AccountId: 011433970860
ContactId: 2a21252e-3bf1-45fa-a35d-4c5c4f3b12b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474839 ms
Total Talk Time (AGENT): 174141 ms
Total Talk Time (CUSTOMER): 248242 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/2a21252e-3bf1-45fa-a35d-4c5c4f3b12b2_20250317T19:06_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]. My name is [PII], and
[CUSTOMER][NEUTRAL] I just received a little note saying that you received my claim, so.
[CUSTOMER][NEUTRAL] I'm a little confused. Can you look me up and so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you know what's going on.
[AGENT][NEUTRAL] Sure, I can.
[AGENT][NEUTRAL] May I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] Uh, yes, it's [PII].
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] 683-264-362
[AGENT][NEUTRAL] That's your APL policy number?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I don't know, it says dear policy holder we received a claim on your policy.
[CUSTOMER][NEUTRAL] And the claim has started.
[AGENT][NEUTRAL] Let me see, hold on. Does it have a reference number on there?
[CUSTOMER][NEUTRAL] So I'm not
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, it says in some cases additional information may be requested.
[CUSTOMER][NEUTRAL] Thank you for trusting APL with your insurance needs as always, feel free to contact with any questions and it has claims department so I'm not, I'm, I don't know what claim or APL.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] American public life.
[AGENT][NEUTRAL] And I believe I have the, um, I believe I just found the policy. I just need you to verify again your first and last name, your date of birth, and your mailing address.
[CUSTOMER][NEUTRAL] It's [PII]. My date of birth is [PII].
[CUSTOMER][NEUTRAL] And my address is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] I think I missed a number. Hold on one second.
[AGENT][NEUTRAL] And I can give you the policy number as well, yeah, Mr. 7257.
[AGENT][NEUTRAL] OK, there we go, hold on one moment.
[AGENT][NEUTRAL] Alright, and thank you so much for verifying all the information provided is a verification of benefits, not a guarantee of payment. So we received a claim on [PII], that's in processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because that.
[CUSTOMER][NEGATIVE] I'm so confused every time I talk to my insurance company there's either a different.
[CUSTOMER][NEUTRAL] Somebody different cause
[AGENT][NEUTRAL] What are you, what, what are you trying to figure out?
[CUSTOMER][NEGATIVE] I'm just really confused.
[CUSTOMER][NEUTRAL] Well, the forms that I sent in the CWA claim support and then your APL and my insurance is managed care with the claims going to admin one, so there's 3 different things that I don't know.
[AGENT][NEUTRAL] So there's with Business Workers of America, there's, it's a little confusing. So you can either like this claim was sent in to us, um, you can, if you send it in, we'll go ahead and process the claim. You also have the option to send it to BWA. They have like an email address there for claims. You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I see. OK.
[AGENT][NEUTRAL] So depending on what you choose, either one of them of us, I guess we could say could could process that claim for you.
[CUSTOMER][NEUTRAL] OK, I see here more papers, paperwork and stuff that's APL too, OK.
[CUSTOMER][NEGATIVE] I'm just so confused.
[AGENT][NEUTRAL] No, but it's, don't worry because we're.
[AGENT][NEUTRAL] We're confused about it too because there's so many different parts and it's new, so I guess we're all just confused together, but, but we got this part though.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK, good. You have that part. I have a question though, um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] With, with this plan that I have, you may or may not know, I need to have surgery, not major, just something real minor. I have a couple of salivary um stones in my salivary glands, which is giving me a headache.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the doctor I saw, she wants to, she's, to get to those, she's gonna have to surgically cut and, and get them out. They won't pass on their own and my salivary gland atrofied because of it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Is that something you guys would pay for too, or like how do I?
[CUSTOMER][NEGATIVE] What would I have to do because the hospital I'm using, they say that this isn't an insurance.
[AGENT][NEUTRAL] There's, OK, so when they say that, that is because this is a, it's not a major medical, like it's not a Blue Cross Blue Shield or Cigna or Aetna. This is a limited uh medical benefit policy. So you, do you know, will you be admitted to the hospital or is it like a same day type of like an outpatient?
[CUSTOMER][NEUTRAL] Just a just an outpatient thing day um yeah just a quick in and out it's like I said she said it would be something she could possibly do in the office, but she said.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Seeing where they are, the one, the one is back in pretty far, so she said, and I would have to have suction and dra, you know, like uh all that jazz, and she would have to put me to sleep so she can't do it in the office.
[AGENT][NEUTRAL] Because I have
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. OK, so for the hospital indemnity policy that you have with us, there is, there is no outpatient coverage. This is more so like if you're admitted into the hospital, if you're confined to the hospital, you do have some outpatient benefits like if you go to the emergency room, the urgent care physician's office, but in terms of like surgery, like outpatient surgery, there will be no coverage on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's what I needed to know then I guess I'll have to wait till I get Medicare.
[AGENT][POSITIVE] Oh, yes, and then it'll be paid in full.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, well that's you answered my question. I've been trying all week to uh see if it would be covered or not, but thank you.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, no, how long does it usually take to hear back once they review this claim and everything?
[AGENT][NEUTRAL] So it's 7, so it's 7 to 10 business days from the day we've received the claim and we received it on [PII].
[CUSTOMER][NEUTRAL] You know?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, well thank you so much Miss [PII] you helped, helped me to make a decision here.
[AGENT][POSITIVE] Well, you're very welcome, missus.
[CUSTOMER][NEUTRAL] So I have no.
[CUSTOMER][NEUTRAL] So no outpatient minor surgery coverage.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, alright, I'll just have to deal with it then until October, but thank you.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL, Ms. [PII]. I hope you have a great week.
[CUSTOMER][POSITIVE] Thank you you as well.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.