AccountId: 011433970860
ContactId: 5d4e792f-5e6e-4ad1-a1f3-2c7740339576
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1438560 ms
Total Talk Time (AGENT): 266096 ms
Total Talk Time (CUSTOMER): 768063 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/5d4e792f-5e6e-4ad1-a1f3-2c7740339576_20250414T17:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling the APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I'm just wondering, may I get a 1095 form for you from you guys?
[AGENT][NEUTRAL] A 1095 form. Hold on one second, let me check on that for you. Give me one moment, please. You're welcome.
[CUSTOMER][NEUTRAL] Right to file with my.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK. Can I get your policy number to see what type of benefit you have with us, please?
[CUSTOMER][NEUTRAL] Oh sure, let me get back there.
[CUSTOMER][NEUTRAL] Alright, I just gotta find my card um.
[CUSTOMER][NEUTRAL] Oh, let's see.
[CUSTOMER][NEUTRAL] No, wrong file. bear with me please.
[AGENT][NEUTRAL] No, no rush. You're fine.
[CUSTOMER][POSITIVE] Oh thank you.
[CUSTOMER][NEUTRAL] When you want something that's just never close by.
[AGENT][NEUTRAL] Never.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, see, I just had it too working on my insurance or taxes.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Policy number you said?
[AGENT][NEUTRAL] Please, or certificate uh number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I have a policy number of 02459557.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Give me just a moment, let me pull that up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, may I have your name, please?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you. And Miss Miss [PII], can we verify your date of birth and then your address, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, [PII], [PII].
[AGENT][NEUTRAL] OK, we have [PII]. I can't even say it.
[AGENT][POSITIVE] Many apples. OK, good, good, she's good.
[CUSTOMER][POSITIVE] Yeah, you got it right it's.
[CUSTOMER][NEUTRAL] Yep, that's uh where I'm a suburb of [PII].
[AGENT][POSITIVE] OK, wonderful. Let's see what you have with us.
[AGENT][NEUTRAL] All right. You have a hospital indemnity plan. I will tell you this is not a major medical plan. It's strictly just a supplement, you know, type benefit. We do not do any kind of major medical here. Um,
[AGENT][NEUTRAL] So I am checking to see if a 1095 form.
[AGENT][NEUTRAL] It's something that we would send out even.
[AGENT][NEUTRAL] I guess trying to check was one who might know.
[AGENT][NEUTRAL] Just one moment please. I'm checking with someone now to see if they may know if we, uh, send this form out or not. I do apologize for the hold, for the wait.
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, that's OK.
[AGENT][NEUTRAL] Do you have a major medical plan uh through your employer?
[AGENT][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] No, I was retired um when I took this plan out in [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, yeah, this is not a major medical plan, um.
[AGENT][NEUTRAL] So that would not what you have with us is just a supplement hospital indemnity plan. So it would, would not require a 1099.
[CUSTOMER][NEUTRAL] A 1095.
[AGENT][NEUTRAL] 1095. I'm so sorry. 1095.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, here's what happened, um, I'm working with my tax adviser. My charges for medical, not including premiums for 2024, was $16,834 out of that my pocket, I'm paying $14,041 so she wants to submit this.
[CUSTOMER][NEUTRAL] Because that's over $14,000 out of my pocket plus the premiums plus the prescriptions.
[CUSTOMER][NEUTRAL] So that we're looking at.
[CUSTOMER][NEUTRAL] Uh, about $19,000 out of my pocket in 2024.
[AGENT][NEUTRAL] OK, let me, uh,
[AGENT][NEUTRAL] I'm going to get someone on the phone to see if they can assist us and to see if there is something that can be sent out. So give me just a moment, please.
[CUSTOMER][NEUTRAL] OK, thanks, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh sure.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hello, [PII]. This is [PII] in customer service. How are you, dear?
[CUSTOMER][POSITIVE] I'm doing good, Ms. [PII]. How are you doing today?
[AGENT][NEUTRAL] I'm fine. No, I'm fine, I'm fine. Miss [PII], I don't know if there's anything we can do for this insured, but will you look at a policy with me, dear?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] It is 245.
[AGENT][NEUTRAL] 9557.
[CUSTOMER][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Fresh.
[AGENT][NEUTRAL] Yes. OK. Miss [PII], she requested a 1095, but this is not a major medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She's doing her taxes and she needs something that shows, I, I don't know if I'm call, even call the right area, honey. I'll be honest, faith. I'm just starting somewhere I need help.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She needs something that shows everything she paid for the year, you know, like in medical and prescription and
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] Things like that.
[AGENT][NEUTRAL] Who would that be?
[CUSTOMER][NEUTRAL] Um, sounds like she needs a pin.
[CUSTOMER][NEUTRAL] [PII] I think is what she's name. Let me look in guru real quick.
[AGENT][NEUTRAL] That is what she said she wanted was a [PII]. Well, so my guru doesn't work. I, I am [PII], I need to get back with her about it. Um.
[AGENT][NEGATIVE] Um, I know y'all, she swamped, y'all are all, we're all swamped.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. So a [PII] comes.
[AGENT][NEUTRAL] But uh, you know, I'm thinking that [PII] is strictly for major medical.
[CUSTOMER][NEUTRAL] It is and she will have to get that from her major medical carrier or her HR department.
[CUSTOMER][NEUTRAL] That's what it says 1095 tax form. This is requested by the insured for filing purposes showing that they pay they had major medical coverage for the tax year. APL does not issue these. The insured will need to contact their major medical carrier or their HR department.
[AGENT][NEGATIVE] I don't think she's even with them anymore.
[CUSTOMER][NEUTRAL] Because we're not a major medical insurance.
[CUSTOMER][NEUTRAL] She can contact them still though.
[AGENT][NEUTRAL] Yeah, uh, she's not even with, she's so, OK, so she had to go to her HR the, the, the.
[AGENT][NEUTRAL] The group contact to get that right.
[CUSTOMER][NEUTRAL] or her major medical insurance.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Well, she doesn't have major medical. Everything she's used has been on this one policy.
[CUSTOMER][NEUTRAL] So she can ask for it, for, for the year that she needs it when she was covered.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] From who? From her?
[AGENT][NEUTRAL] The HR from where she was.
[CUSTOMER][NEUTRAL] Major medical.
[AGENT][NEUTRAL] OK, yeah, I don't think she has made.
[CUSTOMER][POSITIVE] Probably easier, yeah.
[AGENT][NEUTRAL] I don't think she has major medical. I think all she had was this last year.
[CUSTOMER][NEUTRAL] Was just the HI OK yeah oh I see what you're saying.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, she can go to her employer then.
[AGENT][NEUTRAL] OK, so she has to go through her employer to get that. OK. So even though she's not with them anymore, so I guess she was last year since, yeah. All right, let me go back to her darling and tell her that. Thank you.
[CUSTOMER][NEUTRAL] HR department.
[CUSTOMER][POSITIVE] You're welcome, [PII]. I'm glad I was able to help you. Do you want me to talk to her? Or do you want to nip it in the bud?
[AGENT][POSITIVE] All right, dear, have a good day.
[AGENT][NEUTRAL] Uh, um,
[AGENT][NEUTRAL] Well, let me just put it on there and we'll both just stay here. How about that?
[CUSTOMER][POSITIVE] OK. Sounds perfect.
[AGENT][NEUTRAL] OK, uh, uh, maybe I can get her to, uh, let me just put her on here.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh God, let me go back to her name because it doesn't show me. I can't ever remember anybody's name. Alright, Miss [PII], OK.
[AGENT][NEUTRAL] Miss [PII], this is still [PII] in customer service. All right, I have [PII] on the phone and Miss [PII] is gonna try to explain.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] A little bit if you know what she can for you on this 1095.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK. Hi Miss [PII], this is [PII] so um you're hi so your hospital indemnity plan is not a major medical insurance, so we don't do the 1099s. You'll need to go to your human resources I'm sorry, the 1095 I said the wrong 1, 1095, yes, um, you'll need to go to your human resources department and get that information from them.
[CUSTOMER][NEGATIVE] OK, so I'm unemployed. I was retired when I took out this what I thought was a decent policy and um I'm really screwed here. I had $16,834 in charges out of pocket. I've paid $14,041 plus $4700 in premiums and $900 out of pocket for prescriptions, so I don't know what I was paying for for 2024.
[CUSTOMER][NEGATIVE] I mean this is insanity nothing was covered.
[CUSTOMER][NEUTRAL] And when I took out this policy.
[CUSTOMER][NEUTRAL] [PII] said [PII] said, Well, you're too, you're not you're too old to be pregnant you're you're not covered for for for pregnancy for um inpatient treatment, and those are the only two I can think of and I said, oh well I have a CPAP is that covered? Oh yeah, well, I had to pay almost $3000 for that. Nothing was covered. What, what did I do wrong?
[CUSTOMER][NEGATIVE] Why am I so effed up here?
[CUSTOMER][NEUTRAL] I'm so sorry to hear that you're not happy with your policy. Maybe if I explain it just a little bit, so a hospital indemnity plan is, is a plan that's a limited benefit policy. It covers um a.
[CUSTOMER][NEUTRAL] Set amount for a covered procedure. So the set amount is what we pay for a for a covered procedure. I do see that you did send the claim back in on February to us we paid $50 on and let me just use it as an example, um.
[CUSTOMER][NEUTRAL] So you went through an express care and the benefit amount for the procedure that you had was $50 so we paid $50.
[CUSTOMER][NEUTRAL] And not saying that it it would have been less, but if the benefit had or the charge had been $25 for it, we still would have paid $50 if the charge would have been $100 for it, we still would have only paid $50 so it's a set amount for a procedure.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Also, if, if you wanted me to, uh, Business Workers of America is who you employ you were employed through, I can transfer you over to Business Workers of America so you can ask for that 1095 from them if you would like for me to help you like that.
[CUSTOMER][NEUTRAL] Well, just a minute what do you mean who I was employed with? Business workers what does that mean? That was the group that um.
[CUSTOMER][NEUTRAL] That you were employed with that took out the benefits Business workers of America.
[CUSTOMER][NEUTRAL] But I wasn't employed.
[CUSTOMER][NEUTRAL] OK, on the policy that I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But the benefits and the policy was taken out through the group Business Workers of America.
[CUSTOMER][NEUTRAL] And I can transfer you they have a different number and I can transfer you over to them so you can talk to them, um.
[CUSTOMER][NEUTRAL] And maybe get some answers about your policy and and then also ask for the 1095.
[CUSTOMER][NEUTRAL] OK, but before we do that, can I ask you something on APL? Sure, yes. OK, um, so on [PII] I went to have my flu and COVID vaccines, and I usually go to Target or CVS, but I called to see where I'd be covered. They sent me to a Park Nicollet clinic. The charge was $20295.
[CUSTOMER][NEGATIVE] Um, and I paid $206. Why would they send me to a clinic when they weren't gonna pay hardly any of it when it's more expensive to drive to a clinic and have this done?
[CUSTOMER][NEGATIVE] That made no sense to me and now I'm stuck, you know, $206 to pay for, you know, two immunizations.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that was somebody from our company sent you to a to a clinic?
[CUSTOMER][NEGATIVE] Well, on my PHCS card I called um customer service there isn't that where I was supposed to call for help with that?
[CUSTOMER][NEUTRAL] For um to locate a provider.
[CUSTOMER][NEUTRAL] That um your PHCS I'm I'm familiar with PHCS.
[CUSTOMER][NEUTRAL] Well, that's the card I got this started through PHCS.
[CUSTOMER][NEUTRAL] I think I really got taken for a ride.
[CUSTOMER][NEUTRAL] Oh, it's um the plan is Americare plan information.
[CUSTOMER][NEUTRAL] Is that what you asked? I'm sorry, and it says group ID BWA.
[CUSTOMER][POSITIVE] Yes, BWA is Business Workers of America, so you must have gotten that plan through Business Workers of America also.
[CUSTOMER][NEGATIVE] Oh, I really got taken for a ride for this really badly. I didn't do my research. This is horrible. This is really bad.
[CUSTOMER][NEUTRAL] I'm I'm very sorry you're not happy with your policy now like I said, you can, you can talk to business workers of America. I can transfer you directly to them if you would like for me to do that for you.
[CUSTOMER][NEUTRAL] 01 more question, um, so when I filed these, um, APL forms and faxed them.
[CUSTOMER][NEUTRAL] Where it says APL policy number I put my PHCS number there. Would that be why I didn't, I got like $200 back from all the things I um.
[CUSTOMER][NEUTRAL] Filed
[CUSTOMER][NEGATIVE] Of claims I filed, I mean, would, would that have caused the problem because I expected to get more money back when I had charges of, you know, when I had out of pocket of over 14,000. I thought I'd get more help.
[CUSTOMER][NEUTRAL] Did you get a copy of your policy?
[CUSTOMER][NEUTRAL] Um, I asked for it. I don't know that I ever did.
[CUSTOMER][NEUTRAL] OK, um, I can give you your, well, your policy number, uh, which is 2459557 that's with APL.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, that's through us, um.
[CUSTOMER][NEUTRAL] Now I can't I well mhm.
[CUSTOMER][NEUTRAL] When I fill this form out though I put I didn't put my APL policy number I put the PHCS policy number or my member number could that have messed things up as far as me getting um money back? Uh, where did you mail your claim to?
[CUSTOMER][NEUTRAL] I they told me to fax them and I faxed them to.
[CUSTOMER][NEUTRAL] Um, whatever number they gave me, oh wait, I know where that is. That's in my.
[CUSTOMER][NEUTRAL] I got a fax cover sheet here.
[CUSTOMER][NEUTRAL] Um, I was, uh, no, no, no attaches your claim packet. Oh, here it is, um, to claim support APL and then the fax number was [PII].
[CUSTOMER][NEUTRAL] OK, so our fax number for claims, let me give that to you real quick.
[CUSTOMER][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 942 [PII].
[CUSTOMER][NEUTRAL] Now we're also.
[CUSTOMER][NEUTRAL] 3659423
[CUSTOMER][NEUTRAL] OK, and, and because you were through Business Workers of America.
[CUSTOMER][NEUTRAL] I will need to transfer you over to them so that they can further help you because.
[CUSTOMER][NEUTRAL] They have um.
[CUSTOMER][POSITIVE] That's a very special group for us so I wanna make sure that you get good help. Let me give you the phone number I'm getting ready to transfer you to.
[CUSTOMER][NEUTRAL] OK, let me get a new piece of paper.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, [PII], ready.
[CUSTOMER][NEUTRAL] OK, that number is [PII].
[CUSTOMER][NEUTRAL] 886 [PII].
[CUSTOMER][NEUTRAL] OK, should I ask them the question about if I need to resubmit these claims to this fax number and even ask that question you can ask them, yes ma'am, you can.
[CUSTOMER][POSITIVE] Oh boy, OK, thank you very much.
[CUSTOMER][POSITIVE] Oh, you're so welcome and I hope that you have a wonderful rest of your week and we certainly appreciate you calling uh APL Ms [PII]. I'm glad I was able to clear up some of the issues for you. It's gonna be a brief hold before I transfer you on over to them so just know that I'm gonna put you on hold, OK? And if we get disconnected you have that phone number.