AccountId: 011433970860
ContactId: f068a0c1-86fd-4f5d-bcfd-dde84d37d416
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223679 ms
Total Talk Time (AGENT): 113020 ms
Total Talk Time (CUSTOMER): 79929 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/f068a0c1-86fd-4f5d-bcfd-dde84d37d416_20250417T15:36_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling because we have a client that, uh, the patient has this insurance secondary to Blue Cross Blue Shield. Uh, we're billing an X-ray and it said the service is not covered when performed in a doctor's office or clinic. So I was just wondering.
[CUSTOMER][NEUTRAL] For this patient so that we can let them know and if we ever need an X-ray again, we know where to send them. Um, where do they have to go to get an X-ray? Is there a specific place?
[AGENT][NEUTRAL] Well, let's look at their policy, [PII] and see what's uh what's going on with it. What is that policy number?
[CUSTOMER][NEUTRAL] It is 01221549 M as in Mary L7.
[CUSTOMER][NEUTRAL] Oh wait, I'm looking on here this is a different.
[AGENT][POSITIVE] I appreciate that.
[AGENT][NEUTRAL] And the um
[CUSTOMER][NEUTRAL] The policy number on the EOB stops at 9. I don't know if that ML7 is going to affect the policy.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, that's fine. Yeah, that just tells us, that just tells us what product they have, you know, that's that's really more when we're, when we're billing the groups rather than, uh, when we, when we're looking at claims, um, what is the insured's name and date of birth?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] I do appreciate that while I'm looking this up if I could just have a callback number in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Sure, [PII], and that's my direct line.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I have here.
[AGENT][NEUTRAL] Oh, OK. All right.
[AGENT][NEUTRAL] And the data service.
[CUSTOMER][NEUTRAL] 1 15 [PII].
[AGENT][POSITIVE] 1:15. Thank you.
[AGENT][NEUTRAL] Alright, I see. OK. Um,
[AGENT][NEUTRAL] So, the policy, we'll go over the benefits really quickly here.
[AGENT][NEUTRAL] So the, the policy picks up the deductible co-payment or co-insurance for outpatient hospital settings. So if you were to get a um an X-ray, it would have to be in an outpatient hospital setting, uh, such as an imaging center, um, or, or something like that. Uh, it's, uh, it would actually have to be in an outpatient hospital of some sort.
[AGENT][NEUTRAL] And that's the only thing that is covered here. Now, his, his major medical probably does cover it in a physician's office and I, we would have to look at that, that up, but um for his uh secondary insurance to work, anything within a physician's office would not work would not be covered.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So anything, even an office visit wouldn't be covered in a, in a physician, I mean, in, in office settings.
[AGENT][NEGATIVE] No, no.
[AGENT][NEUTRAL] That, that's absolutely right because the, the only thing that's gonna be covered on this is, is gonna be hospital. This is strictly for hospital um services. So, uh, he can certainly get the X-ray anyplace else, um, that he wants to. It's just for his secondary insurance to work, uh, it's, it's got to be in a hospital setting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] All right, thank you so much for all your help. Would you be able to provide a reference number for today's call?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference. Is there anything else at all that I can help with?
[CUSTOMER][NEUTRAL] Uh, no, that'll be all.
[AGENT][NEUTRAL] OK, well thank you for contacting AP have a.