AccountId: 011433970860
ContactId: 2721f75b-c748-420d-b4ed-1712693203b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 639679 ms
Total Talk Time (AGENT): 278828 ms
Total Talk Time (CUSTOMER): 251243 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/2721f75b-c748-420d-b4ed-1712693203b9_20250602T20:29_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am. I'm trying to get some clarification on my, uh, medical coverage of my insurance plan that I have with you guys.
[AGENT][POSITIVE] Yes, I can certainly help with that. And uh do you have your policy number there with you?
[CUSTOMER][NEUTRAL] Yeah, let me get it, um, bear with me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh just trying to find it here with me.
[AGENT][NEUTRAL] Well, I may be able to find it with your uh name or social security number if you like.
[CUSTOMER][NEUTRAL] OK, so yes, it's uh [PII] and it's um.
[CUSTOMER][NEUTRAL] 455
[CUSTOMER][NEUTRAL] 63
[CUSTOMER][NEUTRAL] 841 9
[AGENT][NEUTRAL] OK, thank you. If I could just verify uh your date of birth and the phone number, sir?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[CUSTOMER][POSITIVE] Oh, and I have all the information um right.
[AGENT][NEUTRAL] OK. And what is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, the policy number, that would be the member ID, correct?
[AGENT][NEUTRAL] Uh, it should be.
[CUSTOMER][NEUTRAL] OK, so it's uh 68.
[CUSTOMER][NEUTRAL] 44
[CUSTOMER][NEUTRAL] 90522
[AGENT][NEUTRAL] OK, the social security number you gave me was [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. And you spell your last name, sir, uh [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] And, and I'm sorry, if you don't mind spelling your first name for me, please, sir, I'd appreciate it.
[CUSTOMER][NEUTRAL] Yes, it's uh [PII]
[AGENT][POSITIVE] Great, thank you very much.
[AGENT][NEUTRAL] Well, I don't, I don't see our system, um.
[AGENT][NEUTRAL] You, you had a policy number with us, is that correct? I mean, you.
[CUSTOMER][NEUTRAL] I mean, I'm looking at you guys' paperwork and that this is a number and I'm trying to clarify what is going on here because I purchased an insurance plan.
[CUSTOMER][NEUTRAL] And for a colonoscopy procedure, um, my.
[CUSTOMER][NEGATIVE] My work insurance is not gonna cover it, so I, I, I had to cancel that, and I purchased this one. the insurance agent told me that a coloss will be covered and now the, the facility is saying otherwise. Uh, I'm just trying to, did I get, is this some kind of fraud or what? Like, well, it's not making any sense in regards to the coverage and you guys aren't, aren't able to find like.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Did you get, yes sir?
[AGENT][NEUTRAL] No, no, sir, I'm not able to find your, did you get anything from us, um, Mr. [PII], maybe an, an explanation of benefits, anything at all, or you were just told that it wasn't that.
[CUSTOMER][NEUTRAL] Well, in
[CUSTOMER][NEUTRAL] I haven't
[CUSTOMER][NEUTRAL] I haven't got, I got charged $253 for a premium to get this coverage. I haven't, I haven't submitted a claim yet. I work with insurances, so I know how they work.
[CUSTOMER][NEGATIVE] So if, if the colonoscopy procedure is not covered, then I will need to cancel this appointment. I mean, have you guys heard of this? Like uh insurance people selling coverages that are not.
[CUSTOMER][NEUTRAL] liable?
[AGENT][NEUTRAL] No, um, not really. I mean, normally our policies will cover something like that. It just depends on, on what, what we do is we sell group insurance and usually to your, your employer, um.
[AGENT][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] This is the the plan name is the basic core plus plan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And you guys are not affiliated with them, then why, why do they have you guys in like
[CUSTOMER][NEUTRAL] Information like the whole like um welcome packet and everything on their website.
[AGENT][NEUTRAL] Well, does it show, does it show, um, uh, have they actually signed with us yet, or is it just something that they're getting ready to do? Well, why don't we look and see what your, uh, do you have your employer name there, and this just so that we can, I can see maybe I can look it up by your employer.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] This, this is the thing like um uh it's not through my employer. I had to purchase this insurance.
[CUSTOMER][NEUTRAL] And I called the Blue Cross Blue Shield phone number cause that's where my uh.
[CUSTOMER][NEUTRAL] What my doctor takes and
[CUSTOMER][NEUTRAL] I got this guy, this insurance agent, and he said this, this is a plan where I could go anywhere I, I can go, that's not like in network, which I understand I work with insurances, so I know how that works.
[CUSTOMER][NEGATIVE] And every time the doc the doctor's office called, it's something like they can't get a hold of them. I feel like this insurance or this, I, I feel like I got frauded or like I don't know, um.
[CUSTOMER][NEGATIVE] Uh, you guys are not able to find my coverage either, so what, what's going on?
[AGENT][NEUTRAL] No, sir, because
[AGENT][NEUTRAL] Well, I'm not really sure, sir. Uh, what we do is we sell, um, there, there are different policies that we sell, but what we do is we sell group insurance and it's usually a benefit that you have to your employer. So we don't normally sell insurance just to individuals. What we do is let's say that you were, um, just as an example that you are employed by a temporary agent.
[CUSTOMER][NEUTRAL] Well, well
[CUSTOMER][NEUTRAL] I, I understand, but this is not what happened. Like, I purchased the insurance myself, not through my employer.
[AGENT][NEUTRAL] But you didn't purchase it through us sir?
[CUSTOMER][NEUTRAL] I called an insurance.
[AGENT][NEUTRAL] That's, that's just it. See, we don't, we don't actually sell them to individuals, so it's, um, it's usually through the, uh, the health insurance.
[CUSTOMER][NEUTRAL] No, no
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I didn't
[CUSTOMER][NEUTRAL] I, I did it through an insurance agent. This, this is a thing. So do I need to make like some kind of police report or something? Like I, I don't understand what's going on.
[AGENT][NEUTRAL] I would check with whoever it is who sold you the in the uh the policy um because
[CUSTOMER][NEGATIVE] every, every time I, every time I try and call them, they, they keep me on the line and they disconnect.
[AGENT][NEUTRAL] And then I'm, I'm really not sure what to tell you, sir. I wish that I, I knew, um, I can tell you, uh, you know, if you.
[AGENT][NEUTRAL] I can tell you that we sell through to employers as as the part of the benefit that you receive from for being one of their employees and we have secondary insurance we have hospital indemnity insurance, but what we don't do is is sell to necessarily sell to individuals.
[AGENT][NEUTRAL] Um, no, I wasn't able to find you by your name or your social security number. Uh, if you did not get this through your employer, um, then I'm not really sure, uh, how to help you because that's, that is the way that we, uh, you know, that's the way that we sell these things.
[AGENT][NEUTRAL] If you're unable to, to get a hold of the insurance broker who sold you the, the policy to begin with.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I just do not know what to tell you, sir. I'm, I'm very sorry.
[AGENT][POSITIVE] If, if you went through one of our employers, I would have a yes sir.
[CUSTOMER][NEUTRAL] Oh my gosh, you're telling me that I just.
[AGENT][NEUTRAL] Yeah, I'm, I'm sorry it's just that.
[CUSTOMER][NEGATIVE] I can't believe it. I can't.
[CUSTOMER][NEGATIVE] Can't believe this, can't believe this.
[CUSTOMER][NEGATIVE] They charged me $253 to get this insurance.
[AGENT][NEUTRAL] And you mean it was that was it, that's the only thing that they charged you with the with the that 200+ dollars did they say that that was for the year or?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Well, no, it's gonna be on a monthly basis. It's a, it's a premium.
[AGENT][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] I see.
[AGENT][NEGATIVE] Um, and you just pay for this yourself. This is not for your employer at all, is that, is that what you're telling me?
[CUSTOMER][NEGATIVE] Correct, yes ma'am. I, I, like I said, I called the Blue Cross Blue Shield network and I got this insurance agent. I got his license number and everything, but every time I call him back, like every time I call him or try to call him, they put me on hold. They don't even answer the, the phone like an insurance company, like how you would typically answer. They, I don't understand what's going on.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I, I wish I knew what to tell you, sir. um.
[AGENT][NEUTRAL] We, uh, we don't work with, with, uh, I mean we wouldn't work directly with Blue Cross and Blue Shield. Um, what normally ends up happening is, uh, is that we work with the employer and then if you do have, uh, major medicals such as Blue Cross and Blue Shield, and that's through the employer as well, but we don't necessarily work they wouldn't have given you our number, let me put it that way, and because we are a secondary or gap insurance, we also have uh a limited, uh.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So you don't, you don't think that this is legitimate then?
[AGENT][NEUTRAL] Oh no, I, I don't know whether it is or not. The only thing I'm saying, sir, is that it's not through us. That's, that's the only thing I can tell you is that I, I just do not see that that's, I don't see you in anywhere in our system. And so I'm just, you know, the only thing I can say is that if you do, you do have this insurance or whatever it is, I don't, uh, Blue Cross and Blue Shield would never have given you an agent's number for us. It's just not, um, you know, because we, we don't really work through, uh, major medical, uh.
[AGENT][NEUTRAL] That services we work through the employers, so I, I just do not know what to tell you, sir, but it, it doesn't look like you're one of our employees, I mean one of our clients. I just don't know who did sell you the insurance, but it would not have been American public life.
[CUSTOMER][POSITIVE] OK, well I, I appreciate your help thank you ma'am.
[AGENT][NEUTRAL] OK, I'm sorry I wasn't able to help you. Thank you for calling.