AccountId: 011433970860
ContactId: be325c10-72ff-4d36-976d-fafd52208697
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 675320 ms
Total Talk Time (AGENT): 222202 ms
Total Talk Time (CUSTOMER): 397256 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/be325c10-72ff-4d36-976d-fafd52208697_20250224T18:35_UTC.wav
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[AGENT][POSITIVE] Thank you for calling in. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I have a question. I am trying to, um, I don't know if I wanna accept or I wanna decline.
[CUSTOMER][NEGATIVE] The health benefits for my employer, but it says here that if I decline the benefits, I cannot apply for the APL gap. I don't know how that works because I feel that the benefits are too expensive, like the benefits that I wanted to select, I have to meet my $6000 deductible. Like every time I go to the doctor, I'm gonna have to pay, right?
[CUSTOMER][NEUTRAL] So how does APL gap work? What is that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I am not sure of the plan that you have with your company, but in general, um, you have to have a primary insurance to be able to get the gap insurance because the gap insurance helps with deductible copay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh huh.
[CUSTOMER][NEUTRAL] That's what I assumed.
[CUSTOMER][POSITIVE] So it helps out with the deductible and what else?
[AGENT][NEUTRAL] Deductible co-pay?
[AGENT][NEUTRAL] And co-insurance.
[CUSTOMER][NEUTRAL] What do you mean by coinsurance?
[AGENT][NEUTRAL] So if you're, if the doctor's office has a co-insurance payment that you need to make or the hospital and they have a co-insurance payment, it helps with, with those three things to help you as far as.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Helping with the deductible, your co-insurance or your co-pay.
[CUSTOMER][NEUTRAL] Yes, cause I'm reading here it says um.
[CUSTOMER][NEUTRAL] The provider will submit your claim to both Aetna and APL and APL will pay your gap benefit directly to the provider. But my question is, like, let's say that I go to the doctor because I'm sick, right? I have the flu or something, and
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I was under the impression that
[CUSTOMER][NEUTRAL] You know, you have to meet your $6000 deductible before you don't have a co-payment. So I'm under the impression that when I go and they tell me, OK, mom, it's gonna be $125. OK, that $125 comes off of the $6000 deductible. I haven't met my $6000 but my $6000 will lower every time I pay fees at the doctor.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I was a little confused on this APL because I read where it said submit your um claim to both and then APL so I'm like, how does APL pay it?
[AGENT][NEUTRAL] OK, so what happens is, is when you go to the doctor's, there's a, a piece of paper called the explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Your primary insurance sends in to us the explanation of benefits and everything that you paid. And if there's a deductible, a co-pay or a co-insurance that's been paid through your primary.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Depending on how the claim is filed, um, if the primary calls and verifies your benefits first.
[AGENT][NEUTRAL] And sometimes what they do is they call them to verify your benefits that you have this gap insurance and then they don't make you pay the deductible co-pay or co-insurance because they know your gap insurance will pick it up.
[CUSTOMER][NEUTRAL] So I guess what, when I got.
[AGENT][NEUTRAL] But if they don't do that, then you would have to file the claim yourself and be reimbursed for what you paid.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I get it. So basically, this APL.
[CUSTOMER][NEUTRAL] Is extra coverage that pays your deductible or your co-payment or whatever. So like when you go to the doctor, it says it's $127 either they submit it and APL pays it or I have to pay it and get reimbursed from APL.
[AGENT][NEUTRAL] Right. And it's always for a covered procedure. Yeah. It's always for a coveredger.
[CUSTOMER][NEUTRAL] Something like that.
[AGENT][NEUTRAL] Um, that is on your policy.
[AGENT][NEUTRAL] And it has to be covered by your primary insurance also.
[CUSTOMER][NEUTRAL] Yeah, yeah, so, for like, like, like, I mean, I rarely get sick, but like I said, if I were to get, like, God forbid, the flu and I go see my doctor and they're like, OK, Ma, it's a $75 you have to pay $100.
[CUSTOMER][NEUTRAL] That 100 gets covered by you guys whether it's.
[CUSTOMER][NEUTRAL] Aetna submitting it or I submit it?
[AGENT][NEUTRAL] Right, correct, and I would ask.
[CUSTOMER][NEUTRAL] So y'all basically cover what we gotta pay upfront.
[AGENT][NEUTRAL] Uh, yes, at times, um, I would ask your, uh, the person that has given you your insurance if office visits are covered under that plan.
[CUSTOMER][NEUTRAL] Oh, if office if office office visits are covered, well, I'm gonna, it says right here.
[AGENT][NEUTRAL] Because there's different plans.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Let me see, hold on.
[CUSTOMER][NEUTRAL] Like I think I read that. Hold on, let me go back and just select the insurance so I can open the actual file. Hold on.
[CUSTOMER][NEUTRAL] Enrolling benefits. OK, enrolling benefits. I'm just gonna get the 4621 select.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Save and continue.
[CUSTOMER][NEUTRAL] OK, so now it says 2024 gap 31,500. I'm gonna read the details. OK. Postal International is concerned about your financial security, and we offer benefit plans designed to protect your associates below the summary of our [PII] gap. OK, if you elect medical plan coverage, OK, OK, so it says here it just has the fees and then it says.
[CUSTOMER][NEUTRAL] It doesn't, I don't think it says.
[CUSTOMER][NEUTRAL] Gap insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so I just wanna make sure I clarify this. So the question to ask human resources would be.
[CUSTOMER][NEUTRAL] I'm, I'm considering regis I'm considering enrolling in the health benefit coverage. However, does the gap insurance, the APL, does that cover like inpatient visits?
[CUSTOMER][NEUTRAL] Co-payment?
[AGENT][NEUTRAL] Right, ask them what the benefits are. Ask them what your benefits are, if they have a copy of the policy that you can read over.
[AGENT][NEUTRAL] To make sure that you're making the decision you want to make.
[CUSTOMER][NEUTRAL] Yeah, well, because right here there's an attachment.
[CUSTOMER][NEUTRAL] And the attachment 0 2024 gap summary maybe that's it. Hold on.
[CUSTOMER][NEUTRAL] Yeah, let me click on that 2024.
[CUSTOMER][NEUTRAL] Um, when I open it.
[CUSTOMER][NEUTRAL] OK, it says summary of benefits.
[CUSTOMER][NEUTRAL] Postal Center International and it says, OK, here we go inpatient benefits maximum 3000 inpatient benefits maximum $3000 per coverage per calendar year.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then it says inpatient benefits.
[CUSTOMER][NEUTRAL] Treatment while confined as an inpatient treatment of mental or emotional disorder, treatment of substance, OK, ambulance service, outpatient, maximum.
[CUSTOMER][NEUTRAL] Outpatient benefits, OK.
[CUSTOMER][NEUTRAL] Uh, treatment and urgent care facility, treatment in a hospital outpatient facility not resulting with coverage persons as an inpatient treatment, emergency room urgent care.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Speech therapy, sleep study. I think it does, like, I guess, like if you get sick and go to the doctor. Cause it just, it just literally says outpatient benefits. This is what it covers. Treatment in an urgent care facility, treatment in an emergency room, treatment in a hospital.
[CUSTOMER][NEUTRAL] Outpatient facility.
[CUSTOMER][NEUTRAL] And then it says outpatient sickness and outpatient accident 100%.
[AGENT][NEUTRAL] OK, so what that's telling you is you can go to an ER urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it doesn't say office visit, so if you, if you get sick with the flu, go to the urgent care center.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You're gonna have to do that, yeah, I, I didn't say nothing, yeah.
[AGENT][NEUTRAL] Or the outpatient.
[AGENT][NEUTRAL] Or the outpatient um ambulatory center.
[CUSTOMER][NEUTRAL] Yeah, because it says treatment in hospital outpatient facility not resulting.
[CUSTOMER][NEGATIVE] Not resulting with a covered person as an inpatient, hold on, I don't see nothing about office.
[AGENT][NEUTRAL] And it said also that it's for accident or sickness.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK, so then, OK, so then if I enroll in the health benefits, I'm gonna pay, of course my health benefits amount and then I'm gonna pay this gap $12 whatever $1146 and then you guys, I guess gap pays the deductibles or whatever it is.
[AGENT][POSITIVE] Right. It helps with deductible, your co-pay or your coins. Yes, ma'am. You're right.
[CUSTOMER][NEUTRAL] That's what it looks like.
[CUSTOMER][NEUTRAL] Yeah, so I was thinking it was a percentage. I was like, wait, do they pay a percentage or they cover the full thing?
[AGENT][NEUTRAL] They cover up to the dollar amount that was given for the outpatient maximum for the year.
[CUSTOMER][NEUTRAL] Yeah, outpatient benefit maximum 1500, so by it's only 100 they cover 100.
[CUSTOMER][NEUTRAL] If it's 200, it's 200, but no more than 1500 per calendar year.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Maximum of $4500 per calendar year for all covered persons come by. OK, so it's a $1500 and then that's outpatient inpatient it's a $3000.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, I appreciate it. I, I've never heard of this. That's why I was like, what is this?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] And there's no problem.
[AGENT][POSITIVE] Yes, ma'am. It's a pretty good insurance, um, uh, it's very popular with our company. There's a lot of people that are very pleased with it because it does help with those, you know, because if you didn't have it, then you would have to pay for all that yourself.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, yeah, because.
[CUSTOMER][NEUTRAL] Yeah, because they're quick to say, OK, we're gonna give you health insurance, it's $46 a pay period, but yet you have a freaking $6000 deductible. It's like, OK, uh, no.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] That's not worth it because I'm still paying.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you for your help have a good day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You too you have a blessed one thanks for calling APL.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Bye-bye.