AccountId: 011433970860
ContactId: 4b6d7ba5-c4dc-41ea-8949-9e920d2da60a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353679 ms
Total Talk Time (AGENT): 102447 ms
Total Talk Time (CUSTOMER): 225798 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/4b6d7ba5-c4dc-41ea-8949-9e920d2da60a_20250128T21:51_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello this is [PII].
[CUSTOMER][NEUTRAL] I'm calling because I filed a claim and I'm no longer sure. Do we file claims if I was holding um
[CUSTOMER][NEUTRAL] Because I don't understand what's happening. Let me check my card, sorry. Like, I had an insurance, uh, limited, a limited benefit plan with PHCS.
[AGENT][NEUTRAL] Um, OK, [PII], I really don't understand the question.
[CUSTOMER][NEUTRAL] I had a plan with PHCS and I, and when I called they said I, they gave me a form that said a PF to file claims. So I'm no longer sure if it's where I need to file the claim. Is it I should.
[AGENT][NEUTRAL] OK, are you wanting to know if you have a policy with us?
[CUSTOMER][NEUTRAL] No, I want to ask, like, do you work with HPHCS?
[AGENT][NEUTRAL] OK, um, [PII], can I get a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], do you have your policy number?
[CUSTOMER][NEUTRAL] Yes, 02546845.
[AGENT][NEUTRAL] OK, uh, let's see, can you confirm your date of birth, your address, and your email address for me?
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] And what else did you ask? Email address [PII].
[AGENT][NEUTRAL] Your email address.
[AGENT][NEUTRAL] OK, so I do have your policy pulled up. So,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you wanting to know how to file a claim? Are you, I'm, I'm not sure the the question here.
[CUSTOMER][NEGATIVE] No, I was, I'm filing claims, right? And then they give me, they send me a letter which says this policy does not provide benefits for vaccines and immunizations or the administration of injections.
[CUSTOMER][NEUTRAL] So, I'm like, when I, when I applied for the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For the policy, I was doing it for my kids, and I explained all those things so that they are able to go visit the doctor for those same immunizations that they're saying they do not apply claims for. So now I'm like, is, am I supposed to be doing, is it the same thing? The AP or is it connected with PHS PHCS? Am I doing something wrong?
[AGENT][NEUTRAL] Um, no, you're not doing anything wrong. Um, so let me just state this disclaimer that this is a verification of benefits and not a guarantee of payment, but unfortunately, vaccinations, um, those are non-covered under the policy.
[CUSTOMER][NEUTRAL] So you're saying when I did the policy, like the policy this I had that I had with PHS it wasn't covering vaccines and it was just for hospital stuff.
[AGENT][NEUTRAL] Um, I can only speak for APL. You would have to call PHCS, but as far as APL, um, vaccinations are non-covered under the policy.
[CUSTOMER][NEUTRAL] Uh, so how is PHCS and LPO connected and
[CUSTOMER][NEGATIVE] Why do I just get things from Apple and not from PHCs? It has never sent me anything like in terms of claims and stuff.
[AGENT][NEUTRAL] PHCS is um that's just part of um the contract not the contracted but that's just part of the network that we work through.
[AGENT][NEUTRAL] So as far as the claims and stuff it would come directly to APL for us to um work those claims.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So even if like there's no other claim that you can do except through you when I'm going through PSS because it feels like they gave me your forms for claims.
[AGENT][NEUTRAL] Yes, it would come to APL.
[CUSTOMER][NEGATIVE] I don't understand.
[CUSTOMER][NEUTRAL] So it doesn't, so it doesn't even matter. It's OK. Let me call the PHCS and see what they say, but still they'll say claim, file a claim, file a claim. And now when I file a claim, they told me we do not cover immunizations.
[AGENT][NEUTRAL] OK, yes, ma'am. um, APL just does not cover vaccinations.
[CUSTOMER][NEUTRAL] It's crazy. It's OK.
[CUSTOMER][NEUTRAL] But even though the, the plan covered.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, what do you mean, even though the plan covered, I'm, I'm not sure what you mean. I'm so sorry.
[CUSTOMER][NEUTRAL] Is that, does that make it.
[CUSTOMER][NEUTRAL] So are you say, yeah, so I'm saying like, if it does it matter, does it mean that the plan didn't cover, the plan itself didn't cover the vac the vaccinations as well?
[AGENT][NEUTRAL] Yes ma'am, the plan itself just, it does not cover, it's in the policy, it will not cover the vaccinations.
[CUSTOMER][NEUTRAL] That's crazy. So what did they, OK, let me copy because I cannot be, um, arguing that with you because I don't even understand how this is connected. It's fine. Thank you so much.
[AGENT][NEUTRAL] OK, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, well thank you for contacting APL and I hope you have a great day.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right bye bye.