AccountId: 011433970860
ContactId: bbbf9aa3-a58e-4fef-bc75-371726dd1e0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246440 ms
Total Talk Time (AGENT): 79987 ms
Total Talk Time (CUSTOMER): 64940 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/bbbf9aa3-a58e-4fef-bc75-371726dd1e0e_20250114T18:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from Prisma Health University Medical Group. I'm calling in reference to the status of a claim, please.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with the claim. Can I please get your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII] and there's no extension.
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, and what is [PII] [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number please?
[CUSTOMER][NEUTRAL] 02137806
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] [PII] and the billed amount was $149 and Cigna paid their portion and we're just waiting for.
[CUSTOMER][NEUTRAL] American.
[AGENT][NEUTRAL] OK, and what is the charge amount after Cigna paid their part?
[CUSTOMER][NEUTRAL] $25.65.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then you said you were calling from Prisma Health?
[AGENT][NEUTRAL] Is that correct? OK, alright. I'm gonna put you on a brief hold, Ms. [PII], while I look this claim up for you and I'll be right back.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Thank you. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII] back with you again.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] I did find the claim and the claim number is 353-567-6.
[AGENT][NEUTRAL] And the claim was denied because the benefits had been met for the calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The benefits have.
[CUSTOMER][NEUTRAL] Not been met, did you say?
[AGENT][NEGATIVE] They had been met for the calendar year. The benefits were exhausted.
[CUSTOMER][NEUTRAL] Yeah, I've been met.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] Is this the patient's responsibility then?
[AGENT][NEUTRAL] We can't give patient responsibility uh that is determined by the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Calendar year. OK, do you have a reference number for this call?
[AGENT][NEUTRAL] Yes, yes, ma'am, you can use my name. It's [PII] and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much and have a wonderful rest of the day.
[AGENT][POSITIVE] You too, Miss [PII], you have a blessed one. Thanks for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.