AccountId: 011433970860
ContactId: 1f4dbb31-1a73-49c4-83c8-1d02a7ff52e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 963640 ms
Total Talk Time (AGENT): 388491 ms
Total Talk Time (CUSTOMER): 429560 ms
Interruptions: 7
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/1f4dbb31-1a73-49c4-83c8-1d02a7ff52e2_20250612T15:59_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, I, I sent in, uh, 3 bills, um, so I've got.
[CUSTOMER][NEUTRAL] The insurance I have and I, I pay out of pocket and then I am to fill out a claims form and get an itemized bill and send it on to you guys I guess, uh, and I'm just calling to make sure that you guys got them and that they are correct.
[AGENT][NEUTRAL] Yes, I can certainly look that up. And what is your policy number, please?
[CUSTOMER][NEUTRAL] It is um 682.
[CUSTOMER][NEUTRAL] 980336
[AGENT][NEUTRAL] 6, OK. Um.
[AGENT][NEUTRAL] Is that your social security number, sir?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Is that your social security number, sir? It, it doesn't seem like one of our policy numbers.
[CUSTOMER][NEUTRAL] No, nope.
[AGENT][NEUTRAL] It's not, OK.
[CUSTOMER][NEGATIVE] I don't really even understand this plan. OK, this is the 3rd number that I.
[CUSTOMER][NEUTRAL] Uh, they're like, no, call these other people. They said to call you.
[CUSTOMER][NEUTRAL] So no that was not a social security number.
[AGENT][NEUTRAL] OK, and what, how do you spell your last name, sir?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and I, I apologize. My phone is cutting in and out and so I'm just, I didn't, it sounds like you said [PII] is that or or LA I'm sorry.
[CUSTOMER][POSITIVE] That's right
[CUSTOMER][POSITIVE] Yep, [PII].
[AGENT][NEUTRAL] And your first name, sir?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me see if I can't find you in our system, um.
[AGENT][NEUTRAL] OK, thank you very much. If I could just verify your date of birth, sir, and a phone number, and then we can look this up.
[CUSTOMER][NEUTRAL] It's [PII]. It is [PII].
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is for medical. Is that correct, sir?
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] So yeah, I'm looking at the 3 bills right here that I have sent on to you after paying out of pocket along with the claims form for each one.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, great. Let me see what we got.
[AGENT][NEUTRAL] So I have dates of service in January, April, and uh.
[AGENT][NEUTRAL] November. Does that sound right?
[CUSTOMER][POSITIVE] That's right, yes it is
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, it looks like this is for Doctor [PII].
[CUSTOMER][NEUTRAL] Yes, [PII] Doctor [PII] and then I think Old doc also.
[AGENT][NEUTRAL] Right, in office. OK, these are.
[CUSTOMER][NEUTRAL] [PII], yeah, they're all [PII], never mind, it's all it's it's all [PII], yep.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do see that now that your, your policy does not cover office visits.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So what it, what's uh yes, sir.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] This is what I was told.
[CUSTOMER][NEUTRAL] That I pay out of pocket and that then I send these bills along with the form into the repriser.
[CUSTOMER][NEUTRAL] Which I did 3 times now.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, and everybody tells me different things and I just need to figure out what this is and obviously I wanna know.
[CUSTOMER][NEGATIVE] If, I mean, I'm not sure what this insurance covers if it doesn't cover seeing a doctor. I don't even know what it's for.
[AGENT][NEUTRAL] OK, let's go over, we, we can certainly go over your benefits and, and, uh, so what the policy is, is, it's called a hot, yes sir.
[CUSTOMER][NEUTRAL] No, no, what I, what I need to know is how to figure out how to get, how to, how to get the reimbursement after paying out of pocket, which is why I got it they said that's how it works, uh.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] So I mean are are you telling me that I'm wasting my time here?
[AGENT][NEUTRAL] Well, for the office visits, they're not going to be covered. No, sir. Now, what, uh, what is covered, uh,
[CUSTOMER][NEUTRAL] No, that's, I'm sorry. I'm sorry, that's, that's what, that, that's not what I was told. I was told that I pay out of pocket, but that they reimbursed part of that they that it says reimburses part of it, not even all but part of it.
[AGENT][NEUTRAL] Right, that they do for certain services. There, there are services that are covered, but the hos but the uh office visit is not one of them.
[CUSTOMER][NEUTRAL] But what?
[AGENT][NEUTRAL] Uh, so the office visit is not covered, but there are services that are covered and you can uh be reimbursed.
[CUSTOMER][NEGATIVE] Well then somebody lied to me. Then somebody lied to me, then somebody has been, you know, multiple people have been lying to me. I, I've been working on this for months.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You say this is what you have to do. Yes, it works like this. Yes, you pay out of pocket. You send in the bills to your pricer, then, then the insurance company reimburses you part of it, right? That's what they told me at least 5 times.
[AGENT][NEUTRAL] And this is for now, you, you do get this to your employer. Now your employer also has uh or should have benefits for uh.
[CUSTOMER][NEUTRAL] No, I don't have insurance through my employers.
[AGENT][NEUTRAL] Oh OK, I see. OK.
[CUSTOMER][NEUTRAL] I don't have my.
[AGENT][NEUTRAL] So this is, so this is not to your employer? OK.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK. The, the reason that I was asking that is because um.
[AGENT][NEUTRAL] We, uh, in our system we show uh business workers of America.
[CUSTOMER][NEUTRAL] I have no, I don't even know what that is. Business Workers of America.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Workers of America, no, I, I've never even heard that combination of words.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Well, for this, for this particular policy, um, [PII], I, I don't, I, I, I do apologize if someone told you that it was something that, uh, uh, for office visits, what it does.
[CUSTOMER][NEGATIVE] Oh, but you know they they've been telling me this forever. I've been trying to figure it out. No, no, no, so you, you're telling me that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So why do I have, why do I have this insurance policy if they don't cover anything?
[AGENT][NEUTRAL] Well, I don't know where you would have gotten it if you didn't get it to your employer, um.
[AGENT][NEUTRAL] So, uh, the only, I, I don't know who you got it from if you didn't get it to your employer.
[CUSTOMER][NEUTRAL] I, I got it from, from like the from the, the healthcare marketplace or whatever.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] What, let me, let me explain to you what it is and then you may want to contact them and, and, uh, and then review whether, whether this policy is gonna be good.
[CUSTOMER][NEGATIVE] No, they keep putting no, no, no, no, no, no. They keep pushing me around to you. There's nobody that can give me a straight answer. Everybody gives me different stuff, and now you're telling me, oh, actually, there's nothing at all to it at all.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, the, the only thing that the policy does it is it's it's a hospital indemnity policy, and it is meant primarily for services that are within a hospital setting.
[AGENT][NEUTRAL] That's what this type of policy is.
[CUSTOMER][NEUTRAL] I'm sorry, that, that is, that is incorrect. I know that there is some kind of confusion. Something is wrong here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right, because again, I've been told over and over again, you know, this is how you do it. You, you, you, you send it, you know, you get the itemized bill. They're like that's what they say get the itemized bill from the visit, you know, you pay out of pocket, you get the itemized bill, you get that, and you fill out the claim form and you send it into the pricer.
[CUSTOMER][NEUTRAL] Did you receive those emails?
[AGENT][NEUTRAL] We did what we received your claim, yes.
[CUSTOMER][NEUTRAL] How many of those 3? OK, and you're telling me that.
[CUSTOMER][NEGATIVE] Everybody else who was saying this is how you do it, they're just wrong and like they're just brushing me off on you so you can tell me no no no we're not gonna give you anything.
[AGENT][NEUTRAL] Well, the only thing I can
[CUSTOMER][NEUTRAL] This this insurance is only for a hospital.
[AGENT][NEUTRAL] The only thing I can do is tell you what.
[CUSTOMER][NEGATIVE] It's this is incorrect somehow.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] There's, there's, there's some, something is wrong. There's a disconnect somewhere because I've been told over and over and over and over and over again this is how it works.
[AGENT][NEUTRAL] See what we have here. Now you
[CUSTOMER][NEUTRAL] I don't know if you're
[AGENT][NEUTRAL] You went through
[CUSTOMER][NEUTRAL] Missing something or I'm missing something?
[AGENT][NEUTRAL] OK, so what, what, uh, when this was submitted to us, Cole, it was submitted online.
[AGENT][NEUTRAL] Through a group dashboard.
[AGENT][NEUTRAL] And so what we're showing is that it went through it and, and by that it means that there's somebody that and as I mentioned before, usually these are through your employer.
[AGENT][NEUTRAL] And if it is going through a group dashboard.
[CUSTOMER][NEGATIVE] No, I, again, it's not through my employer at all. It's not through my employers.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so what we have here, let's see, we have the hospital indemnity claim, uh, we show that, uh, uh, that you, uh, you went into our website.
[AGENT][NEUTRAL] To download a uh a statement of insured and I'm looking at that right now and then it says APL hospital identity and everyday Solutions claim form. Now you would have gone into APL uh into the website it's [PII].
[AGENT][NEUTRAL] Which is the website, it looks like you went on to download this and submit it to us.
[AGENT][NEUTRAL] Does does any of that sound correct to you so far? Because that those are the documents that I'm looking.
[CUSTOMER][NEUTRAL] Uh, I've, I've done this shit over and over again in like a bunch of different ways, a bunch of different ways I've done it, so.
[AGENT][NEUTRAL] OK, you go online, is that correct, sir?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] You did go online to submit this to us, is that correct, sir?
[CUSTOMER][NEUTRAL] Uh, either that or I sent it to an email which was, and people tell me all different stuff, man. I, I.
[AGENT][NEUTRAL] Yeah, we don't have an email that, yeah, we don't have an email to send it to, so you, it looks like you would have gone through our website um now on our website there is a.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] That's not OK, let me see if I can find.
[CUSTOMER][NEUTRAL] Let me see if I can find
[CUSTOMER][NEUTRAL] Where I sent this
[AGENT][NEUTRAL] Because these are the documents that I'm seeing that that were submitted to it.
[CUSTOMER][NEUTRAL] OK, let me see here just a moment. No was all time.
[CUSTOMER][NEUTRAL] So you got
[CUSTOMER][NEUTRAL] You received those.
[CUSTOMER][NEUTRAL] Three forms, right? The 3 bills with the, the, the 3 filled out claims.
[AGENT][NEUTRAL] Well, we received, yeah, we received 3 bills on, on, uh, on a single claim form.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, what, what day did you receive them on?
[AGENT][NEUTRAL] We received them on one of our um uh online claim forms.
[CUSTOMER][NEUTRAL] Uh, do you have a date?
[AGENT][NEUTRAL] That we received it, uh, we received it on [PII] at [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Right, so
[CUSTOMER][NEGATIVE] Why would somebody have told me, oh this is how you do it this is how you know, I mean.
[CUSTOMER][NEGATIVE] Why would somebody have told me, OK, you, you should be like this.
[AGENT][NEUTRAL] And who told you that, [PII]? Do you, do you remember who told you that?
[AGENT][NEUTRAL] Because I, I don't show that that uh we only show that you called one time.
[CUSTOMER][NEUTRAL] No, because people keep bouncing around.
[CUSTOMER][NEUTRAL] Yeah, I know people keep bouncing around to other people like all the time, every single time it's not about the same thing every single time. Nope.
[AGENT][NEUTRAL] But, but who what people?
[AGENT][NEUTRAL] What, what people call? What, who are we talking about?
[AGENT][NEUTRAL] Because I, I don't, I show that you called us once.
[CUSTOMER][POSITIVE] Alright, I can give you.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] So what I can do
[CUSTOMER][NEUTRAL] Let's see, um, let's see.
[AGENT][NEUTRAL] I can send you, if you don't mind verifying your email, I have a copy of your schedule of benefits, and it tells you everything that is that is listed or everything that is covered.
[AGENT][NEUTRAL] On this policy.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] Well, so let's see, I have been talking to Aetna.
[CUSTOMER][NEUTRAL] I've been talking to uh um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Which I mean the insurance is all right.
[AGENT][NEUTRAL] That, that's
[AGENT][NEUTRAL] OK, so you've been talking to, to a different insurance company, Aetna. OK.
[CUSTOMER][NEUTRAL] OK, I mean that's just how it.
[CUSTOMER][NEUTRAL] So are you guys the ones that receive my payment every month?
[AGENT][NEUTRAL] We received a payment through Business Workers of America.
[AGENT][NEUTRAL] As a and it's called an employee plan.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] I don't know that
[CUSTOMER][NEUTRAL] OK, no, I have no idea what that is. That's not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't even know what that
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] So I, if you don't mind, what I can do is let me go ahead and send you a copy of your, of your um of what we show is your schedule of benefits. Uh-huh.
[CUSTOMER][NEUTRAL] No, that no no no.
[CUSTOMER][NEUTRAL] I've gotten a million different things from a million different people, right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They have assured me, OK, you know, here, you know, when I said, here is my, you know, my, my member ID. There's my phone number and my date of birth, my date of birth is my name, like, yeah, yeah, yeah, this is how it works.
[CUSTOMER][NEUTRAL] So you're saying that my insurance does not.
[CUSTOMER][NEGATIVE] Covered doctor's visits at all, not even as like to, uh, you know, when I pay out of pocket.
[AGENT][NEUTRAL] This policy does not know.
[CUSTOMER][NEUTRAL] And then I send it in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] I don't even know who to talk to now at this point because everybody's telling me different stuff. Everybody's saying, no, it's not us, it's them, it's not us, it's them. You do this, you do that.
[CUSTOMER][POSITIVE] I mean, I, I certainly do pay a bill and I, I, I know that I am able to um get um reimbursed for some of it because I mean that's what I'm told like every single time that I get this run around from everybody.
[AGENT][NEUTRAL] And then when you pay the bill, sir, is it, is it something that somebody sends you a bill or is it something that comes out of a paycheck or?
[CUSTOMER][NEUTRAL] Uh, did that this is actually how it works.
[CUSTOMER][NEUTRAL] No, I go to a doctor, right? I pay the bill out of pocket.
[CUSTOMER][NEUTRAL] Then
[AGENT][NEUTRAL] Well, I meant for your insurance.
[CUSTOMER][NEUTRAL] I am to
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] Uh, how do you pay your insurance, sir? How do you say that?
[CUSTOMER][NEUTRAL] They, they just deduct it's a credit card, it's a credit card, uh, fee every, every month, the two of them actually.
[AGENT][NEUTRAL] Is that come
[AGENT][NEUTRAL] OK, so it comes from it, who do you get the credit card from, sir?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] From whom do you get the credit card?
[CUSTOMER][NEUTRAL] I think it's called first enroll.
[AGENT][NEUTRAL] OK, OK, so the whoever whoever it is with, with first enroll, first of all, uh, if you spoke with Aetna or first enroll, we would never know about that. Um, what, what the policy is?
[AGENT][NEUTRAL] What what the policy is.
[AGENT][NEUTRAL] Is it that that you have with us?
[AGENT][NEUTRAL] And that's American Public Life.
[AGENT][NEUTRAL] What you have with us is a limited benefit.
[AGENT][NEUTRAL] Hospital
[AGENT][NEUTRAL] Um, policy.
[CUSTOMER][NEUTRAL] OK, then, then I, so I know I've listen, listen, check it out. I've also got like, you know, dental vision and hearing, right? So these are all going to different places. I don't even know.
[AGENT][NEUTRAL] Thr somebody else.
[AGENT][NEUTRAL] Right. You, you, you have them through somebody else, not, not through us.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Right, so there's so, so there's somebody that I need to talk to, and I can't everybody passes me around to different people.
[CUSTOMER][NEUTRAL] So like I mean you know.
[CUSTOMER][NEGATIVE] The people, I don't know who I'm supposed to talk to to figure this out like, you know.
[CUSTOMER][NEUTRAL] Yeah, so there's doctors visits. There's a hospital indentity. I know that that's, that's part of it, right? There's dental vision and hearing. That's part of it too. Nobody can like
[CUSTOMER][NEUTRAL] Figure out who I'm supposed to talk to about the doctor's visits specifically.
[AGENT][NEUTRAL] The only thing that I can tell you is that this policy doesn't cover them.
[AGENT][NEUTRAL] Um, I don't know what other benefits you have from, from whoever this is that you.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, thank you. I'm gonna try to call somebody else.