AccountId: 011433970860
ContactId: 0f9a9ba8-d0c5-43c1-b935-029da67e8d2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 823460 ms
Total Talk Time (AGENT): 462676 ms
Total Talk Time (CUSTOMER): 350490 ms
Interruptions: 11
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/0f9a9ba8-d0c5-43c1-b935-029da67e8d2b_20250218T23:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Um, my name is [PII], and I was calling to find, um, in-network, uh, mental health counseling providers through, uh, my APL insurance, medical insurance.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mental health. OK, let's get that policy pulled up. You said for mental health providers?
[CUSTOMER][NEUTRAL] Yes, I hope that it it helps with co-payments or something at least, so they are expensive.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. We'll get
[AGENT][NEGATIVE] Oh, I know, I know, any kind, really. It's awful.
[CUSTOMER][NEUTRAL] I'm like they want you to, I'm like they want you to get mental health services like, but then they wanna take all the money too. I'm sorry, like, like.
[AGENT][POSITIVE] Mhm, yup. OK, no, no, no, you do not apologize, trust me, I get it, and that is any kind of mess, um, go get therapy. OK, let's pay $500 a visit. That's cool.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No, like, the lady I'm go to tomorrow out of pocket $225 just for her to like tell me how many sessions and then it'll be $175 each session. I'm like, and is that gonna be like twice a month, once a month, like that's expensive like.
[AGENT][NEGATIVE] damn it.
[AGENT][NEUTRAL] Yikes.
[AGENT][NEGATIVE] It's supposed to be helping your mental health. All that's gonna do is stress you out.
[CUSTOMER][NEGATIVE] Yeah, like come on now like what like.
[AGENT][NEUTRAL] For real, well, let's get your policy pulled up and I'll take a look at what kind it is and we'll see um I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Oh, right.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, OK, thank you. I know you did tell me that. OK, and then, uh, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, I do. Is that the member ID number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] For medical ID um D as in dog 468-02148.
[AGENT][NEUTRAL] OK, so that's actually not one of our policy numbers. Um, that's going to be through they're called 90 degrees and it is a bit confusing, um, it's a multi-plan and I know the phone number you probably called it what was on the back, um, a specific option could give you to us and it's possible you do have a policy with us but not with that policy number. So if you'd like I can use your social to search to see if you've got a policy with us, or I can transfer you to 90 Degrees.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, let's see, I, I can give you my social to see first and um my social is [PII].
[AGENT][NEUTRAL] OK. Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. It's a lot of third party stuff going on with this um staffing agency insurance like confusing.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Yeah, it's, uh, it does get very confusing. I mean, I work this job and it confuses me.
[AGENT][POSITIVE] I completely get it.
[CUSTOMER][NEUTRAL] But you're like, I need money though, so I'm gonna deal with it.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I know what our plans are. That's, that's gonna be that. So that's, you know, let's see if you've got one. Give me just a moment.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, I do believe I found you. I'm just gonna verify some information really quick, [PII]. Can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address we've got on file for you uh looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Perfect thank you so much for verifying that. OK, give me just a moment. So sorry to add to the confusion, but um this is, it's a limited indemnity medical plan. So with that, of course it is a bit limited on its coverage. Uh, the indemnity, what that means is it's set to pay a specific dollar amount per covered procedure or office visit. So give me just a moment. I'm gonna get your policy pulled up here so we can take a look at that coverage. They're all very different.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And just to clarify, um, I'm sorry, [PII], is this for, um, specifically for therapy?
[CUSTOMER][NEUTRAL] So like, um, mental health counseling, um, I do have a pre a past history like uh being diagnosed with like mood disorder and stuff like when I was early [PII] years, and I just been kinda like swinging it throughout the years. It's been a very long time, so I'm trying, yeah, just get myself back.
[AGENT][NEUTRAL] Counseling.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I completely understand um the reason I ask is more what kind of facility it's located? Is it specifically for mental health counseling or is it more of a physician's office or a specialist office?
[CUSTOMER][NEUTRAL] It will be like for mental counseling, but I know that's still like I thought it would be like still healthcare because it's your mental health like, no, so yeah, I know it's kind of different like most people probably don't call about that like trying to even get that.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] No, no, no, I completely understand, and they do. The problem is, of course, mental health is such a broad term and these kinds of policies, they can be a bit specific on location, so what kind of facility it is, um, so if you don't mind, um, I'm just going to put you on a brief hold, [PII]. I'm going to reach out to our claim specialist just so that they can let me know for sure.
[CUSTOMER][NEUTRAL] OK, because I don't even know where I'm trying to get a referral sent out to that's why I'm calling you guys to see what, what do you guys have in network and, you know what I'm saying, so yeah.
[AGENT][NEUTRAL] OK, so I can answer that, uh, this plan does not have a set network um the biggest thing I'm wondering is if in fact it would be a covered benefit under this policy, so it's not.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Well, it's
[AGENT][NEUTRAL] Mhm go ahead.
[CUSTOMER][NEGATIVE] Everybody I've called for like with this insurance, I kind of feel like am I wasting my money because every place I call it comes up on Google or anything, they don't accept this insurance. So it's kind of like am I paying for nothing when I call y'all y'all don't have a set specific people that accepts your insurance. So I'm like I'm gonna be calling.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, it is a bit different, yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. It is.
[AGENT][NEUTRAL] It is a bit different, um, it is a bit different, absolutely, and if you would like, I don't know if you have it or not, [PII], but I can send you a copy of your policy.
[CUSTOMER][NEUTRAL] Forever.
[AGENT][NEUTRAL] Um, it's not just a bunch of jargon, I promise it's very easy to read, um, but it does go through, uh, what is and is not covered dollar amounts, frequencies, things like that. Again, I'm going to get clarification on the mental health, but that way you can kind of read it because this kind of policy is certainly not for everyone. So if you go through it, read it, and you determine it's maybe not for you, you can kind of make that educated choice.
[CUSTOMER][NEUTRAL] I don't mind the thing. I
[CUSTOMER][NEGATIVE] This is the thing, yeah, I don't mind it being limited and they own you guys only covering a certain amount of stuff. It's just I can't find any providers and you guys don't know what providers to tell me to call and try to schedule like it's hard like.
[AGENT][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh I see.
[AGENT][NEUTRAL] So with that,
[AGENT][POSITIVE] With that, yes, no, I understand it is extremely frustrating um and so with that the best advice I could give you is number one, if anyone is confused they've not heard of APL, which that does happen quite a bit they are more than welcome to give us a call we do talk to providers all the time and we can go.
[AGENT][NEUTRAL] To verify your coverage with them if they choose not to, um, whatever provider you go to or if you've already received treatment like it was an emergency or something, um, and they won't file the claim for you, you can still file the claim regardless of where you go to uh get treatment.
[AGENT][NEUTRAL] That's essentially what this means as there's no network.
[CUSTOMER][NEGATIVE] Yeah that's gonna be, they, I feel like them doctors gonna be lazy like.
[CUSTOMER][NEGATIVE] Cause you know, it's not their job to call y'all, is it like that's so that's why I feel like they're not gonna want to do it. They're like, oh we don't accept that and just like I'm nobody special for them to be trying to go through all that extra force like you know.
[AGENT][NEUTRAL] It really depends. No, you're right.
[AGENT][NEUTRAL] It's, it really does depend.
[AGENT][NEUTRAL] Well it really depends. That's the thing that's the thing, uh, they're all so different, um, we do have quite a bit that will file claims for these kinds of policies, but we do hear that quite a bit where some are just kind of like I don't wanna mess with that so um.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] And I am sorry again I would really encourage um wherever you go to try to give have them give us a call so that we can explain the policy to them and the benefits and such and hopefully they'll be able to do it for you but again if not you can and we can kinda walk you through that if you need help filing claims.
[CUSTOMER][NEUTRAL] Like, who made up this APO insurance? How long has this been existing? It's basically like, no, I'm serious, like it's basically like unknown and foreign to these people, so everybody I call is like, oh we don't expect that and and it.
[AGENT][NEUTRAL] Well, a lot of our coverage options that we have are considered supplemental, so we have a lot of different policies like um dental, cancer policy, short term disability, things like that that are considered supplemental.
[CUSTOMER][NEUTRAL] Yeah I I see, but.
[CUSTOMER][NEGATIVE] This is the 3rd time. First, it was the eye doctor. I paid almost $400 for my glasses, even though I was paying for this insurance through the job because they didn't accept it. Nationwide vision, they tried to look it up and stuff and it was confusing to them as well, and I still haven't.
[AGENT][NEUTRAL] Mhm. Well, we don't offer vision, we don't offer vision coverage for any of our policies, so that might be through a different carrier.
[CUSTOMER][NEUTRAL] It's some other
[CUSTOMER][NEUTRAL] OK, yeah, they was um wondering if I had some like.
[CUSTOMER][NEUTRAL] I got some kind of vision.
[CUSTOMER][NEGATIVE] Oh, that's the dental. That's dental, but, um, then I called for the dental because I was trying to go get an emergency because my teeth was hurting, so they don't accept it. I was gonna be charged out of pocket. I'm like, I'm literally letting you see what take $10 whatever a little change they take it out of my check for nothing just to go pay doctor's offices full prices still like I'm about.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, and that's the thing too. I, I do hear quite a bit of providers that they just operate so different I think that's the most confusing thing is that um some like I said you can always file the claims to us yourself but some of them will you know I would always hope they can just bill you but some of them are like no we do have to have that payment like right up front and so that's where that biggest thing comes in because we can help with the claims but.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] I don't know it just really depends. Alrighty, well, let's get some clarification on this mental health. oh sorry, go ahead.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Can you ask when you um click over to speak to the other person if they're connected with the taro um mental health cause I called them and made an appointment too and I don't know if they'll accept.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can you see if you guys are in network with them?
[AGENT][NEUTRAL] What was it called? I'm sorry.
[CUSTOMER][NEUTRAL] Taros T E R R O Serros Mental Health.
[AGENT][NEUTRAL] ROA OK.
[CUSTOMER][NEUTRAL] Like I will
[AGENT][NEUTRAL] Yeah, I'll ask them again. These plans aren't really affiliated with a set network, um, and if they have confusion, if you haven't spoken with them already, they can give us a call. But first, of course we do have to make sure that that is a covered benefit at all. So give me just a moment, [PII]. I'm just gonna put you on a brief hold. I'll get right back with you, OK?
[CUSTOMER][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][POSITIVE] Doing well thank you how are you?
[AGENT][POSITIVE] Doing all right thank you. You got a minute left and I'm sorry to hand this to you but.
[AGENT][NEUTRAL] Um, I've got an insured on the line. Um, she has a few questions about the policy. Um, one of them is mental health, which, frankly, I'm not quite sure. I don't see anything explicitly stating, and that's such a broad thing to me. So I'm, I'm not quite sure. I know some people would consider that a sickness, so I'm just not sure if that's going to be anything covered under her policy.
[CUSTOMER][NEUTRAL] OK, what's the policy number?
[AGENT][NEUTRAL] It is 2571784.
[CUSTOMER][NEUTRAL] OK, and that's the insured calling?
[AGENT][NEUTRAL] Yes, uh, [PII].
[CUSTOMER][NEUTRAL] The [PII], OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then is that her callback number or do you have a call back?
[AGENT][NEUTRAL] I do. Let's see if that's the same one. the [PII], yeah.
[CUSTOMER][NEUTRAL] And she's asking specifically you said about mental health benefits, right?
[AGENT][NEUTRAL] Yes, um, she also asked of course what networks were affiliated with, but I did kind of explain how this policy works in short, um, but I don't know if that might be something she asks you as well.
[CUSTOMER][NEUTRAL] OK, and everything's been verified correct?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Alright, I appreciate you thank you.
[CUSTOMER][POSITIVE] You're welcome have a good evening.
[AGENT][NEUTRAL] Alright. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.