AccountId: 011433970860
ContactId: 4e9d4049-5573-4e15-8724-a433279910d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 134300 ms
Total Talk Time (AGENT): 84601 ms
Total Talk Time (CUSTOMER): 35233 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/4e9d4049-5573-4e15-8724-a433279910d5_20250603T19:25_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, did you say your name was [PII]?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][POSITIVE] Thanks [PII], my name is [PII] with Texas Orthopedics just calling for eligibility uh and benefits for a mutual member.
[AGENT][NEUTRAL] I can help with eligibility and benefits. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes ma'am, what I have is 01896415 for [PII].
[AGENT][POSITIVE] I appreciate that. And his date of birth, please?
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][POSITIVE] OK, I appreciate that. While I'm looking that up, I just have a call back please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] OK, thank you so much. So the policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] Now this is a secondary or gap insurance that has both in hospitals and outpatient hospital benefits, and the outpatient hospital uh includes uh treatment within the physician's office, uh, urgent care, the ER. So is there anything in particular that we're looking for from that?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] The gap insurance is this like um does it have deductible and out of pockets or anything like that or no?
[AGENT][NEUTRAL] No, no, this is what we'll do is that we will for outpatient services we'll pay up to $2000 a year per individual for inpatient services we'll pay up to $2000 a year for individual and just that's just the verification that's not a guarantee of payment, um, and as I mentioned before, outpatient services include the ER urgent care, uh, services and physician's office. May's only used $320 of that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and so, uh, about $2000 so, uh, but there's no deductible, co-payment or co-insurance on that. That's what we do is we actually pay that from their major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Got you, do you have a call reference number? I think that's all I need then.
[AGENT][POSITIVE] OK, my name is [PII]. The first letter of my last name is [PII]. We be got today's date of the reference, and but there's nothing else I can help you with, and thank you for contacting us. You have a very good day.
[CUSTOMER][POSITIVE] Thank you Miss.