AccountId: 011433970860
ContactId: 41688a69-2ccd-4b0f-8e9e-d29a0ed23396
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 206500 ms
Total Talk Time (AGENT): 101356 ms
Total Talk Time (CUSTOMER): 43181 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/41688a69-2ccd-4b0f-8e9e-d29a0ed23396_20250610T14:36_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I need to ask a question about a claim please.
[AGENT][NEUTRAL] I can help with the claim status and with whom am I speaking, please?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] [PII], thank you. What's that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] It's 02292696.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. Is there a callback number I can have on the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you so much. And what uh data of service are you looking for for [PII]?
[CUSTOMER][NEUTRAL] The data service is [PII].
[AGENT][NEUTRAL] And is there a particular building mouth that we need to look?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's 40,048381.
[AGENT][NEUTRAL] Thank you. Your claim number is 360-1806. Again, that's 360-1806.
[AGENT][NEUTRAL] It looks like we.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Received your claim. I find it here.
[AGENT][NEUTRAL] Let me check and see
[AGENT][NEUTRAL] It looks like you received your claim on [PII].
[AGENT][NEUTRAL] [PII] and we process it on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] They said these policies have a maximum benefit of $500 per calendar day.
[AGENT][NEUTRAL] And the reason that your claim was denied is because the uh maximum.
[AGENT][NEUTRAL] $500 per calendar day.
[AGENT][POSITIVE] Had already been met by the time that we have received.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] The gap insurance, uh, they paid out its full benefits before we got your claim, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything after afterwards for that day of surgery.
[AGENT][NEUTRAL] I don't know whether [PII] has another.
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] Secondary insurance, uh, if they do, that's great. Um, but for this particular one.
[AGENT][NEUTRAL] The benefits for that calendar day.
[AGENT][NEUTRAL] And I can send you a copy.
[CUSTOMER][NEUTRAL] OK, so they have a benefit max of $500 per calendar day.
[AGENT][NEUTRAL] First of the dead, exactly.
[CUSTOMER][NEUTRAL] And that's already been met.
[AGENT][POSITIVE] Yes, and that, and that benefit is for every service, whether it's the, the facility, the doctor, the anesthesiology, that is what it is for each day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. So we should be receiving that explanation of benefits any minute.
[AGENT][NEUTRAL] Is there anything else that I can help you?
[AGENT][POSITIVE] Just any time, yes, that's correct. Yes, is there anything else at all that I can help with?
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Um, that'll be it. I appreciate your help.
[AGENT][POSITIVE] OK [PII], thanks for contacting me again.