AccountId: 011433970860
ContactId: dadce503-e2da-43de-96af-61cf77f5a1b5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 324839 ms
Total Talk Time (AGENT): 148353 ms
Total Talk Time (CUSTOMER): 164752 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/dadce503-e2da-43de-96af-61cf77f5a1b5_20250318T21:44_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and um I'm calling because I just realized that I have gap insurance. um
[CUSTOMER][NEUTRAL] And there have been a number of expenses that I incurred um over the past year. And I'm hoping that I can talk through, I've never used a gap insurance. I just want to know what types of um
[CUSTOMER][NEUTRAL] Expenses, the gap cover between the expenses I've had to put out of pocket versus um what the insurance, my, my Blue Cross Blue Shield health benefits has covered.
[AGENT][NEUTRAL] Yes, so let's look at that. You see, what is your policy number, please?
[CUSTOMER][NEUTRAL] Policy number is uh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I have a group number.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] It might begin with a 01 or 02. Sometimes they list it as outpatient or inpatient benefits.
[CUSTOMER][NEUTRAL] Yes, I have both. I have an inpatient, I mean I'm sorry, an in hospital and outpatient. I'm gonna give you the outpatient because I believe everything has been outpatient. 002478709 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you. And if I could just verify your last name, uh date of birth, and a phone number, please.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Sure, it's [PII]. Date of birth is August [PII] and um phone number is [PII].
[AGENT][NEUTRAL] Thank you. And of course, you've had this since [PII] and what we do is we cover uh in and out of hospital benefits. So, um, for outpatient hospitals such as the ER, urgent care, outpatient surgery, um, outpatient if you needed to have any imaging done, um, what we do is we, uh, or durable medical, what we do is we pick up the uh deductible co-payment or co-insurance from Blue Cross up to $300 per calendar day.
[AGENT][NEUTRAL] If you ever needed an in-hospital service, if you were ever in the hospital for 18 hours or more, we pick up the deductible, co-payment or co-insurance up to $3000 per occasion.
[AGENT][NEUTRAL] But that is, is what uh we, that's what your, your gap insurance covers.
[CUSTOMER][NEUTRAL] So, let me ask you this, I think I have the, I, I'm understanding. I was, um, taken, I, I had to take myself into the the ER last [PII], um, uh, due to an emergency, I went into preterm labor and I had a $500 co-payment. Is that something that I can put through? I've obviously already paid it, um.
[CUSTOMER][NEUTRAL] Uh, but is that something that I can put through for reimbursement?
[AGENT][NEUTRAL] Absolutely, yes. Uh, please do. Um, you can submit that to us. Now you'll notice on your um on your card, it should have a website. Uh, it, it, it's [PII]. And so what you're going to be sending to us, um, they would have given you walkout papers uh when you left the ER and basically that's just an itemized bill. Um, and then you have the date and it has the diagnosis, you know, why you were in the ER, that sort of thing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you'll have the explanation of benefits from Blue Cross and Blue Shield showing how they, how they process your claim, uh, you know, what they put towards your deductible, co-payment or co-insurance, and that is what you'd need to send to us. uh, and then what we do is because you are submitting the claim, uh, obviously, of course, we, we make that payment to you.
[CUSTOMER][NEUTRAL] OK, and the same, I have the same for imaging. After my loss, I was sent, uh, I was having some after effects, um, and I was sent for a CT scan. Is that something that's that I will also send as far as image like does that fall under imaging?
[AGENT][POSITIVE] Yes, absolutely it would.
[AGENT][NEUTRAL] It certainly would.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] So anything that that was related to that you I would just go ahead and send it all in and what we do is we look at it just to be absolutely certain that it's, you know, that it's something that uh that we can pay. So if you have any questions about it when you're sending these in, um, pleased to send them in, uh, you know, we, we'll be more than glad to look at any bill that you have and if we can pay it, we certainly will do that.
[CUSTOMER][NEUTRAL] And um
[CUSTOMER][NEUTRAL] OK, and, and just I, I, I'm, I'm understanding you and I'm just gonna ask one more question just to see if I'm getting it right or not. There were also a number of set of um like lab work that I was sent for. Would that also be covered or is that not is lab work something that's out of the scope?
[AGENT][NEUTRAL] Sure.
[AGENT][NEGATIVE] That, that would not uh be covered. No, the, the independent labs, unfortunately would not be covered.
[CUSTOMER][POSITIVE] OK. So CT scan and the ER. Thank you so much.
[AGENT][NEUTRAL] Is there anything else at all that I can help with?
[CUSTOMER][POSITIVE] No, [PII], you've been very helpful already thank you very much. I appreciate your assistance.
[AGENT][POSITIVE] OK, thank you for contacting ATO. You have a very.