AccountId: 011433970860
ContactId: d534a0d8-2959-43fc-8eff-990ce27fb7f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512500 ms
Total Talk Time (AGENT): 187664 ms
Total Talk Time (CUSTOMER): 164093 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/d534a0d8-2959-43fc-8eff-990ce27fb7f1_20250122T14:45_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I carry, um, APL gap insurance, um, and I have been seeing a therapist, um, through Headway, and my primary insurance carrier, uh, pays for most of it, but I was wondering if I, if, um, APL will cover the remainder.
[AGENT][NEUTRAL] Can I have your policy number?
[CUSTOMER][NEUTRAL] Yes, give me one second, I'm pulling it up right now.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] I have it right here.
[CUSTOMER][NEUTRAL] Sorry [PII], one second.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][POSITIVE] Thank you. I appreciate it.
[CUSTOMER][NEUTRAL] OK. My policy number is, is it the inhospital or outpatient benefit?
[AGENT][NEUTRAL] It doesn't matter. Either one of them will pull up the policy.
[CUSTOMER][NEUTRAL] Oh, OK. 02404.
[CUSTOMER][NEUTRAL] 34
[CUSTOMER][NEUTRAL] M as in Mary. L as in Lake.
[CUSTOMER][NEUTRAL] 7.
[AGENT][NEGATIVE] Give me that number again without the zeros.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] Um, OK, 240-434.
[CUSTOMER][NEUTRAL] 3 M as in Mary, L as in Lake number 7.
[AGENT][NEUTRAL] And what was your name again?
[CUSTOMER][NEUTRAL] [PII] is my last name, [PII]
[AGENT][NEUTRAL] [PII], could you provide me with your
[AGENT][NEUTRAL] Your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] My date of birth is [PII] and my mailing address should be [PII].
[AGENT][NEUTRAL] Thank you and what is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] Excuse me, um, it should be [PII], thank you, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the callback number is [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] You're calling to verify if physical therapy is covered under your policy. It falls under your outpatient benefits of $4000 per calendar year. What is it?
[CUSTOMER][NEUTRAL] Not physical.
[CUSTOMER][NEUTRAL] It's not physical. It's uh like mental therapy.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So you wanna verify treatment received in the office is covered under your policy. So unfortunately your policy doesn't cover office visits or the treatment received in the office.
[CUSTOMER][NEUTRAL] It's not, I'm doing it like virtual. I'm doing like virtual therapy.
[AGENT][NEUTRAL] It it's, it's still not covered. Treatment is not covered under your policy other than for outpatient or inpatient services. And outpatient consists of physical therapy, diagnostic testing, ER, urgent care.
[AGENT][NEUTRAL] Surgical centers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So like
[CUSTOMER][NEUTRAL] My, my therapy is not covered.
[AGENT][NEUTRAL] That is correct. It's not covered on the APL gap insurance.
[CUSTOMER][POSITIVE] OK. All right, understood. Thank you.
[AGENT][NEUTRAL] The office visits and the treatment received in the office are not covered unfortunately. You may wanna reach out to your HR department to coordinator, benefit the coordinator to see if they have a better option for you to actually add office visits and the treatment received in the office on your policy.
[CUSTOMER][POSITIVE] Yeah, that would be great. It's like $75 every time.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I know, then it's the beginning of the year, so tell me about it.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] Yeah, it's just like, it's so expensive to get any kind of care, so.
[AGENT][NEUTRAL] Mm. Mhm. You'll be amazed at how many people don't go to the doctor because they haven't met their deductible.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah, I mean, it's like.
[CUSTOMER][NEUTRAL] Getting, it's like you have insurance, but then actually getting care is a whole other game, you know.
[AGENT][NEUTRAL] Mhm. It is.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I wonder, is there anything available to me that I'm like not using now that I have you on the phone like I know some people can get a dietitian or certain like.
[AGENT][NEUTRAL] Shows.
[CUSTOMER][NEUTRAL] Like health
[CUSTOMER][NEUTRAL] Professionals that may not be necessarily a.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Like a doc a traditional doctor that I could use this for?
[AGENT][NEUTRAL] So, as I just expressed the policy, it only covers outpatient services like um what I just listed, like, say if you get an X-ray, MRI, CT scan, something of that matter, what you just mentioned, like a specialist, it still will be considered as an office visit or the treatment received in the office, which is not covered unless it's like something surgical and it's taking place in an outpatient setting.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Let me see what else is covered.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Hold on. I think you have like treatment cancer writer.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So you do have a cancer writer. You have labs, say if you go to an independent lab that is covered. You have the cancer writers. We're not gonna pray that you have cancer, so we're gonna just give you the benefits. So if, if someone has cancer, then it'll be covered like the office visits pertaining to cancer, the treatment received for cancer in the office visit setting.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That will be covered, but your inpatient hospital benefits is 18 hours or more outpatient.
[AGENT][NEUTRAL] diagnostics, physical therapy, urgent care, emergency rooms, anything that's taking place in a hospital setting under 18 hours.
[AGENT][NEUTRAL] Um, your cancer writers, anything that's that's um pertaining to cancer diagnosis, your lab is covered.
[AGENT][NEUTRAL] And that's pretty much it.
[CUSTOMER][NEUTRAL] All right, so nothing crazy.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][POSITIVE] All right. Well, thank you so much for going through that with me. I really appreciate it.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it. Just have a great day. Stay healthy.
[AGENT][POSITIVE] Thank you for calling and and warm. It's freezing here in [PII]. Well, thank you and you do the same as well.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh yeah. Yeah, stay warm. Bye-bye.
[AGENT][POSITIVE] Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Right.