AccountId: 011433970860
ContactId: 0c8dd4b6-8662-4a13-975e-08c0ea911cae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 540559 ms
Total Talk Time (AGENT): 284517 ms
Total Talk Time (CUSTOMER): 220058 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/0c8dd4b6-8662-4a13-975e-08c0ea911cae_20250619T15:24_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] And thank you for calling APL.
[AGENT][NEUTRAL] This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Yes, I am trying to figure out um how this policy works.
[AGENT][POSITIVE] OK I'd be glad to help you.
[CUSTOMER][NEGATIVE] Because I have a bunch of different medical appointments set up, and I know that because of my deductible, I'm not gonna, they're not gonna cover stuff. So,
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I'm just trying to understand how it all works.
[AGENT][POSITIVE] Thank you for going and give me your name and your policy number, and I'll be glad to explain it to you.
[CUSTOMER][NEUTRAL] [PII] policy is 02639380.
[AGENT][NEUTRAL] Alrighty, thank you for that information. Now while I'm pulling your plan up, go ahead and give me a good return telephone call number, please, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, thank you for all that information, [PII]. Now go ahead and verify your date of birth, address and email address for me, please.
[CUSTOMER][NEUTRAL] [PII], [PII]. [PII]. I believe is what I have.
[AGENT][NEUTRAL] Yes ma'am. OK, thank you for all of that information, Mr. [PII]. OK, so you're calling wanting to know how this plan works. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, so I've never had a, I've never had a uh gap coverage.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, OK, alright.
[CUSTOMER][NEUTRAL] So what I'm trying to figure out.
[CUSTOMER][NEUTRAL] Yeah, so what I'm trying to figure out is so like, OK, tomorrow I have an MRI.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I know that I think it was.
[CUSTOMER][NEUTRAL] 450, I think is what they were telling me they were gonna charge me. Um,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But I'm not sure. So, so what I'm trying to figure out is if I go there tomorrow and they tell me that it's what, whatever it is, obviously, that's not covered by the insurance because my blood work, my ultrasound, my MRI all have
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEGATIVE] after deductible. So it's not gonna cover anything. The insurance just started [PII]. So it's not, it's not gonna cover anything. Um,
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Until after the deductibles met.
[CUSTOMER][NEUTRAL] So, let's say I go to the MRI center tomorrow, they charge me the $450. Can that be covered under the gap?
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, let me get your benefit plan pulled up now I do say that you did go into.
[AGENT][NEUTRAL] In effect here as well [PII], you're all current and active. Now I'm, I must advise that guarantee of payment is coverage is not a guarantee of payment, but now your benefits here is anything that is applied towards your deductible, your.
[AGENT][NEUTRAL] Pay or any coinsurance at your primary insurance carrier for sickness and injury will be what we review for payment here at APL. So if it applies towards your deductible at your primary, then yes ma'am, that would be something that we would look at as being covered and here you don't have a deductible, you have straight $3000 payable per calendar year benefit for outpatient benefits.
[CUSTOMER][NEUTRAL] OK. So let me ask you another question. OK. So,
[AGENT][NEUTRAL] So it sounds like if you're having that done, uh-huh.
[CUSTOMER][NEGATIVE] Yes, so I'm having blood work done tomorrow, which also is not even covered until after I'm in the deductible, which I've never heard of in my life. Um,
[CUSTOMER][NEUTRAL] So, that's gonna be a significant number. So, does it, does it have to be a, uh, a lab that's covered under a certain network or it doesn't matter? I mean, I'm sure it would be its quest, it's one of the bigger ones, but um,
[AGENT][NEUTRAL] Yeah, well, you're not in a network here, so that wouldn't matter.
[AGENT][NEUTRAL] Mm, but what you do need to do though, Ms. [PII], any doctor you go to, make sure you give them your primary insurance information as well as APL and explain to them that once they get the ELB back, um, then they are to submit all claims no matter what, go ahead and get them submitted here to APL so we can see if it's a covered benefit, OK? So I always have them send it to both.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So what if they won't do it? What if they say, you have to pay this and you have to submit it with your insurance?
[AGENT][NEUTRAL] OK, well then if that's the case, then you can get a copy of your bill and you can submit it in yourself.
[AGENT][NEUTRAL] Doesn't matter either way. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And what about, so let's say I go to my gynecologist. She does not take insurance period. Doesn't take insurance. Um, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] Yeah, she's, she's just an, an, uh GYN now. She's, you know, she only, she doesn't do OB anymore. Um, so she charges me $350.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Can I, can I put that towards my gap?
[CUSTOMER][NEUTRAL] If I get the bill from her, or does it have to be a car insurance coverage expense?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I mean,
[AGENT][NEGATIVE] Well, it, it, your, your primary would either have to apply it towards your deductible co-pay or co-insurance, but now, uh, you don't have any kind of routine benefit here at all. So if it's for a routine checkup, then that's not gonna be covered.
[AGENT][NEUTRAL] Here at all, but go ahead and send us a bill in no matter what, um, and so we can review it, OK? Whether, whether she makes you pay or not, get a bill.
[CUSTOMER][NEUTRAL] OK, so wait, so
[CUSTOMER][NEUTRAL] OK, so you just said something about routine.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Yeah, we don't pay for anything routine here at all.
[AGENT][NEUTRAL] Yeah, only for sickness and injury.
[CUSTOMER][NEUTRAL] OK, so if I have to go for an ultrasound.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] That's only for sickness and injury. That's the only two things we pay for.
[CUSTOMER][NEUTRAL] OK, well, that's a problem because I'm not sick. So,
[AGENT][NEUTRAL] They're doing an ultrasound, just checking something, then your physician may be sending in a medical diagnosis if that's the case. So, like I said, always send a bill in because it could be something that is, that would be covered under your plan.
[CUSTOMER][NEUTRAL] OK. So blood work. If it's a, if it's a routine blood work, then they're not gonna cover it.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Not if it's a routine diagnosis on your claim, no, ma'am.
[AGENT][NEUTRAL] But if it's a medical diagnosis, yeah, then it would be.
[CUSTOMER][NEUTRAL] I don't know that there's
[AGENT][POSITIVE] Because you do have lab benefit here.
[AGENT][NEUTRAL] Yeah, like I said, just always, you know, no matter if they send it in for you or not, get a copy and you can always submit it into APO yourself that way.
[AGENT][NEUTRAL] We, you know, we can at least review it for anything that is possibly covered here under your plan, so I always send all of your claims in the APL.
[CUSTOMER][NEUTRAL] So I'm confused because like blood work, when is blood work ever for anything specific? I mean, usually they want you to do a blood work done.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah, well, there's a lot of medical diagnosis that, that it would be if they find something that they're shaking. So, uh, like I said, a lot of cases that doctor will put a medical diagnosis on your claim.
[AGENT][NEUTRAL] Yeah, so just make sure that yeah you always send all your claims in no matter what.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] All right. I gotta figure out how to have the doctor write this then because, I mean, blood work, it's just here, it was just a panel, it's like here, go get all this blood work done. OK.
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] Because, you know, they like you to have it every so often. Um,
[AGENT][NEUTRAL] Yes, ma'am. But it could be that they're checking for something, so, yeah.
[CUSTOMER][NEGATIVE] But now you're telling me that that's that's gonna be considered with cleaning.
[AGENT][NEUTRAL] Right, like I said, just always get a copy of it and send it in the APL and let's make sure that you know that you don't have any type of benefit here that would cover it, so just make sure I always send it in the APL.
[CUSTOMER][NEUTRAL] OK, so any of my bills that I get from my doctors, if they want, if they won't, if they won't submit them to the insurance, well, even if they won't if they won't submit to you, then I have to. OK.
[AGENT][NEUTRAL] OK. Yes, ma'am.
[AGENT][NEUTRAL] You can't
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we can review that.
[AGENT][NEUTRAL] Is there anything else that I can help answer for you today, [PII]?
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] Well, alrighty then. Well, thank you so much for calling APL and you have a great rest of your day, OK?
[CUSTOMER][POSITIVE] Thanks you too.
[AGENT][POSITIVE] Thank you, ma'am. Bye-bye.
[CUSTOMER][NEUTRAL] Right