AccountId: 011433970860
ContactId: d3e031f6-9dbb-43e6-9161-8b01351297ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398089 ms
Total Talk Time (AGENT): 149926 ms
Total Talk Time (CUSTOMER): 215870 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/d3e031f6-9dbb-43e6-9161-8b01351297ae_20250218T22:31_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, I was calling um to see if you could give me some clarification on my uh gap plan that I have through you all um and I was gonna see if um doctor's visits are covered by gap or not.
[AGENT][NEUTRAL] OK. No, sure, I can assist you with office visit benefits and may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am, so my name is [PII] and the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yes ma'am, so the policy number is going to be 02564459.
[AGENT][NEUTRAL] OK. And for security, may I have your date of birth, mailing address and email address on file for verification?
[CUSTOMER][NEUTRAL] Yes, uh, birthday [PII], uh, address [PII] and email is [PII].
[AGENT][NEUTRAL] We have your work email. Is that OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, yeah, so it'll be um [PII].
[AGENT][POSITIVE] Perfect, thank you. All right, and let's see what we have for office visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm not 100% sure if it is or not. The doctor's office had told me I just got off the phone with my primary, I'm getting some clarification on this, uh, bill that I'm asking about. But earlier when I talked to the doctor's office, they had told me, um, to check because some gap plans may cover office visits and other ones don't, I guess, and this is new to me. I just have had it since October so I was just calling trying to get some information on that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, sure, no problem. Before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. We cannot guarantee until we receive the claim. And let's see, uh, so let's see outpatient inpatient, OK, let me got the break down.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] Let me just a second because this one is a little bit different so let me go through all the benefits thank you.
[CUSTOMER][POSITIVE] OK, yeah, no problem.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So this one will cover for the um any procedures done in the office, but it does not cover the physician's office co-payment.
[AGENT][NEUTRAL] They will cover only for procedures.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK, yeah, let me just write that down if you don't mind that way I'll remember for future reference in office procedures.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Not regular.
[CUSTOMER][NEUTRAL] Is it for your copay? OK, perfect. I think that's what they billed me for was the $40 because I know that my primary covered um a portion of it, um, and then it's showing patient responsibility $40 but the doctor's office has just told me to check on the gap plan. So that makes sense, um, completely and um I had actually was on the phone with somebody earlier um.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] About a bill that I had received and so when you say like an in office procedure um that would be just any type of like uh like what like what type of procedures or does it just vary from claim to claim?
[AGENT][NEUTRAL] It's gonna be any type of procedures done in the office. Basically, if they give you an injection, if they did an X-ray, an ultrasound, um, if, uh, any type of procedure, as long as it's a procedure and it's not just the visit or the, um, just to see the doctor.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got you. OK, because the, the only reason I was asking is I actually have a uh claim out um from [PII], um, which was a in office procedure to remove a uh cyst.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] And the doctor's office hadn't originally filed it with the gap. So just today, I had talked back with the doctor's office and they um had submitted it now to American Public Life, and they said that it may take up to like 30 business days to get a result. Um, and like I know you can't guarantee it until you see it, but like, have you ever had, like, are those procedures normally covered or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Usually, they are. Yeah, we need to be looking at the um codes and everything, but yeah, if it was a cyst removal, it would be like a small surgery in office, which is a treatment or procedure in office. Yes. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. OK. All right. Well, that makes sense then, yeah, and that's kind of what when I even talked to the guy today at the doctor's office because I provided on both of my medical cards um back in October, but I think that they must have only filed with my primary and never followed up to file with the gap plan. um, so just as of today he was gonna submit.
[CUSTOMER][NEUTRAL] that and um so I'll just look to hear back on that but that's good to know on that and I'm assuming this is my first time having a gap plan but if I go to the website like the [PII] could I see what you're seeing um when you're telling me like what it covers and what it doesn't?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes. Um, if you go there and you click, it's gonna be your policy number is gonna appear blue. You're gonna double click that blue number. Um, it's gonna give you a PDF that it's gonna open. Um, it's gonna have like about 26 pages. If you go to page 14, it's gonna tell you, uh, that it's gonna be covered uh any procedures. It's gonna be outpatient physician treatment facility, and it's gonna tell you that um it will cover the treatment, but it will not cover the physician's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, got you. OK, alright, well, perfect. Well I think that's answered all my questions that I need to know.
[AGENT][NEUTRAL] All right. Well, is, is there anything else I may help you with today?
[CUSTOMER][POSITIVE] I think that's it for right now. I appreciate it though.
[AGENT][POSITIVE] OK. You're welcome, and thank you for calling APL. You have a good afternoon, OK?
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.