AccountId: 011433970860
ContactId: 49a6d051-c38d-4b48-a038-c73a22727c95
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 693190 ms
Total Talk Time (AGENT): 408881 ms
Total Talk Time (CUSTOMER): 271610 ms
Interruptions: 4
Overall Sentiment: AGENT=1.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/49a6d051-c38d-4b48-a038-c73a22727c95_20250522T20:25_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. um, we have.
[CUSTOMER][NEUTRAL] What did you say? APL for our gap insurance? Um, we have open enrollment in July.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII] or June June I guess new the policy starts again [PII]. Um, I had a few questions about like what's covered, what's not covered. Um, could you help me or could you, is there someone else that I can talk to?
[AGENT][POSITIVE] OK, it would be my pleasure to assist you. Do you already have an APL policy?
[AGENT][NEUTRAL] With the
[CUSTOMER][NEUTRAL] I do not, but it's offered in with my company that I'm with.
[AGENT][NEUTRAL] And who is your company? Who's your employer?
[CUSTOMER][NEUTRAL] gain your casino.
[AGENT][NEUTRAL] What is that casino name?
[CUSTOMER][NEUTRAL] Daniia Casino, it might be under Dana Entertainment Center. It might be under.
[AGENT][NEUTRAL] Do you mind spelling it?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Sure, D as in dog, A.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] NIA [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Got it. OK. Thank you.
[CUSTOMER][NEUTRAL] Sorry about that I guess.
[CUSTOMER][POSITIVE] People from here understand it but yes I'm sorry.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Where where am I calling?
[AGENT][NEUTRAL] Well, I'm in [PII].
[CUSTOMER][NEUTRAL] Where am I calling because yeah, yeah, I probably never heard of it. It's right next to Fort Lauderdale Airport.
[AGENT][NEUTRAL] Got you, got you, got you, OK, I found it. Let's see, let me get that.
[AGENT][NEUTRAL] Employer pulled up and see what type of coverage, so they're offering the APL gap policy correct?
[AGENT][NEUTRAL] The 2nd grade gap. OK, so with, and it's going to, of course I can't give specific benefits, but I can give you an overview of what might be covered.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, it's going to help cover your deductibles, co-pays, and co-insurance of your primary insurance, and that is for inpatient hospitalization and outpatient facilities.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that means if you're hospitalized, there will be an inpatient hospital benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That we can pay.
[AGENT][NEUTRAL] For and it again it will depend on your primary insurance what they apply to your deductible or co-pay or co-insurance, and that is what this policy is designed to cover, so you don't have to pay out of pocket.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for outpatient, that would be things like outpatient surgery, emergency room.
[CUSTOMER][NEUTRAL] Right, I get that.
[AGENT][NEUTRAL] Um, diagnostic testing in an outpatient facility.
[AGENT][NEUTRAL] Uh, usually ambulance is covered.
[AGENT][NEUTRAL] Um, and again, it just depends on.
[CUSTOMER][NEUTRAL] OK, I guess hypothetically if I break my wrist and it needs to be reset, um, whatever my deductible is, I have to pay and then I get reimbursed, um, as gap or they just charge cap?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So a lot
[AGENT][NEUTRAL] So a lot of times the provider will file with your primary insurance first and then they will file with APL on the gap policy, and then if there's a remaining balance, then they would bill you. That's normally how it works. Some providers do.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, require that payment upfront.
[CUSTOMER][NEUTRAL] OK, OK, um.
[AGENT][NEUTRAL] Um, but they, they usually file the claims for you and then we pay them and then if there's a remaining balance they would bill you. So it would cover things like an urgent care facility. Now doctor's office is not covered.
[AGENT][NEUTRAL] Under most of those plans?
[AGENT][NEUTRAL] Um, the physical therapy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You have
[AGENT][NEUTRAL] Ambulance.
[AGENT][NEUTRAL] Uh, emergency room. I already said I was trying to think about it, missed anything. Those, have they, have they given you a brochure or anything?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have not, no, is there something online I could see or not really?
[AGENT][NEUTRAL] Usually the groups might have uh maybe a brochure or something like that you could ask see if they have that available.
[CUSTOMER][NEUTRAL] It might
[CUSTOMER][NEUTRAL] Yeah, our, our open enrollment doesn't start until the first.
[AGENT][NEUTRAL] And they may, yeah.
[CUSTOMER][NEUTRAL] Um, so I'm just trying to preempt it so that I might be able to get something then, um, I just had other questions, I guess, um.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] if basic, that's not covered, right? Or that is covered?
[AGENT][NEUTRAL] So outpatient surgery is covered. Now, for your eyes, it would have to be due to a medical condition. The medical gap policies pay towards sickness or accident.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So like if you have a glaucoma or something like that. Yeah.
[CUSTOMER][NEUTRAL] But now you say so.
[CUSTOMER][NEUTRAL] Like, um,
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] I guess if if it was um.
[CUSTOMER][NEUTRAL] Like an eye surgery would be covered, but like LASIK won't be covered because that's, I guess.
[CUSTOMER][NEUTRAL] A choice, I guess you can wear glasses.
[AGENT][NEUTRAL] Yeah, and, but if there's a medical condition for your, for your eyes, and it could be considered due to that. Like I had cataract surgery, you know, and cataract is a medical condition. It's not
[CUSTOMER][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Elective surgery and
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, they did do the lens.
[AGENT][NEUTRAL] Replace the lens. Now, I don't have the meddling gap, but I'm just using that for an example, and that would have been covered because the cataracts is a medical condition.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now of course I can't say we would pay, you know, without your policy and the claim I can't guarantee guarantee that we would pay it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it could be considered for benefits if it is due to a medical condition.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there are some medical conditions that are not covered, is that, I guess.
[AGENT][NEUTRAL] No, medical conditions are covered.
[AGENT][NEUTRAL] It would just have to fall under the guidelines of the policy.
[CUSTOMER][NEUTRAL] OK, because you said, because what you said was you're, you, you weren't sure if it would be covered.
[CUSTOMER][NEUTRAL] Like cataracts would be covered.
[AGENT][NEUTRAL] Yeah, cataracts is a medical, is a medical condition.
[CUSTOMER][NEUTRAL] Under our policy.
[AGENT][NEUTRAL] So, I'm just not sure what the premise of the LASIK surgery is. It would have to be due to a medical reason.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, you're saying for like cosmetic to correct your eyes wouldn't be it, but a cataract wouldn't be something for correction for.
[AGENT][POSITIVE] That's right. That's right. That's right, because there was a medical reason behind it.
[CUSTOMER][NEUTRAL] Is that, is that the difference is that, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I get it. I, I, all right.
[AGENT][NEUTRAL] Does that, does that kind of make sense there?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm just, I, I, I, listen, I, I, I like to be fully in at least partially informed before I make a decision. Does that, does that help?
[AGENT][POSITIVE] Absolutely. No, I think that's, I think that's amazing. I, I wish more people would do that. I try to do that myself. And some people just sign up and don't even know what they have and they never use it, you know, and then I.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Like with us, we're like, we want you to use your benefits, you know.
[AGENT][POSITIVE] It could be very helpful.
[CUSTOMER][NEUTRAL] Well, I don't know if you want to use it, but if you have to use it, then use the benefit I guess it would be the way to say it, I guess.
[AGENT][NEUTRAL] Well, that's true. That's true. Don't want you to have any medical conditions, but we do want you to.
[CUSTOMER][NEUTRAL] You know, you don't want anybody to be sick, right? Yeah.
[AGENT][NEUTRAL] If they're needed, we want you to have your benefits because, you know, a happy customer, you know, that's what we like. But, so if, for example, if you went to the emergency room and you twisted your ankle, then um it, whatever your primary insurance applies to your deductible for that emergency room visit, we could cover up to the benefit amount listed on your policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now that's deductible. What if it's
[CUSTOMER][NEUTRAL] What if there's another you don't, you guys don't do charges, you just do up to the deductible.
[AGENT][NEUTRAL] That's right. So when you, when you choose your policy benefits with APL, you'll have a maximum benefit payable. It's usually with this group a per calendar year benefit that we can cover. For example, if the your outpatient benefit is $2500 per calendar year.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We can pay up to that maximum benefit for the covered services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As long as your primary applies it to your deductible or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, and uh, I is, is.
[AGENT][NEUTRAL] And then if you have a 5000 for inpatient, you know, it just depends on the plan that's selected.
[AGENT][NEUTRAL] Or offered through your like.
[CUSTOMER][NEUTRAL] I mean I guess I'll find out, but is there more than is there more than just one plan or it's just if you sign up is what you get I mean there's no choosing different things in that plan for us is that is that does that make sense to the question I'm asking?
[AGENT][NEUTRAL] So, no, yeah.
[AGENT][POSITIVE] It does, and that's a great question. So normally the group will your employer will determine which benefits that will be offered.
[AGENT][NEUTRAL] And sometimes they do have different levels of coverage, meaning that your, your benefit amount that we would cover might be higher if, you know, they may have different levels.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] But from my knowledge, I thought it was just one.
[AGENT][POSITIVE] I hope that's helping so.
[CUSTOMER][NEUTRAL] What's that?
[AGENT][POSITIVE] I hope that's helping some.
[CUSTOMER][NEUTRAL] No, yeah, I guess, yeah, I think for my knowledge it's either you, you get the one policy that they offer or nothing. I don't think there's different things to choose, but I, I will double check on I guess the beginning of June when we start having an open enrollment.
[AGENT][NEUTRAL] Yeah, I just know some some employers do have different levels of coverage that you can choose from.
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] But the benefits would probably be the same, but the benefit amount that that you have coverage for could now I'm not sure about your employer, the casino if they have those options they may just have the one policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But they should be able to provide you with an information sheet possibly or something.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, I, I think they have uh something in the booklet or something about gap, but it, you know what, they have like 3 paragraphs and
[CUSTOMER][POSITIVE] And that's about it, but so I'm glad you took my call. I'm glad you answered the questions I asked.
[AGENT][POSITIVE] Oh, absolutely.
[AGENT][POSITIVE] I hope it does kind of give you a little.
[CUSTOMER][POSITIVE] And you have a good rest of the day, or?
[AGENT][POSITIVE] I hope it helps.
[CUSTOMER][POSITIVE] I think you were very helpful. Thank you.
[AGENT][POSITIVE] It's been my pleasure and you know hopefully when they go to open enrollment they'll have more information to share but give us a call if we can be of further assistance OK?
[CUSTOMER][POSITIVE] Awesome thank you.
[AGENT][POSITIVE] My pleasure, [PII]. Thank you for calling [PII] you have a wonderful evening.
[CUSTOMER][POSITIVE] You too bye bye thanks.
[AGENT][NEUTRAL] Bye-bye.