AccountId: 011433970860
ContactId: 3c771c69-cb56-4f8c-931c-fe9f99a0efab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 539039 ms
Total Talk Time (AGENT): 239481 ms
Total Talk Time (CUSTOMER): 198099 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/3c771c69-cb56-4f8c-931c-fe9f99a0efab_20250117T21:20_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Yes, I'm calling in reference to a claim that was not satisfied.
[AGENT][NEUTRAL] OK, are you the insured that you're want and you're wanting to check claim status on a claim for yourself?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][POSITIVE] Thank you, Mr. [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And your policy number?
[CUSTOMER][NEUTRAL] 683149521
[AGENT][NEUTRAL] OK. Did you say 68314?
[AGENT][NEUTRAL] 951.
[CUSTOMER][NEUTRAL] 684521
[AGENT][NEUTRAL] I'm so sorry, we don't have a very good connection on my end, Mr. [PII]. Could you say that one more time, please?
[CUSTOMER][NEUTRAL] 68
[CUSTOMER][NEUTRAL] 3149521
[AGENT][NEUTRAL] OK, now that is not a policy number for American Public Life, Mr. [PII]. Is that whom you were trying to reach?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] APL policy number 683149521.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And is that on an explanation of benefits that you received from APO?
[CUSTOMER][NEUTRAL] This is on a claim form that I sent to you.
[AGENT][NEUTRAL] OK, but
[AGENT][NEUTRAL] OK. You, OK, so do you have an ID card or something that has that policy number on it?
[CUSTOMER][NEUTRAL] That's my policy number.
[AGENT][NEUTRAL] And again, is that on your ID card?
[CUSTOMER][NEUTRAL] That number.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'm not able to access your information with that number, Mr. [PII]. Let me see if I can locate it another way.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment. And you did say it's [PII], correct? First name is [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And what state do you live in, Mr. [PII]?
[CUSTOMER][NEUTRAL] I have a claim number
[CUSTOMER][NEUTRAL] But state I have a claim number. Does that help you?
[AGENT][NEUTRAL] Um, well, I'm still gonna have to verify a bunch of information with you first for security.
[CUSTOMER][NEUTRAL] I thought it
[CUSTOMER][NEUTRAL] South Carolina.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, Mr. [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. Um, and as I mentioned, I will have to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that we have on file for you is the same as the one that you provided for me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Thank you. And lastly your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. So I see that we have one claim on file for you. um, do you want to provide me the claim number you have?
[CUSTOMER][NEUTRAL] The claim number I have is 355-0356.
[AGENT][NEUTRAL] Hi.
[AGENT][NEGATIVE] And I can see that it was denied. Give me one moment to get the remarks pulled up.
[AGENT][NEUTRAL] OK, so the denial remark on this claim, Mr. [PII] says benefits payable under this certificate are limited to those outlined on the schedule of benefits. This is not a colored loss under the plan. Therefore, no amount is payable for this expense.
[CUSTOMER][POSITIVE] OK, I prechecked this with my insurance company and they even got the code for the test and they gave me the approximate amount it was gonna cost me. They said go take the test when you get the receipt to us and we'll process it, no problem.
[CUSTOMER][NEGATIVE] So I have a problem with that.
[CUSTOMER][NEUTRAL] I'm paying for insurance that.
[CUSTOMER][NEGATIVE] From the beginning has misled me, give me false information, and once more, and now I've paid into this insurance company for several months, got nothing out of them, and I have to pay this on my own.
[CUSTOMER][NEUTRAL] Like a double indemnity.
[CUSTOMER][NEGATIVE] You gotta be kidding me.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] So I need, I need to kill this policy, which they've told me that they're working on. I don't know why it takes so long and I want a refund for all this BS that I've gone through and being misled and then I have a $300 bill to top it off. I'm really happy with your service.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEGATIVE] Gotta be kidding me.
[AGENT][NEUTRAL] So you have
[CUSTOMER][NEUTRAL] What, so what?
[CUSTOMER][NEUTRAL] Do I have what?
[AGENT][NEUTRAL] So you have spoken to someone, yes, you have spoken to someone with member services regarding canceling your coverage?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, because that is separate. OK, so that is separate from APL. I was just gonna make sure that you have the correct phone number.
[CUSTOMER][NEGATIVE] I had to get other coverage.
[AGENT][NEUTRAL] To speak to one of their representatives regarding the cancellation of your coverage.
[AGENT][NEUTRAL] Or any refund request that you may have.
[CUSTOMER][NEUTRAL] Oh, I've spoken to
[CUSTOMER][NEUTRAL] They're not
[CUSTOMER][NEUTRAL] They're not responding very quickly, but I've spoken to several people there.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] And they told me to call you in reference claim and now you're telling me that you're not covering the claim because it's not part of my policy and my original insurance company go ahead and do the procedure it's covered send you guys the receipt so all of that is BS.
[AGENT][NEUTRAL] And do
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, I can't speak on what another insurance company has, you know, told you or what information they gave to you.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Well you
[AGENT][NEUTRAL] But your indemnity policy.
[CUSTOMER][NEUTRAL] Right, well, you guys are the ones they told me.
[CUSTOMER][NEGATIVE] You're the ones that are telling me it's no good and they're my insurance company is telling me that it is good and that you guys should approve it, so I'm in a quandary.
[AGENT][NEUTRAL] So you can actually file an appeal if you would like on the review of this claim, Mr. [PII], and you may file that claim um within 180 days from the date that the decision was rendered on the review.
[AGENT][POSITIVE] And I'll be happy to give you the address.
[AGENT][NEUTRAL] To send that appeal to if you would like to do that.
[CUSTOMER][NEUTRAL] Let me have the
[CUSTOMER][NEGATIVE] I don't wanna have to do it. I don't know. It's probably I'm just probably gonna have to pay for it out of pocket and just move on. I'm just so disgusted. It's not your fault, but have a good day, what a terrible mess, but that.
[AGENT][NEUTRAL] I'm very sorry. Well, yes, sir.
[AGENT][POSITIVE] Well, I'm so sorry and I'm sorry that you're having trouble uh getting that, getting a response from
[AGENT][NEUTRAL] The enrollment company that.
[CUSTOMER][NEGATIVE] I think the company, the insurance company, I'm gonna have to go to Better Business Bureau and social media and just, you know, have buyers beware of all of this stuff that's going on because it's really, really bad. I'm a customer that's come off of Blue Cross Blue Shield for many years and nothing like that goes on with them. I mean this is all ridiculous. Um, it's, I don't know, it's almost fraudulent. I'm, I'm not sure, but, uh, it's really.
[CUSTOMER][NEUTRAL] I've been very pleasant dealing with with the people here um you just get nowhere and it cost your money.
[AGENT][NEUTRAL] OK, now, now member services is separate from APL. Member services is the company that you enrolled with where the agents are located.
[AGENT][NEUTRAL] That I guess provides you your different options for coverage. And that's why, you know, I mentioned to you a while ago about having to reach out to that company about cancellation or refunds, anything like that benefit changes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] And all that. OK, thank you. Have a good weekend. Bye.
[AGENT][POSITIVE] Well, yes, sir, you too. Uh-huh. Thank you again.