AccountId: 011433970860
ContactId: 978fac7c-c351-417b-8622-ff3f0b2db08e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326579 ms
Total Talk Time (AGENT): 171546 ms
Total Talk Time (CUSTOMER): 109750 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/978fac7c-c351-417b-8622-ff3f0b2db08e_20250610T17:24_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from the provider's office. How are you today?
[AGENT][NEUTRAL] I'm fine. How are you?
[CUSTOMER][POSITIVE] Yeah, thanks for asking. I'm fine here.
[AGENT][NEUTRAL] And whom am I speaking to please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] Yeah, um
[CUSTOMER][NEUTRAL] My name is [PII] from MUSC Physicians.
[AGENT][POSITIVE] Yeah, yes, how may I help you?
[CUSTOMER][NEUTRAL] Yeah, I'm looking for a claim status.
[AGENT][NEUTRAL] I can help with the claim. What is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02446548.
[AGENT][NEUTRAL] Thank you. The patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Is there a particular day of service that I can look for for this individual?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, that was [PII].
[AGENT][NEUTRAL] And the build amount, please?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] $179 even. $179.
[AGENT][POSITIVE] OK, I appreciate that. Well, I'm looking that up, if I could just have a callback number please, the event that we're disconnected.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII].
[AGENT][POSITIVE] I do appreciate that being so pick that up now.
[AGENT][NEUTRAL] OK, so your claim number is 35.
[AGENT][NEUTRAL] 07
[CUSTOMER][NEUTRAL] They went through the
[AGENT][NEUTRAL] 103.
[AGENT][NEUTRAL] We received your claim on on [PII].
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] We processed it on [PII].
[CUSTOMER][NEUTRAL] And the milk are there.
[CUSTOMER][NEUTRAL] Hey that it.
[AGENT][NEGATIVE] Now, this secondary or gap insurance does not cover.
[CUSTOMER][NEUTRAL] we're done.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The office visit co-pay.
[AGENT][NEUTRAL] So we were unable to pay that at claim 3507143.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think we don't sorry.
[AGENT][NEUTRAL] Because the policy does not cover this, this type of of uh service.
[CUSTOMER][NEUTRAL] What do you know.
[AGENT][NEUTRAL] So your claim was received on the [PII], we process it on the [PII], it's not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then can I get the patient?
[CUSTOMER][NEUTRAL] All type
[AGENT][NEUTRAL] Yes, this is a secondary or gap insurance. It's meant to pick up the deductible, co-payment or co-insurance for in and out of hospital settings, or treatments within the physician's office.
[CUSTOMER][NEUTRAL] Take off.
[AGENT][NEUTRAL] So that the treatment within the physician's office is covered, but the office is copay is not.
[AGENT][NEUTRAL] And that's why this is the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now is this the only data service that we need to look at? Yes, my name is [PII]. The first letter of my last name.
[CUSTOMER][NEUTRAL] OK, then can I get the call reference number?
[CUSTOMER][NEUTRAL] Yeah, for this member.
[AGENT][NEUTRAL] Yes, my name is [PII]. The first [PII]. We're using that today's date as a reference. Is there another policy or another claim I can help with?
[CUSTOMER][NEUTRAL] Sorry, I'm not able to hear you properly. Could you repeat your name again?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, my name is [PII]. That's [PII]
[AGENT][NEUTRAL] The first initial and my last name is [PII]
[AGENT][NEUTRAL] As in kite
[AGENT][NEUTRAL] And we'll use that today's date, [PII].
[AGENT][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] OK, [PII], the next number.
[AGENT][NEUTRAL] Yes, I can do one more. And what is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The next policy number is 022-057772.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That was [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you very much. And what date of service you were looking for for [PII]?
[CUSTOMER][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] And the building up 0.
[CUSTOMER][NEUTRAL] $246 even 246.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 2475, that's 358.
[AGENT][NEUTRAL] 2475 let's see what we have here.
[AGENT][NEUTRAL] The policy, we received your claim on [PII].
[AGENT][NEUTRAL] We processed it on [PII].
[AGENT][NEUTRAL] [PII]. This is a secondary or gap insurance like the other one that is meant to pick up the deductible for home insurance.
[CUSTOMER][NEUTRAL] That
[AGENT][NEGATIVE] For inside or outside of hospital settings that Damon it doesn't cover anything at all within a hospital within a uh physician's office. So that was denied because uh treatment within the physician's office, the office is a copay, none of that is covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, then.
[CUSTOMER][POSITIVE] Yeah, then thank you, thank you for assistance. Have a wonderful day for you.
[AGENT][NEUTRAL] OK, well thank you for contacting ATO.