AccountId: 011433970860
ContactId: 11661942-5d1a-4d93-a8d0-a0d712d8ca72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382549 ms
Total Talk Time (AGENT): 106768 ms
Total Talk Time (CUSTOMER): 256514 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/11661942-5d1a-4d93-a8d0-a0d712d8ca72_20250211T13:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] and I'm calling from Vanderbilt Medical Group.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. Can you spell your name for me?
[CUSTOMER][NEUTRAL] Yeah, sure, uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, could you help me with the claim status?
[AGENT][NEUTRAL] How can I help you? What's the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, the call, my callback number was [PII] and the policy number was 02497650.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean one of the
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, it's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] In the.
[AGENT][NEUTRAL] And what is the date of service of the claim?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the total charges?
[CUSTOMER][NEUTRAL] $523 523 dollars even.
[AGENT][NEUTRAL] and [PII], you can also check your status online at [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the procedure code on the claim?
[CUSTOMER][NEUTRAL] And it is 99284.
[CUSTOMER][NEUTRAL] Uh, actually, I have the claim number. Can I give you?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the claim number was 3489433.
[AGENT][NEUTRAL] OK, so you've received the ELB information. Did you have a question regarding this claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, actually, I need the Apple status.
[AGENT][NEUTRAL] When was it appealed?
[CUSTOMER][NEUTRAL] Uh, it, it was opened on one moment. It's reconsideration, right? It was reconsideration on [PII], I mean [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I I.
[AGENT][NEUTRAL] And what is the appeal for?
[CUSTOMER][NEUTRAL] Actually, it is denied that benefit met met 4 times occurrence past, so it was being appealed.
[AGENT][NEUTRAL] What is the reason for the appeals?
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] But that that date of birth.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Uh, it's really close.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Yeah I'm not showing an appeal for this state of service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Actually, it is a reconciliation and uh our rep stated that uh the claim denied for the calendar year maximum for the benefits have been.
[AGENT][NEUTRAL] And
[CUSTOMER][NEGATIVE] Exhausted with the payment of this claim.
[AGENT][POSITIVE] Which is correct.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So what are you appealing? That's the maximum benefit for that type of service.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Oh, and second, uh, so the 2nd visit and not existed.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, uh, rep stated that, uh.
[CUSTOMER][NEUTRAL] This, uh, this visit is, uh, is second and not existed.
[AGENT][NEUTRAL] OK, so there was a $50 benefit paid on that claim, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] $50 is the maximum benefit for that service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh, uh, then what, uh what is the status of reconciliation?
[AGENT][NEUTRAL] I don't show that we received a reconsideration, but I can tell you that more than likely it's going to be upheld because $50 is the maximum benefit for an emergency room visit.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] That's all the policy covers is $50.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I know when it's been up upheld it.
[AGENT][NEUTRAL] So are you
[AGENT][NEGATIVE] I'm not showing us receiving an appeal or a reconsideration for that date of service.
[CUSTOMER][NEUTRAL] OK. OK, for this, uh, services, uh, only $50 was the limit, right? OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Is there any patient responsibility for this?
[AGENT][NEUTRAL] We do not determine patients responsibility. Uh, the explanation cites that the payment made is the maximum for that service.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK thank you I like you.
[AGENT][NEUTRAL] All right, [PII], did you have any other questions I can help out with today?
[CUSTOMER][NEUTRAL] Yeah, may I know your name for documentation?
[AGENT][NEUTRAL] You'll use my name and today's date as reference for today's call. It's [PII].
[CUSTOMER][NEUTRAL] To.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Yes, thank you, [PII], for a wonderful time. Have a nice day.
[AGENT][POSITIVE] You're welcome thanks for calling APL [PII] have a good day as well.
[CUSTOMER][NEUTRAL] Yeah bye bye.