AccountId: 011433970860
ContactId: 312bc2e3-4f9b-4e28-b924-8f117dff0b42
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 655539 ms
Total Talk Time (AGENT): 416512 ms
Total Talk Time (CUSTOMER): 198519 ms
Interruptions: 4
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/312bc2e3-4f9b-4e28-b924-8f117dff0b42_20250625T19:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I have a quick question, um, when I.
[CUSTOMER][NEUTRAL] Um, got my insurance. I have my insurance through my employer, and I recall signing up for the gap insurance through APL.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I don't think I've ever received like any proof of insurance or anything like that so I'm not sure if you're able to see that on your end and just send me a link to register and.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um, do you mean like an ID card or something like that?
[CUSTOMER][NEUTRAL] Um, let me see, hold on.
[CUSTOMER][NEUTRAL] Maybe in the beginning of the year we always get an email hold on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] Well I mean I don't have anything from you guys so I've never I've paid for it but never, never really got anything on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, you're fine. OK, yeah, so we could go ahead and get that policy pulled up and I'll see, you know, of course what I can send you and then um if you wanted to register on our online portal you could do that as well. um, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] My first name is spelled [PII] N.
[AGENT][NEUTRAL] OK, and then uh your last name please?
[CUSTOMER][NEUTRAL] [PII] G.
[AGENT][NEUTRAL] OK thank you and then uh before we go any further, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. um, so I imagine you don't have a policy number?
[CUSTOMER][NEGATIVE] No, nothing.
[AGENT][NEUTRAL] OK, that's OK. uh, I can start using your social.
[CUSTOMER][NEUTRAL] Uh, um, anything else that you can use?
[AGENT][NEUTRAL] Oh sure, let's see, I can try searching uh just with your name, um just to verify, you said that first name that was [PII]?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, give me just, uh, what state?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII] [PII].
[AGENT][NEUTRAL] Yes, uh, what state do you live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what was your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. OK, I do believe I found you. um, let's see, just gonna verify some other information really quick uh can I get your mailing address please?
[CUSTOMER][NEUTRAL] My mailing address should be [PII].
[AGENT][POSITIVE] Perfect. Uh, thank you.
[CUSTOMER][NEUTRAL] In uh [PII].
[AGENT][NEUTRAL] Got it thank you just wanted to make sure we have was correct um last thing I need is if you would verify the email address we've got on file for you uh it does look like it might be through your employer.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, so probably you have, uh, my first name is [PII].
[AGENT][POSITIVE] Perfect, yep, that's it. OK. Uh, so I was able to locate your policy. Thank you so much for verifying all of that. Yeah, this policy has been effective since [PII]. My goodness, and you haven't gotten anything from us?
[CUSTOMER][NEGATIVE] Mm no.
[AGENT][POSITIVE] I am so sorry wow, that's crazy. OK, give me just a moment let me get all this pulled up.
[AGENT][NEUTRAL] Um, before I do anything else, would you like me to go ahead and give you your policy number if you wanted to just write it down?
[CUSTOMER][NEUTRAL] Uh, yeah, go ahead please.
[AGENT][NEUTRAL] OK, that is 02.
[AGENT][NEUTRAL] 29
[AGENT][NEUTRAL] 90.
[AGENT][NEUTRAL] 72.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I do, I can give you um I can email uh you the policy certificate and your ID cards, um, and I can, I can also mail it to you or one or the other or both whatever you prefer. How would you like me to send those to you?
[CUSTOMER][POSITIVE] Uh, I'm, I'm so sorry, repeat that one more time.
[AGENT][NEUTRAL] Sure, so I can send you a copy of your ID card as well as your actual policy certificate that of course goes through all of the covered benefits, dollar amounts, frequencies, things like that. um I can email them, I can send a paper copy in the mail or I could do both. Uh, what would you prefer?
[CUSTOMER][NEUTRAL] Uh, by regular mail you can send the ID cards and then everything else can be sent by email because I, I don't, I don't want a huge pocket of the policy. I don't want it by mail, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, yes, OK.
[AGENT][POSITIVE] Got it, no worries. OK, so yes, I will.
[CUSTOMER][NEUTRAL] I just want my ID card, yeah.
[AGENT][NEUTRAL] Yeah, OK, so I can email you the policy certificate and then just the ID card paper copy in the mail. OK, let me, let's see, I know we just verified your mailing address but the zip code that was [PII], is that correct?
[CUSTOMER][NEUTRAL] Yeah, that's correct and when you have a chance if you can kinda, I don't know if this is something that you do or if you have to transfer me but I just wanted to confirm how does it typically work? I might have to use it soon because I'm, I'm gonna be getting.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Possibly I mean I I know I'm getting an X-ray done and I don't know if that's like something that you guys cover or.
[AGENT][POSITIVE] Sure, yeah, I can go over those benefits with you, absolutely. Um, in a short, I will say how this policy works is, uh, as it's a secondary medical policy.
[AGENT][NEUTRAL] It is designed to help with a co-pay, deductible and co-insurance after your major medical pays. Uh, so you've got two separate buckets essentially, uh, for the benefit amount payable. Uh, you've got a bucket for, uh, inpatient procedures. So if you had to stay hospitalized for over a day, um, and then outpatient. So outpatient would be considered anything other than that. So like you said, an X-ray or something like that. Uh, and so each of those buckets, I'm sorry?
[CUSTOMER][NEUTRAL] Mhm it is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, no, no, keep going, keep going.
[AGENT][NEUTRAL] Sure, um, just kind of giving you a brief little breakdown of it, um, so each bucket is, uh, has a $1000 benefit per calendar year, and again that goes towards co-pay, deductible and co-insurance after your major medical pays.
[CUSTOMER][NEUTRAL] Mhm yeah
[CUSTOMER][NEUTRAL] Uh, I'm sorry, say that one more time.
[AGENT][NEUTRAL] Sure, so your inpatient benefit is $1000 per calendar year and your outpatient benefit is also $1000 and of course those are separate, um, and you know again that does go towards co-pay, deductible and co-insurance after your major medical pays.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this policy is very dependent on your major medical. If there's ever a procedure or anything that your primary medical is not willing to pay, then this policy would not be able to. It couldn't be used instead if that makes sense.
[CUSTOMER][NEUTRAL] Um, so for instance if I get this X-ray done and um.
[CUSTOMER][NEUTRAL] I, I know that my deductible is high with my insurance, so if it's, if it's not, if it doesn't exceed the deductible, is that what you're saying it wouldn't be covered?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh no no no that's not what I meant I'm so sorry for the confusion um I meant more for example if um.
[CUSTOMER][NEUTRAL] No, no, no, no, I'm just trying to understand, no, it's OK.
[AGENT][NEUTRAL] Sure, I meant more for example of um you know if it was out of network or something where it was simply a procedure that your major medical was just like absolutely not kind of thing um this policy is meant to help towards your deductible so even if your deductible was, you know, $2000.
[AGENT][NEUTRAL] Uh, as long as we can get, you know, whoever files the claim would have that explanation of benefits from your primary stating that whatever they paid went towards your deductible or it would go towards your deductible that $1000 would go towards that basically reimbursing you.
[CUSTOMER][NEUTRAL] OK, so, um, let me see if I understand. So if my bill right now, it's $500 for my for the X-ray, um, and this is something that it's $500 because my insurance maybe did not cover everything, then this gap insurance is what's gonna cover those $500 that we're seeing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Correct, absolutely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, I, I understand, uh.
[AGENT][NEUTRAL] Sorry, I know it is a bit confused, um, but that's, that's put it in a nutshell.
[CUSTOMER][NEUTRAL] No, I mean it, it has been a little bit confusing, yeah, it has been confusing because like I don't really deal with health insurance.
[AGENT][NEUTRAL] Yes, yes, and I can imagine.
[AGENT][NEUTRAL] Well, and this, this kind of insurance is definitely very different from most, um, you know, traditional gap coverages, um, and of course you know once you it so more specifics as to, you know, um, frequencies and, uh, what's covered, what's not things like that, uh, and of course questions after reading that definitely give us a call back and we'll try to alleviate any kind of confusion.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, now the email that I send this policy to, did you want me to send it to the email address we have for you, your work email, or was there a different one you'd rather me send that to?
[CUSTOMER][NEUTRAL] No, the working man is, is fine. Now, is, is, is the proof of insurance supposed to be submitted at the time that I go to the doctor, or it can be submitted after every procedure? How is it preferable for you guys?
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Proof of insurance, no worries. OK, no, no, so that's gonna be really ultimately up to the provider whatever facility you go to, um, most of the time all you would have to give them is, uh, either a copy of the ID card or depending on the place you could just give them the policy number and if they needed any further information they are, they call us we do call uh we talk to providers all the time.
[AGENT][NEUTRAL] Uh, so if they needed any further clarification as to how it works or where claims are sent, uh, they can give us a call.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and then in the email that I'm gonna send you with the uh policy certificate, I will also include a link to our online portal um and you can create an account there uh just use all of the information that we just verify including that um email address. It's gotta be the same email um and then from there you can view claim status and you should be able to like get ID cards as well way.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] But I did go ahead and um have it a request sent in to have it mailed to you.
[CUSTOMER][NEUTRAL] OK, alright, perfect. So then I more or less I, I understand now how it works. I wasn't sure how, how it works or in general so.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Oh absolutely.
[AGENT][NEUTRAL] Right, I know that was the information overloaded. Did you have any other questions for me at the moment?
[CUSTOMER][POSITIVE] Um, no, that's it, thank you so much.
[AGENT][POSITIVE] OK, yeah, definitely, uh, don't hesitate to give us a call if you think of anything else we're here to help.
[CUSTOMER][POSITIVE] Thank you thank you have a good day.
[AGENT][POSITIVE] I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.