AccountId: 011433970860
ContactId: 28f24c39-f680-4951-baf3-fb3d0669b541
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 614640 ms
Total Talk Time (AGENT): 235644 ms
Total Talk Time (CUSTOMER): 314690 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/28f24c39-f680-4951-baf3-fb3d0669b541_20250213T15:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes hello my name is [PII]. I'm uh.
[CUSTOMER][NEUTRAL] I guess I'm a member with you guys have a uh a plan uh it's my first time having gap insurance so um I'm just looking at like, you know, I guess the best information of what might be covered and then um how I go about.
[CUSTOMER][NEUTRAL] Getting reimbursements if I have uh.
[CUSTOMER][NEUTRAL] Some things I've been employed with this company for like 2.5 years and I really wasn't even uh.
[CUSTOMER][NEUTRAL] Too astute with what goes on so you know I might have to hunt down previous things, um.
[CUSTOMER][NEUTRAL] So I'm just wondering what you could tell me.
[AGENT][POSITIVE] Um, sure, and I can assist you with your benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][POSITIVE] Cool
[CUSTOMER][NEUTRAL] Um, use my cell then if we're just somehow disconnect [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Now, I need your policy number.
[CUSTOMER][NEUTRAL] Oh, that's gonna be the toughie.
[CUSTOMER][NEUTRAL] Um, hold on, I have a photo, uh, of some I took it off a coworker's card because I wasn't even sure if I got it, but now that I'm thinking about it, I do believe maybe I have a packet from you guys. I don't remember having a card with it, but I think I have a book.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, and I can look it up by your social also.
[CUSTOMER][NEUTRAL] Please, um,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Why am I drawing a blank?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Wait, no, wait, that's wrong [PII].
[CUSTOMER][NEUTRAL] Coffee hasn't gotten in the brain yet.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] OK, I found you in our system. Please verify your first and last name again and your date of birth.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And please verify your mailing address and email address.
[CUSTOMER][NEUTRAL] Uh, my home mail, I have a PO box and I have a home. My home's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I have a PO box of 51,740 Lighthouse Point.
[AGENT][NEUTRAL] OK, we have the home address on file and please verify your email address.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I don't recall if I put it to work, but I, I think I did, we, we, we did outside of work, correct? It's not at our world. It, it would probably be steadfast guy. It's either [PII] or [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, the one [PII]. OK.
[CUSTOMER][NEUTRAL] I run both.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK. Yes, sir. I'm showing that this is a policy for secondary gap insurance. What we do is cover the copay, the co-insurance, and the deductible after your primary insurance processes a claim for covered services. I'm showing that you've had this policy since [PII] and there's no timely filing limit, so you can always file a claim or have your provider to file claims um going back that far.
[AGENT][NEUTRAL] And we cover, let's see, services under your policy for inpatient hospital if you're ever admitted, we cover that up to $6600 per calendar year. Um, and that's again for the co-pay, the co-insurance, and the deductible after your primary insurance processes a claim.
[AGENT][NEUTRAL] And we also cover services for outpatient services in the hospital, and we cover outpatient services up to 3000 per calendar year.
[AGENT][NEUTRAL] And then there's also coverage for services done in the doctor's office. Um, we covered that up to 3000 per year.
[AGENT][NEUTRAL] And services done in independent labs and services for durable medical equipment is also covered up to 3000 per calendar year.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Now, is there anything that's above those figures like do you cover a percentage above just out of curiosity for the future? I haven't had that happen, but is there something like if you were in emergency room?
[CUSTOMER][NEUTRAL] You know, long term you're there for a week and a half, obviously the bills could get maybe higher does it kind of like go up to 6600 for a year, 50% after that or is that just capped?
[AGENT][NEUTRAL] Um, well, if you go into the hospital through the ER and end up, um, being admitted, that will be covered under the inpatient um benefits. So that would be covered up to 6000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 0, 6000. I, I somehow, I somehow had 6600 OK, written down. OK, um, and then could I ask you this, uh, you, you mentioned labs. I just had a, uh, stress test done recently. Do you guys cover you guys cover.
[AGENT][NEUTRAL] Yeah, and what
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Like uncovered portions of that.
[AGENT][NEUTRAL] Um, and where, where did it take place?
[CUSTOMER][NEUTRAL] Being, being, being like a lab, it's Holy Cross Hospital.
[AGENT][NEUTRAL] Yes, sir. That sounds like it will be covered under the outpatient benefit. And yeah, and what normally happens is that you'll um give our information to the provider, to the hospital, the same as you would your um um primary insurance and they'll give us a call to verify your benefits and see how to file a claim. And um if you don't have a card, I can have one mailed to your home and also I can give you your policy number.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] Yeah, you know, so I wouldn't mind taking another one. Now let me ask you this because everything's been so far, far back, you know, I haven't done much, but I've had a decent amount of co-pays. I'm, I'm sure between now and then.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And I've had like one biopsy kind of you know sent off that procedural cost um.
[CUSTOMER][NEUTRAL] When I go to see these people, is it basically uh maybe retroactively I can show up there they'll send you the whole gamut of everything, or am I gonna basically almost case by case basis.
[CUSTOMER][NEUTRAL] You know because I was asking for them to email me and send me like the stuff I've done and the visits I've had up until like December of this last year um what's what's the best route to go?
[AGENT][NEUTRAL] Um, yeah, just let them know that you have secondary gap insurance with us. I can give you your policy number, um, give her my phone number and your policy number, and let them know that you have secondary gap insurance and, uh, they'll call us to see how to file a claim and the
[AGENT][NEUTRAL] Information we'll need is the EOB from your primary insurance company along with the claim form that they'll send along with it and we'll review the claim to see if you have um any benefits that we can cover that we'll pay under your policy.
[CUSTOMER][NEUTRAL] OK, um, the ELB for the primary, oh, you said uh the policy and phone number ELB from the primary insurance, is that right?
[AGENT][NEUTRAL] Um, EOB explanation of benefits.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] From your primary insurance company. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, now, um.
[CUSTOMER][NEUTRAL] Where was I? um, they have, uh, I go to them they're gonna.
[CUSTOMER][NEUTRAL] OK, so they'd have to come back to you now oh this was my question, um, for the most part, every doctor, well, I should say a good portion of the doctors.
[CUSTOMER][NEUTRAL] Have been underneath um the umbrella of that Holy Cross Hospital and I guess they're calling themselves like Trinity something now um.
[CUSTOMER][NEUTRAL] Is that kind of maybe like a one stop shop where if I probably go to them they'll be able to pull my doctor's office visits and combine them with the labs with the with the.
[CUSTOMER][NEUTRAL] You know, the machinery of going through the stress test, right, those kind of labs and screenings, X-rays.
[AGENT][NEUTRAL] Yes, sir, they should be able to pull.
[CUSTOMER][NEUTRAL] OK, so that would probably be my first, my first, uh, stop should be the that that would get most stuff done I would guess.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, as far as dental, uh, what, what were you guys cover in the dental sphere?
[AGENT][NEUTRAL] Um, well, under this policy, nothing will be covered under the dental. This is just for medical.
[CUSTOMER][NEUTRAL] OK, so there's no, there's no like root canals or uh any.
[CUSTOMER][NEUTRAL] I mean, isn't isn't that that's kind of like, isn't that like orthodontist with uh I don't know, is that considered dental or is anything that more?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, that, and that'll go under the dental benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, this is good. I, you know, I, I thought somebody even told me they, they thought copays weren't covered. Is that possible? Are there a couple different tiers that our company is dealing with or?
[AGENT][NEUTRAL] Right, for services done in the doctor's office, the co-pay is not covered.
[CUSTOMER][NEUTRAL] Or.
[AGENT][NEUTRAL] But um treatment done in the doctor's office is covered. The charges that goes towards the co-insurance and the deductible, that's covered under the outpatient benefit. But um they're right for a doctor's office, the co-pay is not covered.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, OK.
[AGENT][NEUTRAL] OK. And going back to inpatient, you were right, um, um, it is 6600, not 6000.
[CUSTOMER][POSITIVE] Very good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good catch, OK.
[CUSTOMER][NEUTRAL] Again, I was blaming myself because the coffee hasn't hit yet.
[CUSTOMER][POSITIVE] Alright, I appreciate it and uh you have a good day. I'll look out for that in my mailbox, uh, that card is this gonna be a like a nice plastic durable card or is this gonna be almost like a piece of paper I'm gonna have to find in the in a pack of papers.
[AGENT][POSITIVE] It'll be a nice plastic card. Yeah.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][POSITIVE] Awesome, OK.
[CUSTOMER][POSITIVE] Very good.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] You have
[CUSTOMER][POSITIVE] Oh no that's good you have a good day.
[AGENT][NEUTRAL] You do the same, and thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Thank you bye now.
[AGENT][POSITIVE] Mm. You're welcome