AccountId: 011433970860
ContactId: 40a52b39-2955-4d36-8526-db286511c787
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334440 ms
Total Talk Time (AGENT): 150833 ms
Total Talk Time (CUSTOMER): 99154 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/40a52b39-2955-4d36-8526-db286511c787_20250409T16:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I just called earlier and I spoke to So. Um, I just have a quick question about how the gap works. Can you help me answer the question?
[AGENT][NEUTRAL] Yes, sir. Are you there?
[CUSTOMER][NEUTRAL] Yeah, do you hear me?
[CUSTOMER][NEUTRAL] Hello, do you hear me?
[AGENT][NEUTRAL] Can you? Hi.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] I hear you.
[AGENT][POSITIVE] I hear you too. How can I help you today, sir?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can you help me answer me a question about the gap, the way it works with you guys? I have it within, of course, my employer. Um, my question is, does gap cover if it's in office visits or only when it's hospital?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, um, I can actually help you with your benefits, sir. Can I get your name and your callback number just in case the call is dropped.
[CUSTOMER][NEUTRAL] Um, [PII] call back is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then, uh Mr. [PII], what is your policy number?
[CUSTOMER][NEUTRAL] I have it on my desk. Hold on give you right now.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] It's 0.
[CUSTOMER][NEUTRAL] 02567649
[AGENT][NEUTRAL] OK, let me look up your policy real quick.
[AGENT][NEUTRAL] All right. OK, Mr. [PII], I'm gonna need for you to verify your policy for me. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Of course [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is your address, phone number, and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] [PII]. Email is [PII].
[AGENT][NEUTRAL] OK, thank you. I appreciate you verifying your policy for me, Mr. [PII]. All right, so this is just to verify your benefits. It's not a guarantee of payment. Let me look and see if you have office visits on your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm gonna pull up the policy itself and read it and see what it says about the office visits.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] But the physician's office visit fee is not covered. So no, sir, you do not have office visits on your policy.
[CUSTOMER][NEUTRAL] So, the gap would only really cover me when it's like a hospital visit?
[AGENT][NEUTRAL] Well, uh
[AGENT][NEUTRAL] It will help if you go to um
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] It has inpatient, it has an outpatient benefit per calendar year that helps uh with deductible co-pay or co-insurance of $1500 and that's if you use an ER urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] What about if the office that I went to is like a whole hospital all in one, like there's a hospital ER.
[CUSTOMER][NEUTRAL] And it was just an appointment just I went in, did the procedure, and walked out.
[AGENT][NEUTRAL] Right, OK, so it all depends on how the um.
[AGENT][NEUTRAL] Your primary insurance, how it's coded for your primary insurance. If it's coded as an office visit, then the office visit would not be covered, but if it's coded as an ambulatory center, then it would help.
[AGENT][NEUTRAL] And, and that all depends on, yeah, that all depends on how the claim comes through from your primary insurance and what they cover, because we cover what they cover also.
[CUSTOMER][NEUTRAL] Amber
[CUSTOMER][NEUTRAL] I am the Tori, Tory, um, so who should I call? Should I call my insurance company or should I call, um, where I went?
[AGENT][NEUTRAL] You'll just have to, right. You'll just have to call the office that you went to and ask them if they're considered an ambulatory center or they're considered a physician's office.
[CUSTOMER][NEUTRAL] To go get to this uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you ma'am.
[AGENT][POSITIVE] You're very welcome. Is there anything else I can help you with, sir, before we go?
[CUSTOMER][POSITIVE] That's it, thank you for your help.
[AGENT][POSITIVE] OK. You're very welcome, [PII]. I hope you have a wonderful day and we thank you for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye now.
[AGENT][NEUTRAL] Bye-bye.