AccountId: 011433970860
ContactId: c233b214-5817-4b78-903c-2216d1909fbd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 602080 ms
Total Talk Time (AGENT): 337539 ms
Total Talk Time (CUSTOMER): 243946 ms
Interruptions: 7
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/c233b214-5817-4b78-903c-2216d1909fbd_20250203T19:52_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I have a gap insurance policy and I'm trying to find out what that would cover. Um, I thought I read something about that it helps cover whatever the medical insurance coverage doesn't cover, um, as far as the deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, well I will be glad to help you. Go ahead and give me your name and your policy number and let me get it pulled up for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't know the policy number.
[AGENT][NEUTRAL] OK, well, give me your name and your social security number. I can pull you up by that.
[CUSTOMER][NEUTRAL] OK, my name is [PII], and the social security number is [PII].
[AGENT][NEUTRAL] Well, [PII], thank you so much for that information. Let me get over to that screen. Let's see. Now while I'm pulling this up, go ahead and give me a good return telephone call number please, ma'am.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for all that information. OK, I think I've found your plan. So go ahead and verify your date of birth and your address for me, please.
[CUSTOMER][NEUTRAL] It's [PII]. The zip is [PII].
[AGENT][NEUTRAL] And your birthday, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alrighty, [PII], thank you for all that information. OK, first off, do you want me to give you your correct um policy number here at APL? I'll be glad to do that.
[CUSTOMER][NEUTRAL] Alright, hold on a second, um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, your policy number here at APL is gonna be 024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 567.
[AGENT][NEUTRAL] 96.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, now what's your uh policy here is your medical supplemental plan. I do see that your policy here went into, excuse me, uh, on [PII]. You are still current and active, but I must advise that verification of coverages, not a guarantee of payment on a claim, but you're wanting to go over some benefits and and how this works. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Well, yeah, I want an idea. What happened was like, I've been getting cancer screenings done and so far I got a bill of like over $2000 and the insurance company doesn't want to pay for it. For some reason my deductible just seems to be getting higher and higher. Um, I thought it was only $1200 now it's $3500 then it went to $270,050 in the last couple of days.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have a lot of other things coming up too like I have cataract surgery, um, I also just had another biopsy done, so I know that's gonna cost me um a few 1000 I just wanna know what is this actually covering and how would I put in a claim.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. Mhm.
[AGENT][NEUTRAL] Covered. OK.
[AGENT][NEUTRAL] OK, first off, uh, what we are of course is your medical supplemental plan. Now what we would, uh, pick up and pay on, of course we are your, your, your secondary, so, uh, all of your claims have to go to your primary insurance carrier and then that same provider can send that claim along with um.
[AGENT][NEUTRAL] Uh, I mean that bill to APL so we can process and coordinate any benefits you might have available now your plan here.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEGATIVE] They're supposed to the insurance company supposed to do it because they're gonna tell me no. They don't really wanna do much of anything.
[AGENT][NEUTRAL] No, you're
[AGENT][NEUTRAL] No, what they'll do, your doctor's office is gonna like when you go to the doctor, your doctor's office is gonna send it to your primary insurance carrier. Now when they get the EOB, which is what what we call ELB explanation of benefits that shows what they paid, then your provider, your doctor's office and hospital can then in turn send their bill along with that ELB to APL, so we might coordinate any benefit possible.
[CUSTOMER][NEUTRAL] Well, it, I wasn't done in the hospital. It wasn't done in the hospital.
[AGENT][NEUTRAL] Uh-huh. or any doctor, any doctor anywhere, radiologist, anybody can send it here. Yeah. Now let me explain how that works, uh, because your benefit here, now it has to be a covered benefit at your primary insurance carrier, which means for sickness and injury only, nothing routine here is covered at all, no matter what.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But your benefit here, you have a $100 deductible to meet here before we pay anything and then you have, right, then you have $2400 max benefit payable for anything for sickness and injury for outpatient or in the doctor's office except office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] OK, that's fine because I'm, I'm more or less, yeah, yeah, I'm more worried about because I know the doctor bill is gonna be $500 because of the deductible, but what I'm worried about is that there's gonna be at least a $1500 to $2000 bill for the biopsies that were done.
[AGENT][NEUTRAL] Is that, does that make sense? OK.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes ma'am, yes ma'am, and if you have not given your doctor's office, uh, APL's, um, policy number that I just gave you, call them and tell them that you have a medical supplemental plan and that they need to be sending all of their claims here to APL once your primary insurance company has processed your claim.
[CUSTOMER][POSITIVE] OK, alright, that will help a lot then.
[AGENT][NEUTRAL] OK, so that right, yeah, that way, because you, you might have benefits, you know, that's sitting out there that your providers are not sending your claims in so yes ma'am, let's make sure that they're getting those claims in house to APL so we can review them, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much. This really, really helps a lot. I mean, even if they paid like 200 to $300 that would help me. I mean anything.
[AGENT][NEUTRAL] Oh, yes, ma'am. Yes, ma'am. Anything that might be a covered benefit, right?
[CUSTOMER][NEUTRAL] Cause I just, well, this is the thing now. I had a mammogram and a sonogram, but it was to check for breast cancer, um.
[CUSTOMER][NEGATIVE] And I don't know if they're gonna you're gonna cover that, but I think the insurance company just should have paid for the at least the mammogram because if it wasn't anything cancerous but they're refusing to pay for it.
[AGENT][NEUTRAL] OK, well you might want to call your primary insurance carrier just to get some detailed information as to why they're denying it.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Because they told me because of the um they said because the way the doctor put it in that he put it in as it's possible cancer.
[CUSTOMER][NEUTRAL] And somebody else told me the same thing too and because of the uh deductible.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Oh, OK. Yeah, well, just call those doctors and have them send anything they have the APL so we can at least be getting your claims in and reviewing them, OK?
[CUSTOMER][NEUTRAL] Now how would they send it? What is there a fax number or?
[AGENT][NEUTRAL] OK, let me
[AGENT][NEUTRAL] Uh, no, ma'am, I can, I'm, I'm gonna give you our, our address where they can mail these claims to.
[CUSTOMER][NEUTRAL] Oh, so they can't call it in.
[AGENT][NEUTRAL] No, ma'am, they have to send it in paper because I need to send the claim in along with that EOB from your primary insurance company.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, but let me give you this mailing address. You ready?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII], mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's to [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And our zip is.
[CUSTOMER][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Yes, ma'am. [PII].
[AGENT][NEUTRAL] And our zip here is [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so I'm gonna read that back to you. That's [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ma'am, that is correct. [PII], you have that correct.
[CUSTOMER][POSITIVE] OK and thank you so much for your help.
[AGENT][NEUTRAL] Um, well, yes, ma'am, and is that all that I can help answer for you today, Ms. [PII]?
[CUSTOMER][POSITIVE] That's it thank you.
[AGENT][POSITIVE] OK, well, yes, ma'am, and thank you so much for calling APL and you have a great rest of your day, OK?
[CUSTOMER][NEUTRAL] OK bye.