AccountId: 011433970860
ContactId: 8a21f0e0-c501-4146-a7ce-b7db55016ad8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446959 ms
Total Talk Time (AGENT): 140033 ms
Total Talk Time (CUSTOMER): 148067 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/8a21f0e0-c501-4146-a7ce-b7db55016ad8_20250116T16:15_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, good morning, um, I was calling because, um, I just wanted to know, um, what is it that I have gap insurance and I wanted to know exactly what does it cover because I'm not sure sometimes when I go to the doctors I'm not sure if it covers like, um, specialists like co-payments and things like that.
[AGENT][NEUTRAL] Can I have a policy number and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Um, I don't have the policy number with me. Should I get that from, um, like the HR office before I call you guys?
[AGENT][NEUTRAL] Did you receive a card in the mail yet?
[CUSTOMER][NEUTRAL] No, maybe I did. I'm not sure.
[AGENT][NEUTRAL] Can I have your social?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And what's your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Or say that name again.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. Could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It should be my personal one, my full name, [PII].
[AGENT][POSITIVE] That's correct. And what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you're calling to verify your benefits, so it looks like you have.
[AGENT][NEUTRAL] Inpatient benefits of $2500 per calendar year, meaning as in anything that's considered as 18 hours or more in inpatient inpatient hospital setting, then you have outpatient benefits of $2500 as well per calendar year and it covers um diagnostic testing, physical therapy, anything that's considered as outpatient like emergency room visit, urgent care visits.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, because I have a question. I'm, I'm getting, um, some physical therapy. I, I went yesterday and I, I had to make a copay. I pay, I pay the copayment for $50 so that's why I was calling because they told me, oh, if you come back, um, I have to get paid every time I go, so I was like, I'm not sure. So I just what gap covered that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So did you give them your card?
[AGENT][NEUTRAL] Yes, physical therapy is covered under your gap insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um how would I do me like if I wanna go like to the physical therapy, I was only like maybe a couple of sessions that I need.
[AGENT][NEUTRAL] They will have to submit a claim here once the claim is, or you can submit the claim, but you would need your um itemized bill for that date of service from the facility and you need the EOB which your which is your explanation of benefits from your primary insurance company showing what went towards your deductible co-pay and your co-insurance.
[CUSTOMER][NEUTRAL] OK, and then I also have a question because I have to go to a specialist um.
[CUSTOMER][NEUTRAL] Like two weeks ago, uh, of of trauma, uh, I'm not sure the title of the doctors for my shoulder. Um, and I had to pay the copay for like 1 $150. Do you know if that's covered under that or?
[AGENT][NEUTRAL] No, office visits are not covered or the treatment received in the office, it only covers inpatient and outpatient benefits with the $2500 per calendar year and that is not a guaranteed benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I see, I see, OK, alright, sounds good so um I will uh.
[AGENT][NEUTRAL] Would you like for me to send a copy of your card to your email so that way you can forward it over to your phys physical therapy facility?
[CUSTOMER][POSITIVE] Yes, I greatly appreciate it.
[CUSTOMER][POSITIVE] Yes, I really appreciate it, yes.
[AGENT][NEUTRAL] One moment may I place you on a brief hold?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'll be right back.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding so I've sent that over for you. Could you check to see if you received it?
[CUSTOMER][NEUTRAL] Oh sure, yes, one second.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, let me see here.
[CUSTOMER][NEUTRAL] No, I don't see nothing here.
[CUSTOMER][NEUTRAL] Well, I'm sorry, let me check the other box. OK, I see here yes [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, yes, I have it here, yes.
[AGENT][POSITIVE] Alright, is there anything else that I can assist you with today? So you could just forward that card over to the physical therapy physician um facility or any facility that you have insurance with, or you can download and save it to your phone and give them your policy number so that way they can submit the claims for you and you won't have to worry about the stress.
[CUSTOMER][NEUTRAL] No, that will uh
[CUSTOMER][POSITIVE] OK, alright, sounds good.
[AGENT][NEUTRAL] Alright, um, and if possible, could you fill out, you're welcome if possible, could you fill out the survey in regards to your customer service that you received today?
[CUSTOMER][POSITIVE] Thank you appreciate your help.
[CUSTOMER][POSITIVE] Sure, I can, yes.
[AGENT][POSITIVE] It'd be greatly appreciated. Well, thank you so much, [PII]. Thanks for calling APL, and you have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thanks bye.
[CUSTOMER][NEUTRAL] Bye.