AccountId: 011433970860
ContactId: 12fea520-3137-41ed-8bd0-2678a933b254
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1838800 ms
Total Talk Time (AGENT): 512791 ms
Total Talk Time (CUSTOMER): 656871 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/12fea520-3137-41ed-8bd0-2678a933b254_20250428T19:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling. How are you?
[AGENT][POSITIVE] Doing well, [PII]. How are you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] I'm great thank you and uh a couple of months ago I filed for a claim.
[CUSTOMER][NEUTRAL] Which is um.
[CUSTOMER][NEGATIVE] The hospital keeps sending me the bill and I got a bill today and I don't know what's happening if see, are you guys going to pay this bill or do I have to pay this bill? Uh, could you please help me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I sure can. I can look into um if a claim has been received here and let you know what we need to do. And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Yes. Uh [PII].
[CUSTOMER][NEUTRAL] 6123617
[AGENT][NEUTRAL] Thank you. May I have your policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, 02, hold on one second, I'm driving. OK, 02 51 3502.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] And I do have the claim number too if you like.
[AGENT][NEUTRAL] OK, does it end in 6563 or 4263?
[CUSTOMER][NEUTRAL] 263, yes.
[AGENT][NEUTRAL] Alright, and I
[CUSTOMER][NEUTRAL] Um, 42, yeah, 4263.
[AGENT][NEUTRAL] Thank you, and I just need you to verify.
[CUSTOMER][NEUTRAL] And I have just one.
[AGENT][NEUTRAL] Can you please verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Sure. Um, uh, [PII].
[CUSTOMER][NEUTRAL] And uh [PII].
[AGENT][POSITIVE] Thank you, and then just your um email address.
[CUSTOMER][NEUTRAL] Oh, it's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And do you mind if I place you on just a brief hold while I take a look at the claim and the um the, well just the claim altogether and your policy benefits.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for the wait. So I do see what's going on with this claim. So we did receive a claim from the provider, um, and we denied the claim. The claim was denied, well, the reason is the policy doesn't have any sickness coverage. So you have a hospital indemnity policy. It has coverage for like if you're admitted to the hospital or confined to the hospital.
[AGENT][NEUTRAL] But the benefits that provide for your physician office, emergency room, that's outpatient, but it's outpatient accident treatment, not outpatient accident and sickness. So that's why these are being denied because there is no proof that the policy doesn't cover it unless it's an accident.
[CUSTOMER][NEGATIVE] Are you serious? So I have to pay this whole bill thing?
[CUSTOMER][NEUTRAL] Which is a 4000 and something dollars. I don't remember right now how much it is.
[CUSTOMER][NEUTRAL] I know it's above $4000.
[CUSTOMER][NEUTRAL] Is that you, you saying?
[AGENT][NEUTRAL] If
[AGENT][NEUTRAL] Yes, if this is the only insurance policy that you have, yes, ma'am, there's no coverage for sickness on this policy.
[CUSTOMER][NEUTRAL] Um, so.
[CUSTOMER][NEGATIVE] Uh, so this means it's not worth it to have this policy then. Because what, what happen if I, let's say, um, like this was like a um a basal cell cancer. So what about if it something come up again, something like, and I, I have to go to the doctor, uh, and so I will not be covered that.
[CUSTOMER][NEUTRAL] Except if I go to the emergency room and say I need to be.
[CUSTOMER][NEUTRAL] Check in, right? That's what you mean?
[AGENT][NEUTRAL] Well, no, so,
[AGENT][NEUTRAL] Unless it's due to an accident, this policy, yes, would be no good. What you can do moving forward is reach out to your HR department and I say that because our policies come from your employer, so HR and see if there are other policies that you can elect that have benefits that are more what you need than this.
[CUSTOMER][NEUTRAL] No, no, no, uh, no, uh, I'm so sorry. No, this is a, this is a uh private uh policy doesn't come with my HR uh uh it's not through my, my employer, it's through me.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] So it
[AGENT][NEUTRAL] OK, so AP, the reason I said that is because APL's policies only go through the employer. You signed up through Business Workers of America, which is a third party because you don't have an employer. So instead of saying go to HR, it would be Business Workers of America because that's who you signed up with.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] However, APL cannot make any policy changes. So you will have to go to who you signed up with, which is Business Workers of America, and see if there's all I'm all I'm suggesting is see if there's a better plan that fits what you need.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] And then if they put me in something else then we'll be covered.
[AGENT][NEGATIVE] Right, it still won't be.
[CUSTOMER][NEUTRAL] Or if
[AGENT][NEUTRAL] It still won't assist with this claim, but moving forward, if you were to upgrade it or make changes to your policy, it can help you moving forward.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEGATIVE] OK, so what about, let's say this API I'm gonna cancel this policy, and I'm gonna go to somebody else because when, when I signed for this policy, they said, uh, covers everything, everything that I was, you know, anything happened to me was being covered.
[CUSTOMER][NEUTRAL] But they didn't say, oh, on a, on accident.
[CUSTOMER][NEUTRAL] You know, like specific, like, uh, so like you're saying, this, this cover if it was activist.
[CUSTOMER][NEUTRAL] Not like, what about if I have cancer, like per se.
[AGENT][NEUTRAL] That's not, uh, it wouldn't.
[AGENT][NEUTRAL] Unless you're admitted into the hospital or confined to the hospital.
[AGENT][NEUTRAL] Then
[AGENT][NEUTRAL] All the other benefits are for accidents.
[CUSTOMER][NEUTRAL] Hm, OK.
[CUSTOMER][NEGATIVE] And I have been paying like, you know, for nothing. I spent like.
[CUSTOMER][NEUTRAL] A bunch because I had been on this policy for almost a year and.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] That did not help me at all.
[AGENT][NEUTRAL] And I'm so sorry that they did not explain this policy to you correctly so that you could be able to choose if you needed this one or something else.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] What can I ask you a question? So, if I, do you recommend me, what is the best insurance to have that does not cause you any like trouble, like they are on points. Do, do you, uh, can you recommend someone?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I mean, being in insurance and also being
[CUSTOMER][NEUTRAL] Cause I, I'm the one.
[CUSTOMER][NEUTRAL] I'm sorry, you can go ahead.
[AGENT][NEUTRAL] So as a as a patient and as a person who works in insurance, I mean, it's going to be something with all of them, but the issue here is the representative that you talked to at Business Workers of America did not explain to you fully what you were signing up for or if there were other policies that matched more of what you needed. So,
[AGENT][NEUTRAL] That's where the apology comes in because they should have gone thoroughly with you with the policy, so you can make a decision on what works best for you.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[AGENT][NEUTRAL] So I certainly do apologize for that, but I, I mean, if you, it's up to you if you want to, um, if you want me to connect you to Business Workers of America to see what are the options you have, we can do that, uh, how however you want to proceed.
[CUSTOMER][NEUTRAL] Yeah, that
[CUSTOMER][NEGATIVE] Yes, could you please connect me to them because I'm gonna forgive me my word but I'm gonna cheat on them.
[CUSTOMER][NEUTRAL] You know.
[AGENT][NEUTRAL] Well.
[CUSTOMER][NEGATIVE] Because this is no no now I'm stuck with um uh let's see I have right here in front of me um a $4000 bill.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] For sure, I thought I was going to be covered.
[CUSTOMER][NEGATIVE] Like, I mean, I, I was not thinking like the whole bill, but for some, and now I have to pay this whole thing, you know?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And I, I mean, I can't even apologize enough because I would be so upset if I signed up for something, paid for it, and it wasn't what.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] I agreed to.
[CUSTOMER][POSITIVE] Exactly. Exactly.
[AGENT][NEUTRAL] I thought I was, you know,
[AGENT][NEUTRAL] So I can definitely get a representative for you, um, and I'm actually, um, also, I don't know if you hear me typing over here, but I'm actually reaching out to my team to see if there's some maybe we can compile like a list of these types of situations because business workers of America is not like a
[CUSTOMER][NEUTRAL] Mhm. Exactly.
[AGENT][NEUTRAL] It's kind of like a third party, like they're not APL, but they, they like, um, offer our services. So if that's the case, then we need to make sure that we're being represented correctly all the way around because that makes us look bad and we don't even know what's going on because they went through another company, you know what I mean, and we don't want to lose our customers because they're not being transparent.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Because our brokers go through line by line and make sure you understand and so I mean, I cannot apologize enough um for your experience.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEGATIVE] I it's like this. I, I moved to [PII] and uh I didn't have any coverage here. And then I was referred to them. They, they, and then the time like last year, they, they just like, oh my gosh, that is a 100% cover, you have no deductible, no this, no that, and blah, blah blah.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] And I was like, whoa, this is great. How much is it? And then like they include me with dental, which is I'm paying for dental. I never been used in dental insurance. I mean, this is the first time I went to the dermatologist and they found this thing on my forehead and they say, oh this is a basal cell we need to remove, which is like I end up with 15 stitches on my forehead. I was like, oh my gosh, I was.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] Scared because I have a history. My daughter, a couple of years ago, she had melanoma, and she was even on the uh chemotherapy because they was so severe. And I was like, oh my gosh, I don't want this comes like my daughter, you know what I'm saying? So I, and I thought I like, oh my, I have, now I have insurance, that's gonna be covered. And look at, look at that.
[CUSTOMER][NEGATIVE] And every time that I call them, which is I, I did call them like a couple of weeks ago, and to just to make sure what is my, my coverage. And they said, oh you have no deductible. That's what they say to me.
[AGENT][NEUTRAL] And that
[CUSTOMER][NEUTRAL] So, now, what is that, you know?
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] Um, well, let me go ahead. I have 2 phone numbers for them. Did you want me to give you the phone numbers and transfer or you just want me to transfer you over to the representative that I get?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] You can give me the phone number and also you can transfer me. Let me write it down. OK, I'm ready.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so the first number is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And on the sec the second customer service number is [PII].
[CUSTOMER][NEUTRAL] OK, alright, and if you, if you don't mind transfer me to them.
[CUSTOMER][POSITIVE] It would be great.
[AGENT][NEUTRAL] Sure, I don't mind, and before I transfer you, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, thank you so very much.
[AGENT][POSITIVE] You're welcome. Well, thank you so much for calling APL and hold on one moment for your transfer, OK?
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling member services. All calls are recorded for quality assurance. Our hours of operation are Monday through Friday [PII] Central Standard Time. If you know your party's extension, please dial it now.
[CUSTOMER][NEUTRAL] For customer support, press 2. For agent support, press 3. For claim support, press 4. For provider support, press 5. Thank you.
[CUSTOMER][NEGATIVE] We have not received a valid response. Please try again.
[CUSTOMER][NEGATIVE] We have not received a valid response. Please try again.
[CUSTOMER][NEUTRAL] You are currently caller number 13 waiting to speak with a representative. The estimated hold time is currently 7 minutes. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 12 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 11, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 10 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 9, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] Thank you for calling member services. All calls are recorded for quality assurance. Our hours of operation are Monday through Friday [PII] Central Standard Time. If you know your party's extension, please dial it now.
[CUSTOMER][NEUTRAL] For customer support, press 2. For agent support, press 3. For claim support, press 4. For provider support, press 5. Thank you. You are currently caller number 12 waiting to speak with a representative. The estimated hold time is currently 5 minutes. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 11, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 10, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 9, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 8 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 7, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 5, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 3, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 2 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] Hello, this is [PII]. Can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] calling from APL. I have a a member on the other line who is kind of upset. She signed up with Business Workers of America, but what she was told is not what she really was signed up for, and she's wanted to know if she can maybe make some changes to her policy or what her options would be at this point.
[CUSTOMER][NEUTRAL] Alright, give me just one moment here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check that with her because we were on hold for a while. hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEGATIVE] Yes, honey, looks like they're not.
[AGENT][NEUTRAL] Hey, I just wanted to check back.
[AGENT][NEUTRAL] With you
[CUSTOMER][NEGATIVE] No, they're not picking up.
[AGENT][NEUTRAL] Give me just a moment. So I'm, I was on hold on the other line. I got a representative. She's pulling up the computer now, so it'll be just a few more moments, OK?
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, I'm still here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so can you give me that member ID number?
[AGENT][NEUTRAL] Yes, um, well, I don't have y'all, y'all's member ID. I have her policy number with APL.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, uh, is the member still on the other line?
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Yes, she is. She's waiting to talk to you. Um, let me see if I can pull the member number, sometimes it shows in the screen.
[AGENT][NEUTRAL] Yeah, no, it's not on here. Oh, wait a minute, this might be it. 682-738-934.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And the name and um date of birth?
[AGENT][NEUTRAL] [PII], date of birth is.
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] OK, so how can I help?
[AGENT][NEUTRAL] So she signed up with with um Business Workers of America. What she was told she signed up for is not what she really signed up for. So her benefits are different. She's wanted to know if she can make any changes or what the options are, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basically, she goes to like the doctors and offices, but this policy is an outpatient accident, doesn't even have sickness on it, so she's trying to see what her options are.
[CUSTOMER][NEUTRAL] So we wouldn't have access to that information you'd have to talk to the agent.
[CUSTOMER][NEUTRAL] The member would have to contact their agent.
[AGENT][NEUTRAL] So who is the agent that Business Workers of America uses?
[AGENT][NEUTRAL] Because for for us it says policy benefit changes would come to this number.
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] So the member would have to contact the customer service line or um their agency and they should have all that information.
[AGENT][NEUTRAL] So what line am I calling?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's BWA we're the group.
[CUSTOMER][NEUTRAL] And the plan changes don't go through BWA.
[CUSTOMER][NEUTRAL] And the second claim is actually to.
[AGENT][NEUTRAL] So, if a member needs to terminate their policy or do policy changes, they no longer call BWA.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] So the member would have to contact the customer service number on the located on the back of her card.
[CUSTOMER][NEUTRAL] For cancellation.
[AGENT][NEUTRAL] OK. The reason I'm asking is because that's what I'm calling for. So we have the [PII] number for customer service for BWA and then we have [PII] and then we have an email address. So is this not the correct number to call to get to customer service because that this is the only two numbers we've had.
[CUSTOMER][NEUTRAL] So you can.
[CUSTOMER][NEUTRAL] You can transfer the member over to me and I can discuss it with her.
[AGENT][NEUTRAL] Right, OK. So, thank you. Hold on one moment.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][POSITIVE] All right. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Hi there.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.