AccountId: 011433970860
ContactId: b0df8794-070a-442f-ac39-28fc0bebe545
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667299 ms
Total Talk Time (AGENT): 346397 ms
Total Talk Time (CUSTOMER): 312373 ms
Interruptions: 6
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/b0df8794-070a-442f-ac39-28fc0bebe545_20250527T18:34_UTC.wav
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[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII] in the customer service department. How may I help you?
[CUSTOMER][NEUTRAL] And [PII], my name is [PII], director of HR for Coral Springs Improvement District. Um, I'm the plan admin. I, I need your help on something. Um, is there a way I can, I can get you to email me a breakdown of what actually is covered and what is not covered?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm, I'm I'm a little confused because every time I call it they say it's not covered so I just need to really need to know is it worth it to have this gap coverage or not? I'm just trying to do like a cost analysis. Our group number is 16577.
[AGENT][NEUTRAL] Thank you for that, [PII] and before we proceed, is it possible to get your callback number in the event that we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, because I just got hung up on uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for that. I apologize for that disconnection. And you said your group number was 16577?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, bear with me one moment let me pull up the information.
[AGENT][NEUTRAL] All right, Mr. [PII]. And just to verify, can you verify the group's mailing address and your email account?
[CUSTOMER][NEUTRAL] Uh, [PII] and my email is [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Thank you for that. So what I can do, you stated you were calling today to basically see what the benefit details are on the plan if this plan is feasible for you guys, um, the gap coverage. So what I can do is send you a copy of both plans that you guys have. It looks like you guys have two gap plans, a 1000 and a 2000 plan. I can send you a certificate.
[AGENT][NEUTRAL] Of policy certificates for both plans, which will give you all the details that you're needing as far as what's payable, what benefits, um.
[AGENT][NEUTRAL] Cover as far on a group level, or are you wanting it on an individual level?
[CUSTOMER][NEGATIVE] Well, I guess more of an, on an individual level like let's just say I go to urgent care, it's not covered, which makes no sense. What's the point of having gap or you know or copays or RXs things like that it's not covered.
[AGENT][NEUTRAL] Do you have a policy?
[AGENT][NEUTRAL] Mr. [PII], do you have a policy with us directly? You do, don't you? OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me look at your policy.
[CUSTOMER][NEUTRAL] Yeah, everyone does it, it's provided, it's provided by the thing. They all should be the same, so whether it's a 1000 or 2000 should shouldn't make a difference.
[AGENT][NEUTRAL] They would be.
[AGENT][NEUTRAL] Yes, sir. It was, it doesn't, but I was just trying to get.
[CUSTOMER][NEUTRAL] But I just kinda wanna break down of like not not for us as a group but like OK what what what is covered what is covered under this policy like do I is it only covered through like for hospital visits or what? I'm just trying to see if it's even worth that we pay for we pay for.
[CUSTOMER][NEUTRAL] This for for our employees right? but I'm just kind of seeing if it's worth it because I mean we really don't have a deductible on our health insurance so it's not sure why we would even need a gap insurance. I'm just trying to look because we have open enrollment coming up in a couple of months I'm just trying to do my due diligence, you know, and see, you know, it's what what's even feasible why is it even.
[CUSTOMER][NEUTRAL] Are we gonna need it or something like that? So, so just, you know, is there a breakdown? OK, you know what, OK, it has to be an emergency room visit or hospital stay or this, I mean just what is, what is actually covered for this gap insurance.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir, I understand.
[AGENT][NEUTRAL] OK, what I can do since you do have a policy and the individual policy would be a little bit more detailed as far as what's payable, um, and what is not payable.
[AGENT][NEUTRAL] I can send you your individual certificate. Now, the way the policy is billed, it's two plans into one. So what that means is there's several sections in there that gives you a fee schedule. Um, you do have in-hospital benefits, and there is a detailed breakdown on what in-hospital benefits you have if someone is admitted into the hospital.
[AGENT][NEUTRAL] Um, for treatment, whether it's mental or emotional. There is an ambulance benefit and it does give you the details of
[AGENT][NEUTRAL] What is covered for that, um, and you have a separate outpatient benefit.
[AGENT][NEUTRAL] And that section does have its own separate fee schedule. So what I can do is email it to you and then if you feel like, you know, there's still some more details that you wanna get verified on the coverage I may have to transfer you to someone in the claims department to help you further with that. Um, do you wanna do that first, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, just email because it's gonna be the same for everyone on the plan so it's nothing's gonna change so yeah right yeah.
[AGENT][NEUTRAL] Right, um, the only thing that's gonna change is if somebody has the [PII] plan, they'll have a higher inpatient benefit. That's the only variation. There's a 1000 plan and there's a 2000 plan. So, of course, if someone has a 2000 benefit.
[CUSTOMER][NEUTRAL] Right, but that, that's, that's for a hospital, right? That the only difference would be in like a hospital visit, right? So it's not gonna cover urgent care, it's not covering RX things like that, correct?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, that would be.
[AGENT][NEUTRAL] From what I can see on the inpatient note, but you guys do have an outpatient lab facility writer. And that outpatient lab facility writer should pick up some of that stuff. And it also depends on how they're coding it, um, whether, you know, where you had it out, it was in an outpatient facility. And another thing that comes into play is major medical.
[CUSTOMER][NEUTRAL] Right, but that's like an out that's, that's still almost a, that's still almost a hospital because you're going to an out, you know, a same day or an outpatient facility which is pretty much a hospital. So you're gonna have to have still some kind of procedure. So going to a regular doctor, it's not covered this or that. So yeah, just send me that and I'll look it over and if I, if, if I'll, I'll call back if I need to.
[AGENT][NEUTRAL] OK. Well, I just wanted to let you know that there's several sections in there as far as the fee schedule. So when you see a schedule of benefits that does detail a specific benefit rider. I'm gonna go ahead and email this to you, Mr. [PII], but before I email it to you, let me get you to verify a few things just to make sure everything's correct on our end. And since I am emailing you, I wanna verify your email address. Um, can you verify your mailing address and your date of birth, please?
[CUSTOMER][NEUTRAL] I just gave you my mail, the mail, my my personal one or my.
[AGENT][POSITIVE] You gave me the group. Yes, your personal one. Yes, sir.
[CUSTOMER][NEUTRAL] Oh, you want my personal, uh, uh, [PII] at [PII].
[AGENT][NEUTRAL] Thank you for that and I'm showing we've got your personal email account is that where you want me to email your certificate to?
[CUSTOMER][NEUTRAL] No, no, no, email to to my work, my [PII], yeah.
[AGENT][NEUTRAL] To the work
[AGENT][NEUTRAL] OK, OK, not a problem. I didn't want to assume that you wanted it to your work, so I was gonna ask. All right, so you're gonna be getting an email from [PII]. You should have it in about 5 or 10 minutes. Again, it's gonna be your policy certificate, and if there's any questions, please feel free to email or contact me back. Is there anything else I can help you with before you go, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, real, real quick, I, I send in a thing today because I need to if I, if I stay with you, if we stay with you, I need to get this switch to that if but I have to mail, I have to email in the, the application form or you know the um anyway I sent one in today to the yeah to the A care for a new uh employee that's eligible starting on [PII]. I just wanna make sure that was received. Can you check on that?
[AGENT][NEUTRAL] Group coverage form.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, sir. I can definitely check.
[CUSTOMER][NEUTRAL] I sent it to the whatever the the care yeah the care team email, yeah, yeah.
[AGENT][NEUTRAL] The care team. Yes, sir. OK.
[AGENT][NEUTRAL] Let me pull it up. Give me just a second. I do have access to that server, so bear with me.
[CUSTOMER][NEUTRAL] Yeah, because if I don't put in with like 30 days of hire, which makes no, you know, no sense that it if it it it won't let me do it online, so I have to email it in so that's something I might have to look at changing too.
[AGENT][NEUTRAL] And if you do decide that you guys need you can need to change your new hire waiting period we can we can do that for you we just need an email.
[AGENT][NEUTRAL] Um, to the care team explaining that what, what do you want to change it to pretty much. Um, did you just send it to us?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I sent it this morning.
[AGENT][NEUTRAL] Like, just
[AGENT][NEUTRAL] This morning, OK, maybe, maybe they've already did it. Let me check.
[CUSTOMER][NEUTRAL] Today
[CUSTOMER][NEUTRAL] Uh, let's see uh.
[CUSTOMER][NEUTRAL] I've, I
[CUSTOMER][NEUTRAL] Usually they send it within a day. I would just why I had you I sent it at uh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I thought I
[CUSTOMER][NEUTRAL] Cap
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] I sent it at uh [PII] this morning [PII].
[AGENT][NEUTRAL] OK, let me check one more thing. It doesn't look like it's made it to new business, but that doesn't mean we don't have it. Give me just a second.
[CUSTOMER][NEUTRAL] That's that's fine. It usually takes a day or so. I just figured while I had you I check so.
[AGENT][NEUTRAL] I don't see it yet um but I will let you know if you did send it to the care team as soon as they open it, they do send you an email confirming that we got it um they're real, real good about that, so it may be they're still working.
[CUSTOMER][NEUTRAL] Yeah, yeah, I've got an, yeah, I've got, I got an, I think I did get an email that they got it. I was just making sure I was just, well I had just, uh, yeah, I got an email and, uh, you know, no, I, no, I don't think I did. I got where my bill was ready. I already printed that off, uh, yeah, sorry, uh, yeah, we received your email and a customer care team is happily researching your request. Yeah, so I, OK, that's fine. I must have overlooked it. OK, alright, and you'll email that to me you said though.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, Mr. [PII], I'm getting it prepared now to send to your work email that we have on file that we verified earlier.
[CUSTOMER][POSITIVE] OK, alright, alright, thank you so much I appreciate your help.
[AGENT][POSITIVE] Alright, Mr. Honey, you're welcome and thank you again for calling APL. Is there anything else I can help you with before you go?
[CUSTOMER][POSITIVE] No, no, that's it thank you.
[AGENT][POSITIVE] Thank you again for calling APO. You have a wonderful day, Mr. [PII].
[CUSTOMER][POSITIVE] You too alright bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.