you.
[AGENT][POSITIVE] My pleasure, and I'm ready for the next policy number, [PII].
[CUSTOMER][NEUTRAL] It is 0193.
[CUSTOMER][NEUTRAL] 0681.
[CUSTOMER][NEUTRAL] L as in Lima. L as in
[CUSTOMER][NEUTRAL] Sorry, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] All right, thank you. And that patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It is uh [PII] and uh
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what is that data service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the total bill amount is $409 even.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And that's the total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the total bill amount is, I'm sorry, $2,818.45.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what is that facility name?
[CUSTOMER][NEUTRAL] Uh, the, under the facility name of the Cleveland Clinic Choral.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is that Cleveland Canlanic Foundation?
[CUSTOMER][NEUTRAL] Yeah, correct. Same only.
[AGENT][NEUTRAL] OK. Thank you. All right, I did receive that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Now this claim was denied also as benefits are payable only if the major medical insurance provider provides benefits. Now, we only pay for the deductible co-pay or co-insurance of the major medical.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And according to the EOB, nothing was applied to deductible co-pay or coinsurance. Therefore, no benefits were payable. Now, if the primary goes back and rep reprocesses the claim and does apply something to the deductible co-payer coinsurance, please resubmit that claim for reconsideration.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like this claim number?
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] Claim number is 353.
[AGENT][NEUTRAL] 2280.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] So first claim, we need to submit with the primary year, correct?
[AGENT][POSITIVE] That's correct from Allstate.
[CUSTOMER][POSITIVE] All right. OK, thank you. Thank you so much.
[AGENT][POSITIVE] It's been a pleasure to assist you with that claim status, [PII]. Isn't there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, I can, thank you.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm, you too, bye.
[AGENT][NEUTRAL] Bye-bye.