AccountId: 011433970860
ContactId: 45088e04-70f4-4ba9-a4db-4fa2c9cdef78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 707159 ms
Total Talk Time (AGENT): 363719 ms
Total Talk Time (CUSTOMER): 170805 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/45088e04-70f4-4ba9-a4db-4fa2c9cdef78_20250327T14:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. My husband has a doctor's appointment and they're saying my medical insurance is no longer active.
[AGENT][NEUTRAL] OK, Ms. [PII], I can check um the eligibility of your, your policy. Can you please give me your policy number so I can look it up?
[CUSTOMER][NEUTRAL] 02351659
[AGENT][NEUTRAL] OK, let me look that up real quick, Ms. [PII].
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and then what is your address, phone number, and email address that we have on the policy for you, ma'am?
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII]. My phone number is [PII] and my email is [PII].
[AGENT][NEUTRAL] Now the phone number that you just gave me, if our call gets disconnected, is that a good number to call you back on?
[CUSTOMER][NEGATIVE] Yeah, I was talking to another lady and then all of a sudden she couldn't hear me.
[AGENT][NEGATIVE] Yeah, we've had some phone issues today.
[AGENT][NEUTRAL] And um they're trying to get to the bottom of it but yes we've we have had some issues with our telephones today that's why I wanted to make sure I got a good call back number in case something happened I'll be able to call you back.
[CUSTOMER][NEUTRAL] But anyway, my husband goes to a doctor, Doctor [PII]. He has to get a checkup for cancer. It's blood work. And, and I've had this for like 2 years, this insurance.
[AGENT][NEUTRAL] OK. All right. Let me look and see cause the policy number that you gave me was your dental policy and let me see if the cancer is still active.
[CUSTOMER][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] I don't know. I've got like 3 different cards here.
[AGENT][NEUTRAL] OK, I have, um, I'm showing that you have a hospital indemnity plan.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] A group accident plan.
[AGENT][NEUTRAL] A short term disability plan, a critical illness plan.
[AGENT][NEUTRAL] A life insurance plan and a dental plan. I don't show that you have cancer insurance with us.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] But would it cover any of his doctor visits?
[AGENT][NEUTRAL] You can um file claims on the hospital indemnity plan.
[AGENT][NEUTRAL] Let me give you that policy number.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Got it yeah
[CUSTOMER][NEUTRAL] I don't think you can change it right in the middle though.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's really just, but they're saying we don't have any insurance.
[AGENT][NEUTRAL] No, ma'am. You have several active policies. The ones I read to you were all active and current.
[CUSTOMER][NEUTRAL] OK, so this one.
[CUSTOMER][NEUTRAL] The policy num, do you want the policy number on this card?
[AGENT][NEUTRAL] Um, I can give you the policy number of the hospital indemnity plan.
[AGENT][NEUTRAL] If you would like
[CUSTOMER][NEUTRAL] But what does that do? What does that do though?
[AGENT][NEUTRAL] OK, so as far as coverage for hospital indemnity and this is just to verify your benefits, it's not a guarantee of payment. He has
[AGENT][NEUTRAL] It looks like you guys have um hospital admission benefits, accident, uh, sickness benefits for surgery, and diagnostic testing.
[CUSTOMER][NEUTRAL] Uh, well, that's what it is, it's testing.
[AGENT][NEUTRAL] OK. Yes, there is diagnostic testing that's covered under your plan. Uh, the first initial, uh, diagnostic test will cover up to $100 and then if there's a follow up.
[AGENT][NEUTRAL] Did you hear me say that?
[CUSTOMER][NEUTRAL] Uh, not the last part.
[AGENT][NEUTRAL] OK, and if you have a follow up testing for diagnostic, it'll cover up to $25.
[CUSTOMER][NEUTRAL] OK, so he has been going to this doctor and we keep getting denial letters from y'all, but they called and said we have, but they called and said,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I don't have insurance. That's the problem.
[AGENT][NEUTRAL] OK, so you do not have a major medical insurance with us?
[CUSTOMER][NEUTRAL] So your insurance doesn't even cover like a doctor visit?
[AGENT][NEUTRAL] Right. This is not the major medical. This is a limited hospital indemnity plan.
[CUSTOMER][NEGATIVE] So if I went to the doctor and I was sick, y'all don't cover any of that?
[AGENT][NEUTRAL] Let me look pull up your policy and I'm gonna read it and see exactly what it says, OK?
[AGENT][NEUTRAL] If it says anything about office visits for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And I went to two eye doctors and neither of them could find coverage for that either.
[AGENT][NEUTRAL] We don't have, we don't carry your vision insurance. We don't carry vision insurance at all.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] So if he goes to a urologist, that's not covered?
[AGENT][NEUTRAL] If he goes to a urologist, that would be considered an office visit, and that's what I'm checking now to see if you have office visits on your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on your policy, it says physician's office and it describes what it is and it's for sickness or injury.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Where you can have health examinations, diagnosis and treatments of sickness or injury due to an accident on an ambulatory or telemedicine basis.
[AGENT][NEUTRAL] So if you go to an ambulatory center,
[AGENT][NEUTRAL] Or do telemedicine face to face between the patient and the physician.
[AGENT][NEUTRAL] And then it says office does not include.
[AGENT][NEUTRAL] A free-standing outpatient surgery center, hospital emergency room, hospital outpatient facility, physical therapy facility, or urgent care facility.
[CUSTOMER][NEGATIVE] So basically, it covers nothing.
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] A hospital indemnity plan. So it's basically
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The benefits that you have are better if you go into the hospital. So if you go into a hospital and you get admitted in the hospital for more than 18 hours,
[CUSTOMER][NEUTRAL] And
[AGENT][POSITIVE] It helps with that. Your benefits for that are, um, the first time you go into the hospital that very first day per calendar year, it pays $1000.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And then if you're confined to the hospital, you know, you have to stay more than one day.
[AGENT][NEUTRAL] You get 30 days per calendar year that pay $100 per day.
[CUSTOMER][NEUTRAL] I have never had insurance this bad before in my life, I swear to God.
[CUSTOMER][NEUTRAL] So y'all don't cover office visits.
[CUSTOMER][NEUTRAL] Or the checkups following cancer.
[AGENT][NEUTRAL] Well, we have, you have a physician's office.
[AGENT][NEUTRAL] Visit for accident or sickness.
[AGENT][NEUTRAL] And it's a surgical benefit in a physician's office that pays $125.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEGATIVE] That is insane because every time he's gone to Doctor T Arena, y'all deny the payment cause we get the papers every time.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Do you have a copy of your policy, or are you able to uh get on the online service center so you can see your policy and everything that it covers and it doesn't cover?
[AGENT][NEUTRAL] Have you ever signed up for the online service center?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I will have to what is it a multi planner or something?
[AGENT][NEUTRAL] It's, um,
[CUSTOMER][NEUTRAL] I'll have to get on
[AGENT][NEUTRAL] It's, let me give you the website so you can get on there and you can also file claims on there with us too.
[AGENT][POSITIVE] It is um secured, S E C U [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And when you go in there for the first time you're gonna click that you're a new user.
[AGENT][NEUTRAL] And then the second screen is gonna be you're an individual with an APL policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you'll just figure out what your username and password are going to be.
[AGENT][NEUTRAL] And there's a copy of your policy on there.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that you can read it and see exactly what the policy covers or doesn't cover.
[CUSTOMER][NEUTRAL] Yeah, I don't think y'all cover very much.
[AGENT][NEUTRAL] It, like I said, it is a limited hospital indemnity plan.
[AGENT][NEUTRAL] And I don't know um who you have your major medical insurance through, if you have it because we don't have that information.
[AGENT][NEUTRAL] Or who you have your vision through either.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Well, I thought that y'all provided that, but apparently not.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Damn. All righty, thank you.
[AGENT][POSITIVE] Now, you're very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No, I don't think so.
[AGENT][POSITIVE] OK. Well, you have a wonderful day and thank you for calling