AccountId: 011433970860
ContactId: 9570763b-0350-4eb0-998a-95e7c67dae27
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519710 ms
Total Talk Time (AGENT): 269313 ms
Total Talk Time (CUSTOMER): 212706 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/9570763b-0350-4eb0-998a-95e7c67dae27_20250113T16:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], hey, um, I have this insurance through gap plan, um, but I don't have the information like my the details so that I can make a claim, you know what I mean, so I don't know that do you guys send out or is it more just done online stuff?
[AGENT][NEUTRAL] So yeah I mean you can submit claims online um you can send them in the mail or fax them with the claim form honestly online is the easiest way to do it we have an online service center where you can just upload the documentation and file them that way um if you want, I, I could send you some information on how to like create an account and all that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would be great and then can you, I need to know my like member ID number and all of that too.
[AGENT][NEUTRAL] OK, so yeah, let's look that up here right so I can do a search by your name or social, whichever you would prefer to give me.
[CUSTOMER][NEUTRAL] Um, let's do my name. It's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And then [PII], just like the color.
[AGENT][NEUTRAL] OK. Thank you, [PII]. Let me just take a look here one sec.
[AGENT][NEUTRAL] And then for security, may I please have your date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you so much for that and then I just need to verify the address we would have on file for you also please.
[CUSTOMER][NEUTRAL] Yeah, [PII] or at May say [PII], um, zip code the same [PII] [PII].
[CUSTOMER][NEUTRAL] Does it say [PII] or [PII]?
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The zip code is the same but.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, um, it looks like we actually don't have an email address on file for you. What is an email that is good to send this information to?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 04
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Got you. OK.
[AGENT][NEUTRAL] Alright, so I will also, I'm gonna send you right now, [PII], so you have this for your records. um, I'll send you an ID card. This is gonna have your policy number and stuff on it, um, and so I can put in a request to to would you like to have one mailed to you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, if can you send it via email today and then send one a hard copy too?
[AGENT][POSITIVE] Yeah, absolutely, yep, I can do both, yeah.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Alright, so I will send you the ID card and then I'll also attach the online service and user guide um it'll show you how to go in and create an account and then from there um.
[AGENT][NEUTRAL] File any sort of claims or anything like that that you need to.
[CUSTOMER][NEUTRAL] OK, now tell me because I, I mean I've had this cat plan. I had it all last year and this year and I didn't, I mean I know now, but I didn't know all last year that I had it, um, so can I go back and make a claim from last year still?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yep, absolutely. So there's um there's not a time frame as far as, you know, when the claims have to be filed by. So yeah, if you have um anything else that has occurred while you had active coverage, you can definitely still file those claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then also explain to me, so this coverage or this gap plan is to help cover the deductible meeting the deductible correct?
[AGENT][POSITIVE] Right. It bridges the gap between your major medical, yeah, and then anything that you may have remaining. So, um, anytime that you've gone to the doctor, you know, and you've had some out of pocket costs, this covers like the deductible, the co-pay, any of that, it would be reimbursed to you.
[CUSTOMER][POSITIVE] OK awesome now.
[CUSTOMER][NEUTRAL] It's like for say I was in the hospital, I wasn't but say I was, can I just put this ID number on my, so like I've got my major medical insurance and I've got this can I put that so I don't have to even do claims like they can just submit it to you but like the hospital? Can we do it that way or no?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, absolutely. And honestly, um, you know, going forward since now you kinda know you have the plan, that's honestly the easiest way to go going forward. Yeah, if you go a doctor like you said, or in the hospital, let them know that this is your secondary insurance and so yeah, they will bill your primary and then they bill us for the remaining.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Previously.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. OK, um, and then, OK, so another question since like last year I met my deductible but didn't use the benefit of this like I paid for it out of pocket so well would you guys reimburse me then?
[AGENT][NEUTRAL] Mhm, mhm.
[AGENT][POSITIVE] Mhm, yeah, absolutely. Yeah.
[CUSTOMER][NEUTRAL] Is that how it would work? OK, OK.
[AGENT][NEUTRAL] And then obviously if the provider if the provider's filing the claim on your behalf then we would submit payment to the provider.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] And then can you just.
[CUSTOMER][NEUTRAL] I don't really know the details of it. I just did an open enrollment and open enrollment. I paired the gap plan with the.
[CUSTOMER][NEUTRAL] One that I had selected, but is it like $3000 benefit or something or to help cover that deductible?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So your
[CUSTOMER][NEUTRAL] I feel like that's maybe what it is.
[AGENT][NEUTRAL] Yeah, so your inpatient benefit max is 3000. Now your outpatient is a calendar day, so the outpatient benefit amount is different than the inpatient inpatient on your plan is defined as being in the hospital, let's see for.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] At least 18 continuous hours so your benefits would only fall under inpatient if you're in the hospital and like I said, it would have to be for over 18 hours on the outpatient, your calendar day benefit max is 350, so outpatient is gonna be everything else as far as like treatment in an office by a physician, those types of things.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it, OK.
[CUSTOMER][NEUTRAL] And then can you actually look, I think that I may have had this in [PII] also. I think I probably started at like [PII]. Can you verify that?
[AGENT][NEUTRAL] Alright, this plan shows an effective date of [PII].
[CUSTOMER][NEUTRAL] OK, OK, that's fine.
[CUSTOMER][NEUTRAL] I wasn't sure. I started a new job 3 and I thought I had probably
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Get it in it so that's fine.
[AGENT][POSITIVE] Yeah, no worries.
[CUSTOMER][POSITIVE] OK. Well, you've been super helpful.
[AGENT][NEUTRAL] Was there anything?
[AGENT][POSITIVE] Yeah, no worries, [PII]. Anything else I can check on?
[CUSTOMER][NEUTRAL] Um, no, if you just send me that ID card today to my email and then the directions of how to submit and then.
[CUSTOMER][POSITIVE] I'll get working on that.
[AGENT][NEUTRAL] OK, yeah, those are all on their way to you, so that'll include, like I said, your policy number and anything you need to present to a medical professional to use it as well and then I did put in a request to have one mailed to you.
[CUSTOMER][POSITIVE] Awesome, remind me your name.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] [PII], thank you so much I appreciate your help today.
[AGENT][POSITIVE] Yeah, you're welcome, [PII]. Have a good one.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.