AccountId: 011433970860
ContactId: 6f1d8164-2038-43c8-aa60-5897de4ee0e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 174440 ms
Total Talk Time (AGENT): 79939 ms
Total Talk Time (CUSTOMER): 81117 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/6f1d8164-2038-43c8-aa60-5897de4ee0e0_20250411T13:25_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Hi, good morning, [PII], and um, I'm calling from the facility. I have a patient that have um.
[CUSTOMER][NEUTRAL] I this is a gap insurance. Um, do you need the member ID certification number?
[AGENT][NEUTRAL] Uh, yes, what is that policy number, please?
[CUSTOMER][NEUTRAL] Or the group number?
[AGENT][NEUTRAL] Uh, well, the policy number would be fine.
[CUSTOMER][NEUTRAL] Uh, it would be, OK, it will be 02424707 M as in Mary, L as in Lima, and the number 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you and is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Thank you. It looks like the policy went into effect on
[AGENT][NEUTRAL] [PII], uh, let's see, sorry, I forgot what date it was. Um, it looks like it was [PII] and it is active. Now is there anything else besides the eligibility I may help with?
[CUSTOMER][NEUTRAL] Yes, uh, does the patient still have, um, and like benefits for outpatient facility?
[AGENT][NEUTRAL] Uh, let's just check.
[CUSTOMER][NEUTRAL] If it the primary insurance does not cover?
[AGENT][NEUTRAL] Uh, let me just check. And now, uh, for the calendar year for outpatient hospital, we will pick up the deductible, co-payment or co-insurance up to $5500 for calendar year. That's just a verification of the benefits, not a guarantee of payment. And so it looks like for the current year,
[AGENT][NEUTRAL] He's only used about $120 of that. So it looks like he has available benefits, uh, quite a lot of benefits for this calendar year.
[CUSTOMER][NEUTRAL] OK perfect um so the operation is active since [PII] and the current balance is like like a 4000 and something because it's like 5000 right the current.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, it's like, well, he's only used about $120 of, of that uh $5500 so.
[CUSTOMER][NEUTRAL] OK, perfect. OK, let me double check what I have here on the papers.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Let me see the clean address.
[CUSTOMER][NEUTRAL] OK, and then to submit claims, uh, I just put [PII], right?
[AGENT][NEUTRAL] Uh, [PII], um, it's [PII].
[AGENT][NEUTRAL] And that is in [PII]. Yes, uh-huh, that, that's our, that is our address. That's correct.
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] Alright perfect.
[CUSTOMER][POSITIVE] Alright, perfect, OK.
[AGENT][NEUTRAL] Is there anything else at all I may help with?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, well, thank, thanks for contacting APR.
[CUSTOMER][POSITIVE] No, thank you so much um.