AccountId: 011433970860
ContactId: c69c1fa2-5fbc-499b-981b-3b9644ea4634
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 829099 ms
Total Talk Time (AGENT): 445945 ms
Total Talk Time (CUSTOMER): 462685 ms
Interruptions: 16
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/c69c1fa2-5fbc-499b-981b-3b9644ea4634_20250207T17:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I was wondering if you could um try to answer some questions I have about using the APL that I have um uh through my employer.
[AGENT][NEUTRAL] Sure we could take a look at what kinds of policies you have and how you can use them. uh, what was your name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and [PII], uh, can I first get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have a policy number?
[CUSTOMER][NEUTRAL] Yes, um, 02572567.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] OK, and [PII], just gonna verify some information really quick. Can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you. Uh, looks like it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that information [PII]. OK, so you've just got the one policy with us. This is a secondary medical policy. So in short, um, what it's designed to do is to help with co-pay, deductible and co-insurance after your major medical pays. So this plan is very dependent on your major medical, um, if they're not willing to pay this policy can't. If they do, then this policy can.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the two specific questions I have are, so one thing which I brought up with my employer is that our.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] In our Blue Cross plan year starts in September, and this was effective, I guess not until January. So it really is a disservice to us because I, um, in that matter of time, because of the um health conditions I have, have, um, already met a lot of my um out of pocket, um, uh requirements.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So I'm wondering, uh, first of all, like I'm thinking is this even gonna be helpful for me in the future? And if that is something that you guys um ever deal with the employers and trying to get those plan years to match up because otherwise it, it can be useless.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] You're right, and frankly speaking, no, I've not, that's a really good point and honestly now that I'm thinking about it, I'm kind of shocked that we haven't or I personally haven't heard that before, um, so and that that does make complete sense, um.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, I don't think there's a lot of people whose plan years. I don't think, yeah, I don't think a lot of people's, um, insurance plan years start other than January because people are always surprised that ours does, but, um, but it, um, you know, that wasn't really pointed out to us. I had to kind of figure that out myself, um, that this is offset from that so I'm kind of paying. I don't even know if I'm gonna be able to use it, um, so for.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Of course, that, and yeah, that's a really good point. Go ahead.
[CUSTOMER][NEUTRAL] Mhm so yeah that would be helpful to maybe have you guys um uh talk about um and I have brought it up to my employer I I don't know um what the kind of coming together of that is but I'll keep bringing it up with um you know, whoever she directs me to but so for example um.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, my daughter, um, today, she, that's [PII], and I play pay for employee and child. So she had uh outpatient, um, oral surgery today, and I had to pay $545. And so, um, is that something that, uh, potentially can be covered then?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check, um, so as this is a secondary medical policy, uh, some of these are explicitly state that they don't cover anything to do with, um, oral or vision, um, but let me get that policy pulled up and we will just double check, um, now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] While this is getting pulled up, I will say um I completely understand where you're coming from as far as having already met your deductible and things like that but this plan does also again assist with co-pay and co-insurance. So if you ever had co-pays or whatever is left over after you said it was Blue Cross that you have.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] If there was ever like a remaining balance that they were unable to meet, that's where this policy kind of kicks in as well.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So there
[CUSTOMER][NEGATIVE] Right, so I had a lot of co-pays and co-insurance already from the start of our plan year, [PII], but now I either have met or I'm approaching meeting my co-insurance and out of pocket maximum, meaning I, I, you know, at some point will not have anything to pay. And so I've already paid, that will be $9000 of my maximum for the year and I haven't been able to use this because.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It didn't start until Sept until January, right? So if it, if this had coincided with our plan year, um, starting over, then it would have been very helpful for me. I'm actually getting ready to have a surgery next week, um, uh, and in a, in a hospital. Um, and so if my deductible and my out of pocket, my, if I don't have any patient responsibility, this pays nothing. Is that right?
[AGENT][NEUTRAL] Man, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Essentially, that is how that works, yes, um, again, it's, it's just that co-pay deductible coinsurance, it's not, this plan is extremely dependent on basically picking up where your major medical leaves off for you. Um, so then again, I've really, I never really, I thought about it or had anyone point that out, but um I'm kind of shocked now that you mentioned it that I haven't cause that's a very good point.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The Blue Cross, yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yeah, I mean, I, I just, you know, I mean, I, I probably won't take this out again because if it, if it's gonna be offset like that every year, it's not ever gonna, right, yeah.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Sure, if that's not going to do you any good, yeah, I don't blame you at all if that's not going to work for you now I would, um, like you said, uh, this seems to be something generally going to be in your employer's ballpark as to when it would be effective, um, so the calendar year reset so if they're willing to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It kind of just shift that a bit to match your major medical, which I'm not sure why they wouldn't, especially since both are going to be through them, but I don't know that's, that's definitely an odd one.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, and I will say, um, I did go ahead and look in your policy, and, and under the exclusions are dental or vision services including treatment, surgery, extractions, or X-rays. Um, and if you would like, [PII], it sure sounds like you really well about getting all your ducks in a row anyway, but if you don't already have it, I can send you a copy of the policy certificate. Do you have it for this policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yes, uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I, I don't believe I have the full certificate, um, so that would be great if you could send it by email, OK OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can go ahead and send that to you so you could, yes, you can give that a good look and that way you can of course make a good full educated decision as to whether or not this policy would be right for you and your dependent um now do you want me to just send that to your, uh, this Cox email that we've got?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yes, that would be great. So in your experience, have you seen some policies that don't, that's I mean on the on your side, the APL side that start at different times of the year?
[AGENT][POSITIVE] OK. All righty.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, but I will say that our policies are on a calendar year, so even if they're the effective date, which is usually what we look at, and now of course yours effective date is [PII], um, but some could be in October or you know a random day, but it's still the benefits for this plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and then it goes October to October.
[AGENT][NEUTRAL] This the benefits for this plan are on a calendar year, uh, reset so and I don't usually, I don't have access to of course major medical plans or and when they start or if they're a calendar year or a specific day um but this is certainly a point that's never been brought up to me before, so that's very odd. I'm not sure if that's your just employer is a bit different with that or if that's just something most people don't think about it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Gosh, it's crazy.
[CUSTOMER][NEUTRAL] I mean, it, it seems like if you guys, if
[CUSTOMER][NEGATIVE] Yeah, I don't know, um, and if, um if you guys operate on calendar year, um, only then even if they changed our date to [PII], which is when our Blue Cross changes, it still is gonna roll over to the end of the year. I, I don't know that, yeah, so I'll just have to talk to my employer after since I don't have this information from you and it's a mess.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, I would say because I'm not quite sure how the major medical if they were to do calendar year that would make a lot more sense with it working with this kind of policy or if it was even, you know, shifting closer to the beginning of the year so that would kind of match up a bit better.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. And then um what about uh co-pays for medication or medical um supplies? Is that included or it's just like the surgeries and things like that?
[AGENT][NEUTRAL] I can take a look for sure. Give me just a moment. I'm, I'm sending this policy to you really quick, um, just so I can get that taken care of first, um, and then I'll double check to see if um there are any prescription benefits on this policy.
[CUSTOMER][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I did send that to you.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So there are no prescription benefits under this policy that is listed under the uh exclusions as well. And then um did you, was it, um you said medical equipment like uh durable medical equipment, is that what you meant?
[CUSTOMER][NEUTRAL] Yes, like, uh, my daughter has type one diabetes, so diabetes supplies. I don't think I see anything like that on here. I think it's just inpatient and outpatient ER cancer writer, independent lab. This is one little one-page thing my employer sent me.
[AGENT][NEUTRAL] Mm, yes, sure, let's see.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Outpatient cover charges do not include charges for durable medical equipment that is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Under the policy
[CUSTOMER][NEUTRAL] Yeah, OK, so that's what I needed to know and um it's just so I can, you know, kind of make sure that I'm reading all of this right? so.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] Absolutely making, yes, so you could see if this is working best for you. Mhm.
[CUSTOMER][NEUTRAL] So, so the inhospital benefit, so ultimately, when I go in the hospital next week to have surgery, if I don't have any out of pocket, co-pay, deductible left to pay to, to pay, then, um, because Blue Cross pays it all, if that were to happen, then there's nothing to, you don't get an amount for going in the hospital.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, so if we, because this plan would need the explanation of benefits from primary obviously seeing what they contributed so if we were to get that and we see that they paid everything 100%, there's nothing that this plan can pay that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You don't pay anything.
[CUSTOMER][NEUTRAL] OK, alright, that's what I'm understanding this to be, so I do wish that they would have, um, and you know, maybe it's something to mention, um, to, you know, somebody that you, um, have access to to talk about that. I, I definitely am my I mean, you know, just for.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Sure, I, like I said, I'm a bit blown away by this cause that's an excellent point and I, again, I'm very shocked. This is the first I'm kind of coming across this, um, but you, absolutely good point.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, and so I have had cancer and so I have like certain things I have to do at certain times of the year. So since um those weren't due until after my Blue Cross started again in September, then I've had a majority of those done. um I need to check and see. I, I don't think this is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So it probably would have been uh well after your deductible has already been met.
[CUSTOMER][NEUTRAL] Well, yes, I've, yeah, I've already, yeah, so most of that happened between September and, and January 1, and then I only have a few things left to do now, and I, I'm getting pretty close to have met my deductible if I haven't already. Um, urgent care, surgery.
[AGENT][NEUTRAL] Is that what you mean?
[AGENT][NEUTRAL] And for you that you need that and then it um it resets in September is that what you said?
[CUSTOMER][NEUTRAL] Yeah. Mhm. Yep, yep.
[AGENT][NEUTRAL] OK, so I mean in the terms of like longevity this could help because even if you had to pay out of pocket um this plan resets on the calendar year so if you did have to pay anything out of pocket since this policy was active going forward I mean you could still file those claims but as of this present time, yeah.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yeah, so like this September in [PII] this will already be active my stuff reset, so if I have to have something done in the fall, then it then this might potentially, yeah, OK, maybe it's just this first year it'll end up not working out very well um but but.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Plus
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Be a bit, yeah, but again, that's what it go go ahead and give that policy a good look through um just so that you can weigh out what's obviously going to be best for you and your family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK. All right, very good, thank you for your help. I really appreciate the information.
[AGENT][NEUTRAL] Do you have any other questions for me? Absolutely.
[CUSTOMER][NEUTRAL] I don't think, yeah, I don't think so right now. I'll look through the stuff that you sent and um talk with my employer so, all righty, thank you very much. Have a good day. OK, thanks. Yeah, thank you. Uh-huh. Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely, yeah, thanks for giving us a call. You too. Thank you. Bye bye.