AccountId: 011433970860
ContactId: 47c02e86-dc7c-4433-b3de-391978d25af7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 182100 ms
Total Talk Time (AGENT): 101425 ms
Total Talk Time (CUSTOMER): 63251 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/47c02e86-dc7c-4433-b3de-391978d25af7_20250626T13:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for contacting ATO. My name is [PII]. How may I?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm, I'm calling from South Florida ENT is to verify some benefits for a member, please.
[AGENT][POSITIVE] Yes, I can certainly help with benefits. What's that policy number, please?
[CUSTOMER][NEUTRAL] 02003102 ML 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] I appreciate that. I just need a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] Um, now, this is a secondary or gap insurance, uh, with benefits, uh, in and out of hospital, as well as treatment within the physician's office. Is there anything in particular that I can tell you about this gap insurance?
[CUSTOMER][NEUTRAL] Yes, um, she's coming for an allergy testing where she has to pay a high deductible with the primer from the primary, and the allergy testing is gonna be done in the specialist's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, what we will do for the treatments within the physician's office is we will pick up the deductible, co-payment or co-insurance up to $7350 per calendar year.
[AGENT][NEUTRAL] Uh, that's just a verification, the benefits, not a guarantee of payment, but the policy does not cover the office visit co-pay.
[AGENT][NEUTRAL] So the treatment is covered, but the, um, but the office visit co-pay is not.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] It's not, OK, OK. Yeah, the allergy testing is considered with us like a diagnosis test. So it should be covered, right?
[AGENT][POSITIVE] Uh, that's correct, yes, and, um, as of this year, uh, [PII] has only used about $2600 of that $7300 so she's got plenty of money left over for the month for the year.
[AGENT][NEUTRAL] Is there anything else at all that I can take you?
[CUSTOMER][NEUTRAL] You said [PII].
[AGENT][NEUTRAL] Yeah, she's only used about $2000 of her benefits. I'm sorry. My phone is echoing and I, and I can hear some, yeah.
[CUSTOMER][NEUTRAL] No, I'm sorry, 2000.
[CUSTOMER][NEUTRAL] Yeah, it's like
[AGENT][NEUTRAL] And I'm sorry, what was your question?
[CUSTOMER][POSITIVE] OK, perfect, good.
[CUSTOMER][NEUTRAL] Yeah, so it's 2600 that has been used so far.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] That's right, yes. So she's got, uh, a lot of money left over. Now, would you, is there anything else at all that I can tell you about the policy, where to send your claim or anything like that?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] No, that will be all. Thank you so much. You say your name is?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII]. We're gonna use that in today's date as our reference.
[CUSTOMER][NEUTRAL] OK. Uh, how do you spell your name, please?
[AGENT][NEUTRAL] Uh, it's [PII] Y.
[CUSTOMER][POSITIVE] OK perfect thank you so much OK have a nice day.
[AGENT][POSITIVE] OK thanks thanks for contacting us too.