AccountId: 011433970860
ContactId: 28380ecc-c60e-4165-b007-d0b18341adb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 847700 ms
Total Talk Time (AGENT): 472419 ms
Total Talk Time (CUSTOMER): 220623 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/28380ecc-c60e-4165-b007-d0b18341adb1_20250523T21:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, my name is [PII] and um I'm just learning that I've got the gap insurance through you all and I don't have any information on it.
[AGENT][NEUTRAL] OK, um, [PII].
[CUSTOMER][NEUTRAL] I don't have the card. I didn't go ahead.
[AGENT][NEUTRAL] Yeah, I was just gonna ask for a callback number in case we get disconnected and then I can look you up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you don't have a card or anything? All right, let me see.
[CUSTOMER][NEGATIVE] No, I, I, I've never even heard of this company, um, and I mean it's no.
[CUSTOMER][NEUTRAL] I've just not had to use my insurance until now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you spell your last name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, let me see if I can find you in here and see.
[AGENT][NEUTRAL] But all we've got
[AGENT][NEUTRAL] Give me just a moment while I search for you.
[AGENT][NEUTRAL] You said [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify with me what state you're calling from?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, just wanted to make sure cause there's a couple with your name, but they're all in different states.
[AGENT][NEUTRAL] Or with similar names.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can I get you to verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the address we would have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do not have a phone number for you. Would you like me to add the number you're calling from?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see here.
[AGENT][NEUTRAL] So it looks like, so this is a medlink policy, so what that means is its secondary gap insurance. So if you have a claim, um, this is after the primary, it helps cover co-insurance, co-deductible and co-pay. Um, so anytime you would submit a claim or your, your hospital or whoever you go see for services files a claim.
[AGENT][NEUTRAL] They will need the primary um explanation of benefits first to show benefits are met. Should your primary insurance deny claims this uh policy will also deny the claim because it has to have major medical pay first.
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] Are there any specific questions you have?
[AGENT][NEUTRAL] Benefits wise or?
[CUSTOMER][NEGATIVE] Well, yeah, so I'm, I'm, yeah, I'm supposed to be having um a heart procedure done and the hospital keeps telling me that I haven't met my deductible. I I haven't met my deductible. I was like, that's not how this works. But so, so then I realized I called my HR and they, they connected me with um our United rep and he said, well, you've got the gap insurance. I said, I've never even heard of American Public Life.
[CUSTOMER][NEUTRAL] So I, this is the first time we learned. I mean, it's the first I've needed insurance too, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But I don't have a card. I, I, I mean, I don't, I don't know what to do now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yeah, it looks like you've had this policy since [PII]. Um, I'm going to go over some benefits with you if that's all right, um, just to kind of give you a breakdown of what you have and then I can help you. Um, I do want to say that that's just a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] Uh, so it looks like you have an in-hospital benefit of up to $6500 per calendar year with a $0 inhospital deductible.
[AGENT][NEUTRAL] That also includes an ambulance benefit and treatment in a hospital for mental or emotional disorders with a maximum of 30 days. And then let me see, since you said you were doing surgery. Yeah.
[CUSTOMER][NEUTRAL] OK, so can I, can I stop you right there?
[CUSTOMER][NEUTRAL] Yeah, can I, can I stop you right there? So, um.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So I had to um uh
[CUSTOMER][NEUTRAL] Taken, I had to call an ambulance on myself. I was having heart issues. Um, but I paid the ambulance in the, the bill from the ambulance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, the insurance paid a portion of it, so would this gap coverage help cover that?
[AGENT][POSITIVE] Yes, and I do want to say um it's it's very good that we also don't have timely filing so that means even if you had a claim way back when you first got this in uh August, as long as you have a claim for a date of service during your active policy period, um, we will try to honor that as long as it's a covered service so um since that's been a while and you have everything done, I would go ahead and file the claim yourself um.
[AGENT][NEUTRAL] And you can do that through our online portal which is [PII]. If you would like, I can send you an email with a help guide on how to get that started and if and on that you'll be able to even uh see your policy certificate, your policy number will be on there should you ever need it. And then should you ever want to just see what benefits you have, you'll be able to see your schedule of benefits on there.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Um, so let me see if we have an email on file. What email address would you like us to have?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I'm sorry, it's [PII] what?
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I will send you.
[AGENT][NEUTRAL] Um, a help guide on how to do that through email when you're going to set up your account, you will need to use the email address that we have on file so that email, um, you'll need your, um.
[AGENT][NEUTRAL] Zip code, the email address, your last name, and I believe the phone number that we have on file, which is the one that you provided me with today, um, and I think your zip code and then you'll be able to follow the the instructions. I think there's only 3 steps and then from there you'll have an online account where you can submit claims on your behalf, you can check the claim status, you can see your schedule of benefits and then you'll even have your uh.
[AGENT][NEUTRAL] Your policy number right there. Sometimes depending on the employers, they like to give out their policy cards. Some don't have cards, this one should have. um so you you might want to ask your HR if they have a card that they can give you or they can request a card for you. Um, some like to give them all at once.
[CUSTOMER][NEUTRAL] I, I can't request the card.
[CUSTOMER][NEUTRAL] I can't request a card myself.
[AGENT][NEUTRAL] Let me see, it will be in your in your online account um.
[AGENT][NEUTRAL] I'm not seeing.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let me make sure that I have it on file too.
[AGENT][NEUTRAL] So I do show your card is online so whenever you set up that online account you'll have your card right there.
[AGENT][NEUTRAL] Um, that might be a quicker way to do it than through the mail because the email won't be secured and it has um information on there about your coverage and so uh we don't wanna send that through email that will be in your online your online account under policy uh cert card or policy certificate card and it'll be right there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so I do have a question. What is the, uh, for instance, if I have an outpatient surgery, um.
[CUSTOMER][NEUTRAL] What is 30, what is co-insurance? 30% co-insurance.
[AGENT][NEUTRAL] So that's after what you've already been, so it's after what your primary has paid.
[AGENT][NEUTRAL] Um, I'm not showing 30% on your benefits. Let me double check because I was in your inpatient. Let me look at your outpatient.
[AGENT][NEUTRAL] Yeah, because I'm not showing a 30%. This is just it pays up to an amount after your primary insurance covers it.
[AGENT][NEUTRAL] I'm not seeing anything about 30%.
[CUSTOMER][NEUTRAL] So I'm looking at the benefit, the summary benefits and coverage, not specifically to me, but for what the United Healthcare gap is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, OK, that would be through United, not through through us. Ours is, yeah, ours is specific numbers.
[CUSTOMER][NEUTRAL] Oh maybe
[CUSTOMER][NEUTRAL] That's United. OK, never mind, I swear I, I was looking at the wrong.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and since you were talking about surgery, it does show that you have an outpatient benefit maximum of up to $6000 per calendar year. That also includes the emergency room deductible of $0. It includes a hospital emergency room, urgent care, and it does show surgery in a hospital outpatient facility or freestanding surgery center. So you should have that covered and it also has ambulance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so, um, because I have the ambulance, I, I think I can manage that through that, but my deductible through United was 500.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For you know that's just my.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does that apply? I mean, does the gap help cover that deductible?
[AGENT][NEUTRAL] Yes ma'am, so if your deductible hadn't been met, but your insurance, your primary insurance did pay, sometimes you might see something that says it's a code of denial, but it's because the benefits like say this $6000 it would go towards your deductible so sometimes it'll call it as a denied claim, but it's because the money being owed is going to your deductible instead of to the provider themselves directly.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does that kind of make sense?
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Kind of. Um, so my co-pay for an emergency room visit is $500 through United.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So at what point or does, does American public life help with that $500 in any way or do I have to just meet that co-pay with United?
[AGENT][NEUTRAL] No, we should be able to help with that deductible, but sometimes the it won't come directly to you or to the provider. It will go towards whoever your insurance is to pay for that deductible.
[CUSTOMER][NEUTRAL] OK, no, not deductible. It was that's the copay.
[AGENT][NEUTRAL] 00, I'm sorry I meant I meant copay, sorry.
[CUSTOMER][NEUTRAL] OK, so, so what would, what would my, my plan cover up that $500?
[AGENT][NEUTRAL] The plan will cover it up until you've used that $6000 per calendar year as long as it is benefits that are in this policy, so like the ones that I had mentioned and as long as we have your primary insurance showing that they paid a portion of it, we helped pick up that portion that they did not meet.
[AGENT][NEUTRAL] So say you have a
[CUSTOMER][NEUTRAL] OK, but it was, but it was only it was only $500 because that is my co-pay.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So this gap insurance isn't going to help cover that co-pay, correct?
[AGENT][NEUTRAL] It it will help cover that copay. You might just see it as a claim denial, but it's because the benefits are being paid to the deductible and not specifically the provider. So that's how it shows up as I was just stating that if you ever get a claim that's denied and it says that the payment went towards the deductible, it's because we paid that deductible through this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, thank you very much.
[AGENT][NEUTRAL] Alright, expect an email um from us in just uh in about 10 minutes and um if you don't see it within the hour, check your spam, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] OK.