AccountId: 011433970860
ContactId: 5c0a8240-92eb-4b4b-95b5-e1ece81813e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387279 ms
Total Talk Time (AGENT): 136609 ms
Total Talk Time (CUSTOMER): 223902 ms
Interruptions: 9
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/5c0a8240-92eb-4b4b-95b5-e1ece81813e4_20250506T13:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is. How may I help you?
[CUSTOMER][NEUTRAL] Hello, hi. Um, my name is [PII].
[CUSTOMER][NEUTRAL] I'm calling because I have some inquiries um.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] I have a
[CUSTOMER][NEUTRAL] There's a specialist outside of the state um that my primary insurance does not cover, so I was wondering, do that with my um gap insurance cover the service that I receive or would I just strictly be stuck paying out of pocket for that? Is that something you could help me with?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. Do you have a phone number in case we get disconnected, I can call you back?
[CUSTOMER][NEUTRAL] Yes I do. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, one second.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] What, what would, would that be the group number?
[AGENT][NEUTRAL] Um, it should be inpatient outpatient certificate number, something like that.
[CUSTOMER][NEUTRAL] Or the payer ID?
[CUSTOMER][NEUTRAL] OK, I have, I have both of those inpatient and outpatient. I have 2 numbers.
[AGENT][NEUTRAL] Either one's fine.
[CUSTOMER][NEUTRAL] OK, 02260011 M as in Mary, L as in Larry, number 7.
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify your address and email address, please?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yes, my address is [PII]. My email address is [PII]. Um, it may be my work email though because this is through my job.
[AGENT][NEUTRAL] It's the first one you gave me. Thank you, Ms. [PII]. And you're wanting to know if we would cover something that your major medical didn't cover?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][NEUTRAL] OK. No, ma'am, if they do not pay.
[CUSTOMER][NEUTRAL] Well, there's two things. 11.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can help you with that. If, if they do not pay, we do not pay.
[CUSTOMER][NEUTRAL] it up.
[CUSTOMER][NEUTRAL] OK, OK, well, so this is the thing they they pay.
[AGENT][NEUTRAL] Because it coordinates with your primary.
[CUSTOMER][NEUTRAL] So they pay and then they, there was a balance.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Oh, they did pay on it?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Correct, there was just a a balance left over.
[AGENT][NEUTRAL] OK. What type of, what type of service was it outpatient, inpatient, doctor's office?
[CUSTOMER][NEUTRAL] It's like $2000 something dollars.
[CUSTOMER][NEUTRAL] Um, it was in the hospital.
[CUSTOMER][NEUTRAL] So outpatient I guess.
[AGENT][NEUTRAL] It was outpatient?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, I believe so. I had to stay in the hospital for a procedure.
[AGENT][NEUTRAL] OK, any benefits given over the phone is not a guarantee of payment, and this policy does coordinate with your primary, whatever your primary applies to your deductible, co-pay or co-insurance for outpatient, we'll pay up to $500 per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I was in there about 10 days.
[AGENT][NEUTRAL] Oh, you was impatient?
[CUSTOMER][NEUTRAL] I was in the hospital for about 10 days.
[AGENT][NEUTRAL] So that would be
[CUSTOMER][NEUTRAL] Um, I don't know if that's considered inpatient or outpatient, but.
[AGENT][NEUTRAL] That would be considered inpatient, so for inpatient benefits we would pay up to $2000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So how do I go about um
[CUSTOMER][NEUTRAL] I go about that because I think the difference.
[AGENT][NEUTRAL] Did you give them our information to file the claim for you or you're, you're trying to file the claim, or?
[CUSTOMER][NEUTRAL] Well, I, I, this will be my first time. I really didn't know what to do, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I, I did provide them with um my gap insurance as a secondary insurance um when I.
[AGENT][NEUTRAL] Did they say they would file it for you?
[CUSTOMER][NEUTRAL] No, they didn't say anything about it. This was before any procedure was talked about or anything. Just upfront when I first became a patient with them, um,
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I gave them my primary insurance as well as my gap insurance as a secondary so they put it in the system, but we never had any discussions about anything because I really don't know how the gap insurance works. I just had a coworker mention it to me today, and that's why I'm calling.
[AGENT][NEUTRAL] OK, if you gave them the information they're probably gonna file it for you, but if they don't, you can file it yourself. We will need an itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That has procedure codes.
[AGENT][NEUTRAL] Diagnosis codes and the charges on it.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Along with your explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] OK, exclamation. I'm finish it, and where would I send it?
[AGENT][NEUTRAL] You can go on our online service center and upload it there or you can mail it or fax it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And our online service center is secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Think of the number and say it out loud.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, well thank you so much for that to clear up my questions.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, thank you. That'll be all.
[AGENT][POSITIVE] Thank you, Ms. [PII] for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye