AccountId: 011433970860
ContactId: c50f29d3-7f4c-408b-aaba-f62be24a1689
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 881909 ms
Total Talk Time (AGENT): 329703 ms
Total Talk Time (CUSTOMER): 474531 ms
Interruptions: 3
Overall Sentiment: AGENT=1.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/c50f29d3-7f4c-408b-aaba-f62be24a1689_20250107T18:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good afternoon. My name is [PII]. How are you?
[AGENT][POSITIVE] I'm doing good, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing fine, thank you for asking.
[AGENT][POSITIVE] Good, sir.
[AGENT][POSITIVE] How can I help you today, sir?
[CUSTOMER][NEUTRAL] OK, I have, I have a question.
[CUSTOMER][NEGATIVE] I just hung up with the with my insurance company about a claim that I received on an email from a surgery that I had last June.
[CUSTOMER][NEUTRAL] And uh um I would like some clarification if possible about my gap insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, [PII], I can help you with your gap insurance. Can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] My number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then what is your um policy number, sir?
[CUSTOMER][NEUTRAL] Uh, you need my policy number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, I'm looking at my card and I see.
[CUSTOMER][NEUTRAL] I have group number is that with the group number is OK or something else?
[AGENT][NEUTRAL] Uh, do you see an inpatient certification number or an outpatient certification number?
[CUSTOMER][NEUTRAL] It says in hospital benefit certification number.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, sir. Can you give me that number?
[CUSTOMER][NEUTRAL] OK, I have 0148.
[CUSTOMER][NEUTRAL] 15.
[CUSTOMER][NEUTRAL] 96.
[CUSTOMER][NEUTRAL] And then letters, letters, Mary, Larry, 7.
[AGENT][NEUTRAL] OK, let me pull your policy in real quick, sir.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're very welcome, [PII]. Well, uh, OK, so we'll need to verify your policy. Can you please give me your date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you sir, and then also I'll need for you to verify your address, your phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] OK, [PII] that's my number. I live at [PII] and my email address is [PII].
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] OK thank you I appreciate that so much that you verified that for me OK so looking at your policy you were calling about a claim that you had in June do you have the claim number?
[CUSTOMER][NEUTRAL] I have nothing about that claim number. I'm sorry.
[AGENT][NEUTRAL] OK. OK, that's fine. I can, I can go ahead and look anyway for you and is the claim for yourself?
[CUSTOMER][NEUTRAL] It's for myself.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and what was the name of the place that you went to go to?
[CUSTOMER][NEUTRAL] That was at Memorial Hospital.
[AGENT][POSITIVE] OK, I do show that we paid a claim for you.
[AGENT][NEUTRAL] Uh, for the date of service, the date that you, um, were at the hospital was [PII]. Is that correct?
[CUSTOMER][NEGATIVE] I don't know exactly. I know it was in June, but I, I don't have anything with me.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'm showing that we paid $500 to Memorial Regional Hospital for the date of service for 6 for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is my coverage with this gap insurance?
[AGENT][NEUTRAL] OK, so this gap insurance and this is just to verify your coverage, it's not a guarantee of payment.
[AGENT][NEUTRAL] So what it does is it helps you with your deductible, your co-pay, or your co-insurance. So like in this case when you went to the hospital.
[AGENT][NEUTRAL] You had a $500.
[AGENT][NEUTRAL] Deductible or co-pay or co-insurance that we paid for you. Um, your outpatient.
[CUSTOMER][NEUTRAL] They, I'm sorry to, sorry to interrupt, they were telling me that it was 800.
[AGENT][NEUTRAL] OK, so on your plan.
[AGENT][NEUTRAL] For outpatient per calendar day so per day you get $500 benefit after that $500 is paid for that day, then it, there's no more that we can pay because it's only $500 payment uh per your policy.
[AGENT][NEUTRAL] So your outpatient calendar per day is $500. So if it was $800 we paid the $500 that your insurance covers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the gap insurance pays $500 max daily.
[AGENT][NEUTRAL] Yeah, for outpatient procedures $500 per calendar day.
[CUSTOMER][NEUTRAL] That's about it. Anything else.
[AGENT][NEUTRAL] You also have an inpatient benefit. If you go into the hospital for more than
[CUSTOMER][NEUTRAL] A what?
[AGENT][NEUTRAL] Inpatient, if you go into the hospital for more than 18 hours and you're admitted to the hospital and confined.
[AGENT][NEUTRAL] You have a benefit amount per calendar year.
[AGENT][NEUTRAL] Of $6350 that helps towards your hospital bill for deductible, co-pay, or co-insurance for accident or sickness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So because I was talking to my, I, I then I was completely I've I've been paying for this and I, I, I, I never knew how I pay. I thought that this was that this gap insurance was to pay whatever was not covered by the insurance.
[AGENT][NEUTRAL] Oh,
[AGENT][NEGATIVE] No sir, that's not how the plan works.
[CUSTOMER][NEUTRAL] Because right now they are telling me that I have like a a a uh a copayment of $800. I, they told me that that you paid the, the $500.
[CUSTOMER][NEGATIVE] But on top of that, there is like uh out of pocket, whatever, whatever, which I don't understand it still.
[CUSTOMER][NEUTRAL] That I'm responsible for.
[CUSTOMER][NEUTRAL] And that has nothing to do then with, with, with the gap insurance.
[AGENT][NEUTRAL] Right, so the charges that they gave you, you'll, you'll have to work out with them, but we paid our part of $500 towards your bill.
[AGENT][NEUTRAL] Your insurance covered the 500 that your policy is written for.
[AGENT][NEUTRAL] And you may just need to talk to them about your, about your bill and see if they can work something out with you.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Uh, I just spoke to the, to the, to, to Ana.
[CUSTOMER][NEUTRAL] Aetna, it seems that I have the $800 co-payment and then I have.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I don't, I don't understand deductible copayment, whatever it is, and then I, what, what is it where you go is the deductible, correct? No, no copayment.
[AGENT][NEUTRAL] Right, um, now, your, your policy covers deductible, co-pay, or co-insurance. All together, it will only pay $500 per calendar day. So that could go towards the deductible, that could go towards co-pay or that could be um co-insurance, but it's only $500 combined for the day of $500.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEGATIVE] I thought, I thought it was like the gap was to cover because now I'm in the middle of $5000 out of pocket whatever whatever which I never understood that it seems that I had to pay something out of pocket so that they start working on the or they have to pay, but I just find out and and and and and this is just I'm pretty sure you, you know probably it seems that the bill was for $29,000.
[CUSTOMER][NEUTRAL] Then the insurance get a discount rate of $14,000. That's great. Then the remaining was like $9000 and then out of the $9000 the insurance pay only $3000 and I have to pay, of course my out of pocket which is $5000. So out of all these.
[CUSTOMER][NEUTRAL] Business because this is a business.
[CUSTOMER][NEGATIVE] The patient that has been paying more than $2000 monthly for his insurance has to pay now almost double of what the insurance pays.
[AGENT][NEUTRAL] Mm, yes, that.
[CUSTOMER][NEGATIVE] This is completely ridiculous. Do you think, do you think that's fair?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Well, unfortunately, the economy, the way the economy is now, yes, I, that would be, uh, that would hurt my heart if it was me. Yes, sir, and I totally am compassionate for you.
[CUSTOMER][NEUTRAL] That's why
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I, it, it, it makes, it makes no sense at all. I've been paying for my family insurance about $2000 monthly and then when I had to, when I need my insurance to cover, they get the big brother, they get a big discount for their big brothers, which are the hospitals, and then they only pay $3000 and I'm, I'm still stuck with $5000.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] If they're gonna give a discount, OK, we're gonna give you $14,000 discount. Let's include those $5000 that the customer has to pay.
[AGENT][NEUTRAL] Yeah, I
[CUSTOMER][NEUTRAL] And then, let's go the rest.
[AGENT][NEUTRAL] I understand. Yes, I will, yeah.
[CUSTOMER][NEGATIVE] The only, the only discretion, the only discretion for this, and this is the first time I'm going through this after 23 years paying insurance and now I see myself and that's why I have people that have never paid for insurance, you know, my insurance cost me annually.
[CUSTOMER][NEUTRAL] More than $24,000 or $24,000 a year.
[CUSTOMER][NEUTRAL] And now look at the predicament that I'm into, it's crazy. That's why.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] There's a lot of people that don't have insurance.
[AGENT][POSITIVE] Yes, I agree with you.
[AGENT][POSITIVE] Yes, and I'm so sorry.
[AGENT][POSITIVE] I'm so so sorry. I do, I am.
[CUSTOMER][POSITIVE] And the good thing
[CUSTOMER][POSITIVE] And the good
[AGENT][POSITIVE] I am happy that we pay our part that we were supposed to pay.
[CUSTOMER][POSITIVE] The good thing about this.
[CUSTOMER][NEGATIVE] I know, I see, I see something that I didn't understand it. I'm paying almost $80 a day, uh, monthly for my, no, no monthly. I pay like.
[CUSTOMER][NEUTRAL] 1,600 $160 probably monthly because it's biweekly for this insurance that I thought because the gap is, you know, that word gap meaning let's pay, we're gonna cover whatever difference is not covered by the insurance. That's how I understood when it was explained to me.
[CUSTOMER][NEUTRAL] Now I realize that it only pays either the deductible or the difference between.
[CUSTOMER][NEUTRAL] This is the, this is where, this is where we are living.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Less less, less.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEGATIVE] And it's hard, it's very hard, yes.
[CUSTOMER][NEUTRAL] Let's save ourselves.
[CUSTOMER][NEUTRAL] And the customer is always the one that it's, you know, we heard.
[CUSTOMER][MIXED] But it's OK. This the only description description that I have for this is two words has nothing to do with you, but it's really those two words. One is B and the other is S. It's, it's, it's the reality. It's crazy. The millionaire company Aetna pays 3, the full customer struggling to live and pay his rent, 5000, crazy, but thank you for your time.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I understand, sir.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're welcome, [PII] and I'm so sorry that you're having to go through this, um, but I do understand your frustration, yes.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, this is, this is.
[CUSTOMER][NEGATIVE] This is, this is, this is gonna be the first time that I'm gonna, I'm gonna stop or not do a payment in this country after 24 years living here, so whoever has to pay, I don't know who is not gonna be one for sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, sir. OK, and I'm glad you're uh.
[CUSTOMER][NEUTRAL] Even though I have plenty, even though, hey, even though I have plenty of money, which I don't, but if I would have had a lot of money, still I'm not gonna pay it. I'm gonna do what? 95% of people do.
[CUSTOMER][POSITIVE] And stop being or trying to be the good guy. Good guys, good people.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEGATIVE] Go nowhere.
[CUSTOMER][POSITIVE] Uh thank you for your time, OK?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] You're welcome [PII] and I hope you have a blessed rest of your day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][NEUTRAL] People