AccountId: 011433970860
ContactId: 53e5058c-6810-44c1-bfa8-3b88aa2d5305
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1288439 ms
Total Talk Time (AGENT): 395235 ms
Total Talk Time (CUSTOMER): 419535 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/53e5058c-6810-44c1-bfa8-3b88aa2d5305_20250218T19:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um,
[CUSTOMER][NEUTRAL] I guess I'm new to this benefit and I'm questioning whether I should have signed up having some buyers remorse so I'm wondering if somebody there can help me to understand what the value of this.
[CUSTOMER][NEUTRAL] Benefit is
[AGENT][NEUTRAL] OK, sure, I can explain this policy to you. Um, have you received the policy number or any information about the policy?
[CUSTOMER][NEUTRAL] I've got the card. I tried. I, I don't tell me what this is for because I'm starting, I'm feeling a little like.
[AGENT][NEUTRAL] But we have.
[CUSTOMER][NEGATIVE] That I'm wasting my money and I should not have gotten this.
[AGENT][NEUTRAL] Well, we have many products. Um, we don't have just one product, but um we have secondary insurance, supplemental insurance, dental, um, health, um, so it really depends on the policy.
[CUSTOMER][NEUTRAL] Medlik 4 supplemental Limited Benefit group medical expense insurance.
[AGENT][NEUTRAL] OK, so that is to help with high deductible you have from your major medical.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I have a high deductible?
[AGENT][NEUTRAL] With your major medical, more than likely you do if you have a secondary insurance to help with that deductible.
[CUSTOMER][NEUTRAL] Well, hopefully I do, um, so it's I have a $1000 deductible.
[AGENT][NEUTRAL] OK, uh, let me have the policy number so I can look at.
[CUSTOMER][NEUTRAL] Is that a high deductible?
[CUSTOMER][NEUTRAL] I don't think it's considered a high deductible. I couldn't have a health savings account, so it's not a high deductible normally.
[AGENT][NEUTRAL] It could be.
[AGENT][NEUTRAL] OK, um, yeah, in order to give you like information about the policy, I need the policy number because again we have many, many products so I don't know exactly what you purchased or how much is it for.
[CUSTOMER][NEUTRAL] Where would I get that?
[AGENT][NEUTRAL] Um, I can give you that information if you provide to me the policy number which is in the bottom of that card where it says outpatient er number.
[CUSTOMER][NEUTRAL] I don't have the card
[CUSTOMER][NEUTRAL] On me that's at home.
[AGENT][NEUTRAL] OK. Um, may I have your name and
[CUSTOMER][NEUTRAL] So is it American Public Life gap enhanced 500-250?
[AGENT][NEUTRAL] OK, who's your employer? Let me look at the products they have.
[CUSTOMER][NEUTRAL] The Brie.
[AGENT][NEUTRAL] And may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Phone number [PII].
[AGENT][POSITIVE] Thank you, Miss [PII].
[CUSTOMER][NEGATIVE] When I spoke with somebody, they made it sound like I could like present it at a doctor's appointment and when I showed it to my doctor's office, they're like looking at it like I don't know what to do with that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So there is some places that they don't work with secondary insurance. There are places that they do, um, not, um, all of them have the system to put in the secondary insurance, and I'm not sure if that's one of the places that you visit.
[CUSTOMER][NEGATIVE] OK, well then I don't know what the benefit is because if, if I go to all these doctors and they're like, yeah, we don't what it's a total waste of money.
[CUSTOMER][NEUTRAL] And nobody told me like oh yeah well some people take it some people don't like.
[AGENT][NEUTRAL] But you can always submit a claim for reimbursement.
[CUSTOMER][POSITIVE] OK, well I'd like to know what the benefit of the of this is to start.
[AGENT][NEUTRAL] OK. OK. All right. I found your policy. Um, let me go ahead and get some information um to verify you, to make sure that you are the owner of the policy. Um, may I have your date of birth and mailing address?
[CUSTOMER][NEUTRAL] Mhm sure.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][POSITIVE] Mm, thank you.
[AGENT][NEUTRAL] OK, let me pull the benefits of your policy, one moment.
[AGENT][NEUTRAL] Alright, and I just need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] Um let's see.
[AGENT][NEUTRAL] So you have in-hospital benefit, um, which is if you're in the hospital, um, and they leave you there for 18 hours or more, either observation or admitted, we cover up to $500 every time you are admitted or you are in um observation of your deductible or co-payment or co-insurance.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I don't know that that's something that is like I think I've got another insurance for that like I don't tell me more like what else is this.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any good for.
[AGENT][NEUTRAL] You also have benefits for outpatient service which is 250 per occurrence. This is if you go to a hospital emergency room, urgent care facility.
[AGENT][NEUTRAL] Outpatient surgical center or surgery in a hospital, diagnostic center.
[AGENT][NEUTRAL] Or hospital diagnostic testing?
[AGENT][NEUTRAL] And treatment for mental and emotional disorder. Mhm.
[CUSTOMER][NEUTRAL] If it's diagnostic testing, diagnostic or preventative?
[AGENT][NEUTRAL] No, diagnostic. Like if they need to do an MRI because you have pain, you know, if they need to do a CT scan because they believe something is wrong with your abdomen or anything like that, um, any type of those type of tests.
[AGENT][NEUTRAL] So, um, just an example, if the co-payment from your major medical is 250, we will cover the full amount. If it's 300, we cover 250, you cover 50, if it's 500, we cover $250 you cover 250. So that's how it works.
[CUSTOMER][NEUTRAL] Wait, say that again?
[AGENT][NEUTRAL] OK, uh, if the major medical has a co-payment for you to go and do a CT scan, the co-payment is $250 then we'll cover the full amount. If it's $300 we'll cover $250 and you're responsible for 50. So we will cover $250 of that test, um, or whatever the co-payment it is or the deductible or the co-insurance from your major medical.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For that test.
[AGENT][NEUTRAL] And that's also um for emergency room. If you have a co-payment for the emergency room, and the co-payment is $250 or 300, then we'll cover the 250.
[AGENT][NEUTRAL] Including the urgent care, that's also for the urgent care. So it just covers the co-payment co-insurance and deduct.
[CUSTOMER][NEUTRAL] Outpatient surgery in hospital outpatient facility or free standing outpatient surgery center payable up to maximum outpatient benefit. What is that outpatient surgery?
[AGENT][NEUTRAL] Outpatient surgery is when you go in and out the same day and you have a small surgery.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, they're more than likely you have it.
[CUSTOMER][NEUTRAL] Are procedures are procedures included in this or no?
[AGENT][NEUTRAL] When you say procedures, what type of procedures?
[CUSTOMER][NEUTRAL] Like a colonoscopy?
[AGENT][NEUTRAL] If it's a diagnostic colonoscopy and it's done in a diagnostic center, yes. If it's a preventative colonoscopy, we do not cover preventative. Preventatives are usually covered 100% by the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, that's not happening, so, um, which I'm trying to fight, but, um, so far I guess I don't necessarily see what the benefit is of this because.
[CUSTOMER][NEUTRAL] And you can correct me if I'm wrong, but I have this insurance.
[CUSTOMER][NEUTRAL] Plus I have.
[CUSTOMER][POSITIVE] So life gap enhanced.
[CUSTOMER][NEUTRAL] This is that's related to accident that's cancer.
[CUSTOMER][NEUTRAL] Short term disability I've got like I am insured to the.
[CUSTOMER][NEUTRAL] Health, what is this? MetLife LTD.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Because it it's just like.
[CUSTOMER][NEUTRAL] When when I spoke to the person who was talking about the benefit, it sounded like I could bring it to like a doctor's appointment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, this one is not for office. This is for outpatient facilities.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So urgent care visits.
[CUSTOMER][NEUTRAL] Diagnostic testing, so.
[AGENT][NEUTRAL] Diagnostic centers.
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Well it says diagnostic testing in a hospital or blah blah blah. So if let's say I went for a preventative screening and they thought there might be something, then the follow up testing would be what would be included or covered partly.
[CUSTOMER][NEUTRAL] Is that what you're saying?
[AGENT][NEUTRAL] If it's, uh, if you go in for a preventative and it end up being that they find something and it's a sickness because they had to go in and do surgery or anything like that and they uh go ahead and change the diagnosis from preventative to diagnosis.
[CUSTOMER][NEUTRAL] No, but, but, but, but if they, if.
[CUSTOMER][NEUTRAL] If it's preventative and then they need to do additional scans or whatever then it becomes.
[CUSTOMER][NEUTRAL] Diagnostic or it's only diagnostic when they've confirmed that there's a problem?
[AGENT][NEUTRAL] Diagnostic is when they find something wrong and they need to double check to make sure that there's not a problem.
[AGENT][NEUTRAL] Preventative is just um just a routine.
[CUSTOMER][NEUTRAL] And this says subject to the outpatient benefit deductible who which outpatient benefit deductible?
[AGENT][NEUTRAL] Your major medical.
[CUSTOMER][NEUTRAL] So payable up to the maximum outpatient benefit.
[CUSTOMER][NEUTRAL] Subject to the outpatient benefit deductible, so if my outpatient benefit deductible, let's say is $1000.
[CUSTOMER][NEUTRAL] What's being paid?
[AGENT][NEUTRAL] You have a 250 per occurrence benefit.
[CUSTOMER][NEUTRAL] For diagnostic testing?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] That's not really great.
[CUSTOMER][NEUTRAL] So any of these things on this policy where it says base policy, it's only option one.
[AGENT][NEUTRAL] When you say option one, you mean the.
[CUSTOMER][NEUTRAL] Because this is option 1, option 2, option 3, option 4, it says 500 per covered person this is for the hospital benefit, for example, or outpatient benefit it says option 1 is $250 per covered.
[CUSTOMER][NEUTRAL] Option 2 is 500 per covered. Option 3 is 500 per covered.
[AGENT][NEUTRAL] OK, you're probably looking at the brochure and that's how they put it in the um in the brochure for that group. Um, here, I don't see option 123. Yours, yeah, yours is the one I just mentioned to you, which is in hospital, 500.
[CUSTOMER][NEUTRAL] I need to know what my coverage is my specific coverage.
[CUSTOMER][NEUTRAL] Can I have that sent to me? Could you email me the very specific that's only for this policy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, what is the email?
[CUSTOMER][NEUTRAL] It should be in that same record you were looking at, um, [PII].
[AGENT][NEUTRAL] OK, we don't have the email here. So it's um [PII].
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] And [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me go ahead and send this email to you right now. Do you mind holding for me?
[CUSTOMER][NEUTRAL] No, that's OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Mel. Have you received the email I sent?
[CUSTOMER][NEUTRAL] Oh let me look.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, I received it, it's downloading.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and you said basically like if it's.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] What I was thinking I was getting I could call and.
[CUSTOMER][NEUTRAL] Do something else.
[AGENT][NEUTRAL] Well, you will have to contact your employer and see what are your options.
[CUSTOMER][NEUTRAL] Well it'd be the benefits people it wouldn't be my employer, but.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, if they're working with an institution, yeah you you call that institution, but usually it's like the department or the benefit department for your for your employer.
[CUSTOMER][NEUTRAL] Wow, this is really long document.
[AGENT][NEUTRAL] Mhm. It's 39.
[CUSTOMER][NEUTRAL] And it's gonna specifically tell me.
[AGENT][NEUTRAL] Mhm, yes, um, if you're looking specifically for what I was looking into with the benefit description is on page 18.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, and I find it very interesting, um, and I appreciate your.
[CUSTOMER][NEUTRAL] Sharing it with me. Um, but my, I am scheduled for a, um, colonoscopy and um they are trying to charge me $1000.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And I'm like, but this is preventative.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And they've changed codes to supposedly and it's in network.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So it's supposed to be covered but it's a mystery, but that's not your problem, um.
[AGENT][NEUTRAL] Have you checked with your major medical to see how much you're covering out of that 1000 or is that your deductible?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They're they're saying it should be.
[CUSTOMER][NEUTRAL] Covered.
[CUSTOMER][NEUTRAL] Like I don't know if if it's a covered service, why would there be a deductible at all?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] You need to check with [PII] and see. It looks like.
[CUSTOMER][NEUTRAL] Like a deductible for a specialist, you know, like if it's a specialist.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] You know, a service or whatever maybe $50 or something, but um.
[CUSTOMER][NEUTRAL] Not $1000.
[AGENT][NEUTRAL] Yeah, you might want to check with Aetna and see why they're charging you $1000. Aetna is the primary insurance, so they should be able to tell you why.
[CUSTOMER][POSITIVE] I've never had to pay for it before, yeah.
[CUSTOMER][POSITIVE] Yeah, no, I know, yeah, no, they, they, I maybe I'll end up calling maybe I'll end up emailing them what was sent to me, um, OK, thank you very much for your help I appreciate it I hope you have a great day.
[AGENT][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling ATM. Bye bye.
[CUSTOMER][POSITIVE] Yep take care bye bye.