AccountId: 011433970860
ContactId: a7d5ba11-1ed5-4f76-94ff-9e41e2b45fb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 600150 ms
Total Talk Time (AGENT): 359380 ms
Total Talk Time (CUSTOMER): 141760 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/a7d5ba11-1ed5-4f76-94ff-9e41e2b45fb1_20250409T15:27_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so my name is [PII]. Um, I paid for Gap with United with you guys. I believe you guys work with United, correct?
[AGENT][NEUTRAL] We work with your employer.
[CUSTOMER][NEUTRAL] Oh my employer, OK, I don't know how it works.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so question, I, I did, uh, I, I went to a doctor and my whole procedure is like $8000.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And I have to pay a deductible of $2000. When does the gap kick in for for you guys?
[AGENT][NEUTRAL] OK. It really depends on how everything was handled, Mr. [PII]. Um, do you have the policy number with you?
[CUSTOMER][NEUTRAL] No, I don't. I have to get it from other coworker. I can give you my social.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, um, let me have a
[CUSTOMER][NEUTRAL] Or whatever you guys need.
[AGENT][NEUTRAL] OK, let me have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Right, thank you. Um, let me go ahead and pull another system that I can use the social. Bear with me just a minute, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, go ahead with the social.
[CUSTOMER][NEUTRAL] Sorry, um, um, [PII].
[AGENT][NEUTRAL] OK. And may I have your date of birth, mailing address, and email address for verification.
[CUSTOMER][NEUTRAL] Sure, [PII] mailing address is [PII].
[CUSTOMER][NEUTRAL] Um, what else did you want?
[AGENT][NEUTRAL] The email address?
[CUSTOMER][NEUTRAL] Email address, it should be under [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Well, I don't know if it's my work email.
[AGENT][NEUTRAL] All right. No, it's, it's OK. Thank you. All right, so let's see.
[AGENT][NEUTRAL] And uh this
[AGENT][NEUTRAL] The procedure that you had, um, that you had to pay that $2000 deductible. Um, was that in a hospital or was it outpatient facility? What type of test was it?
[CUSTOMER][NEUTRAL] It was a I think it's called colonoscopy. It was from my stomach. It was in Cleveland Clinic.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I know there's a hospital there, but there's a bunch of clinics inside there also.
[AGENT][NEUTRAL] OK. And um the colonoscopy took place because of a sickness or was it like a preventative colonoscopy?
[CUSTOMER][NEGATIVE] Um, it was, I have, I have acid reflux and it was, it was really bad. So the doc, so the doctor made me go to, go look at my stomach.
[AGENT][NEUTRAL] Uh that's that's OK.
[AGENT][NEUTRAL] OK, um, did you, do you have the card with us? Did you present the card or no?
[CUSTOMER][NEUTRAL] No, I didn't know. I thought it was through United. I didn't know it was a different card. I don't even know where that card is at.
[AGENT][NEUTRAL] Got you. OK.
[AGENT][NEUTRAL] All right. So when it comes to Cleveland Clinic, um, they charge different ways, um, and in order to determine benefits, we will have to be looking at the paperwork because um if they charge as a um outpatient facility, imaging facility or outpatient facility through the hospital, then it may be considered, but if they charge as an office setting, then it will not be covered because you don't have office benefits.
[AGENT][NEUTRAL] So with Cleveland Clinic, we really need to be looking at the paperwork because they they charge different than any other company. So, um now the benefits that you have with this policy and this is not a guarantee of payment, just a verification of coverage, um, you do have an outpatient maximum benefit of 1500 for outpatient service either in a hospital or freestanding diagnostic center.
[AGENT][NEUTRAL] Um, so again, um, you can go ahead and submit the claim and let us look into it and see how they charge this and if it's something that is payable through the policy, we can go ahead and send you a reimbursement, um, but you do have 1500 calendar year maximum for outpatient service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so how do I send this, the, the document that they charge? how can I send this to you?
[AGENT][NEUTRAL] OK, so, um, in order to have a full claim, let me go ahead and give you the instructions and the paperwork you need to send in with it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the first thing you're gonna need is the claim form. The claim form you can find it in our website at [PII].
[CUSTOMER][NEUTRAL] 94 OK.
[AGENT][NEUTRAL] And that's again [PII] and you're looking for medling claim form.
[CUSTOMER][NEUTRAL] [PII] you said?
[AGENT][NEUTRAL] Meddling
[AGENT][NEUTRAL] Claim for.
[CUSTOMER][NEUTRAL] 24.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. On the first page of that form is gonna give you the same instructions, but I'm gonna go ahead and let you know that together with the form, we need an itemized bill.
[AGENT][NEUTRAL] The itemized bill needs to have the diagnosis codes, procedure codes, and place of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can get that through um by calling Cleveland Clinic if you don't have one, you can just call and let them know that you're trying to submit your own claim and you need a fully itemized bill with diagnosis procedure close in place of service.
[AGENT][NEUTRAL] And um you also need a copy of the explanation of benefits from the primary insurance indicating the amount applied towards the deductible.
[CUSTOMER][NEUTRAL] Is that in the same form or is it different separate thing I need?
[AGENT][NEUTRAL] No, the explanation of benefits is through your major medical. So I guess through United, you, you call United or usually they send it to you or they, they let you know whenever they process a claim. It's usually either put on the website through them or you can, you will get it through the mail saying that it's not a bill and explaining uh how much they pay, how much what's your discount, and how much is your responsibility. That's the paper we need.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's it called an explanation of what?
[AGENT][NEUTRAL] Explanation of benefits.
[CUSTOMER][NEUTRAL] Let me just
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what else?
[AGENT][NEUTRAL] And that's all. So once you have the claim form filled out, you have the itemized bill from the provider and you have the explanation of benefits from the major medical, and you can just go ahead and submit all three, that will be a a full claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And again, yes, and go ahead.
[CUSTOMER][NEUTRAL] Alright, perfect. Is there any way for me to for you to send me my ID card?
[AGENT][NEUTRAL] Um, yeah, I can go ahead and request for one to be sent out by mail. If you need one to, like a temporary one, you can always go to the same website to [PII] and click on sign in and create your account and you can get a temporary one that you can either save to your computer or save to your phone or just um print it out, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Alright, so let me go ahead and order one by mail. Bear with me just a second.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. And here we go.
[AGENT][NEUTRAL] OK, so I went ahead and send that request. It usually takes um 5 to 7 business days for you to get it by mail, OK? And it's just gonna go to the address on file. Um, let me just double check on that address just to make sure. You're welcome. And that was [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] There's not an apartment number or anything like that?
[CUSTOMER][NEUTRAL] Nope, the home.
[AGENT][NEUTRAL] OK. All right. OK, so I went ahead and um send that card, OK? So it should be there within 5 to 7 business days. Is there anything else I can help you with today, Mr. [PII]?
[CUSTOMER][POSITIVE] No, thank you, so you've been a great help.
[AGENT][NEUTRAL] Do you need the policy number now, just to write it down.
[CUSTOMER][POSITIVE] Oh, that'll be good to have.
[AGENT][NEUTRAL] Yeah, I can give it to you over the phone. All right, sure, that is 02.
[CUSTOMER][NEUTRAL] OK, what is it?
[AGENT][NEUTRAL] 56
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7649.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you sir I really appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. You have a good day, Mr. [PII].
[CUSTOMER][NEUTRAL] You you too now, bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.