AccountId: 011433970860
ContactId: 801b5d24-1c04-427e-99ce-51a5ee07bf86
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500640 ms
Total Talk Time (AGENT): 214182 ms
Total Talk Time (CUSTOMER): 200543 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/801b5d24-1c04-427e-99ce-51a5ee07bf86_20250226T19:45_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you? I'm sorry, good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, I want some information on my gap insurance. I've never used it before and I'm just wondering how do I use it and, and what's the best way to use it.
[AGENT][NEUTRAL] OK, I can verify that information for you and your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] You know what, I don't know the policy number. I'm actually, um,
[CUSTOMER][NEUTRAL] Logging into the system now. I don't know this is my first time.
[AGENT][NEUTRAL] Uh, what's your social?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I think I've probably found you, Ms. [PII], and verify your date of birth, mailing address and the email address for me.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The um
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my mailing address is [PII].
[AGENT][NEUTRAL] OK, and your email address for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Um, sure, the [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you say you're calling to verify um the type of policy you have and how to use it?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, uh, with this policy is secondary, what it does, it helps with your major medicals, deductible, co-pay or co-insurance for services in an outpatient facility such as ER, urgent care, ambulatory surgery center, MRI or imaging center, and you have benefits if you are confined as inpatient in the hospital. Um, if you have any services for outpatient or in-hospital, when you give the provider your primary insurance information.
[AGENT][NEUTRAL] You can also give them our information as your secondary, that way they can call and verify benefits.
[CUSTOMER][NEUTRAL] OK. So, I have been going to the University of Chicago, and when I go into my chart, I'm noticing that I have an amount that's due.
[AGENT][NEUTRAL] OK. Were they for outpatient or in-hospital services?
[CUSTOMER][NEUTRAL] But I.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK. Uh, for like ER, urgent care, ambulatory surgery center, imaging center, or was it for a doctor's office?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, it's some imaging, um.
[CUSTOMER][NEUTRAL] Yeah, it's some imaging and so forth. Mhm.
[AGENT][NEUTRAL] OK, um, if there were for, well, and I just wanna let you know, office visits are not covered or procedures in office, but if you have procedures, uh, performed in an outpatient facility, um, you can either give the information to the provider or if you like, you can submit claim information we need to process.
[CUSTOMER][NEUTRAL] OK. So when I go to my doctor and they do imaging, right? So, I have with my doctor right now, I have $529 worth of bills.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Those, let me see, those bills are.
[CUSTOMER][NEUTRAL] Looks like some of them are co-pays.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So I can't do it for the copays.
[AGENT][NEUTRAL] Not for office visits or if those, if that imaging or procedures were in office, no, ma'am.
[CUSTOMER][NEUTRAL] OK. So, OK. So, I have, so, and it doesn't cover medicine also. It won't cover that?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So it's only covering my hospital visits. Does it cover like after, like I went to the emergency room.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, will we cover those bills or no?
[AGENT][NEUTRAL] Oh yes, ER is outpatient is considered outpatient for the policy, so that is covered. Um, what we will need is the itemized bill showing the diagnosis and procedure codes and that primary insurance explanation of benefits for the data service.
[CUSTOMER][NEUTRAL] OK. All right. And then I will be reimbursed for that. So, OK. And
[AGENT][NEUTRAL] It could be. I can't give a guarantee, but if it was outpatient and um if your primary applied anything towards deductible, co-pay or co-insurance, it could be, um.
[AGENT][NEUTRAL] Do you, have you set up on our online service center? because we do have it to where you can view your policy as well as submit claims and check claim status from the site.
[CUSTOMER][POSITIVE] Yeah, I'm actually on it now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm just trying to get some more.
[CUSTOMER][NEUTRAL] I'm trying to see how I'm gonna be able to get, I guess when those bills come in.
[AGENT][NEUTRAL] Yes, ma'am. The billing, um, you would get from the provider, which would be the physician or the facility and the EOB, you will get that from your major medical insurance company.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it would show the um.
[AGENT][NEUTRAL] For that data service you, you would be filing for.
[CUSTOMER][NEUTRAL] OK, so I can get everything from my primary insurance.
[AGENT][NEUTRAL] Now, the only the EOB as far as the billing, most provider or most insurance companies wouldn't give that information. That's something you have to contact the medical provider for, like for the ER facility or ER physician.
[AGENT][NEUTRAL] And request that billing.
[CUSTOMER][NEUTRAL] OK, alright, so, and I have, and you don't do anything with the um prescription meds.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright then, well, um, I see it says payment policy contact info.
[CUSTOMER][NEUTRAL] But where do I get the um the actual uh information on my policy?
[AGENT][NEUTRAL] Um, it should be, uh, do you see the policy number, the 2553306?
[CUSTOMER][POSITIVE] Yes, I can click on that.
[AGENT][NEUTRAL] You should be able to click on that and the policy comes up.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] That works out well. And how far does this go back?
[AGENT][NEUTRAL] Well, your policy became effective [PII], so anything from [PII] till now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, OK, that sounds good.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, I think that'll do it. Thank you.
[AGENT][POSITIVE] You are welcome, Ms. [PII], and I thank you for calling APL. You have a great day.
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] Bye.