AccountId: 011433970860
ContactId: 5af45b5a-58ed-4b74-b6ff-0fbd9db1a330
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335369 ms
Total Talk Time (AGENT): 86514 ms
Total Talk Time (CUSTOMER): 90805 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/5af45b5a-58ed-4b74-b6ff-0fbd9db1a330_20250421T19:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATO. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I just had a question about um some benefits for a member account.
[AGENT][POSITIVE] Yeah, of course. I can help you with benefits today. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, is the, uh, let me see if this is correct, 0, I'm sorry, 60801.
[CUSTOMER][NEUTRAL] You right.
[AGENT][NEUTRAL] That looks like the group number.
[CUSTOMER][NEUTRAL] Oh, I probably have to call the patient for the can we do like a name search or I have to have the policy number?
[AGENT][NEUTRAL] No, do you have their first and last name?
[CUSTOMER][NEUTRAL] Sure. [PII] is the first name, [PII] and [PII] is the last name, [PII]
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The date of birth is [PII] if that helps.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what was your name and a good callback number?
[CUSTOMER][NEUTRAL] My first name is [PII] and call back is [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Sorry, my computer's thinking. Just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And you said her date of birth was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so her policy is currently active. And then what benefits were you wondering about today?
[CUSTOMER][NEUTRAL] Um, oh, because we are a doctor's office, I need to know, um, what's the coverage for it.
[CUSTOMER][NEUTRAL] Um, I don't know if you guys do CPT codes or.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, we just have like an outpatient amount, um.
[AGENT][NEUTRAL] For them
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is not a guarantee of payment, it's just a verification of coverage and it looks like the outpatient benefit max per calendar year.
[AGENT][NEUTRAL] Is 2500.
[AGENT][NEUTRAL] And then they have an outpatient calendar year deductible for accident and sickness.
[AGENT][NEUTRAL] And I cannot see that. Let me pull up her certificate really quick.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so it looks like outpatient deductible is 0 per covered person per calendar year.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK. And then is this a specialist office or physician's office?
[CUSTOMER][NEUTRAL] Yes, this is a specialist office, so would it cover um like co-payments, coinsurances and deductibles?
[AGENT][NEUTRAL] Hello, are you there?
[CUSTOMER][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh my god.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello? Yes, can you hear me?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] Hello, can you hear me now?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] This must be her phone. Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] It's, it's her phone cause I done switched phones and she's. Hello?
[AGENT][POSITIVE] OK, I'm hanging up. I'll give you a call back.