AccountId: 011433970860
ContactId: d5463e8e-5c5e-4ec1-8407-2318c9e01fc7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320480 ms
Total Talk Time (AGENT): 140919 ms
Total Talk Time (CUSTOMER): 104602 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/d5463e8e-5c5e-4ec1-8407-2318c9e01fc7_20250624T15:05_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 [PII], my name is [PII], and I am calling from Ain Professional Association with a question regarding benefits for a member.
[AGENT][NEUTRAL] I can help with benefits. What's that policy number we're looking at today, [PII]?
[CUSTOMER][NEUTRAL] It is sorry you picked up really quick. I have gotten off the screen.
[AGENT][NEGATIVE] Oh sorry.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's D as in David, 43732456.
[AGENT][NEUTRAL] Let's see, that's not one of our policy numbers, so maybe we can look it up by their name. How do you spell their last name, please?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][POSITIVE] Thank you. And the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And her date of birth.
[CUSTOMER][NEUTRAL] is [PII].
[AGENT][POSITIVE] I appreciate that while I'm looking that up, if I could just have a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][POSITIVE] OK, thank you so much. I'm just gonna see if we can't find this lady, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's probably a hospital indemnity policy. Now, are we looking for dental or are we looking for medical?
[CUSTOMER][NEUTRAL] Medical, did I push the wrong button?
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] No, no, no, no, not at all. Um.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] It's just, yeah, it's, it's just that these policies, um, they usually get them if they begin with that D number there, they have, uh, medical and dental policy uh benefits as well and so we just need to make sure that we get it to the, you know, I give you the right benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And come up to the uh to the window, OK?
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Got you, OK.
[AGENT][NEUTRAL] I'm still just checking, um, sir, I'll be right back. Excuse me, just one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, success. We've got. Um, your policy number for this.
[AGENT][NEUTRAL] Is 02.
[AGENT][NEUTRAL] 57
[AGENT][NEUTRAL] 3937. Now her policy went into effect.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Yes, uh,
[AGENT][NEUTRAL] And this is a hospital indemnity policy.
[AGENT][NEUTRAL] And all that really means is that it pays a flat rate benefit for certain very specific services. So for example, a hospital admission.
[AGENT][NEUTRAL] Um, or, uh, sometimes surgery. So is there, uh, or an office visit. So is there anything in particular that we needed to be looking at for [PII]?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] My question was, is because I see that this is um it looks like administered through multiplan and we are not in network with we are not in network with multi plan however the members it the plan paid so I'm just trying to just so we know how to it it wasn't caught when the member was initially seen that we aren't in network but then when I saw the claim paid.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm just kind of wanting to touch base and see does she have out of network benefits? Is that why it's paying?
[AGENT][NEUTRAL] Oh, OK, certainly. Uh.
[CUSTOMER][NEUTRAL] It's for office office visits sorry.
[AGENT][NEUTRAL] For office visits, yes, of course. So these policies, um, because they pay a flat rate benefit and they only pay for very specific things.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEGATIVE] There is no network. She can go anywhere.
[AGENT][NEUTRAL] And it will pay the exact amount no matter what, um, and so that is why this is paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] It's because there is no network.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Yeah, and, and, but she only has specific numbers of office of office benefits each year, so I think she's got like 3 when she hits 3, then, then that's it.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] No matter what it's for.
[CUSTOMER][POSITIVE] 3 office visits, got you. So it and that's anywhere it doesn't matter where she goes. OK, perfect.
[AGENT][POSITIVE] Right, absolutely, absolutely.
[CUSTOMER][POSITIVE] Perfect, that is what I needed to know [PII], thank you so much for your help. I really appreciate it. Is there any kind of reference number for our call?
[AGENT][POSITIVE] Yes, my name is [PII]. The first letter of my last name is [PII]. We'll use that in today's day as our reference and if there's nothing else I can help with, and [PII], thank you very much for calling us. Any other questions you have, just let us know. Otherwise, thank you and have a very good day.