AccountId: 011433970860
ContactId: eb22cad8-7c17-4679-90cf-07db005cc376
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351839 ms
Total Talk Time (AGENT): 123957 ms
Total Talk Time (CUSTOMER): 144214 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/eb22cad8-7c17-4679-90cf-07db005cc376_20250603T12:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, um, I don't have my, uh, membership number. Can you pull up on my social?
[AGENT][NEUTRAL] Um, yes, sir. One moment. Um, first, can I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. And could I get a callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, and I'm ready for your social.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. What do you need?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm sorry, [PII]. Let me get your social one more time, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found you in our system. Please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and please verify your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, sir. And how can I help you?
[CUSTOMER][NEUTRAL] Yeah, I have to go see the eye doctor again today. Um, what's is there a maximum on claims?
[AGENT][NEUTRAL] Um, for office visits.
[CUSTOMER][NEUTRAL] Because I'm about to send one in.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's a.
[AGENT][NEUTRAL] Yes, sir, I'm showing that for services provided in office, we don't cover the copays, but for office treatments, we cover up to $500 per day.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] OK, I have gap insurance. They said that they does cover copay.
[AGENT][NEUTRAL] Well, not for office visits. Um, it covers the co-pays for inpatient hospital if you're ever admitted or for outpatient hospital services like ER visits or outpatient surgeries. But if a, a procedure is done in office, the co-pay is not covered, but the co-insurance and the deductible is covered and that's covered up to 500 per day.
[CUSTOMER][NEUTRAL] Yeah, how much power.
[CUSTOMER][NEUTRAL] OK, so, so what's the, what is the point of gap insurance if you never have major work done?
[AGENT][NEUTRAL] Well, um, charges go towards the.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] They, they told me co-pays were covered.
[AGENT][NEUTRAL] Not for office visits, co-pays are, copays are covered, but not for office visits, sir.
[CUSTOMER][NEUTRAL] Are you positive?
[CUSTOMER][NEUTRAL] Well, what else would it be covered for than an office visit?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What other things have copay?
[AGENT][NEUTRAL] Um, DME services, services provided in urgent care facilities. There's several.
[CUSTOMER][NEUTRAL] After you've used up your total.
[CUSTOMER][NEUTRAL] OK, I've used up all my out of pocket, so whenever I go to a doctor now there's a copay, so you're saying the gap doesn't cover anything but a major.
[CUSTOMER][NEUTRAL] Going in for treatment.
[AGENT][NEUTRAL] When you go in for an office visits, there's charges that go towards your um co-insurance and your deductible as well, and that gap insurance covers for office visits up to $500.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK, so let me get this straight. I'm going into the eye doctor today for an office visit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] My my insurance is already used up, OK? So my out of pocket is at the max.
[CUSTOMER][NEUTRAL] So what is the gap insurance cover?
[AGENT][NEUTRAL] The gap insurance is going to cover all the charges that go towards the co-insurance and the deductible for your office visit. We cover up to $500.
[CUSTOMER][NEUTRAL] OK, so if it cost me $100 to go to the office visit.
[CUSTOMER][NEUTRAL] It will be covered by gap insurance.
[AGENT][NEUTRAL] The charges that go towards the co-insurance and the deductible. Yes, sir. The gap will cover up to 500.
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] OK, alright, I, I, yeah, I'm gonna call my, I got Blue Cross, um, Florida Blue Insurance. I'm gonna call them and ask them where I stand. So, OK, alright, that's all I needed to know. So there's not, it's up to $500 a year, I guess.
[AGENT][NEUTRAL] Yes. Well, $500 a day for, for outpatient services. It's $500 a day.
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][POSITIVE] OK, thanks all right, thank you very much.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else I