AccountId: 011433970860
ContactId: fd1cbc95-cf8c-442e-a1ab-48b9e58af81a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 780409 ms
Total Talk Time (AGENT): 192799 ms
Total Talk Time (CUSTOMER): 207238 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/fd1cbc95-cf8c-442e-a1ab-48b9e58af81a_20250530T14:24_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], this is [PII] calling from Pro office to check on the time status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status of this how many claims do you have today?
[CUSTOMER][NEUTRAL] Uh, I only two clients.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh yeah, sure. It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Oh yeah, sure, [PII]. It's 01678796.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. Patient's first name is [PII] and the last name is [PII] and the patient's date of birth is [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] Uh yes, sure. Uh, it's [PII] and the total charge amount is $349 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, sure, I know. It's Cleveland Clinic Foundation.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm sure we receive the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3504815.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm. So stating the POS is incorrect, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So, stating the place of service is incur in the claim form, right?
[AGENT][NEUTRAL] It doesn't say that it's incorrect, it's not covered. A doc when the service is done in a doctor's office or clinic, it's not covered by the policy.
[CUSTOMER][POSITIVE] Um, OK, got it. Thank you so much for that information, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Oh, OK. Just give me one minute.
[CUSTOMER][NEGATIVE] Uh no thank you.
[CUSTOMER][POSITIVE] And I thank you so much for being in line. Uh, can you send a corrected client for this?
[AGENT][NEUTRAL] Um, I mean, I can't advise you not to, but unless the place of service changes, the claim is going to be denied because it's not covered by the patient's policy.
[CUSTOMER][NEUTRAL] Uh, OK, sure, and uh, I'm gonna check on this again, uh, but can I know the correct and timely filing them if you don't mind?
[AGENT][NEGATIVE] There's no um timely filing on a corrected claim.
[CUSTOMER][POSITIVE] No sir. Oh, thank you so much for that information.
[CUSTOMER][POSITIVE] OK, yeah, I'm gonna check on this one, [PII]. Thank you so much for assisting. And I have one more plan. Can you please just on that one if you don't mind.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, and is it for the same member or a different member?
[CUSTOMER][NEUTRAL] Uh, it's a different number. Before that, can I have the reference number, [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The reference number for the entire call is going to be my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Uh, it's [PII], [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Oh, thank you so much for that information. Um, yeah, shall we go for the next number?
[AGENT][POSITIVE] Yes, I'm ready when you are.
[CUSTOMER][NEUTRAL] Uh, yes, I'm ready. Uh, the member ID is D as in Delta, 43301781.
[AGENT][NEUTRAL] And do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] A copy of member ID card.
[CUSTOMER][NEUTRAL] Oh yeah, I need to check on that one I know.
[AGENT][NEUTRAL] OK, um, because that D number is for 90 degree benefits, so we can't use that policy number, but um,
[AGENT][NEUTRAL] I can help you locate the policy number on the card if you have one.
[CUSTOMER][POSITIVE] Oh just a minute. Thank you so much for that information. I'm gonna check on that. Mhm.
[AGENT][POSITIVE] You're welcome. OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] And can you please check whether the 02294566?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure, [PII]. My first name is [PII] and the last name is [PII] and the patient's date of birth is [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?
[CUSTOMER][NEUTRAL] Um, yeah, sure, I know. It's for [PII] and the total charge amount is $1700 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, here it is. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the name of the provider's office on this claim?
[CUSTOMER][NEUTRAL] Um, it's Cleveland Clinic Foundation, I know.
[AGENT][NEUTRAL] OK, it's the same. OK, thank you.
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] And I'm sure we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 345.
[AGENT][NEUTRAL] 8[PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the benefit maximum for the data service has been met.
[CUSTOMER][NEUTRAL] question.
[CUSTOMER][POSITIVE] OK, nice and benefit I exhausted. Thank you so much.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Uh, can I know the maximum number of receipt is exhausted or the maximum dollars or is exhausted?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm waiting for the benefits to come up now, hold on one moment.
[CUSTOMER][NEUTRAL] Uh, sure.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Uh, yes, sure, take your time.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Uh, yes, I'm in line right now.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So the policy will pay up to $75 per day with a max of 4, I'm sorry, 5 visits per calendar year.
[CUSTOMER][NEUTRAL] Visit OK 5 visits.
[CUSTOMER][NEUTRAL] $5.75 dollars you're saying, right? So you're stating the maximum dollar value is exhausted, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Do one is. Got it. Thank you so much for that information.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, just give me one minute, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for being in line. [PII], you're stating that only $75 will pay for this claim, right?
[AGENT][NEUTRAL] You ask the maximum for the benefit amount and the max is $75.05 days per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So for your claim, it was denied because the $75 had already been applied to a previous claim for the same date of service.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] the service. Oh, thank you so much for that information, [PII]. Uh, you said that there is no time limit for corrected claim, am I right?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] That's correct. Only for an appeal.
[CUSTOMER][POSITIVE] Oh, thank you.
[CUSTOMER][NEUTRAL] Uh, can I know the Apple time refunding limit?
[AGENT][NEUTRAL] It's 180 days from the denial date?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. I got all the record information from your end and thank you so much for assisting for today. Have a great day, [PII].
[AGENT][POSITIVE] You also, and thanks for calling APL. Have a great weekend.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.