AccountId: 011433970860
ContactId: a66e7d51-2ca9-4a81-84fe-09ac7d1f4625
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1504520 ms
Total Talk Time (AGENT): 583213 ms
Total Talk Time (CUSTOMER): 708377 ms
Interruptions: 6
Overall Sentiment: AGENT=0, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/a66e7d51-2ca9-4a81-84fe-09ac7d1f4625_20250501T16:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I think I spoke with you yesterday. My name is [PII]. I'm with Aquisure Insurance calling in regards of Ferretti 19145, um.
[CUSTOMER][NEUTRAL] I, you were going to have [PII] or uh.
[CUSTOMER][NEUTRAL] What are their names? Hold on one moment. I just have to find it.
[CUSTOMER][NEUTRAL] Um, [PII] or [PII] called me back after lunch yesterday, uh, about this time, about [PII] yesterday, um, nobody called back. I did send an email also, um.
[CUSTOMER][NEUTRAL] And I haven't heard back from anyone. I need to speak to somebody and get this answer because the group is closing their open enrollment and I need to know if this person can use the high the um APL gap on the high plan.
[AGENT][NEUTRAL] OK, what I, I'm not sure that this was me. So what's going on?
[CUSTOMER][NEUTRAL] OK, maybe you weren't the one I spoke to yesterday. Your voice sounded kind of familiar. I called in yesterday because I have group Ferretti 19145, um, they're a Florida group. I was asking if they, if that group can have members enroll in the APL gap plan if they're on the high plan with Cigna instead of just the low plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, we had somebody that elected it, and the girl I spoke with yesterday, whoever that was, you or someone else said that [PII] and [PII] were the [PII] people, and they were at lunch, and they were gonna have them call me back. I never heard back from them. I also sent them an email about [PII] yesterday afternoon because actually I think it was right about this time yesterday I had called and she said that one of them was supposed to come back in like 20 minutes, which would have been around [PII] um.
[CUSTOMER][NEGATIVE] And I don't know about the other, but no one called me back, no one's answered my email. I need an answer so who can I speak with?
[AGENT][NEUTRAL] Um, OK, give me just a minute. I need to look through the groups, um.
[AGENT][NEUTRAL] Folder to see exactly what they've got um with their gap in major medical um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll try to help, um, give me just a second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] They have 2 major medical plans and 1 gap plan.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Hello. OK.
[CUSTOMER][NEUTRAL] So originally, yeah, can you hear me?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, originally, um, the.
[CUSTOMER][NEUTRAL] They were just originally when they signed up and I don't know how long it's been because this is like my I was new last year when they were renewing and I did it with the the other account manager but um.
[CUSTOMER][NEUTRAL] So I don't know how long they've had it, but the gap plan originally was set up with the 600 inpatient and a 6600 outpatient um amount which coincided with the deductible or the out of pocket max I think it might have been the out of pocket max um.
[CUSTOMER][NEUTRAL] So this year they're um.
[CUSTOMER][NEUTRAL] Low plan actually lowered the deductible and out of pocket max and there was an email from someone and maybe I should try looking for that guy um that said.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] That's fine. Then they'll just have 900, you know, it's fine that the um deductible and out of pocket max lower than the.
[CUSTOMER][NEUTRAL] The employee will only have 900 left of their out of pocket max to meet, but there's this a high plan with Cigna that has a lower out of pocket max and deductible, and one of the employees tried to elect it along they moved to the high plan from the low plan and then tried to elect um.
[CUSTOMER][NEUTRAL] The gap, and I don't know if they're allowed. Do you have gap for the high plan or just only for the low plan?
[AGENT][NEUTRAL] So I'm like, yeah, on my side though, I'm only seeing that they've got a, that their major medical is 6600, um, and then their out of pocket is 7500. I'm not showing that they have a lower or a higher plan than that, and it could be wrong. I just don't know. Do you know what the higher plan is or the difference? I'm only just showing one plan on my end.
[CUSTOMER][NEUTRAL] That makes sense.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Yeah, the, the higher plan, well, and that's the thing is that that was from last year's renewal, this year's renewal, it's a $5000.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] It's a $5000 deductible instead of a $6600 deductible, and I don't even, I'm not sitting.
[CUSTOMER][MIXED] Exactly where I can see it right at this moment, but I don't know what the out of pocket max is um.
[AGENT][NEUTRAL] Alright, let me
[CUSTOMER][NEUTRAL] So, but then they have another medical, major medical plan that's like uh 1000.
[CUSTOMER][NEUTRAL] dollar or $1000 deductible and a lower out of pocket max, I think it's $4000. So, our question is, can people on that high plan
[CUSTOMER][NEUTRAL] Take the gap plan also.
[CUSTOMER][NEUTRAL] I'm gonna try to find.
[AGENT][NEUTRAL] Yeah, I I guess I'm trying to figure out exactly what the other plan is because everything that I'm pulling up like from even last year, so like on the group coverage form like I'm only seeing 6600, 6600 for medical for major medical. I'm not showing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A different
[AGENT][NEUTRAL] Like another plan.
[CUSTOMER][NEUTRAL] Well, that was the last year on the low plan. uh, and the high plan this year is $1000. I just looked it up. It's a $1000 deductible and a $4000 out of pocket max, but we got an email from.
[CUSTOMER][NEUTRAL] Um, who is that from? Hold on a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The the account executiv[PII] got an email.
[CUSTOMER][POSITIVE] Hold on. I'm so sorry. I'm trying to find it though.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] Because it wasn't originally sent to me. I just got put on it further on down the road.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So let's see.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So a guy named [PII].
[CUSTOMER][NEUTRAL] Said to [PII].
[CUSTOMER][NEUTRAL] I'm following up on your question to [PII] on [PII] regarding Ferreti Group. The group currently has a 6600 inpatient 6600 outpatient which will function well with the proposed $5000 deductible and $7500 out of pocket max medical plan. Employees can file claims for eligible expenses up to $6600 for both inpatient and outpatient.
[CUSTOMER][NEGATIVE] Services leaving only 900 for the insured to reach their out of pocket max. I believe when we initially wrote this group, they had a 6600 out of pocket max, which is why the rating agent shows that number. However, there's no reason to believe the group won't be adequately covered with their current gap coverage since the group is receiving a rate pass from APL. Everything will continue as if they chose not to change their plan to renew the client, we only need the group coverage for any changes, blah blah blah.
[CUSTOMER][NEUTRAL] I don't have this [PII]'s contact because I'm the account manager and those the ones that was being written to were the um account executives. I'm just trying to find out because the group asked me to find out if somebody that took the high Cigna plan could still have the gap.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Um, give me just a second. I'm gonna put you on a brief hold. [PII] with um NAS, and I can, I mean, I'm happy to give you his email address if you wanna reach back out to him. I've got a, as long as they're the gap plan can be utilized for both plans as long as the um out of pocket isn't doesn't exceed like whatever the major medical.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So if you still have a $6600 plan and you have a $6600 gap plan then those can be used together. If you have a $7500 gap plan then you can't use it with the.
[CUSTOMER][NEUTRAL] OK, but
[AGENT][NEUTRAL] 6600.
[AGENT][NEUTRAL] I just can't because they
[CUSTOMER][NEUTRAL] OK, so what is that?
[CUSTOMER][NEUTRAL] Uh, so what if you have a.
[CUSTOMER][NEUTRAL] $6600 gap plan but your out of pocket max is $4000.
[AGENT][NEUTRAL] The Dutch
[CUSTOMER][NEUTRAL] What you said just kind of confused me.
[CUSTOMER][NEUTRAL] And what is, uh, NAS, what's that?
[AGENT][NEUTRAL] Yeah they're just national agency solution is who um all [PII] brokers they're just start in between um like help if you will for all [PII] brokers.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, are they kind of like.
[CUSTOMER][NEUTRAL] They do small well this is in a small group but OK alright so.
[AGENT][NEUTRAL] Yeah they just do all yeah they're just do all Florida groups.
[CUSTOMER][NEUTRAL] OK, so who am I supposed to be asking this question of your APL, right?
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Yeah, we're American Public Life. We have, we do have a [PII] group, but [PII] is unfortunately out and [PII] is here, but she is a little bit newer, so I don't know if she could let me get, let me put you on hold and let me get you one of our seniors and see if they can answer this question. I, I.
[AGENT][NEUTRAL] Understand what you're asking. I just, for whatever reason, I don't have, I'm not seeing the other major medical plan that you guys have in our system. So like I'm only seeing one.
[CUSTOMER][NEUTRAL] Well, I think it could potentially be that that was because originally the group was only using it for the low plan because the high plan.
[CUSTOMER][NEUTRAL] Was lower deductible and out of pocket max and so that's where I'm confused when you say.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] If their out of pocket max is 7500.
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] Let me um hold on just a second, let me just make sure I'm.
[CUSTOMER][NEUTRAL] Group has a gap plan.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, I'm just wanna, I wanna pull this up. I wanna make sure that I'm even saying this right.
[CUSTOMER][NEUTRAL] OK, and the group has a gap plan for 6600, so that is.
[CUSTOMER][NEUTRAL] More than the deductible, but less than the out of pocket max. So in my mind, and this is my only group that has a gap plan, so I'm not that familiar with them. But in my mind, it kind of makes sense that they can use it because they still have money. The gap plan isn't gonna be more than what their out of pocket max is. But on the low plan,
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] They have a $1000 deductible and a $4000 out of pocket max. So then,
[CUSTOMER][NEGATIVE] I'm just confused as to buy um.
[CUSTOMER][NEGATIVE] I'm confused as if.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So they, they do have the 4000.
[CUSTOMER][NEUTRAL] And they have a gap plan that is more than the max out of pocket.
[CUSTOMER][NEUTRAL] I guess that's my question.
[AGENT][NEUTRAL] Yeah, so if they're, so if they're lower, if their lower plan is $4000 outpatient benefit max, then they wouldn't be able to use the $6600 gap plan, is that what you just stated?
[CUSTOMER][NEUTRAL] By one question.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, because they can't, because then they would be right, because they would be overinsured at that point in terms of like, um, yeah, like your out of pocket has to be lower.
[CUSTOMER][NEUTRAL] Yeah, that's kind of what I'm asking because.
[AGENT][NEUTRAL] Then what your major medical is.
[AGENT][NEUTRAL] Like your gap plan has to be lower than your out of pocket major medical plan.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so the gap must be lower than, wait a minute, but then that still doesn't make sense because he said, well, they're out of pocket max on the $5000 deductible with 7500.
[CUSTOMER][NEUTRAL] So 66 is less than 7500 so I guess that's why that one's OK. OK, so out of pocket max.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Must be less than the gap plan.
[CUSTOMER][NEUTRAL] Right, that's what you're saying?
[AGENT][NEUTRAL] Yes, now I'm now I'm getting confused. So, yeah, yeah, so, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, why don't you check with your seniors? I'll hold if you don't mind and then I will need it in writing, but I just wanted to understand it because like logically to me if they're saying, well, my thought originally was if it's a 1000, 4000 out of pocket max, and 6600 is gap, so there's enough to cover the out of pocket max in the gap. So my thought was, oh well, it should be allowed because it is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You know they're not gonna have, they're not gonna pay more than 6600.
[AGENT][NEUTRAL] Right, OK, let me, let me get.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah, but now that now it sounds like you're saying the opposite like because 4000 is less than 66, they can't have it and it's fine either way. I just need to know what to tell the group.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure. Yeah, OK, give me just a second, OK? And you said that your name, your first name was uh [PII], correct?
[CUSTOMER][POSITIVE] Sure, thanks [PII].
[CUSTOMER][NEUTRAL] Right, [PII]
[AGENT][NEUTRAL] OK, and you sent an email yesterday.
[CUSTOMER][NEUTRAL] And I'm with Aquier. I'm the account manager. Yeah, I sent an email at [PII] yesterday to the APL sales and I CC it to [PII] and I wrote hello [PII] and [PII].
[AGENT][NEUTRAL] OK, give me just a second.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me just a second, OK?
[CUSTOMER][NEUTRAL] OK, thanks, [PII].
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, how are you?
[AGENT][NEUTRAL] I'm all right. Uh, I have, um, so I have a [PII] broker on the phone and
[AGENT][NEUTRAL] She called yesterday and talked to somebody and then she sent an email. Her name is [PII]. Do you recall that email coming that was addressed to you and [PII]?
[AGENT][NEUTRAL] Did it get, did you get it? Did you forward it to NAS?
[AGENT][NEGATIVE] I'm sure you did. She's just calling now and she's wanting it, I just hate this whole Florida NAS situation cause it's just like, I don't know how to like, it's like I know that you guys probably forwarded it to NAS for them to reach out to her, but she's like demanding an answer, so it's like cool, like, can we.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I just don't know, yeah, I just don't know how to, um, I mean, I guess I could tell her that [PII] is gonna reach out to her, um, but she's
[AGENT][POSITIVE] Yeah, I mean, whatever you wanna do. She just is demanding an answer, and her answer I think is something that I can.
[AGENT][NEUTRAL] That I can that I can help with, it's just she's, she, they have two major medical plans and they have one gap plan. So she wants to know if her gap plan can beized with both plans regardless if it's a low or high. And I'm like, and if I'm, if I'm remembering my like what I.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] have been taught, it's typically your out of pocket, cannot be like your gap plan out of pocket cannot be above your major medical out of pocket.
[AGENT][NEUTRAL] Is that correct?
[AGENT][NEGATIVE] Right, because then you'd be overinsured, and that's what I keep telling her, but then she keeps talking and now I'm confused, and I'm just like, I'm like, I don't know how to help you cause I technically can't help you like NAS is, but that's what I'm telling her. I'm like, your gap plan cannot be above your major medical because then you would be over insured.
[AGENT][NEUTRAL] And she just keeps talking and I'm like, I, I was like, let me figure it out, like I was like, I'm unfortunately [PII]'s not here. I was like, so I can't pass you off to her, and I was like, [PII] is here, she's a little bit newer. I was like I can call, give her a call really quick, um, but
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, so I guess just, I'll, I mean, I can switch back over to her and say that [PII] is reaching out and that I am correct with that your gap plan cannot be, cannot exceed your major medical plan.
[AGENT][NEUTRAL] Yeah, got plan and.
[AGENT][NEUTRAL] Not writing this down so I don't get confused to exceed the major medical plan.
[AGENT][NEUTRAL] I know that I'm correct, but now I'm confused.
[AGENT][NEGATIVE] It does, and especially like because she keeps, I'm like, you're giving me numbers and I don't even see in your, I was like, I'm so sorry, but like I don't see that you have another major medical plan. In my system, it shows that you have one major medical plan and it's for 6600 to 6600. That's what I am seeing. So what is your major medical plan, but or or your other one, and she like won't like, just give me direct answers.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] She just keeps, yeah, so let me switch back and I'll tell her that [PII]'s gonna reach out and then I'll just confirm what I've told her.
[AGENT][NEUTRAL] And we'll see.
[AGENT][NEUTRAL] Well, or just freaking tell in your email I have a 6600 plan and a 7500, 6500 or whatever she has and just say, does my gap and does my gap allow to work with both like something like that.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's what she's wanting to know, and I'm like, your gap can't exceed regardless of what it is, like, so what is their gap plan? What did I say? 6600?
[AGENT][NEUTRAL] Yeah, 6600, 6600.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, OK, well, 6660. Well, unfortunately in line it says 6600, 7500, so I don't know.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Still impatient. All right, let me see what she says. I'll let you know.
[AGENT][POSITIVE] Thanks bye.
[AGENT][NEUTRAL] Are you still with me, [PII]?
[CUSTOMER][NEUTRAL] Yep, I am.
[AGENT][NEUTRAL] OK. I just spoke with [PII] and she did receive your email yesterday and she has um asked [PII] to reach out to you. So he is going to reach out, going to reach out to you. And I did confirm that your gap plan cannot exceed your major medical plan because then the person, then the individual will be overinsured.
[CUSTOMER][NEUTRAL] OK, so can you put that in writing and then I'll just take it back to the group and tell them, yeah, no, we can't, we can't do that, um, because that does logically that kind of makes sense, um, although I didn't know if like you just stopped at the max of the medical plan, you know what I'm saying? Like, OK, so it's 4000, so you're really only insuring 4000 and not 6600, um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, yeah, no, it, it, it won't pair with um a major medical plan that's higher. Um, I
[CUSTOMER][NEUTRAL] Will not, and I like how that sounds, will not pair with an.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, um, [PII] will be able to put that in writing. I
[CUSTOMER][NEUTRAL] P
[AGENT][NEUTRAL] Um, I can see what I can do in terms of putting it in.
[CUSTOMER][NEUTRAL] Oh wait, it will not pair with a major medical plan that is lower than the gap plan, right?
[AGENT][NEUTRAL] So a gap plan cannot exceed the major medical plan.
[CUSTOMER][NEUTRAL] OK. OK. Yeah, so then that will not pair with a major medical plan that is lower than the gap plan.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Cause they'll be overinsured.
[AGENT][NEUTRAL] Right, yes.
[CUSTOMER][NEUTRAL] Canno exceed major medical.
[CUSTOMER][NEUTRAL] Wait, say what you say the one sentence you just said to me, cannot exceed. Say that again.
[AGENT][NEUTRAL] No, you're fine. Just your, yeah, your gap plan cannot exceed the major medical plan.
[CUSTOMER][NEUTRAL] Gap cannot exceed major major medical. OK. That's the part I didn't write gap. I just wrote cannot exceed major medical gap. I know it seems like I'm parsing words, but it means differently when you say it.
[AGENT][NEUTRAL] Oh yeah, your gap.
[CUSTOMER][NEUTRAL] Slightly differently, you know what I mean?
[AGENT][NEUTRAL] No, I understand. Yeah, yeah, you're, yes, it does, it does get a little confusing when numbers are thrown around, but just it just in short, if you have two major medical plans, your gap cannot exceed your major medical plan regardless of low or high.
[CUSTOMER][NEUTRAL] Either of them, OK, got it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But because it's less, like, even though, OK, and that makes sense, because it's less than the deductible, but it's more, or it's still less than the out of pocket max. So out of pocket max is more on the low plan. So that makes sense cause it's not exceeding the major medical. OK. All right.
[AGENT][NEUTRAL] Mhm. Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And [PII] is reaching out to you also.
[CUSTOMER][NEUTRAL] Um, is there a phone number?
[CUSTOMER][NEUTRAL] OK, what's his phone number just in case I need to try and reach him.
[AGENT][NEUTRAL] Um, to be honest, I don't know if I have. I just have his email address. I can give you his email address.
[CUSTOMER][NEUTRAL] Oh, you know what? He might be calling me right now. Someone's calling. Oh, well, wait a minute, whatever it was they hung up, but all right, well, I have my answer.
[AGENT][NEUTRAL] Oh, maybe.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Oh no.
[CUSTOMER][POSITIVE] Oh, United Healthcare is fine, and I do need to grab them. So thanks so much and I'll look forward to him. Thank you. Mm bye-bye.
[AGENT][NEUTRAL] OK. Of course, of course.
[AGENT][POSITIVE] OK. Have a great day. Bye.