AccountId: 011433970860
ContactId: e53727ec-3a30-4c97-98e9-f003ccd4b887
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497299 ms
Total Talk Time (AGENT): 272503 ms
Total Talk Time (CUSTOMER): 231931 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/e53727ec-3a30-4c97-98e9-f003ccd4b887_20250612T14:04_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], uh, I got a question. I have gap insurance through my company.
[CUSTOMER][NEUTRAL] And uh I wanted to see if this also included uh gap insurance for, for dental coverage like for any dental bills that I have. So I don't usually, I, you know.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Go ahead. I'm sorry.
[AGENT][NEUTRAL] Oh, please, please go ahead. No, I'm sorry. I, my, my phone is kind of on a delay and so I, I could, I, I thought that you had finished. So, oh no, I'm sorry, please go ahead and finish telling me what you needed.
[CUSTOMER][NEUTRAL] OK, like I very rarely have used my coverage and I now have a, a large dental claim, and I wanted to know if what I, if I can submit it and what I need if it's covered.
[AGENT][POSITIVE] Yes, I'd be glad to help you with that. What is your policy number, please?
[CUSTOMER][NEUTRAL] My policy, I have a group number. It's uh 17294.
[AGENT][NEUTRAL] And on your card, does it have an inpatient or outpatient? Uh, on your card, does it have?
[CUSTOMER][NEUTRAL] If that's what you need.
[CUSTOMER][NEUTRAL] Oh, you, oh, you know what? I'm sorry. I'm sorry, I do have a policy number. I just realized it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is that, please?
[CUSTOMER][NEUTRAL] It's 02287961.
[AGENT][NEUTRAL] Thank you. And so that I make sure that I have the right policy, if you could give me your name, a date of birth, and a phone number, please.
[CUSTOMER][NEUTRAL] Yes, my, and this is through my employer. My name is [PII]
[CUSTOMER][NEUTRAL] And my date of birth is [PII].
[CUSTOMER][NEUTRAL] And my employer, you said? Or what else do you need?
[AGENT][NEUTRAL] Uh, no, no, is this your phone number?
[CUSTOMER][NEUTRAL] Oh, my phone number? Uh, well, you probably have my my cell number is [PII].
[AGENT][POSITIVE] That's great. Thank you very much. Um, [PII], your policy, uh, which went into effect on [PII].
[AGENT][NEUTRAL] This covers inpatient or outpatient hospital services as well as um.
[AGENT][NEUTRAL] Uh, the office visit co-pay, but there's, there's no specific dental coverage. Now if there is, uh, if you are in an accident or if it's, um, uh, a sickness, uh, related to, uh, your, your mouth or, or, or your, uh, or, or teeth, um, then we will be more than glad to look at the claim, uh.
[AGENT][NEUTRAL] But this is for accident and sickness, so the general, um, uh, general benefits for your, for your dental are not gonna be covered under this. Now, normally your employer will have a separate dental or or vision coverage.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, which is why this, this policy doesn't cover that. Did, did you check with your HR to determine?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Well, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, actually I am HR, but again, this is nothing that I usually use cause luckily, luckily I'm not usually sick. This is for a crown that I had that I that it fell off, so now I have to replace it and I don't have dental coverage. So I was wondering if that was covered because it's costing me like, I don't know, 15 $1600.
[AGENT][NEUTRAL] 00.
[AGENT][NEUTRAL] 00, I see. Oh, I, um, yeah, oh yeah, bless your heart. Um, no, this is, this is not gonna cover something like a print, um, it's, it's not going to do that. It will, and I am sorry about that. Yeah, it, it, what it will do is it will cover, um, uh, if, if there was like an accident or something like that, uh, we can certainly look at it for that sort of thing. But if we are looking at for anything else.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Well, I accidentally fell off.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, I, I wish that it were. I wish if that were possible. That would be very nice if that, if that was the way it was gonna work, um, but it's not gonna under this, under this policy, it's, um, you can certainly submit it by all means submit a claim, um, if you would like, but under normal circumstances that that is not gonna be covered under this policy.
[CUSTOMER][NEUTRAL] OK, and, and like I said, even though I'm HR I very rarely, I mean, um, you probably can check cause we've had APL for I don't know how long, and I don't recall even the last time that I submitted a claim, uh, for just so that I can at least make up some of the money, just regular uh doctor bills or whatnot or lab work, is that covered?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Well, let's, uh, let's go over your benefits. Absolutely, let's go over your, your policy. Um, so for outpatient services, um, then that includes, uh, urgent care, uh, the ER, um.
[CUSTOMER][NEUTRAL] As small as they might be?
[CUSTOMER][NEGATIVE] Oh no. Nope.
[AGENT][NEUTRAL] It covers uh.
[AGENT][NEUTRAL] If you uh outpatient surgeries?
[CUSTOMER][NEUTRAL] No, I I haven't had any of that.
[AGENT][NEUTRAL] OK, um, it also covers that, uh, office visit co-pay, the, the actual copay, and then there's in-hospital benefits.
[CUSTOMER][NEUTRAL] Nope.
[CUSTOMER][NEUTRAL] Not a lot.
[AGENT][NEUTRAL] That, that, that is what these policies cover.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so just the copay, no lab work either? Well, lab work is really not a whole lot either.
[AGENT][NEGATIVE] Uh there's not, no, it does not cover.
[AGENT][NEUTRAL] Yeah, it doesn't cover the lab work either.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Any, oh what did I do the other day, uh, diagnostics, like, you know, not X-rays, but like MRIs or, you know, kind of any kind of scanner or stuff like that.
[AGENT][NEUTRAL] If it's done in an outpatient setting then yes.
[AGENT][NEUTRAL] That that's considered outpatient.
[CUSTOMER][NEUTRAL] OK, I got
[CUSTOMER][NEUTRAL] Yeah, OK, let me check my bills, what I've submitted because I always forget that I have this. So OK, let me check to see what I paid and how long do I have to submit it when I've had the procedure done or any work done?
[AGENT][NEUTRAL] Well, there's no timely filing, um, so you can, you can submit it at any time.
[AGENT][NEUTRAL] So if, if it even if it's a couple of years out, I, I would just go ahead and submit it to us. Um, sometimes it happens that people have forgotten that they have their gap insurance and so we, you know, we, we do get that every now and again and, uh, so we don't have any sort of timely filing this please send it in any time and, um, then we will see what we can do about getting that taken care of you, but that is what your, your, uh, coverage, uh, is it for the inpatient outpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, let me go back and see what I've done and see what I can get and I, and what's because I know there's a number that is it uh the number that you need from from the service provider, what's that number that you guys call? It's not, I know it's not a claim number it's got, uh, because I used to fill it out for one of the owners here, uh, the number of the service.
[AGENT][NEUTRAL] We do have a claim.
[AGENT][NEUTRAL] Uh, well, it's uh it's physician, it's uh um place of service 22 or 21.
[AGENT][NEUTRAL] Is that, but if you're looking, if you're thinking about the form itself, uh, or that that we do have that on online.
[AGENT][NEUTRAL] Um, you can submit these claims.
[CUSTOMER][NEUTRAL] Well, yeah, that's true. I used to get it from there for someone else. OK.
[AGENT][POSITIVE] Yeah, and I would certainly go online now. I will tell you that uh we just recently updated our online services and so you will probably have to go in and, and, uh, rebuild it with a new account number and a new um a new password, but you can track your claim, you can uh print out cards, uh, you can get the, um, uh, you can download things and, and we get it in real time and the faster that we get that, you know, here in our office so that we can process it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The faster that we can get the benefit back to you. So, um, our online service center is going to be on your, uh, card. It's [PII], or you can fax it or mail it if you like.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] The online service centers a lot faster.
[CUSTOMER][NEUTRAL] Yeah, no, I
[CUSTOMER][POSITIVE] Yeah, no, like I said, I used to do it actually for one of the owners and I would submit it for him online, because I know that that's usually quicker. But yeah, let me go through my old bills and see what I have there and hopefully I can get something back, because it will help with my crown.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely, absolutely. Well, if you do have any questions submitting that, please call us and we'll be glad to walk you through it.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well, I really appreciate your help. You've been super, super helpful.
[AGENT][POSITIVE] Mhm. Well, thank you for contacting API. You have a very good morning.