AccountId: 011433970860
ContactId: f3cd761e-295c-409c-aabc-709dedbc6c80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 156100 ms
Total Talk Time (AGENT): 90491 ms
Total Talk Time (CUSTOMER): 63151 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/f3cd761e-295c-409c-aabc-709dedbc6c80_20250123T19:11_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Thank you for contacting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], this is [PII] in the cancer cue. I have a provider on the phone. Her name is [PII]. Callback number [PII]. This is on policy 246-59007.
[CUSTOMER][NEUTRAL] I have assisted [PII] with eligibility for this member. She's asking about benefits for an ultrasound, a trans um vaginal ultrasound in a office um setting. I'm not too sure about that. Can you assist her, please?
[AGENT][POSITIVE] Yes, I would be glad to. Thank you.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] [PII], my name is [PII]. I'm with the claims department. I'm looking at uh the um policy that you gave to April. Now, you're wanting to know about a transvaginal ultrasound within a physician's office?
[CUSTOMER][NEUTRAL] Yes, I'm just trying to verify the benefits for the patient.
[AGENT][NEUTRAL] Yes, the policy will pick up the deductible, co-payment, or co-insurance up to $3000 per calendar year for such an, uh, a, uh, service. Um, that's just a verification of the benefits, not a guarantee of payment, but one of the covered places of, of, uh, service, um, on this policy is treatment within a physician's office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, that would be covered up to $3000. We would pick up the deductible, co-payment, or co-insurance. We are the, uh, secondary insurance, so you would file through the major medical first and then through us and, and again, it's just a verification of the benefits, not a guarantee of payment, but yes, those, those services um are covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK perfect and I'm sorry, I, uh, is it calendar year or calendar days? Sorry about that.
[AGENT][NEUTRAL] Is it
[AGENT][NEUTRAL] It's a calendar year.
[AGENT][NEUTRAL] Now, is there anything else at all that I may help with where to file the claim.
[CUSTOMER][NEUTRAL] Calendar year OK.
[CUSTOMER][NEUTRAL] Um, yes, have they met any?
[CUSTOMER][NEUTRAL] Have they met anything so far?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, uh, as far as the benefits go, um, nothing has been used for the calendar year [PII]. So what we do is this isn't the deductible itself. What we do is we, we pay out the deductible, co-payment or co-insurance, so nothing has been used for this current year, so it looks like it's all available.
[CUSTOMER][NEUTRAL] Mhm. OK. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great thank you can I just have your first name again?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as our reference.
[CUSTOMER][POSITIVE] Perfect thank you [PII] you have a great day.
[AGENT][POSITIVE] OK, thanks for contacting APO have a good.