AccountId: 011433970860
ContactId: af896554-e93e-42cc-8cf1-09ef819cb4af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216389 ms
Total Talk Time (AGENT): 113808 ms
Total Talk Time (CUSTOMER): 118146 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/af896554-e93e-42cc-8cf1-09ef819cb4af_20250211T16:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah hi good morning uh I had a question um I have, I'm uh.
[CUSTOMER][NEUTRAL] I'm currently with, you know, uh, with you guys as a customer for with the gap insurance, um, and I have an outpatient procedure going, um, and they called and is it actual that you guys only on an outpatient medical something you only covered like $200 is that accurate or no?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I will get your policy pulled up. We can definitely take a look at how much that benefit is. Um, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, I can give you the number. Oh, my name's [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], really quick, if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, uh [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, 021.
[CUSTOMER][NEUTRAL] 99611.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK, thank you. I'm just gonna verify some information really quick uh [PII], can I get your date of birth please?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Alrighty, give me just a moment let me take a look at your benefits. OK, so for this policy, the outpatient benefit does pay on a per calendar day basis, so it's not a calendar year max, it's a daily max, uh, and that maximum amount is $200 per calendar day.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I have a CDF.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, that's what I needed to know then that's what they told me, but I just wanted to verify.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, absolutely. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] Uh, no, that's it. Oh, I do have a question, yeah, no, I do have a, I do have a question. So I had some, uh, I did go to a care center, uh, twice.
[AGENT][POSITIVE] OK, well thanks for calling. Sure, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And obviously insurance covered most of it, but I had an $80 co-payment. Does gap insurance pay that as well?
[AGENT][NEUTRAL] Um, uh, you said a care center, um, is that, do you mean like a physician's office?
[CUSTOMER][NEUTRAL] Not a physician's office per se, it's, it's a like a.
[CUSTOMER][NEUTRAL] I know it's a care center. I don't know what else to call it. It's not really a doctor's office, but there are doctors there, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, so without specifically knowing what it was.
[CUSTOMER][NEGATIVE] The care center where there's doctors and I had to see the doctor and it's still in relationship to this thing, to this problem I'm having.
[AGENT][NEUTRAL] OK, did you receive treatment there or was it more of a consultation? You did receive treatment. You did. OK, so in short your policy uh does not cover strictly just office visits but treatment in office is covered, um, so that should be. OK, so if there's any questions they are more.
[CUSTOMER][NEUTRAL] Yes, no, I had no I had treatment, yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I did get treatment in office.
[CUSTOMER][NEUTRAL] So what I paid them in cash, would I, I pay those in cash. I can submit those bills somehow or no?
[AGENT][NEUTRAL] You already did pay that, yes, you can absolutely file those claims with us.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and I just get a copy of the receipt and send it like email or whatever and go from there I'll call you back and.
[AGENT][NEUTRAL] So we would need um the itemized statement that shows diagnosis and procedure codes and then we would also need the explanation of benefits uh essentially showing what your primary insurance did pay and you should be able to get all of that information from that provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, alright, alright, when I get that I'll, I'll, no, that would be it, thank you.
[AGENT][NEUTRAL] All right, anything else I can help you with?
[AGENT][POSITIVE] OK, yeah, thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][POSITIVE] Thank you bye bye.