AccountId: 011433970860
ContactId: 29a3a101-e069-46b2-babc-ec688dc619d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342799 ms
Total Talk Time (AGENT): 155230 ms
Total Talk Time (CUSTOMER): 157386 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/29a3a101-e069-46b2-babc-ec688dc619d5_20250529T20:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good afternoon. How are you today?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm doing pretty good.
[CUSTOMER][NEUTRAL] Uh, the reason that I'm calling is I have this insurance through my employer, but I'm not sure as to what can I apply it to or what can I use it for. Is there any way that I can speak to someone that can help me or explain to me what the different, you know, applications where I can submit it, where I can use it so I can save some money?
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with your benefits. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, uh first name is [PII]. It's spelled [PII] Last name is [PII] and my cell number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, I need your policy number. Um, if you have your um ID card, it's the outpatient certificate number.
[CUSTOMER][NEUTRAL] Uh, yes, I do have the card here. The outpatient benefit certificate number is 01.
[CUSTOMER][NEUTRAL] 813208 ML 8
[AGENT][NEUTRAL] OK. Thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the mailing address is [PII].
[AGENT][NEUTRAL] And please verify your email address.
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] OK. Yes, sir. And I'm showing that this is a policy for secondary gap insurance. And what we do is cover the we cover the co-pay, the co-insurance, and the deductible for medical services after your primary insurance um processes a claim for certain services and up to a certain amount. It depends on the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Type of service um for inpatient hospital, if you or your dependent is ever admitted, we cover up to $7350 per calendar year and that's for the co-pay, the co-insurance, and the deductible after your primary insurance processes a claim. And for outpatient services, um, services provided in the outpatient hospital facility.
[AGENT][NEUTRAL] Um, the ER urgent care facility, um, independent labs or in the doctor's office, we cover up to $500 per day, and that's for the co-pay, the co-insurance, and the deductible after your primary insurance processes the claim. Um, except for office visits, we don't cover the co-pay. We only cover the co-insurance and the deductible. And again, that's up to $500 per day.
[AGENT][NEUTRAL] And um what normally happens is that you give your provider our information along with your primary insurance information and they'll call us to verify your benefits and see how to submit a claim if they're not familiar with us. And um for coverage services, they'll submit the claim themselves and we'll pay them directly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so for example, I have a um.
[CUSTOMER][NEUTRAL] A procedure. My uh urologist signed me up for it. Uh, he said I can cancel it, you know, within 2 days of the, the date of the procedure, and I've been looking on my own.
[CUSTOMER][NEUTRAL] The procedure is called a right extracorporeal shockwave lysotrisy. It's basically I have a uh kidney stone.
[CUSTOMER][NEGATIVE] And they're gonna, you know, break it down.
[CUSTOMER][NEUTRAL] Don't need to pass it, uh, it's, uh, from what I understand it's an outpatient.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Situation where I go in for about 3 hours and then I can go home.
[CUSTOMER][NEUTRAL] Uh, I've been doing some research on my own between the, the actual doctor that's gonna do the procedure, the facility where the procedure is gonna be done, and.
[CUSTOMER][NEUTRAL] The anesthesia that's gonna be involved, I'm looking at a cost of $999,900.
[CUSTOMER][NEUTRAL] Uh, I know that I have a deductible of $3700 through my primary insurance. Where would this insurance come into play regarding something like that?
[AGENT][NEUTRAL] OK. That will be for outpatient services. That'll be covered under the outpatient benefit and under your policy for outpatient services, including surgeries, we cover up to $500. So, the portion that goes towards the copay, the co-insurance, or the deductible, um, it'll be covered up to $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's, that's, that's the uh the overall coverage $500.
[AGENT][NEUTRAL] Yes, sir, we cover up to 500 per day for outpatient services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, um, let me go ahead and, and, and make sure everybody has the information on this insurance coverage.
[CUSTOMER][POSITIVE] Thank you very much. I appreciate it.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Have a nice day.
[CUSTOMER][NEUTRAL] No, I don't think so no right now thank you.
[AGENT][POSITIVE] OK. Thank you, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.