AccountId: 011433970860
ContactId: e58a0ed9-8aa0-47b5-bfaf-73e6aeb8a40e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498059 ms
Total Talk Time (AGENT): 322859 ms
Total Talk Time (CUSTOMER): 168593 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/e58a0ed9-8aa0-47b5-bfaf-73e6aeb8a40e_20250623T12:13_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I have coverage and I was at the emergency room on Saturday night, Sunday morning, so I was trying to see about getting reimbursed.
[AGENT][POSITIVE] Yes, I can certainly help with that for now. I'm sorry to hear that. What is your policy number and we'll look up your uh your benefit.
[CUSTOMER][NEUTRAL] OK, my card says policy slash I guess uh 02565559.
[AGENT][NEUTRAL] Thank you. If I could just verify your uh date of birth and a phone number, please?
[CUSTOMER][NEUTRAL] Yes, date of birth is [PII] and phone number is [PII].
[AGENT][NEUTRAL] Thank you, [PII], I, I do show that you've had a policy with us since [PII]. Now,
[AGENT][NEUTRAL] For outpatient sur uh uh services such as the ER, um, we will need to go through your, you'll need to um get an explanation of benefits first from, uh, your, um, major medical, uh, UMR. You need to have that before you submit, but, um, what you will need from the emergency room is uh a copy of the bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on that they will give you that and it will say why you went to the emergency room. Now we need to have something from the uh from the provider is, is what the bill was, the date, and then what it was for as long and also with your explanation of benefits from your primary insurance. So once you have that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can go online, you can, um, either submit it to us online or you can also, uh, send it to us by mail or by fax.
[AGENT][POSITIVE] And then we will get that taken care of and you're covered for up to $2000 for this type of service.
[AGENT][NEUTRAL] So once we um once we get that.
[CUSTOMER][NEUTRAL] OK, I
[CUSTOMER][NEUTRAL] OK, I paid, I paid this, uh, myself Friday, uh, Saturday night or whatever, so I have that receipt. I don't guess I have the bill yet from them because you know they don't bill real quick.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, yeah, well, yeah, yeah, once they do that, um, once they do that, then, then you'll be able to submit the, the claim, but we also need the explanation benefits from UMR before we can, uh, begin to process the claim. Yeah, absolutely.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] From UMR.
[CUSTOMER][NEUTRAL] Yes, yes, ma'am, OK, because I, uh, I have had some blood work done on Friday and then the doctor called me at [PII] or [PII] Saturday night.
[CUSTOMER][MIXED] I needed to go to the emergency room immediately cause my calcium levels had dropped way too much. So anyway, they, they sent me and then it turned out everything was, everything was OK, so I'm fine, but
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Oh, well, yes.
[AGENT][POSITIVE] Well, that's good. That's always wanted.
[CUSTOMER][POSITIVE] OK, I tried, that's real good. That's real good. I tried to go online to create an account and it said it didn't find my account or something. I don't know, um.
[AGENT][NEUTRAL] OK, yes, now what's, uh, what's, um, let's look at what that could possibly be because there's we, we updated our, um, online service center and we need to, uh, you know, we sometimes there are these little glitches whenever we do that so we'll need to look at that personally. What is the, um, email address, uh, [PII], if you don't mind telling me what that you were using to sign in.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Uh, at, uh, [PII].
[AGENT][POSITIVE] Awesome, that's great so.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I would go back in let's let's see if if you don't mind going back in and when you try to uh create your account.
[AGENT][NEUTRAL] When you try to create your account, if you could um go in and it will say uh yeah where you're where you're actually trying to set up the account, we have to do uh we have to recreate it all over again unfortunately for each one of these if you would hit create your account and then you are an individual.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then when you do it, I would just put your last name where it says enter the required information. I would just put your last name and your email address and your date of birth. Now if it still says that it doesn't recognize you, let's just say for whatever reason that it still says that it doesn't recognize you, we will then need to go in ourselves.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And figure out why the why the computer isn't uh is accepting it and it's not any big deal it's just because we've updated the the online service center.
[AGENT][NEUTRAL] And so what we're asking that you do is is.
[CUSTOMER][NEUTRAL] OK, I'm here.
[AGENT][POSITIVE] Oh, great. Where are you right now?
[CUSTOMER][NEUTRAL] OK, I'm here, I'm here now. OK, I'm putting my last name and just my date of birth, is that all?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, your last name, your email address, and your date of birth. I'll try that and see if it works.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then click next and it should.
[CUSTOMER][NEUTRAL] OK, next.
[CUSTOMER][NEUTRAL] Alright, complete your account set up, continue.
[CUSTOMER][NEUTRAL] And then it wants a new, a new password so I need to do my email and a password.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then it's gonna send you a verification to that.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Email address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] password. OK, and it has a place for display name, given name, surname. I need to do all that.
[CUSTOMER][NEUTRAL] Or just to send verification first.
[AGENT][NEUTRAL] I will send you verification please.
[AGENT][NEUTRAL] Yeah, just do your
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It should say thank you for verifying and then it says you and it should give you a code number that's your email address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um
[CUSTOMER][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] I think we just have to wait for that to go through to your email address.
[CUSTOMER][NEUTRAL] OK, it shouldn't take me just a minute to come through. So I tried that and I, and I did the verification code and it said invalid or something.
[AGENT][NEUTRAL] Sometimes it takes a
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, now when it, when it happens, we're, we need you to take a screenshot of that and there is a, uh, we have an online service center.
[AGENT][POSITIVE] And what we'll do is we'll research it ourselves and figure out what's going on and then we will get back to you and get you on online because of course we want to get everyone online.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It's just easier that way.
[CUSTOMER][POSITIVE] Yes, ma'am. Yes, yes, yeah, everything's easier.
[AGENT][NEUTRAL] It yes it is, isn't it? And uh so if you don't mind when.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] Is it, is it going, is it letting you do it now? Is it?
[CUSTOMER][NEUTRAL] Well, it, it hadn't sent me the verification code to my email yet, but it could be.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Now when you get that, then you'll go ahead and, and you'll put in your, um, after that's verified then uh uh you'll create a new password um it'll have your name and, and, and your last name and you'll hit continue and then you'll be in. Now if for whatever reason, [PII], it, it doesn't let you do it, that's when we're going to take a screenshot of the error so that the screen will be.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Computer can't find you. The system can't find you. And then we will go in and we will have to personally, uh, research and find out what's going on and it's, it's not anything ominous or anything. It's just that we have to because of the system was updated, we just have to do this, you know, sometimes it will, it will work it's great, and sometimes it, it works and sometimes it doesn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, that's just the way that those are, but once we do that, once you get that created, if you would please get the bill from the ER and they should be sending it to you soon.
[AGENT][NEUTRAL] Um, and then we'll get the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And then if you don't mind submitting that to us, we will get that to you and it takes us about 8 to 10 business days.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To have that process.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So is there anything else at all that.
[CUSTOMER][POSITIVE] OK, that's no problem. I paid out of my, I paid out of my, I paid out of my health savings, so I mean it's OK.
[AGENT][NEUTRAL] Of course, we
[AGENT][POSITIVE] OK, OK, well, good, that's wonderful.
[CUSTOMER][NEUTRAL] And that's why we have that but.
[AGENT][POSITIVE] Yeah, that's wonderful. Well then we'll try and get that back to you as soon as possible. Now, is there any, is there anything else that I can help with that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] No ma'am, and I'll get this set up once my email comes through so it may just take a minute here sitting at my desk. Thank you for your help.
[AGENT][POSITIVE] Yeah, sometimes it does. It's just one of those things. Thanks for contacting ATO. You have a very good one.