AccountId: 011433970860
ContactId: 99fafa62-39d6-467b-885d-f33994454242
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355480 ms
Total Talk Time (AGENT): 117230 ms
Total Talk Time (CUSTOMER): 110137 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/99fafa62-39d6-467b-885d-f33994454242_20250529T13:55_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] Uh, hi, [PII]. My name is [PII] calling from provider's office to check on the claim status. Can you please help me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, sure. It's [PII], a direct line.
[AGENT][NEUTRAL] Thank you and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] One claim.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh yes, sure.
[CUSTOMER][NEUTRAL] Member policy is 02372298.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes. The member's name is [PII] and the 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 bill for the claim?
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] The date of service is [PII] for the bill amount $134 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] You're welcome mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, yes, sure.
[CUSTOMER][NEUTRAL] The provider office is MUSC Health Columbia Medical Center.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you for that, and I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 359-439-93.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the maximum benefit has been exhausted.
[CUSTOMER][NEUTRAL] And may I know if this benefit is exhausted as per the visit or dollar?
[AGENT][NEUTRAL] Uh, well, really it's both. Um, the policy will pay, hold on one moment.
[CUSTOMER][NEUTRAL] Uh, yes, sure.
[AGENT][NEUTRAL] The policy will pay up to $200 for diagnostic testing, but one time per calendar year, so it's both. They've used the dollar amount and the visit.
[CUSTOMER][NEUTRAL] $200. Uh, I'm so sorry, but can you please repeat again, policy will pay $200 after that.
[AGENT][NEUTRAL] The policy will pay $200 for diagnostic testing one time per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So to answer your question, they've exhausted both the dollar amount, $200 and the visit, which is 1 per calendar year.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right. OK, thank you so much. And um may I know when it was last?
[CUSTOMER][NEUTRAL] Uh, with, uh, uh.
[CUSTOMER][NEUTRAL] Exhausted, like in which state of service was paid?
[AGENT][NEUTRAL] When the benefit was used?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, it's a different provider, so I can't give the claim status, um, but I can say [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] If you need a date is [PII] that the claim was processed that exhausted the benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] All right, [PII], was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, so now the remaining balance is patient responsibility, right?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right. OK, no problem. Thank you so much for the information. It was a great help and
[CUSTOMER][NEUTRAL] OK. Can you please provide me a call reference number?
[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] All right. OK. Thank you so much, [PII], for the information. It was a great help and have a wonderful day.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Mhm. Bye bye.