AccountId: 011433970860
ContactId: 7c2e0a39-d042-44a7-9b17-e7cf5d454079
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 845299 ms
Total Talk Time (AGENT): 414068 ms
Total Talk Time (CUSTOMER): 389630 ms
Interruptions: 3
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/7c2e0a39-d042-44a7-9b17-e7cf5d454079_20250116T17:54_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, my company switched over insurance providers in January, and one of the things I signed up for was this Medlik gap insurance as they're calling it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I just wanted to kind of get a clear understanding of it um because the broker here kind of said get this and then mid policy ba da ba ba and I wanna make sure I'm using it right for physiotherapy.
[AGENT][POSITIVE] It would be my, yeah, it would be a pleasure to assist you.
[CUSTOMER][NEUTRAL] And they kind of, yeah.
[AGENT][NEUTRAL] Do you happen to have your APL policy number available?
[CUSTOMER][NEUTRAL] Uh, let me see, would it be on my card? Let me see.
[AGENT][NEUTRAL] Do you have a card?
[CUSTOMER][NEUTRAL] Yeah, let me fish it out here.
[AGENT][POSITIVE] And take your time.
[CUSTOMER][NEUTRAL] Ok, here we go da da da.
[CUSTOMER][NEUTRAL] Would it just be my regular member ID number on my card?
[AGENT][NEUTRAL] Does it have an inpatient or outpatient benefit certificate number?
[CUSTOMER][NEUTRAL] Where to be
[CUSTOMER][NEUTRAL] It's just my regular member ID number. Let me see, hold on, I think it is mail and thing.
[AGENT][NEUTRAL] Is that on your APL card?
[CUSTOMER][NEUTRAL] With a group.
[CUSTOMER][NEUTRAL] It's not, it's just my regular medical one. I got something in the mail called my group issue med link forms. Would that make more sense?
[AGENT][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] OK, this might be it it's on the front of this packet. Let me give you this see if this is right. 02582282.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Yes, ma'am. And can you, can you verify your date of birth and current mailing address, please?
[CUSTOMER][NEUTRAL] That's on the front
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Um, [PII] [PII] [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and I don't have an email on file for you, Miss [PII]. Can I add an email?
[CUSTOMER][NEUTRAL] Yeah, it's [PII], so pink like the color.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Now, that is just the cutest little email I've ever heard.
[CUSTOMER][NEUTRAL] Pink piggy dog.
[CUSTOMER][NEUTRAL] Actually, uh, it's a, it's a name of a toy my sister and I named those kids, so.
[AGENT][POSITIVE] I love it.
[CUSTOMER][POSITIVE] And surprise, surprise, of course it was available, so it was an easy one to grab.
[AGENT][NEUTRAL] Now that wasn't like the slinky dog. No, that was slinky dog. OK, never mind.
[CUSTOMER][NEUTRAL] That was slinky, yeah, it was just some toy that we decided look.
[CUSTOMER][NEUTRAL] It was a pig, but we decided it kind of looked like a dog as well and.
[AGENT][POSITIVE] Well, I love that.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] It's that
[AGENT][NEUTRAL] Let me ask you, have you received your APL card yet?
[CUSTOMER][NEUTRAL] I feel like no since I didn't realize it was a separate one it may be in a stack of mail here.
[CUSTOMER][NEUTRAL] Uh, since I did receive the big booklet and I just haven't opened it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it might be in there.
[CUSTOMER][NEUTRAL] So that's very possible.
[AGENT][NEUTRAL] So what I'm gonna do is I'm going to pull up your benefits. And you said, you said that you were needing for physical therapy, is that correct?
[CUSTOMER][NEUTRAL] Yeah, so, yeah, hold on, let me just grab out of the mailbox, see if maybe I just wasn't paying attention. No, there's nothing in there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But I could have easily gotten it and just not.
[CUSTOMER][NEUTRAL] Be mindful if not all.
[CUSTOMER][NEUTRAL] Call and request another.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] I know exactly what you're talking about.
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEUTRAL] Yeah, I didn't necessarily think about it coming separately, so I wasn't on the lookout really.
[AGENT][NEUTRAL] Yeah, well, what I can do is I can actually mail you a copy of your card.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Oh yeah, that'd be great, wouldn't be bad to have.
[AGENT][POSITIVE] We can mail one or I can just email it to you real quick.
[CUSTOMER][NEUTRAL] The second one is
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] Now on our email when I email that to you it's going to have our website and we you can create a login and password and you can click on your policy number and view your policy benefits you can print additional cards and.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Once we receive claims, you can click on claim numbers and view the claims and the claims decisions. So all that's available online.
[CUSTOMER][NEUTRAL] OK, great, um.
[AGENT][POSITIVE] I'm getting this copy over to you right now.
[CUSTOMER][NEGATIVE] So basically when I got this, it was kind of a mad dash and they didn't really like looking at it now it's the first time I'm even seeing in the booklet, um, 30 day maximum. They didn't have any of this. It was kind of just uh get the middle plan and get gap and do do do and you know, out the door they went. So, um, now at least I'm seeing as a 30 day.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, maximum on outpatients. I'm kind of getting some details now that we didn't have before, which is good.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so, but I wanna make sure I don't kind of mess up any of this because obviously it's mostly for in case of course you're putting in, you know, the hospital help out with bills, but because I am going to do some physio, I want to make sure I did this right.
[CUSTOMER][NEUTRAL] Um, so my understanding is, as long as I go to, I guess, what an in-network physiotherapist, does it have to be a certain type or certain building or a certain something, how does it work?
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Mhm. So,
[AGENT][NEUTRAL] I'm just getting your card. Let me see.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] I am so sorry that my computer is just doing its little own dance and I'm like, I don't want you to dance that way.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So I just sent you a copy of your card.
[AGENT][NEUTRAL] Now, with this APL policy, it is secondary to your major medical.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, we can help provide benefits to cover your deductible or co-insurance for inpatient hospitalization. You've also got benefits for emergency room, urgent care facility, outpatient surgery, diagnostic testing in an outpatient facility.
[AGENT][NEUTRAL] You do have physical therapy facility benefits, so it does cover physical therapy.
[AGENT][NEUTRAL] Occupational speech or um.
[AGENT][NEUTRAL] Those are not covered. It has to be for physical therapy.
[CUSTOMER][NEUTRAL] Occupational speech is not covered. That's interesting. OK, that's good to know.
[AGENT][NEUTRAL] Mhm. It is only for physical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you have that benefit amount and and all benefits given over the phone is verification of coverage on your policy. It's not a guarantee of payment.
[AGENT][NEUTRAL] It just means we can't guarantee payment until we have the claim and it's processed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But your outpatient benefit amount is $2250 per calendar year, that we can help pay your co-pays for physical therapy or your deductible amount of your major medical.
[AGENT][NEUTRAL] If you were hospitalized and inpatient hospitalization is anything over 18 hours if you're in the hospital. Over 18 hours, it is considered inpatient hospital, and you have a calendar year maximum of $6750 that we can pay towards your inpatient hospital stay.
[CUSTOMER][NEUTRAL] That's separate that's in, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No services and the doctors, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] So that's it
[CUSTOMER][NEUTRAL] So that's anything big that would be an ambulance towards an inpatient and an inpatient which is over 18 hours.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, services in the doctor's office are not covered under this policy.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this is just deductible co-pays. That's where we at, right? Deductibles, copays, what else would there be?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] In coinsurance.
[AGENT][NEUTRAL] Coinsurance.
[CUSTOMER][NEUTRAL] Colin OK.
[CUSTOMER][NEUTRAL] And coinsurance.
[CUSTOMER][NEUTRAL] I'm not run into needing that yet, so OK.
[AGENT][NEUTRAL] So what I would suggest is always take your APL ID card with you.
[CUSTOMER][NEUTRAL] 189.
[AGENT][NEUTRAL] And always show it when you go for medical services outside of a doctor's office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's a good way to look at it. So, for for example, like you said, the urgent care, I know on my card when I looked at, I think it was like $100 I guess it's called deductible or co-pay. I don't know the difference. So something like that, I put in the claim and ideally I would get reimbursed $100 through this policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] The easiest thing, now you can certainly file for reimbursement, but the easiest thing is to always show it to your provider for your urgent career wherever you go for those services. Normally they will file a claim and we can pay them direct so you don't have to pay that benefit out of your pocket.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] At the time for services, yeah, unless there's a balance remaining. So it all depends on how your primary insurance processes. For example, if you go to urgent care and your primary insurance says you've got a co-pay of $50 for urgent care.
[CUSTOMER][NEUTRAL] Oh, at all.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, we, we can cover that $50 if the benefits are available, then, you know, they may pay say it's a $300 urgent care visit. We pay the $50 co-pay, they may apply.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Say that they only allow $200 for the urgent care facility to charge.
[AGENT][NEUTRAL] And then you have your
[AGENT][NEUTRAL] Let's say they pay 150 and then you have your your co-pay.
[AGENT][NEUTRAL] What we cover for $50. There may be a remaining balance of what you would be your responsibility, that would be the only time that you would have to pay out.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Got it, got it. OK, alright, good, so I might not even need to submit anything, just put it in beforehand, OK.
[AGENT][POSITIVE] That that's the easiest way because your providers are gonna have all the documents needed to file a claim and then you just don't even have to worry about let all that magic happen behind the scenes. You don't have to do anything.
[CUSTOMER][NEUTRAL] Alright, so
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, I haven't been in the hospital since uh I had my son, so hopefully I never need it.
[AGENT][POSITIVE] Yeah, but it's a good.
[CUSTOMER][NEGATIVE] They're terrible place to go.
[AGENT][POSITIVE] Yeah, it's a good policy to have if you need it. I mean, it does help, you know, that way you don't have to pay out of your pocket, at least up to that benefit amount.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] On the policy.
[CUSTOMER][NEUTRAL] Yeah, absolutely, but I'm gonna do a little, I'm gonna try to get back into my physio this year, so that's what I wanna kind of check on it. So I'll show it to them and if not I guess I'll submit it. So but as far as you know.
[CUSTOMER][NEUTRAL] Any like it's just physio that's covered by my regular.
[CUSTOMER][NEUTRAL] Um, I wanna say United, but it's Cigna now as long as it's Cigna.
[AGENT][NEUTRAL] Insurance
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm. As long as it's covered by them and they apply something to your deductible or co-pay or co-insurance, that's what we would cover, and as long as it is for physical therapy.
[CUSTOMER][NEUTRAL] Just in network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect so as long as it's network.
[CUSTOMER][NEUTRAL] And through them.
[AGENT][NEUTRAL] Yeah, because our policy, there's no network participation. We just follow the guidelines of your primary insurance.
[CUSTOMER][NEUTRAL] And I see her
[CUSTOMER][NEUTRAL] Got it. OK. And it's only physio, no occupational. I actually don't know the difference between physical and occupational, but I'm assuming there is one.
[AGENT][NEUTRAL] Well, I'll be honest with you, I'm not sure there is either. I think the physical therapy has to do with your muscle and joints and then occupational. It's when you relearn how to use like everyday.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not sure you
[CUSTOMER][POSITIVE] Oh yeah, yeah, but I, that kind of sounds right. OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Well, we'll agree on it anyway, right? until we're told differently.
[CUSTOMER][POSITIVE] I, I a fine line between the two. Feels like a fine line between the two, but all right, perfect. I wanted to make sure I got those right.
[AGENT][POSITIVE] That's right.
[AGENT][POSITIVE] That's right.
[AGENT][NEUTRAL] Now also
[AGENT][NEUTRAL] Yeah, now set up your account online if you're interested because you can click on your policy number and within the policy documents there's a page called the schedule of benefits page, has it all listed out on one.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One page.
[CUSTOMER][NEUTRAL] OK, perfect. diagnostic testing in hospital. I don't think I'd ever need that. OK, alright, cool, all sorts of little things listed in here.
[AGENT][NEUTRAL] And I sent you that email.
[CUSTOMER][POSITIVE] All right, great, and I'll that that.
[AGENT][NEUTRAL] And if you would like we can, yeah, you should have a card in the mail but if you don't you call us back and we can email you a card.
[CUSTOMER][NEUTRAL] Yeah, and I'll get set up
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK, oh yep, I see it here is my email.
[CUSTOMER][POSITIVE] Perfect all right great thank you so much for your time.
[AGENT][POSITIVE] It's been such a pleasure to assist you, Ms. [PII]. Anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's great. Thank you much.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day and hope it doesn't get too cold down there.
[CUSTOMER][POSITIVE] Oh yeah, thank you much, you too.
[AGENT][POSITIVE] Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But