AccountId: 011433970860
ContactId: fe5156b4-b88c-45b1-bdf7-b057874c0fea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397850 ms
Total Talk Time (AGENT): 105055 ms
Total Talk Time (CUSTOMER): 129094 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/fe5156b4-b88c-45b1-bdf7-b057874c0fea_20250402T13:59_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] calling from Cleveland Clinic Foundation to check on the client status. Could you please tell me your name?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Um name is [PII]. It's [PII]
[CUSTOMER][NEUTRAL] OK. Yeah. Hi, [PII]. And could you please help me with this kind status?
[AGENT][NEUTRAL] Yes, I can help you with claim status, [PII]. Do you have the policy number?
[CUSTOMER][NEUTRAL] Um, you, you want, what, what number you want?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, I have the policy number.
[AGENT][NEUTRAL] Remember ID?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah. It is 02493728.
[AGENT][NEUTRAL] And then the patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] It is $423 even.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it looks like this was not a covered service under the policy.
[CUSTOMER][NEUTRAL] Uh, non-covered service under the policy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, can I, may I know the received date and processed date?
[AGENT][NEUTRAL] I received date [PII] process [PII].
[CUSTOMER][NEUTRAL] OK. Can I get the claim number?
[AGENT][NEUTRAL] 351-1189.
[CUSTOMER][NEUTRAL] OK. Uh
[CUSTOMER][NEUTRAL] Uh, OK. May I know why this service is not covered under the patient's plan?
[AGENT][NEGATIVE] It's, it's just not covered under this policy.
[AGENT][NEUTRAL] It's it only covers certain things.
[CUSTOMER][NEUTRAL] Um, may I know what, uh,
[CUSTOMER][NEUTRAL] Um, OK. May I know what is the patient's plan type?
[AGENT][NEUTRAL] It's a hospital indemnity, a supplemental policy.
[CUSTOMER][NEUTRAL] Hospital and
[AGENT][NEUTRAL] Hospital indemnity plan. It's a supplemental policy.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEGATIVE] This policy won't pay for this, for this service, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] OK. Uh, can I be the patient for this?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, I, uh, may I have to bill the patient?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility, so we, we can't tell if, if you can build a patient or not.
[AGENT][NEGATIVE] Just under this policy, it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] That'll be my first name, [PII], and then first initial and last name which is [PII], today's date.
[AGENT][NEUTRAL] Can I help with anything else today, [PII]?
[CUSTOMER][NEUTRAL] OK. It is.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] One moment, one moment, let me check.
[CUSTOMER][NEUTRAL] Oh, for this, is there any possibilities that we could, uh, submit any character claim?
[AGENT][NEUTRAL] It it send a corrected claim, is that what you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Well, we received two claims after this, which were both denied as well as duplicates.
[AGENT][NEUTRAL] So I mean yeah you you can submit a corrected claim but it's not a covered service so.
[CUSTOMER][NEUTRAL] OK, fine
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get the character claim information?
[CUSTOMER][NEUTRAL] Mailing address and TFL.
[AGENT][NEUTRAL] You need our mailing address?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], [PII]. OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And uh may I know the correct claim timely filing limit?
[AGENT][NEUTRAL] Uh, 180 days.
[CUSTOMER][NEUTRAL] From the date of service or from the date?
[AGENT][NEUTRAL] Um, from the, the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this is denied on [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Yeah. Mm, yeah, thank you for your kind help, [PII]. Have a great day.
[AGENT][POSITIVE] OK, thanks for calling APL have a good day.