AccountId: 011433970860
ContactId: 0f6a17d6-362a-4313-9bd7-24800a86eece
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 153740 ms
Total Talk Time (AGENT): 79762 ms
Total Talk Time (CUSTOMER): 56077 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/0f6a17d6-362a-4313-9bd7-24800a86eece_20250603T15:55_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Daycare Outpatient imaging. I was just calling to verify benefits and to check to see if pre-certification was required for an ultrasound on a mutual patient.
[AGENT][NEUTRAL] OK, I can certainly look up uh benefits. What's the policy number, please?
[CUSTOMER][NEUTRAL] It is, give me one second while I jump back into the screen.
[CUSTOMER][NEUTRAL] It is 0242712.
[CUSTOMER][NEUTRAL] 4 ML 8
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] Like [PII] date of birth [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and that's my direct line.
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. Now for uh an ultrasound, uh, in an outpatient setting, we will pick up the deductible, co-payment or co-insurance up to $3000 per calendar year. It is just a verification of the benefits, not a guarantee of payment.
[AGENT][NEUTRAL] None of those benefits have been used for the calendar year [PII], so they're all available and because we are the secondary or gap insurance, we don't require a pre-certification. So as long as you are in network with their major medical and there's a deductible, co-payment or coinsurance, then we're good.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, does it show who their major medical is because we had had like Blue Cross Simply Blue, but it says it's inactive.
[AGENT][NEUTRAL] OK, let's see, uh, that's what I have is Florida Blue. Um, so if they've changed, uh, that they may have changed to the group. I don't know, um, but that was, that is what we're showing is Florida blue.
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][NEUTRAL] Do you show the member number on there?
[AGENT][NEUTRAL] Uh, no, ma'am, I'm sorry. I wish it did, uh, but it's, yeah, we just showed that that's what they got.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I'll give the patient a call and see what's going on.
[AGENT][NEUTRAL] OK. Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could I have a reference number for this call?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as our reference.
[CUSTOMER][POSITIVE] Alright, thank you so much [PII] and have a great day.
[AGENT][POSITIVE] Thanks for contacting AP