AccountId: 011433970860
ContactId: 4328bd1f-fcc9-42df-beec-67c3c39e39fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1214709 ms
Total Talk Time (AGENT): 516826 ms
Total Talk Time (CUSTOMER): 351276 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/4328bd1f-fcc9-42df-beec-67c3c39e39fa_20250106T15:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. Um, I have a question.
[CUSTOMER][NEUTRAL] A general question. Does the gap insurance, um, does it cover like anything that has a deductible, like a doctor's office visit or anything like that, or is it just like emergency department visits?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it depends on the type of policy are you with the provider's office or you the policy holder?
[CUSTOMER][NEUTRAL] Um, well, I'm the benefits manager at the company and um we just got a policy with you guys, so I was um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Trying to find that out to make sure it's clear to everybody.
[AGENT][NEUTRAL] OK, I can pull up your group and, and look at the policy that the group has. What's your name?
[CUSTOMER][NEUTRAL] OK. My name is [PII].
[AGENT][NEUTRAL] [PII], OK, and what's the group number, [PII]?
[CUSTOMER][NEUTRAL] The group number is, give me one second.
[CUSTOMER][NEUTRAL] It is 26867. It's anatomy 1212 LLC.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected? I can call you back.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, let me pull up the information.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And see what we can find out.
[AGENT][NEUTRAL] And you said the name of the group of anatomy 1212 LLC?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], what's your email address?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, and what's the address at this location?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you have, did you get the policy, [PII]?
[CUSTOMER][NEGATIVE] I did not get it, no.
[AGENT][NEUTRAL] I'm asking I don't show you as the one of the group admins?
[AGENT][NEUTRAL] For this group?
[CUSTOMER][NEUTRAL] OK, um, give me a second. Do you mind if I, um, if the thing is that my boss is asking this question, so he wanted me to call and, and get him on the line. So do you mind if I just, uh, patch him in?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Uh, who is your, what's your boss's name?
[CUSTOMER][NEUTRAL] [PII], he has a policy.
[AGENT][NEUTRAL] I'm I'm showing a female that's a the group contact for this group.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I could get her on the line as well.
[AGENT][NEUTRAL] Oh OK and it's just a general question I should be able to answer it, but we've got to make sure that we verify and provide information to who we're supposed to that's all.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one second please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Hi, I have [PII] on the line.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Hi [PII], this is [PII] with American Public Life Insurance Company. How are you?
[CUSTOMER][POSITIVE] I'm good how are you, [PII]? How can I help you?
[AGENT][NEUTRAL] Good, so I believe [PII] and we have to verify the caller and I didn't show her listed as a group admin. It is a general question, but we still needed to speak with you first and um I believe [PII] was wanting to know if [PII], correct me, is it if the policy covers office visits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello? Hello?
[AGENT][NEUTRAL] Yes, yeah, give me a second. I'm pulling the policy because I think you offer 2 different 2 different policies to your employees. Is that correct?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] What was that? Sorry, I couldn't hear you.
[AGENT][NEUTRAL] Do you offer two different types of policies to the employees?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it's gonna depend on, you know, which policy they selected so I'm trying to pull up a copy of each of those policies.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the one that I'm looking at now has a per calendar day benefit of 500, um, and let me check to see if that includes the office visit fee.
[AGENT][NEUTRAL] OK, per the policy it says other treatment in a physician's office, not including the physician office fee, so that would be the co-pay. Uh this is under the policy that has the outpatient, um, benefit of $500 per calendar day. The copay is not covered, but if they have treatment in the office, covered treatment can be considered under that benefit.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Um, no, can you say it again? Sorry.
[AGENT][NEUTRAL] So when, when uh uh when someone presents to their, their primary care or a specialist office.
[AGENT][NEGATIVE] The physician's co-pay is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] But if they have treatment, treatment could be an injection, X-ray.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Ear wax removal, that's the type of treatment. The treatment can be considered, but the copay is not covered.
[CUSTOMER][NEUTRAL] Oh, OK, that makes sense.
[AGENT][NEUTRAL] For the physician's visit or fee.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now that's on one of the policies. Let me locate the other policy that you offer and I'll verify under that one if the office visit is covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did that make sense to you? Because it can get a little confusing sometimes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, that makes sense.
[AGENT][NEUTRAL] Alright, let me move to that other policy.
[CUSTOMER][NEUTRAL] Well, um,
[CUSTOMER][NEUTRAL] Can I, do you need vaccine for anything else?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, [PII], if you can, if, if [PII] is gonna be calling regarding the group, uh, you can send an email to the [PII] and we can get her added.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Public, uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK, [PII]. OK, I'll do that now.
[AGENT][NEUTRAL] And you just put the, the group number and name in the subject line and then the body just give us instructions as to what we need to do to get her at it.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and it's OK to speak with her, right?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes, for sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, [PII] and I'm looking at the 2nd policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I, um, can I now just call my boss because he wanted to be on the call?
[AGENT][NEUTRAL] Oh, sure. Sure.
[CUSTOMER][NEUTRAL] Give me one second. Let me just add it's gonna be him and um [PII]. His name is [PII] and [PII]. They're gonna, they're in a meeting right now, so it's gonna be both of them. Let me just add them one second.
[CUSTOMER][NEUTRAL] You see, because if you look at the presentation, physician. I yeah.
[AGENT][POSITIVE] Yes, good morning.
[CUSTOMER][POSITIVE] Good morning. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] Good, good, thank you.
[CUSTOMER][POSITIVE] So hi, how are you? So we have a question in regards we just started with this new plan, right, this new gap, and you know our broker who's a lovely person made a presentation and the presentation.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Says that the gap insurance covers things, and this is on an APL.
[CUSTOMER][NEUTRAL] I don't know if that's APL stationery, but it says it cover inpatient benefits such as, well, first of all, the question is, is.
[CUSTOMER][NEUTRAL] Does it only cover things if you're in the hospital.
[AGENT][NEUTRAL] Yeah, so there are several benefits under the plan, um.
[CUSTOMER][NEUTRAL] So there are several
[AGENT][NEUTRAL] Let me pull the policy back up covers inpatient um outpatient facility.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh, durable medical equipment, diagnostic testing. Uh, there's an ambulance service benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, physical therapy, speech study in a hospital, um.
[AGENT][NEUTRAL] Or physician's office, surgery?
[CUSTOMER][NEUTRAL] In a, in a hospital though, or a facility or a physician's office, I see, got it. OK. But there is also physical therapy.
[AGENT][NEUTRAL] Mhm. Uh, Sheen earlier asked if the physician's co-pay is covered under the policy, and I was letting her know that this group offered two different policies to the employees and so I looked at both of them.
[AGENT][NEUTRAL] So if they went to a primary care doctor or a specialist.
[AGENT][NEUTRAL] Treatment in the office, covered treatment can be considered. Treatment looks like um
[AGENT][NEUTRAL] um, like X-rays or injections, ear wax removal, a minor procedure in the doctor's office. Those items can be considered, but then there may also be a physician's co-pay. The co-pay is not covered.
[AGENT][NEUTRAL] But should they have treatment in the office, the covered items for treatment can be considered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] really good. So for example, I'm hearing impaired and I go to the, the ear doctor, right? And they come and they put probes in my ears and vacuums in my ears and scopes and they actually remove it. They do a lot of different things. That would be covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The treatment would be.
[CUSTOMER][NEUTRAL] Procedures, the treatment. So my partner just went to the um dermatologist and they did things to his face. The doctor's office said they do not take that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so now is the doctor's office comment stating that they're not familiar with the policy?
[AGENT][NEUTRAL] Is that what they mean when they say they do not accept it?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, yeah, yes, they said they're not familiar with the policy. They said they usually use a credit card thing, you know, people have a credit card, they don't use this. They said they need to get information from the hospital or something, so it, they just didn't accept it.
[AGENT][NEUTRAL] OK, so now whether a providers accepts the card, I mean we have no control over that that doesn't mean that there is not a benefit.
[AGENT][NEUTRAL] In this instance for treatment in the office.
[AGENT][NEUTRAL] So what I would suggest is to perhaps have that provider contact American Public Life, and then we can go over the policy benefits to make sure that we're understanding the provider correctly.
[AGENT][NEUTRAL] When they say we do not accept the coverage.
[CUSTOMER][NEUTRAL] Right, well they said, so
[CUSTOMER][NEUTRAL] Yeah, they didn't even know what it was, right? But what you're saying is it doesn't cover copays, but it should cover treatment in the office.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Covered treatment and so we could also verify the specific type of treatment that's being done for the employee that you referred to.
[CUSTOMER][NEUTRAL] Got it. I see. Got it. So that makes sense. This is not cover prescriptions, is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, there is no prescription benefit under this policy.
[CUSTOMER][NEUTRAL] OK, thank you. So this is, so it's inpatient services done.
[CUSTOMER][NEUTRAL] Not just hospital things, inpatient service is done.
[AGENT][NEUTRAL] So if they were admitted to a hospital?
[CUSTOMER][NEUTRAL] Uh treatment for.
[CUSTOMER][NEUTRAL] But what if you got admitted to a hospital, if you just go to the doctor period and he removes the earwax.
[AGENT][NEUTRAL] Yeah, so treatment in a part usually treatment is not done in a primary care, but treatment in a specialist office can be considered if it's covered. And so the provider would need to contact us and then we can probe for additional ques information as to what type of treatment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Is being performed.
[CUSTOMER][NEUTRAL] And let's say they, sorry, let's say they said that they don't take the car, but they just, they're not aware of this uh uh insurance uh policy, and then what do we do? Should we call the doctor and have them call the, the, the, you know, the insurance uh uh policy people so they can figure it out together or what's the next step?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I would suggest to have the provider's office contact American Public Life and then we can just go over the policy benefits with the provider's office.
[CUSTOMER][NEUTRAL] Before going to the doctor.
[AGENT][NEUTRAL] Correct. Another option if um.
[CUSTOMER][NEUTRAL] OK, in case you wanna get it.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] In case you want to get a treatment.
[AGENT][NEUTRAL] Correct, but we need to verify what the treatment is.
[CUSTOMER][NEUTRAL] We should do it before.
[CUSTOMER][NEUTRAL] OK, right. So when you're presenting the card, if the doctor's office says I don't take this, the suggestion by the, by the by the patient is to say, call American and talk to them about it.
[AGENT][NEUTRAL] Yes, could you contact American Public Life to verify my benefit information and even in doing that if the provider still says no you know we're not familiar, the employee can submit the claim to American Public Life let's say if they required that they pay out of it.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, they can, they can request a reimbursement.
[AGENT][NEUTRAL] The employee
[AGENT][MIXED] Correct, but there are 3 documents that we require.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So one would be the American Public Life claim form. Uh this form can be downloaded from our website and I can give you that if you would like.
[CUSTOMER][NEUTRAL] Yes, please, you can send it to us on an email.
[AGENT][NEUTRAL] OK. It's [PII].
[AGENT][NEUTRAL] The word [PII], so [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once they received, you know, to the site they would up the upper right corner is a link, a claims and form link click the link.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It populates our claim forms. They are in alphabetical order, so they would scroll until they get to the metin claim form.
[AGENT][NEUTRAL] You can download that.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Um Medlig claim form.
[AGENT][NEUTRAL] Yes sir, and then on page one of that claim form are specific instructions as to what documents are required when the employee submits the claim to APL and I can go ahead and briefly tell you it's 3 documents, one including the APL claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The second would be the primary insurance explanation of benefits, because this plan is secondary to the major medical.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. That's after you get the bill, correct?
[CUSTOMER][NEUTRAL] Yeah, that's, that's to get reimbursed. Right, yeah, OK. Mhm. And then the 3rd.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, right after the service is done, it'll take them about a week or so to create the itemized bill, the provider's office to create the itemized bill, of course they would have to send it to um is your primary UnitedHealthcare.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] They would send it to United Healthcare.
[AGENT][NEUTRAL] United Healthcare will respond back to them as to how the claim was processed, so we'll need a copy of United Healthcare's explanation of benefits that corresponds with the date of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the 3rd document is an itemized bill.
[AGENT][NEUTRAL] Uh, the employee would need to obtain that from the physician's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright [PII], did you get that all? Yes. Oh great, thank you so much, thank you, because I'm like, I'm writing off the side of the papers. Thanks. Yes, sorry. Got it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and so if it's, if it's a, it's a if it's a claim in a physician or specialist office, I'll give you the form to request.
[AGENT][NEUTRAL] Let me know when you're ready.
[CUSTOMER][POSITIVE] Ready.
[AGENT][NEUTRAL] C as in Charlie, M Mary S Sam.
[AGENT][NEUTRAL] 1500 so you're gonna request the CMS 1500 form and that's the itemized bill.
[AGENT][NEUTRAL] For the physician's office, for the doctor's office.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Uh, it's different if it's in a hospital, a service in a hospital, it would be different, a different form, but right now for the office, it's the CMS 1500 form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] I don't think so at this point, no.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, well, if you all have any further questions just feel free to give us a call back, OK?
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] All righty. Well, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye bye.
[AGENT][NEUTRAL] Bye bye.