AccountId: 011433970860
ContactId: 5ed687bd-dd42-4f7b-a6e8-08ed4e5eecd5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2540810 ms
Total Talk Time (AGENT): 859304 ms
Total Talk Time (CUSTOMER): 956327 ms
Interruptions: 6
Overall Sentiment: AGENT=0.1, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/5ed687bd-dd42-4f7b-a6e8-08ed4e5eecd5_20250207T15:49_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII], and I currently have a claim I'm calling to check in on, um,
[AGENT][NEUTRAL] OK, Ms. [PII], so this claim is for yourself and you're calling to check status?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and your policy number, please?
[CUSTOMER][NEUTRAL] My member ID number is 682888-527.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so I'm gonna have to go about looking up your policy a different way. Is that the only number that's on your ID card?
[AGENT][NEUTRAL] Ms. [PII], how.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Hold on, I have a copy of my ID card.
[AGENT][POSITIVE] Sure, thank you.
[CUSTOMER][NEUTRAL] Yeah, so it just says member ID and that's the only number.
[AGENT][NEUTRAL] OK, so, um, what, give me the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a group ID number.
[AGENT][NEUTRAL] What is, what does that say?
[CUSTOMER][NEUTRAL] Um, it says group ID G12.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 03273
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so, no, ma'am, that's not gonna be. So spell your last name for me to make sure I get it correct.
[CUSTOMER][NEUTRAL] Sure, it's [PII]
[AGENT][NEUTRAL] Huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. OK. And again, the first name, please?
[CUSTOMER][NEUTRAL] [PII] is [PII]
[AGENT][NEUTRAL] OK, thank you. So give me just a moment, Ms. [PII], please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and would the policy be in your name, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, yeah, it says member name [PII], and then I had a family plan.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah, so I only paid for this, um, plan for the month of [PII].
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Just that month I didn't have it for the rest of the year at all.
[AGENT][NEUTRAL] OK, so give me just, I may have located the information one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so first off, Miss [PII], any information that I do provide for you will be a verification of benefits and not a guarantee of payment. First off, what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and your home mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number that is on file for you is the same as the one you gave me, so again, that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you and lastly your email address please.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, thank you. So, um, and again, what is the date of service, Miss [PII] that you're calling in regards to?
[CUSTOMER][NEUTRAL] Um, so I submitted a claim.
[CUSTOMER][NEUTRAL] A long time ago. Let me look exactly on the date that I sent it in, um.
[CUSTOMER][NEUTRAL] [PII] or [PII], and I've called multiple times to get a check in and apparently my claim hadn't been reviewed, so I was told to call after the end of January. Um, date of bills that I sent in that I emailed copies for, um, the first one being [PII] in the amount of $239.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The, the second one being the same day, um, for a lab work.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] For $366.82. And then the final bill I sent in for was for um [PII], and that was for $2,471.73.
[AGENT][NEUTRAL] OK, so I do see that this claim was received and processed on [PII], it was processed on [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We did issue a benefit payment that was mailed to that address that you provided for me in the amount of one.
[CUSTOMER][NEUTRAL] My home address?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, I never received.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the amount of $100 and that was on for the data service of 81.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The other two of the other part of the 81 data service, it was denied because the max, the calendar year max for this benefit was exhausted.
[AGENT][NEUTRAL] Therefore, no additional benefits are payable. When we pay that $100 benefit, it that max that out. The date of service for [PII].
[AGENT][NEGATIVE] It is the same remark that the calendar marks for this benefit has been exhausted.
[AGENT][NEUTRAL] But, yes, ma'am. So you did, you did not receive that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, so let's hold on here. So I paid $900 out of my pocket.
[CUSTOMER][NEGATIVE] Um, for this state health insurance for my family, so then I went to the doctor knowing I had insurance, and even if it's out of network, which I don't think it is, but that was the original reason why it was denied, um, you don't cover like half, which is what I was told when I bought this insurance that where I was going specifically was in network. So now you're saying I'm responsible for over $3000 worth of stuff just because poof, no.
[CUSTOMER][NEGATIVE] That doesn't make any sense.
[AGENT][NEUTRAL] Now
[AGENT][NEUTRAL] Now this I'm not sure we've only reviewed your claim once. You may have additional coverages, Ms. [PII], but APL has only received this one claim and reviewed that. Now this was through your association with the Business Workers of America, is that correct?
[CUSTOMER][NEUTRAL] Um, I purchased.
[AGENT][NEUTRAL] That's who you enrolled.
[CUSTOMER][NEUTRAL] On my medical card, it says PHC Limited benefit plan, plan name FE-Americare 500.
[AGENT][NEUTRAL] All right. I'm gonna, just so I can put this in your note. Um, say that again. PHD limited benefit plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh. And then America.
[CUSTOMER][NEUTRAL] And then my the plan name was FE-Americare 500.
[AGENT][NEUTRAL] Is it A M E R I C A R E?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So PHC limited benefit plan and then you said the plan name.
[AGENT][NEUTRAL] Was FEAmericare 500. Is that correct?
[CUSTOMER][NEUTRAL] Correct. And when I submitted my claim, I also submitted a copy of my medical card and these bills that we are discussing. So I don't know if you can pull that up to reference.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a moment please.
[AGENT][NEUTRAL] It takes a moment, Ms. [PII] for this information to load for me, so please bear with me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I was gonna say I have the email I can forward it to you if if you need.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm sorry, what type of email do you have?
[CUSTOMER][NEUTRAL] So, um, I was told to submit a claim since this claim was initially denied, so I filled out all the paperwork and sent it in.
[CUSTOMER][NEUTRAL] Via email um to [PII], which is what it advises.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, and I did that
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so that is for the, the customer support at 4 member services is not actually the company that I am with.
[AGENT][NEUTRAL] But give me just a moment. That's, that's the enrollment company?
[AGENT][NEUTRAL] That you enroll through.
[AGENT][NEUTRAL] Um, just one moment.
[CUSTOMER][NEGATIVE] It's like every time I call I have to speak to a different person, a different company. It's uh I get different answers every single time I called. I've called 5 times now.
[CUSTOMER][NEGATIVE] Um, I'm just getting very, very frustrated with this situation.
[AGENT][POSITIVE] Yes, ma'am. I, I can completely understand your situation and I'm, I'm very sorry about that.
[AGENT][NEUTRAL] OK, so let's see, let me, let me look at this document that we received.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So what we received came from
[AGENT][NEUTRAL] The member services.
[AGENT][NEUTRAL] But there is not a cop, uh, let's see, who's just one number.
[AGENT][NEUTRAL] OK. All right. So, um, again, on with APL, the plan that you have with our company, Ms. [PII] was a limited benefit plan.
[AGENT][NEUTRAL] It's not a major medical coverage that you have with us.
[AGENT][NEUTRAL] So again, it only pays specific amounts for certain coverage services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So nothing, I covered nothing.
[AGENT][NEUTRAL] So, yes, this $100 benefit was the maximum that this policy would pay for those services.
[AGENT][NEUTRAL] And that, that was issued. Now, I, because you did not receive this check, I can send a request to have that, you know, verified that it was still outstanding and have that reissued to you.
[CUSTOMER][NEGATIVE] I mean, what's $100 gonna do for the $3000 I'm now responsible for? I, I guess I, I was lied to when I purchased this plan because I.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] Verified that this would cover me, um, and I know apparently it's a different company, whoever the hell sold it to me, um.
[CUSTOMER][NEGATIVE] Uh, I don't know. I'm just literally at a loss for words. This was just to confirm that I was pregnant. So now I'm responsible for $3000 for some blood work, um.
[CUSTOMER][NEGATIVE] Uh, I, I don't know if I can speak to a supervisor if like if there's anything else you can do, um, I'm just very, very frustrated with this situation because it's like I paid $1000 you know, $900 and change for my family to have insurance when my husband had lost his job that month.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][POSITIVE] And now I'm responsible for even more. I would have saved myself money. I would at least like a refund for, you know, the $900 that I paid to put towards these medical bills since nothing was covered.
[AGENT][NEUTRAL] Sure. Um,
[AGENT][NEUTRAL] Now, I can, I can understand now, Ms. [PII], we here at APL we do not have anything, you know, to do as far as your deductions or what was paid in.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] The member services.
[AGENT][NEUTRAL] is who you would need to speak to.
[CUSTOMER][NEUTRAL] But I got, but I got your number from member services and they said that you were responsible. I wouldn't have just speak.
[AGENT][NEUTRAL] OK, but
[AGENT][NEUTRAL] And who, who did you, no, ma'am. Who, who did you speak to at member services?
[CUSTOMER][NEUTRAL] Oh, I don't know. I've called 700 times at this point, um.
[AGENT][NEUTRAL] But member services told you that APL would be responsible for refunding you your premiums. Is that correct?
[CUSTOMER][NEGATIVE] That that's who I needed to talk to to get answers to see if I would get any money at all and then was given this number. Um, I definitely didn't pull that number out of thin air. Um, I called [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Of this year and was given this number and said to call back around the end of July because my claim had not been processed.
[CUSTOMER][NEUTRAL] Or end of January, I'm sorry.
[AGENT][NEUTRAL] I'm just taking a note on this.
[CUSTOMER][NEUTRAL] So I can call this member services back and see where that gets me, but they gave me your number and said that.
[AGENT][NEUTRAL] Now, as far as for processing your claim for this particular hospital indemnity plan that you had at that time,
[AGENT][NEUTRAL] That is correct as far as they forwarded because it appears that you sent your information to them which you said that you had emailed it to member services they forwarded that over to APL and we did review it.
[AGENT][NEUTRAL] For that data service for this particular policy. Now there I know that there was a portal you all have access to through the member services where you enrolled. Is that correct?
[CUSTOMER][NEUTRAL] No, I've never. I, I enrolled via phone.
[CUSTOMER][NEUTRAL] Um, so you're saying that APL is a branch of this PHC network that I'm that I was a part of for one month?
[AGENT][NEUTRAL] I mean
[AGENT][NEUTRAL] We're not part of any network.
[CUSTOMER][NEGATIVE] I don't understand what this APL even is I guess um because it doesn't reference any of that on my card.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This was just, we were
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you, do you mind now I will be I'm assuming you already have the member services phone number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yup.
[AGENT][NEUTRAL] So what I can do is I can just offer to escalate your situation to one of our management to let them know what.
[AGENT][NEGATIVE] You know what has happened, you said none of your information mentions APL, your ID card. I'm looking at it. It's very, it's not very easy to read. The quality is not.
[AGENT][MIXED] It is not good, but I can see.
[AGENT][NEUTRAL] That information.
[AGENT][NEUTRAL] I, I can see that it does not have any of your information related to APL on this card.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Again, we have been told that you all would have received a welcome email through member services for our portals.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] that you all would have access to?
[CUSTOMER][NEUTRAL] Um, I mean, I can.
[CUSTOMER][NEUTRAL] Search, I mean, I got my claim form.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] It's just that
[CUSTOMER][NEUTRAL] Copy of my ID card and plan, which I click on in it.
[CUSTOMER][NEUTRAL] The link is now gone, but it's what I, you know, have submitted it's this page that you print with your card.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean, it just has the member's customer service number and an email.
[AGENT][NEUTRAL] So give me, let me a moment.
[CUSTOMER][NEGATIVE] I, I don't even know what this portal would do for me. What's it gonna do? Log on and say no, you, you owe $3000.
[AGENT][NEUTRAL] Again, that's the portal that we were to direct any members to that had enrolled through this association.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] As far as any question, yeah.
[CUSTOMER][NEUTRAL] But why? What do I need? What do I need to be directed there for?
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] I can only provide you uh well I can only provide you the claims information that was sent over to us that we reviewed and paid the benefit on for the plan that you have with APL.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I didn't even realize I was getting a plan with APL. I thought it was with this other.
[CUSTOMER][NEGATIVE] Thing, obviously, um, regardless what I bought was garbage or what I was told I was buying or lied to.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean, I guess I found this portal it says it's inactive. It, you know, it just has the.
[CUSTOMER][NEUTRAL] Same thing I'm looking at the cards.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The exact same thing I sent you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Doesn't say anything different.
[CUSTOMER][NEGATIVE] Says it's inactive now at the end of August, which again I only paid for it for one month and apparently I was flushing money down the drain at this point. It's costing me money.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] View your what what is the portal gonna do for me here?
[AGENT][NEUTRAL] Now unfortunately I can't, we have just been instructed that you all have a link to a portal through your enrollment through this association.
[AGENT][NEUTRAL] They would have provided you with all of your information related to your enrollment.
[AGENT][NEUTRAL] And I have the phone number and that same email that it appears you emailed this claim to for member services.
[CUSTOMER][NEGATIVE] Yeah, which is useless.
[AGENT][NEUTRAL] As
[AGENT][POSITIVE] As to, you know, for us to refer calls to. Now, I will be happy again, as I said to.
[AGENT][NEUTRAL] Get your information to one of our executives who can reach out.
[AGENT][NEUTRAL] Regarding your circumstances since you were
[CUSTOMER][NEUTRAL] Sure, I think I've tried to do that before.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, this is just copies of stuff that I signed that that I paid $900.
[CUSTOMER][NEUTRAL] That my husband and child were on this, even though it cost us.
[CUSTOMER][NEUTRAL] It's that $3000 now.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So I have a I'm sorry, BWAmericare plan number 4.
[CUSTOMER][NEUTRAL] And then it says APL HI plan cert 4.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] So that is my company that was the plan that you had with us through that enrollment.
[CUSTOMER][NEGATIVE] And it covered nothing, obviously.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] And this was just to confirm I was pregnant. This was literally blood work to confirm I was pregnant.
[CUSTOMER][NEGATIVE] So that doesn't get covered under the plan.
[AGENT][NEUTRAL] Again, because it's not a major medical plan, it only paid specific dollar amounts for certain services, and when the claim was processed with that $100 payment that maxed out that particular benefit under this policy.
[CUSTOMER][NEUTRAL] So I paid $900 to get $100.
[CUSTOMER][NEUTRAL] Towards my
[CUSTOMER][NEUTRAL] Blood work.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I, yeah, and again, Ms. [PII], I understand your frustration. Unfortunately, I can't see any of your premium information because that is not something that we handle.
[CUSTOMER][NEUTRAL] Yeah, for me to a supervisor, even though I'm pretty sure I've done this before and nobody ever called me back, so.
[CUSTOMER][NEUTRAL] Just keep going down the rabbit hole.
[AGENT][NEUTRAL] OK, now, the supervisor that I'm going to try to connect you, well, I'm gonna have to send an escal. Let me see if there's one even available. If not, um, but you said you've requested a supervisor with American Public Life to call you or through the member services? Because I don't see where that request has been made. I just want to.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEGATIVE] It must have been member services then I never heard from anybody.
[AGENT][NEUTRAL] Yes ma'am, because
[AGENT][NEUTRAL] Yes, ma'am, because I don't actually even see where we have actually spoken to you before here at APL until now.
[AGENT][NEUTRAL] So do you mind letting me place you on hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Where is this? Where's that?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Where's my escalation?
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] She, no, no.
[AGENT][NEGATIVE] She don't want to call back.
[AGENT][NEGATIVE] This is garbage.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] God dang it, [PII], the fuck.
[AGENT][NEUTRAL] Well, I would accept.
[AGENT][NEUTRAL] Really?
[AGENT][POSITIVE] God dang it.
[AGENT][NEGATIVE] Fucking shit's sakes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Huh
[AGENT][NEGATIVE] God damn it.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] On base
[AGENT][NEGATIVE] No info about APL. She can't reach BWA. No one calls her.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Ms. [PII], this is, um, thank you for your patience. I am trying to get you connected with one of our supervisors.
[AGENT][POSITIVE] So that you can express your concerns. Um, again, thank you for your patience while I'm doing this, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And while I'm waiting for a response on this, Ms. [PII], I will request, if you want me to, that that check.
[AGENT][NEUTRAL] That we did issue to you?
[AGENT][POSITIVE] Verify that it is still indeed outstanding and have that reissued.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm going to get you connected now with one of our supervisors who is going to um I'll join her in the call though before I leave and give her an overview of the nature of your call OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Well, is there anything else, Ms. [PII], that I can help you with first?
[CUSTOMER][NEUTRAL] Nope.
[AGENT][POSITIVE] OK, well, thank you so much for calling APL. I'm very sorry that you've gone through all of this, um.
[AGENT][POSITIVE] And I hope you have a nice weekend, OK?
[CUSTOMER][POSITIVE] You too. Thanks.
[AGENT][POSITIVE] Alright, yes ma'am. Thank you. So one moment.
[AGENT][NEUTRAL] Crysta.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hey. Hey, [PII].
[AGENT][NEUTRAL] Hey, can you hear me? Hey, can you hear me?
[CUSTOMER][NEUTRAL] Hey, I can, um, hold on just a second. I'm gonna get, um.
[AGENT][NEUTRAL] Yeah, you're fine.
[AGENT][NEUTRAL] Because I'm wanting to, yes, I would like to remain on this call, please, so that you, I can hear what you all have to say to her. I feel so bad for this lady because if you're looking on base, that ID card has that [PII] address that I have been given before.
[CUSTOMER][NEUTRAL] OK, I'm gonna get [PII].
[AGENT][NEUTRAL] Anyway
[AGENT][NEGATIVE] This poor lady, she, it's been a nightmare for her.
[CUSTOMER][NEUTRAL] Well, we, we, we were told yesterday we can't help it, but send it to us.
[AGENT][NEUTRAL] And I've
[AGENT][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] And they look
[CUSTOMER][NEUTRAL] Let me look at the, let me look at the card in the face.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEGATIVE] Because I don't understand why the card and Ona didn't have APL on it.
[AGENT][NEUTRAL] You can
[AGENT][NEGATIVE] Oh, it has nothing on it. It has that [PII] address. It has, there's only mention of APL is in that portal that she really doesn't even have access to anymore. I tried to direct her there. Nobody from BWA will call her. She has called it garbage, not legitimate, um.
[CUSTOMER][NEGATIVE] Well, we can, we can't help it. I mean our hands are tied, so we're gonna all we're gonna tell her is is that we're gonna escalate this to um executive management so they can get a hold of the agent.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I mean, we
[AGENT][NEUTRAL] Uh-huh. Yes.
[AGENT][NEUTRAL] Uh, and I would just, as I told her I'd like to just remain on the line when I join her in.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Sure you can listen in for, you know, we can now her now this policy 253-7361 that is lapsed.
[AGENT][NEUTRAL] Uh-huh. But her date of service was back during when it was active.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK.
[AGENT][NEUTRAL] But the claim didn't come to us. The claim went to BWA and after months and months, it got sent over to APL.
[AGENT][NEUTRAL] Months.
[CUSTOMER][NEUTRAL] OK, but what's the issue?
[AGENT][NEUTRAL] It got.
[AGENT][NEUTRAL] The issue is the lady that she
[CUSTOMER][NEUTRAL] What what
[AGENT][NEUTRAL] We went over her claim.
[AGENT][NEGATIVE] I, we went over the remarks. We paid her $100 which she's never received, and she is extremely upset that she was assured this was in-network and on and I don't know which, I don't know how to help her because I don't understand what she's talking about.
[AGENT][NEUTRAL] She was assured this was in network to confirm her pregnancy. Now she's gonna be responsible for $3000 worth of labs that she was assured was covered.
[CUSTOMER][NEUTRAL] OK, so
[AGENT][NEUTRAL] Who's assuring her of these things?
[CUSTOMER][NEUTRAL] What do the notes say?
[AGENT][NEGATIVE] There are no notes because she's never called APL until now, but she doesn't even know who the hell she's talking to because she talked to so she can't, she doesn't know who she's talking to just like the rest of these people.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so what's her HI policy say?
[AGENT][NEUTRAL] What do you mean, what does it say there?
[CUSTOMER][NEUTRAL] About paying for um maternity type.
[AGENT][POSITIVE] No, we paid for her, the claim was processed properly.
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] I just need to get, I need to do a hub request after this call so that I can get this check, tried to be reissued to her, but I want you all to hear her concerns because this is what we're dealing with.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it's very difficult with these callers.
[CUSTOMER][NEUTRAL] Did she ask for a supervisor or did you?
[AGENT][NEGATIVE] Yes, she most definitely did. She, I offered to open it up, but she wanted to speak to somebody, but she said, I don't expect anybody to call me back because they never do.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that's when I
[CUSTOMER][NEUTRAL] OK, well, are you ready, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I'm ready. And how do you say her name, [PII]?
[AGENT][NEUTRAL] OK, do you want me?
[AGENT][NEUTRAL] [PII]. [PII].
[CUSTOMER][NEUTRAL] Blooming hour, OK, send her on.
[AGENT][NEUTRAL] And I'm gonna announce both of you. Am I gonna announce both of you on the line?
[CUSTOMER][NEUTRAL] Just announce [PII], I'm just learning. Yes, [PII]'s gonna stay on mute.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, all right, yeah.
[AGENT][NEUTRAL] All right, thank you. All right, just a moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Hi, Ms. [PII]. This is still [PII]. Are you still there?
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] OK, so thank you so much again for your patience and holding while I was uh getting one of our supervisors. This, I have [PII] on the line.
[AGENT][NEUTRAL] [PII], can you hear Ms. [PII]? Ms. [PII], can you hear [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, yes, hi Miss [PII], this is [PII].
[AGENT][NEUTRAL] So I've given [PII] a little bit of your background information, but if you would like to, you know, go ahead, she now that I know that both of you all can hear each other.
[CUSTOMER][NEUTRAL] Hi, [PII].
[CUSTOMER][POSITIVE] Yes ma'am, thank you [PII] I appreciate it. Hi Miss [PII] um.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][POSITIVE] Yes ma'am, hi Miss [PII]. [PII] has told me, um, your concerns, and I do apologize for all of the inconvenience that you're experiencing. So what I can do is, um, I am going to reach out to to my upper management team and have them reach out to the agent that's over BWA and I will get you some answers.
[CUSTOMER][NEUTRAL] Would that be OK for you?
[CUSTOMER][NEGATIVE] Yeah, um, obviously, I'm extremely frustrated with the situation, um.
[CUSTOMER][NEGATIVE] You know, purchasing health insurance for my family for one month and then being responsible for every single penny that I went to the doctor for, not even like 50% if it's out of network or, you know, something like that. Um.
[CUSTOMER][NEGATIVE] It's not like I have thousands and thousands of dollars laying around to just uh get routine checkups.
[CUSTOMER][POSITIVE] Yes ma'am, I, I completely understand um so what I will do is I'll, you know, escalate this up further. Can you give me your call back number just so that um I will have that um and we can get the agent to contact you.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, alright, so just as soon as we get off of this phone call I will reach out to my upper management team and [PII] will also be um submitting um a request to have that original check for $100 that was submitted to you. We will have it voided and have that claim reprocessed.
[CUSTOMER][NEUTRAL] OK. Um, and what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK, um, do you have everything that you need to review the claim like you have a copy of the itemized bills in the claim that I submitted?
[CUSTOMER][NEUTRAL] Yes ma'am, we have everything. [PII] passed that, um, passed your policy number along to us and she is going to handle that the reprocessing of that claim and that check reissuance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so you're saying I should hear from someone soon or it's gonna take a while to be reprocessed?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, now that, that we will, um, we will have that, that, um, claim reprocessed, um, today is Friday. It should be reprocessed Monday or Tuesday of next week because we have to void it in our system and if there's like a nightly process that we have to, you know, go by to where, you know, it voids out of our system and then we reprocess it and then during that nightly system it reprocesses a check, but now, um, Miss [PII] now, um.
[AGENT][NEUTRAL] It's
[CUSTOMER][NEUTRAL] What I could offer you instead of receiving a check via mail, I could send you out a direct deposit form to where you can have this payment direct deposited into your checking account if you'd like that.
[CUSTOMER][NEUTRAL] OK, um, so you're saying basically the $100 is the most I'm gonna get out of all this though?
[CUSTOMER][NEUTRAL] Well, I will definitely have, have the claim reviewed during the reprocess, and yes, ma'am, I will have, have the claim reviewed.
[CUSTOMER][NEUTRAL] OK, yeah, we can just, I guess, guess wait until it gets reviewed just because I'm, I'm asking for over $3000 worth of coverage, so $100 really isn't gonna do too much for me, um.
[CUSTOMER][NEUTRAL] Yes ma'am, yes, and, and if you'd like, once, once we do have that claim reprocessed.
[CUSTOMER][NEUTRAL] I can have a claims representative reach out to you to go over the claim with you personally if you like.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right then, yes, ma'am. Now, is there anything else that I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Um, no, I guess I will just sit and wait to hear from someone on this, um, yes ma'am, I'm gonna try to have you a call back today or Monday.
[CUSTOMER][NEUTRAL] OK. Yeah, if I don't hear from anybody by the end of the week, I will, um,
[CUSTOMER][NEUTRAL] Give a call back to this number that I was given from member services, um, and I guess asked for either you or [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, or, um, we will, I'll, I've got your policy notated in here, but it should not take us so you know, APL a week to get you a response back, um, just as soon as we get off the phone I'll, I'll get this sent up to our upper management team for you.
[CUSTOMER][POSITIVE] OK. Well, thank you.
[CUSTOMER][POSITIVE] You're welcome. Thank you for calling APL, Ms. [PII]. I hope you have a good, a good weekend. You too. Yes, ma'am. All right, bye bye.
[CUSTOMER][NEUTRAL] So she submitted.
[CUSTOMER][NEUTRAL] Claims totaling 3000 and all we paid was 100. Right. And so what I'm thinking.
[AGENT][NEUTRAL] That's correct, but it was yeah it was emailed. I mean it wasn't even submitted to APL until we got it via email from.
[AGENT][NEUTRAL] BWA.
[CUSTOMER][NEUTRAL] OK, so [PII], can you do this? Can you, um, maybe if it's OK with them, go to project and send us a step by step with that an email that she sent it to the to BWA that the claim and then we didn't get it until months after, you know, on whatever date and all that, then that way I can we can get this all in 11, yeah.
[AGENT][NEUTRAL] Yeah, and when she's talking about in-network, was assured that it would be covered and all, where is she getting that?
[CUSTOMER][NEUTRAL] Yeah, we'll get.
[CUSTOMER][NEUTRAL] Probably BWA or some other company to make sure you include that.
[AGENT][NEUTRAL] Yeah, cause she's
[CUSTOMER][NEUTRAL] Yeah, put it in the summary what she was saying.
[CUSTOMER][NEUTRAL] I gotta get him. He got, yeah, alright, well we got a 10:30.
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] Thank you, thank you, thank you y'all.
[CUSTOMER][POSITIVE] Thank you bye bye bye.
[AGENT][NEUTRAL] Uh