AccountId: 011433970860
ContactId: 51d27a76-6b31-4864-adb9-4a9b0f06f321
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498739 ms
Total Talk Time (AGENT): 219091 ms
Total Talk Time (CUSTOMER): 229603 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/51d27a76-6b31-4864-adb9-4a9b0f06f321_20250113T14:41_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, this is [PII].
[CUSTOMER][NEUTRAL] And I was calling because I'm with the Creek County and we're supposed to have like a gap plan.
[CUSTOMER][NEUTRAL] Um, well, we have like a $3000 but we have this gap plan through y'all that I'm understanding that we're only supposed to have to pay a $500 deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can assist you with verifying benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. Now I need your policy number.
[CUSTOMER][NEUTRAL] I've got, uh.
[CUSTOMER][NEUTRAL] Uh, on which one? I mean, I have the community care and then this one, is this the one you're needing?
[AGENT][NEUTRAL] Um, yes, ma'am. Is it
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] OK. What number are you showing?
[CUSTOMER][NEUTRAL] The group I have on the APL is 21101.
[AGENT][NEUTRAL] I'll
[AGENT][NEUTRAL] OK. Well,
[CUSTOMER][NEUTRAL] The policy is 0.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 01457121 [PII].
[AGENT][NEUTRAL] OK. Please repeat that policy number.
[CUSTOMER][NEUTRAL] 01457121
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you, [PII]. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, I'm showing that you don't have an email address on file. Would you like to add one?
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] OK. And let's see, for your benefits, one moment.
[AGENT][NEUTRAL] I'm showing that for inpatient, we cover up to 2500 per calendar year and that's for the copay, the co-insurance and deductible after your primary insurance processes the claim and also for outpatient services. I'm showing that we also cover up to 2500 per calendar year and that's um secondary to the primary insurance.
[CUSTOMER][NEUTRAL] OK, so what I'm, what I'm not understanding is on the gap plan they say with this APL card that we're only supposed to have to pay the $500 deductible and then you pay up to so much calendar year but there's a $500 deductible that's what I'm so confused about.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm
[AGENT][NEUTRAL] Yeah, I'm actually not showing a deductible under your policy, under a gap insurance policy.
[CUSTOMER][NEUTRAL] So I, what do I need to do because I'm with the county and they say we're just supposed to have to pay up to $500.
[AGENT][NEUTRAL] OK, who's the provider?
[CUSTOMER][NEUTRAL] It's Creek County. I work for Creek County and I have community care and then we have a gap plan.
[CUSTOMER][NEGATIVE] And we just had an insurance meeting and that's what they say that we have to pay so now it's not working so I'm confused.
[CUSTOMER][NEUTRAL] And I have to have surgery on Wednesday.
[AGENT][NEUTRAL] OK. Yes, ma'am. It sounds like you would just need to give your provider your primary insurance and they would need to call and verify it and also give them our insurance so they can call and verify it because I'm showing that there's no deductible that needs to be met under your gap insurance policy.
[AGENT][NEUTRAL] So if your primary
[CUSTOMER][NEUTRAL] That there has to be.
[AGENT][NEUTRAL] No, there's no um deductible that needs to be met under your gap insurance policy. So if your primary insurance files a claim first and something goes towards your deductible, um, is the surgery for outpatient or will you be admitted?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's for outpatients.
[CUSTOMER][NEUTRAL] Yeah, it's cataract surgery.
[AGENT][NEUTRAL] OK. Well, yeah, then we'll cover up to 2500 and you won't have to meet a deductible with us first.
[CUSTOMER][NEGATIVE] Well, they said I gotta pay $1000 out of pocket.
[AGENT][NEUTRAL] Who's saying that your primary insurance is saying that you have to pay 1000?
[CUSTOMER][NEGATIVE] No, this place, this place where I'm trying to get my eyes done won't do my eyes without me paying $1000 and something dollars.
[AGENT][NEGATIVE] So they won't verify your insurance first cause you have insurance coverage, so why are they charging you?
[CUSTOMER][NEUTRAL] They said that, but they're saying I gotta pay that over the amount.
[CUSTOMER][NEUTRAL] I, I guess I don't, I don't know. I, [PII] help me. I don't know. I don't know.
[AGENT][NEUTRAL] Have you spoke with your primary?
[CUSTOMER][NEUTRAL] But they got up there
[AGENT][NEUTRAL] Insurance.
[CUSTOMER][NEUTRAL] Yeah, I've, I've talked to community care and I, uh, they don't know nothing about the gap plan which we just had a meeting that they do this for the county because it's a $3000 deductible. So we adopted this gap plan so it's only supposed to be $500 and then up to so much money. I don't know why nobody knows nothing about it.
[CUSTOMER][NEGATIVE] I'm so confused.
[AGENT][NEUTRAL] Yeah, they
[AGENT][NEUTRAL] Yeah, well, you would need to contact them and they would need to call us to verify your benefits because you do have coverage.
[CUSTOMER][NEUTRAL] Well, do I have to pay this $1000 up front?
[AGENT][NEUTRAL] No, normally, that's not what happened. If you would pay it upfront, then you will file a claim with us um along with the EOB from your primary insurance company showing where charges went.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] I don't know how to do all this. this is stressing me plumb out.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yeah, I apologize.
[CUSTOMER][NEUTRAL] Can you call this lady?
[AGENT][NEUTRAL] Well, they would need to call us, ma'am. We can't call the providers. Just give them um our phone number and your policy number.
[CUSTOMER][NEUTRAL] Can you call?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They said
[CUSTOMER][NEUTRAL] They said they called this APL.
[AGENT][NEUTRAL] OK, let me look at my notes and see if they've called. One moment.
[CUSTOMER][NEUTRAL] They said they called. It's the eye care.
[CUSTOMER][NEGATIVE] Oh God, this is stressing me out so bad.
[AGENT][NEUTRAL] Is her name [PII]?
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] It is, uh, hang on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, yeah, I'm showing that [PII] called on the night to verify your benefits and we gave her your benefits. So she, she knows that.
[CUSTOMER][NEUTRAL] And what was the benefit?
[AGENT][NEUTRAL] For outpatient services, what I just gave you, we cover up to 2500 per calendar year for the co-pay, the co-insurance, and the deductible after your primary insurance processes the claim.
[CUSTOMER][NEUTRAL] So after it, so.
[CUSTOMER][NEGATIVE] Oh, so after that I'm just not understanding why she's wanting to charge me $1000.
[AGENT][NEUTRAL] OK. Well, your, and, and they've already verified your primary insurance is active and they're covering um their part on the cataract surgery, right?
[CUSTOMER][NEUTRAL] Well, they know what they said I have a $3000 deductible.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, OK, it's going all towards the deductible and then we cover up to 2500.
[AGENT][NEUTRAL] Of that
[CUSTOMER][NEGATIVE] So I shouldn't have to pay that 500.
[AGENT][NEUTRAL] That's exactly. You should only have to pay 500.
[CUSTOMER][NEUTRAL] OK, what's your name?
[AGENT][NEUTRAL] My name is [PII]. Um, it's spelled [PII] and my last [PII] is [PII].
[CUSTOMER][NEUTRAL] If they
[CUSTOMER][NEUTRAL] OK, [PII]
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and your last initials what?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, let me call her back. OK, thank you and let me see what I can do.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] I don't know, help my, just pray for my brain, I mean my nerves.
[AGENT][NEUTRAL] It sounds like it's gonna work out, [PII]. Yeah, just.
[CUSTOMER][POSITIVE] Alright thank you honey.
[AGENT][POSITIVE] Mhm. I thank you for calling us. You're welcome.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Uh, all right, bye bye.
[AGENT][NEUTRAL] Mm bye.