AccountId: 011433970860
ContactId: c52804f3-efd1-45a9-b59e-acd760025c78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 639020 ms
Total Talk Time (AGENT): 298522 ms
Total Talk Time (CUSTOMER): 231833 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/c52804f3-efd1-45a9-b59e-acd760025c78_20250218T22:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ACL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, good afternoon, good evening, [PII]. Um, this is [PII]. I have a couple of simple questions since it's our first time dealing with, um, gap insurance.
[AGENT][POSITIVE] Yes ma'am, I can help you with the benefits, Miss [PII]. Can you please give me your policy number?
[CUSTOMER][NEUTRAL] Um, yes, one second.
[CUSTOMER][NEUTRAL] I'll have to put you on um.
[CUSTOMER][NEUTRAL] On speaker for me to look that up. OK, so.
[CUSTOMER][NEUTRAL] You said policy number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, it might even say inpatient or outpatient certificate number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, yes, um, 02.
[CUSTOMER][NEUTRAL] 5757. [PII], I'm on the phone. I'm sorry, uh 0257254.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] 3 Mary Larry 7.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, Ms. [PII], can you verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then also for security reasons can you verify your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, address [PII].
[CUSTOMER][NEUTRAL] Um, my phone number or my husband's?
[AGENT][NEUTRAL] Uh, it, your husband is the account holder, so we would have his information.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, um, his number is [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And let me.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I don't know what he used.
[CUSTOMER][NEUTRAL] It is huge.
[AGENT][NEUTRAL] It looks like it's a personal email address if you know it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm not sure what email he used, but um maybe [PII].
[AGENT][POSITIVE] Yes, that's correct. Thank you so much for verifying the policy for me.
[CUSTOMER][POSITIVE] Oh good.
[AGENT][POSITIVE] Good.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is just to verify your benefits, it's not a guarantee of payment, so you're correct, this is a supplemental insurance policy so when you go to the doctors, you're gonna bring both cards with you, your primary insurance and this one.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] It helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if you go inpatient to a hospital, you have a $3000 benefit amount per calendar year that will go towards that deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] And then for outpatient you have a $1500 benefit amount per calendar year.
[AGENT][NEUTRAL] Um, let me see, let me pull up something real quick.
[AGENT][NEUTRAL] I'm gonna pull up your policy to see what facilities that you can go to for outpatient because it's based by facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm not really familiar with insurance and stuff, but outpatient is it like an emergency service type thing.
[AGENT][NEUTRAL] Outpatient, um, is anything that's outside of the hospital. So hospital stay would be 18 hours or more.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Um, so for example, the main reason why I'm calling is, um, currently 28, about to be 29 weeks pregnant, and I will be due in May. Um, I've already received the hospital bill, um, but it, it's.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The insurance that we have has a really high um deductible. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And my sister has my, my and my sister-in-law has worked with your um gap insurance and stuff, and she said that she's uh worked with that and it has helped, so I didn't really understand at that.
[CUSTOMER][NEUTRAL] The gap insurance is basically what we couldn't cover, but she said they could cover the deductible as well, or I'm not sure if I understood.
[AGENT][NEUTRAL] Right, it helps with deductible copay or co-insurance, so.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, the explanation of benefits that we get from the primary insurance showing what they paid is based on what we pay. So if it's a, if it's um, not covered on the primary insurance, it wouldn't be covered on ours either because they have to pay first.
[AGENT][NEUTRAL] Um, let me look and see.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, you do not have physician office visits?
[AGENT][NEUTRAL] So your policy will cover if you go to an ER urgent care center, MRI imaging center, or an ambulatory center.
[AGENT][NEUTRAL] And of course inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] So, so that's how, that's how it works. Um, always make sure that you give both cards and if you ever get
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It it's fine.
[AGENT][NEUTRAL] Go to the doctor or the hospital and they need to verify the benefits for you, have them call us and we'll verify the benefits over the phone for them.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Excuse me, um, and calling would be at any time?
[AGENT][NEUTRAL] Uh, we're open from [PII] in the morning till [PII] in the evening Central time.
[CUSTOMER][NEUTRAL] Central time, OK.
[AGENT][NEUTRAL] And just a quick review for your outpatient benefits.
[AGENT][NEUTRAL] So you know hospital is anything that's 18 hours or more. So you know that's for your inpatient benefits.
[AGENT][NEUTRAL] And then everything else would be your outpatient benefits.
[AGENT][NEUTRAL] You can use a hospital emergency room, urgent care facility, surgery in a hospital outpatient facility or a free-standing outpatient surgery center.
[AGENT][NEUTRAL] Diagnostic testing in a hospital.
[AGENT][NEUTRAL] Outpatient facility or an MRI facility.
[AGENT][NEUTRAL] Um, outpatient treatment for mental or emotional disorder in a hospital outpatient facility.
[AGENT][NEUTRAL] And you have physical therapy.
[AGENT][NEUTRAL] An ambulance.
[AGENT][NEUTRAL] For your outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It said nothing with um labor delivery.
[AGENT][NEUTRAL] That would be inpatient.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, yes, but.
[CUSTOMER][NEUTRAL] You said it wouldn't be covered because it's not being covered by the primary insurance?
[AGENT][NEUTRAL] No, if you go inpatient for more than 18 hours.
[AGENT][NEUTRAL] Then your policy pays up to $3000 per calendar year.
[AGENT][NEUTRAL] To help with the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the policy is for accident or sickness, and pregnancy is considered a sickness.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Under insurance rules. Yeah, so you're good.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] I, I feel sick all the time, so.
[CUSTOMER][POSITIVE] I guess so that's that's good.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, when I first found that out when I started working here and they told me that pregnancy was considered a sickness. Well, I had 4 kids, so I was like, well, that explains everything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, this is, uh, um, our 3rd 1, and I've never worked with Gap Insurance. We've always, um, worked with just regular insurance, um, so I'm just trying to get used to how does this work and just because our deductible was a lot higher than before and the policy is different and
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Yeah, it's always a good thing to have that little extra little bit of help. Any little bit helps to me anyway.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, definitely, um, so say that the, the deductible is 7000, you guys said that up to $3000 is what you guys would cover.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Gotcha. OK.
[CUSTOMER][POSITIVE] That sounds good to me. Um, and I will have to submit that to the hospital.
[CUSTOMER][NEUTRAL] Right now or once I, or after they give me.
[CUSTOMER][NEUTRAL] Uh, treatments.
[AGENT][NEUTRAL] Uh yes ma'am. Any time you go, go ahead and give it to them even if they've already got it, go ahead and give it to them.
[CUSTOMER][POSITIVE] Got you. OK. OK. Thank you, ma'am.
[AGENT][POSITIVE] You're so welcome, Ms. [PII], and I wish you the best with your new baby and everything goes well. OK. You're welcome. You're welcome. Thanks for calling ATL. You have a blessed night.
[CUSTOMER][POSITIVE] Yes, thank you. Thank you.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][NEUTRAL] Bye-bye.