AccountId: 011433970860
ContactId: 25f594e4-b7d2-49ec-bc95-f766a846c3ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 633799 ms
Total Talk Time (AGENT): 313883 ms
Total Talk Time (CUSTOMER): 192713 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/25f594e4-b7d2-49ec-bc95-f766a846c3ce_20250131T17:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] How you doing? Um, I was told to call y'all by um.
[CUSTOMER][NEUTRAL] By my doctor's office because apparently I guess they don't accept your insurance and they were telling me to give you all a call to find out.
[CUSTOMER][NEUTRAL] Find a provider where my insurance is uh accepted.
[AGENT][NEUTRAL] OK, OK, we could take a look at what kind of policy that is, um, and then we can go from there and I'll let you know your options, um, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, uh, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh yes, 025.
[CUSTOMER][NEUTRAL] 10299
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Alright, 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 can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. Last thing I need is the email address that we've got on file for you. uh, looks like it is a [PII] account.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you for verifying all of that, [PII]. OK, so this policy.
[AGENT][NEUTRAL] It is a limited indemnity medical plan so it actually does not have a set network or a list of providers that do accept this coverage it really is going to be up to each individual provider whether or not they would file those claims for you or not. That being said, if there's ever any confusion, they're not sure what kind of policy this is or they've never heard of APL.
[AGENT][POSITIVE] The providers are more than welcome to give us a call we're more than happy to speak with them about your coverage and the kind of plans how to file claims and such, or you can also file those claims yourself. It's completely up to you.
[CUSTOMER][NEUTRAL] Well, I'm, I'm assuming they have been filing the claims and they, because I have a, uh, a stack of papers here saying that these, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] That this insurance is not covering those.
[CUSTOMER][NEUTRAL] Those procedures
[AGENT][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] OK, yes, I do see several claims from oh my goodness, we received on the [PII] just a few days ago, um.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Let's see, did you want me to take a look at them?
[CUSTOMER][NEUTRAL] No, what I need is, OK, let me, let me, let me take a step back. I was hit by a car riding my scooter to work, OK? So.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Everything that I am doing now is basically
[CUSTOMER][NEUTRAL] Follow-ups because I, I got hurt kind of bad, you know, I had backed sterile, uh, I may have a torn rotator cuff. My wrist was fractured. So I've been back and forth to the doctor and right now, they want me to come in and do another MRI just to, to double check to see if my rotator cuff is actually torn. Um.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But they called me today.
[CUSTOMER][NEUTRAL] stated that I had to find somebody that
[CUSTOMER][NEUTRAL] That this provider
[CUSTOMER][NEUTRAL] That my insurance company.
[CUSTOMER][NEUTRAL] I can use with my insurance company to get this MRI done.
[AGENT][NEUTRAL] OK, so they were accepting it but they just said that they weren't going to any longer?
[CUSTOMER][NEUTRAL] I guess I guess I'm guessing so because we're not covering anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If it's
[AGENT][NEUTRAL] Sure, so you do have a diagnostic testing benefit, um, and that does cover MRIs, um, I do see that it pays $100 for that test, um, so you can let them know that, or, um, again if it's easier for you instead of just trying to hunt somebody down, you can get that MRI and then you can file that claim to us directly.
[CUSTOMER][NEUTRAL] Alright, how, um, how do I do that?
[AGENT][NEUTRAL] OK, I would say the quickest and easiest way is going to be through our online portal um I can give you that web address do you have access to a laptop or a desktop computer chance?
[CUSTOMER][NEUTRAL] You talking about the [PII]?
[AGENT][NEUTRAL] No, it would be our website, so American or excuse me, um, American Public Life.
[CUSTOMER][NEUTRAL] Hold on, let me grab a pen.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Actually, um, [PII], are you still there?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, um, I was going to say if it's easier I could do this for you anyway. I can email you a copy of your policy just so you've got that it does go over, um, what is and is not covered dollar amounts, frequencies, things like that and in the body of the email I can include a link to our web address, the online portal.
[AGENT][NEUTRAL] Would that be easier?
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK, let me go ahead and do that, um, and then let's see, do the [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me go ahead and get that sent now.
[AGENT][NEUTRAL] Um, also I did just kind of take a peek at a few of the claims that we received. It looks it looks like a lot of the dates of services at least that I saw were from, uh, December last year, and the reason for a lot of the denials was that the, uh, calendar year maximum from, uh, most of those benefits had been exhausted. So if you were going to get a procedure now they do reset every calendar year, so you should have all of those benefits available now. Does that make sense?
[CUSTOMER][NEUTRAL] Yeah, that makes sense. So let me ask you this you're telling me that I'm paying for insurance that I can only use but a certain amount of times a year?
[AGENT][NEUTRAL] OK. Uh-huh.
[AGENT][NEUTRAL] There are certain things, and again that will all be in the policy. I know it's a bit confusing, um, but certain things are.
[CUSTOMER][NEGATIVE] Not really. It, it's frustrating because I'm paying for insurance, but I can only use it. I can only barely use it.
[AGENT][NEUTRAL] Sorry?
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] So this is a limited indemnity medical plan. It's very different from traditional major medical, so it does have a set dollar amount uh for benefits and certain benefits such as the diagnostic tests and such. They are limited to so many per calendar year.
[CUSTOMER][NEGATIVE] Uh, I, I, I understand. So basically what you're telling me is if something happens to me, I can only go to the doctor a certain amount of times of the year and the rest of the time I'm, I'm shit out of luck.
[AGENT][NEUTRAL] I wouldn't put it like that. Um, this, uh, I, and again, this all of this information would be in your policy.
[CUSTOMER][NEUTRAL] I mean, I, I, I understand. I know you can't really necessarily agree with that because you work for the company, but that's basically what it boils down to.
[AGENT][NEUTRAL] As it's a limited indemnity plan that's essentially how it functions and you will see all of that in your policy uh for all of that information.
[CUSTOMER][POSITIVE] Wow, that's crazy. All right, that's about.
[AGENT][NEUTRAL] I did just send that email to you.
[CUSTOMER][POSITIVE] OK, I appreciate it. I just said I'm not mad at you. I'm just.
[AGENT][NEUTRAL] Yeah,
[AGENT][POSITIVE] No, no, I understand the frustration. I really do. I understand the frustration. It like I said, it is a very different kind of policy than traditional major medical, um, but that's why I always like trying to send that policy so that you've got it in front of you. You can see clear cut and dry, you know, frequencies, dollar amounts, what is and isn't covered, um, but yeah, if you've got any other questions or anything feel free to give us a call back, [PII].
[CUSTOMER][NEUTRAL] It can.
[CUSTOMER][NEUTRAL] OK, I have one more question.
[AGENT][NEUTRAL] Did you have any other questions for me? Yes, of course.
[CUSTOMER][NEUTRAL] Now, um,
[CUSTOMER][NEUTRAL] With the company that I worked for, there was like one more like they had like 3 levels of insurance, and I picked like the middle level, right, there was one above it. Now if I switch to one above it, is it the same thing where I'm, I'm limited to how many times I can go to the doctor?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] I'm not quite sure it really does depend on your specific employer they each offer many different kinds of policies and they are unique to those companies. I would personally get with them, um, get the information for the higher graded one, and you can kind of compare that information to the policy that I just sent you so you can kind of weigh out what you think would be better for you.
[CUSTOMER][NEUTRAL] All right, that's a bit.
[AGENT][NEUTRAL] OK, I'm sorry I wish I could help more.
[CUSTOMER][POSITIVE] No, you helped out a lot. I, I have a better understanding of what's going on, so basically just.
[AGENT][NEGATIVE] Yeah, it's, it is very confusing.
[AGENT][NEUTRAL] All righty. Well, let us
[CUSTOMER][NEUTRAL] I wouldn't use the word confusing, but I'm not going to use the word that I, I have in mind because it has nothing to do with you.
[AGENT][POSITIVE] That is understandable. Well, um, again, I apologize, and if you have any other questions feel free to give us a call back and I hope you have a great rest of your day, [PII].
[CUSTOMER][NEUTRAL] Alright you too man.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye