AccountId: 011433970860
ContactId: f59d4e7b-34c0-4891-99d7-f4f0b5bfc1bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243399 ms
Total Talk Time (AGENT): 132853 ms
Total Talk Time (CUSTOMER): 69602 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/f59d4e7b-34c0-4891-99d7-f4f0b5bfc1bc_20250612T12:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for contacting ATO. My name is [PII]. How may I?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling from Wait Med Specialist Group, and I'm calling to get a status of, uh, some out an outstanding claim, please.
[AGENT][NEUTRAL] Yes, I can certainly help with a claim status, um, [PII], what is that, uh, policy?
[CUSTOMER][NEUTRAL] I'm, I'm sorry. I can barely hear you. You're like echoing.
[AGENT][NEUTRAL] Can you hear me a little better now? Yeah, I'm having a little trouble with my phone. I can, I can't really hear you very well either, and I do apologize for that. [PII], what is the policy number that we're looking at so that I can uh check on your claim?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Thank you. Policy number is
[CUSTOMER][NEUTRAL] Uh, can you hear me better? 025.
[AGENT][NEUTRAL] A little bit. Uh-huh.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] 79,860.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] extension is [PII].
[AGENT][POSITIVE] Thank you, I appreciate that. What's that date of service for Antoine?
[CUSTOMER][NEUTRAL] Data service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you, and the build out?
[CUSTOMER][NEUTRAL] The bill amount is $781.
[AGENT][POSITIVE] OK, great, thank you very much. It does look like we received that let me see what how that was processed.
[AGENT][NEGATIVE] I apologize my computer is just a little bit slow.
[AGENT][NEUTRAL] they're wanting to come out today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a hospital indemnity policy, Amy, and what it does is it pays a flat rate benefits for certain very specific services. Now it looks like we received your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Excuse me, it looks like we received your claim.
[AGENT][NEUTRAL] On the [PII] we processed it on the [PII], but this policy has a calendar year maximum of $75 for this type of service. Now that had already been met by another claim by the time that we received your your claim, so all the benefits for this calendar year have already been met.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh so when we sent you back your, your claim, it was as a denial because uh everything had already been taken to uh you know, had already been met with this calendar year.
[AGENT][NEUTRAL] Now this, as I mentioned before, this is a um hospital indemnity policy. It's not the same as major medical, uh, although our contractual obligation was met with this with that, uh, check that was paid to the other provider, it's possible that [PII] has another, uh, has more insurance, so, um, you may want to check with him.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] You may have another policy.
[CUSTOMER][NEUTRAL] OK, even if it's
[CUSTOMER][NEUTRAL] Even if the patient does not have more insurances can balance be applied to patient responsibilities.
[AGENT][NEUTRAL] Well, I can't tell you that. The only thing I can tell you is that is that our contractual obligation has been made for this year.
[CUSTOMER][NEUTRAL] OK, and can I get the claim number that you processed?
[AGENT][NEUTRAL] Absolutely, it's 358.
[AGENT][NEUTRAL] 4602. And would you like me to fax you a copy of that?
[CUSTOMER][NEUTRAL] No, ma'am, that's fine as long as I have it in documentation, I'm good. And can I get a reference number for the call please?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that in today's date as our reference.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. You have a wonderful day.
[AGENT][NEUTRAL] Is there any
[AGENT][NEUTRAL] OK, if there's nothing else to help with, thanks for contacting ATO.
[CUSTOMER][NEUTRAL] No