AccountId: 011433970860
ContactId: 830c23f7-593b-4105-8b40-0b5fd2b8f6c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1270869 ms
Total Talk Time (AGENT): 531686 ms
Total Talk Time (CUSTOMER): 700024 ms
Interruptions: 28
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/830c23f7-593b-4105-8b40-0b5fd2b8f6c8_20250416T20:35_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi there, um, I had just called a few minutes ago, um.
[CUSTOMER][NEUTRAL] And I, I've never filed a claim before and the lady was real helpful with um giving the instructions on how I can go about doing so but I had forgot to ask um one important question um and that was um verifying which plan I had um can you help me with that?
[AGENT][NEUTRAL] Sure. Can I have a policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh.
[CUSTOMER][NEUTRAL] Yes, it is, uh, sorry, one second, 02446504.
[AGENT][NEUTRAL] And what is this member's name? Oh, [PII], is you. What's your name, mailing address and your date of birth? I'm so used to talking to a provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, that's OK. [PII] and um I'm sorry, what did you ask?
[AGENT][NEUTRAL] Your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] What, oh, where the verification, yeah.
[CUSTOMER][NEUTRAL] Right, uh, mailing address is [PII], and my date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So your policy, you're calling and your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you [PII] and what is your email address that we have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I know it's a lot we have to verify and make sure that it's you.
[AGENT][NEUTRAL] Um, so you're calling to verify what type of policy you have. This is a midli, a Metlink gap policy. Do you see that option for a Metlink gap policy?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] That is really.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So I have, I have a sheet that says accident insurance and it has um.
[CUSTOMER][NEUTRAL] It has plan 12, plan 3.
[CUSTOMER][NEUTRAL] That's why I was wondering what what mine would fall under if it would be under plan 1, plan 2, or plan 3.
[CUSTOMER][NEUTRAL] I, I have no idea. It's, it's like a.
[CUSTOMER][NEUTRAL] Um, this was a, um.
[CUSTOMER][NEUTRAL] I don't know. I mean this is like a packet that we got, hold on, um, so.
[CUSTOMER][NEUTRAL] Yeah, I mean it says meddling supplemental gap plan um.
[CUSTOMER][NEUTRAL] Do do do but um.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah, it just I mean, but this is that was that's one page but it goes further into that it it has.
[CUSTOMER][NEUTRAL] Oh wait, hold on.
[CUSTOMER][NEUTRAL] Med bank supplemental gap plan.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So is, is this, I'm, I'm confused, is this not considered accident insurance?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Ma'am?
[AGENT][NEUTRAL] I'm here. This is a gap insurance. Your policy is a gap insurance. It's not an accidental insurance, accidental policy.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Did she tell you that someone tell you that it was an accidental policy?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause this is not an accidental policy.
[CUSTOMER][NEUTRAL] Well, I mean, I'm, I'm confused like what is, what is the diff like I don't, I guess I'm, I'm what is the difference?
[AGENT][NEUTRAL] The difference, so you have two policies here. The policy number that you gave me is a meddling gap policy. So which policy are you trying to get a claim submitted for? Is it for your accidental policy or your gap insurance policy? Because your gap insurance policy is a policy that covers your, your deductible co-pay and co-insurance.
[AGENT][NEUTRAL] For medical services to your primary insurance, but what they don't pay and they put towards your deductible, co-pay and co-insurance balance. However, you have a second policy here as well, which you gave me the policy number to your meddling gap insurance, but there is an accidental policy here as well. So are you trying to submit a claim for that policy instead of a meddling policy? I'm, I'm confused. I don't know which one that you, it is that you're inquiring about today.
[CUSTOMER][NEUTRAL] Oh hey, you're gonna give me. I'm sorry, um.
[CUSTOMER][NEUTRAL] I don't, you said I have, you said I have an accent.
[AGENT][NEUTRAL] But you gave me the policy number.
[CUSTOMER][NEGATIVE] Wow, I'm so confused.
[AGENT][NEUTRAL] So the policy number that you provided me with in the beginning of the phone call was your gap insurance, your Metlink gap insurance. So then I looked when you said you was confused that this is not an accidental policy, so I looked to verify if you have multiple policies here at American Public Life, and it looked like you do have a another insurance policy here with American Public Life.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Which is an accidental insurance policy, so which one are you trying to submit a claim for? Is it Medlink or accidental? Because if it's accidental, then I will have to transfer you to another queue, which is the accidental queue because I can only assist with the Medins information.
[CUSTOMER][NEUTRAL] I do. And
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Ma'am, I, I don't know. I'm all confused. So you said I have you.
[AGENT][NEUTRAL] So what, what type of claim do you have?
[AGENT][NEUTRAL] So, so for us to be able to not be confused, you or myself, what type of claim are you trying to file?
[CUSTOMER][NEUTRAL] Girl, I don't know.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, your guess is as good as mine because with me not filing any claims before, I don't know. So, um, all right, well.
[CUSTOMER][NEUTRAL] How about helping me with this? OK. So, being that I, I only feel like I have
[CUSTOMER][NEUTRAL] Hold on. OK. So,
[CUSTOMER][NEUTRAL] And I am just, I'm really confused now, so.
[AGENT][NEUTRAL] So have you been to the doctor for an accident? Like were you in an accident, something happened to you, you were causing, that caused you to be harmful from an accident or something? Cause that's considered as an accident.
[CUSTOMER][NEUTRAL] Let's, let's back up just a little bit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, well, no, um, I just, I'm, I'm looking at, I'm looking at some things but see.
[CUSTOMER][NEUTRAL] Oh, I don't even know how to describe it. Like I'm, I'm.
[CUSTOMER][NEUTRAL] I'm kind of a hot mess, to, to put it lightly. Like I haven't been in a quote unquote accident, but I, I go to the doctor. I, I have a lot going on, OK? So, I've, I've had MRI's, I've had CTs, I've had X-rays. I am in and out of the doctor. I
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that'll be considered as a sickness. So that will go under your meddling. That's considered as a sickness, go under your meddling, your gap insurance.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. OK. But I'm, I, and I'm getting ready to have some outpatient surgery, um, you know, so it's like,
[AGENT][NEUTRAL] They will go to your gap insurance.
[CUSTOMER][NEUTRAL] I feel like I have, you know, I, I feel like it's gonna be a combination of both, you know, accident and meddling. So I probably, but
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So were you in an accident?
[AGENT][NEUTRAL] Were you in an accident and this is the reason you have to go through these medical necessities cause you was in an accident?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] So it won't be an accident. It'll just be on the meddling.
[CUSTOMER][NEUTRAL] No. Um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I got you. I got you. OK. So, but, but just so that I understand, because I, I am, I'm looking, I'm looking at a copy of, of my um APL card. I, I don't have my wallet in front of me, but I'm looking at my, all of my paperwork from my employer, OK? And I have my, a copy of my card in front of me, or, you know, a copy of my APL card, but I only have.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm only looking at a copy of one of my, well, the only card that I know that I have which says plan med link with benefit assignment. So if you're telling me that I also have.
[CUSTOMER][NEUTRAL] Accident insurance under APL.
[AGENT][NEUTRAL] Which so what an accident is?
[CUSTOMER][NEUTRAL] How come I
[AGENT][NEUTRAL] So, OK, so if you want, I can only answer questions about your Medlink policy. Now, if you need for someone to explain to you about your accidental policy, I could be gladly to transfer you to the accidental policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right. Oh, I understand. OK, yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right. [PII], yeah, I got you, I got you. OK, but
[AGENT][NEUTRAL] So would you like for me to transfer you to accidental because I can only answer your meddling stuff.
[CUSTOMER][NEUTRAL] I got you I got you. Are you just able to answer just like would it?
[CUSTOMER][NEUTRAL] I, and I get, I get that you're only able to answer meddling questions. However, comma, I just am curious if when the cards are issued initially, if you have multiple
[AGENT][NEUTRAL] You're only gonna get one.
[AGENT][NEUTRAL] You're just gonna get one which is your Metlink, which is for Metlink.
[CUSTOMER][NEUTRAL] OK. That's what I'm wondering. OK.
[CUSTOMER][NEUTRAL] OK. That's what I was curious cause I'm like, wait a minute, how come I don't have multiple cards here? Because I'm confused. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because you're meddling
[AGENT][NEUTRAL] And the reason why you're getting the med link is because when you go to your doctor's office, your doctor's visits, you're gonna provide them that so that they can submit your claims and you have multiple claims on file, so it looks like somebody's been submitting claims on your behalf for the providers.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I know. Well, yes, yes, because I always submit that card. I do because I have it in my wallet. That's just the extra card that I'm looking at.
[AGENT][POSITIVE] OK, so that you're doing right.
[CUSTOMER][POSITIVE] Yes, yes. I always submit that card cause the guy that came to, to, to, that always comes to speak to us at our job, he always tells me to, to always turn that card in, which is good. And I'm, I'm listening to that. My problem is that I just have been very slack and not submitting my claims for myself, which is not good, but I've learned that from the last lady I just talked to.
[AGENT][POSITIVE] Yeah, you're doing, you're doing right.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's good.
[AGENT][POSITIVE] But your providers are doing them for you.
[CUSTOMER][NEUTRAL] Well, but at the same time, I'm not, uh, but I'm not getting, I'm, I'm not, um, I'm not filing the claim in order to get the compensation. Do you see what I mean?
[AGENT][NEUTRAL] It looked like that.
[AGENT][NEUTRAL] Cause
[AGENT][NEUTRAL] So if the provider.
[CUSTOMER][NEUTRAL] Like I'm not providing the information.
[AGENT][NEUTRAL] Right, if you, so uh, so this is how the gap insurance works, so.
[CUSTOMER][NEGATIVE] Like, I'm not turning in the explanation of benefits or something. I don't know, but I'm not getting, I haven't gotten a single dime. You know what I mean? Like, in my pocket.
[AGENT][NEUTRAL] So you're not gonna get one if the provider, so if the provider is submitting the claims, then whatever is the patient's responsibility towards the deductible copay and co-insurance, that's gonna go to the provider. I'm not sure if the first agent that you spoke with, I know she probably was very helpful, but I hope she expressed to you that if the provider submits the claims, then the claim, the payment is gonna go to the provider because you owe the provider money. Now.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's a difference. It's, it's, it'll be different if you are submitting the claims, showing your receipt, the itemized bill, and the explanation of benefits for that date of service along with the diagnosis code, and it shows that you paid the provider for those services, then the money is gonna go to you. However, providers have been submitting the claims on your behalf. So therefore, you're not gonna receive any payments because the payments are going to the providers where the payment is due to.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEGATIVE] If that makes sense, that's why you're not getting any compensation for it.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Ah.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] Now if you're paying the provider and then they're coming back and submitting the claim, and they're not giving you the money because you've already paid them beforehand, and that's something you have to take up with the, with the facility.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So I, I, I kinda get it. So I, I got you. So it's kind of
[AGENT][NEUTRAL] But I'm not sure.
[CUSTOMER][POSITIVE] I, I get, I, I think I kinda understand how it all, in a sense works. It's almost like
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] The reason that I'm not seeing
[CUSTOMER][NEGATIVE] Very like costly, quote unquote, costly doctor bills is because the, the providers have been doing this.
[AGENT][NEUTRAL] It's because we're paying on them.
[AGENT][NEUTRAL] Yes, yes, ma'am.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Like, in a sense, the providers have been doing this for me and that's why like, I'm only seeing maybe like $21 bills or, you know, just kind of smaller bills trickling in from these providers because that's the remaining amount.
[AGENT][NEUTRAL] Right, versus the 300 and 3000. Right, yes.
[CUSTOMER][NEUTRAL] Right, or, or, yeah, I gotcha. I gotcha. OK.
[CUSTOMER][POSITIVE] I got you. OK. So it's, I mean, what do they say, 61, half dozen and I mean, it's almost like, instead of me, I get, I got you. Instead of me getting the money, quote unquote kind of from you all, and then paying the, the doctor bill with the money that I get from you all, it's, it's almost like, OK, y'all are just getting, I got you. They're getting the money from you all. I get it. I kinda get it. I kinda get it. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][NEUTRAL] All righty. All right. But yes, OK. Um
[CUSTOMER][NEUTRAL] OK. But if I, yes, OK, OK. So it can be done to, it can be done two ways. They either they can do it or I can start doing it.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Right, but if you don't wanna be frustrated.
[CUSTOMER][POSITIVE] That makes, that makes good sense. Yes, she didn't explain that.
[AGENT][NEUTRAL] I would keep giving the card to the provider, allowing them to submit the claim, because say if you submit the claim and then you don't have all the information, so we're going to deny the claim, requesting that information, then you're gonna have to send that information in that we're requesting, but then you may not even send in the correct information. So then we have to deny it again and I.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] a payment on it, requesting the information for more information, then that's gonna be frustrating. Then you're gonna feel like, oh, I'm paying for this policy, and they not want they don't wanna pay anything, but it's not that we don't wanna pay anything. It's just we're lacking the information that is needed to process and pay and make payment on the claim.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right. So it's, I feel what you're saying. So it's best to just give them the card, let them do the, the paperwork portion of it. And, yeah, OK, OK, OK. So, in a sense, I have been kind of doing
[CUSTOMER][NEUTRAL] I have been kind of submitting cause I, you know, it, it's like I did get, I got on the, uh, yeah, I've, I've, cause, yes, I, I did get on the app and I told the lady, the last lady, I said, well, it says, it says on there that, you know, that they're processed or what does it say? Um
[AGENT][NEUTRAL] Yeah, you've been saving yourself a headache.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They've been processed.
[CUSTOMER][NEUTRAL] Whatever it says, yeah, it says like process but it doesn't have a confirmation number I think is what it.
[AGENT][NEUTRAL] Payment amount
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or something, something to that effect. Yeah, so I was thinking that.
[CUSTOMER][POSITIVE] That I hadn't, you know, that I hadn't been paid or so, you know, like I just wasn't really sure how it all worked. Yes, but thank you for explaining that. That makes sense.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then when when I get done with assisting you, you want me to transfer you to the.
[AGENT][NEUTRAL] Accidental policy queue so you can verify what's all under your policy because I think like say if you go for a wellness check, excuse me, a wellness checkup and stuff, you get reimbursed for that every year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's, yes, and that's what I want, yes, that's what I'm looking at here, because like, for example, like I, that's what I wanna see what plan I fall under, because like, like I went for an MRI and it says something like plan pays 150, plan pays 3, whatever, like, and I think, if I'm not mistaken, I think that money comes to me. I'm not sure though.
[AGENT][NEUTRAL] Right, if now that's the accidental policy. That's the accidental policy. So the accidental policy, see now, I'm gonna have to transfer you cause I don't know too much about the accidental policy, so I don't want to give you the wrong information.
[CUSTOMER][NEUTRAL] I don't know if it's the same type of thing.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right. I know you don't know. Yes. Yes, yes, I'm gonna, I'm, yeah.
[CUSTOMER][NEUTRAL] Right, right, yes, please transfer me.
[AGENT][NEUTRAL] Now the accidental, all of that goes to you. So let me transfer you over to someone that can better assist you with that, OK?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much for all your help, ma'am. Happy [PII] to you.
[AGENT][POSITIVE] No worries. That's why we're here. Same to you as well, [PII]. Same to you. That's why we're here. I always call if you don't know something, call and and ask the question. You don't, you don't have it.
[CUSTOMER][NEUTRAL] Yes. Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, and it's, it's, it's nice because, exactly, and, and, and it's funny because uh not funny, but it's nice because all of y'all have different, you know, different ways to help, you know, cause the last lady was very helpful too, but just in a different way, you know, that you, you were helpful. So thank you, thank you again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome. You're welcome. So hold one moment, let me get someone to assist you, OK?
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] [PII], I'm gonna believe that there's no one working in that queue but you. Is this, this, I, it's not, I'm not gonna say anything other than what I just said earlier because I'm always getting you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][POSITIVE] That's funny.
[AGENT][NEUTRAL] Sorry, I have an insured.
[CUSTOMER][NEUTRAL] Yeah, believe it or not, we do have a bunch of people on the phone.
[AGENT][NEUTRAL] Mm, I have an insured on the phone who's calling about her accidental policy. Now I was able to read some stuff to her about it, but she had more questions about it, so I'm not sure if you're familiar with the accidental policy or not. Let me know when you're ready for the policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, what is that policy number?
[AGENT][NEUTRAL] 2446426. That's 2446426.
[CUSTOMER][NEUTRAL] OK, and what is her name?
[AGENT][NEUTRAL] This is [PII]. I'm not gonna pronounce the last name cause they may, I may butcher it, but she's verified all of her information.
[AGENT][NEUTRAL] And her callback number is [PII] and she's a very sweet lady. She's just confused about her policies and I had to give her all the information I could on Metlink and then she got to the accidental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so if she's filed a claim there's not much I can answer other than what we can see, but I can't oh OK.
[AGENT][NEUTRAL] No, she didn't file a claim. She just want to know the benefits for accidental, just the benefits, no claims on file.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] 01 moment.
[CUSTOMER][NEUTRAL] Yeah, I can, I can pull up her policy.
[AGENT][NEUTRAL] All right. Thank you, [PII]. Hold on one moment. Did you pull it up before I transfer?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, I'll go ahead and get on the phone with her and let her know that I'm pulling it up just in case it doesn't come up before she's on the phone.
[AGENT][NEUTRAL] Did I give you the policy number 2446426?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Alrighty, so let me let her know. Hold one moment.
[CUSTOMER][POSITIVE] OK. All [PII]. You're welcome. You too.
[AGENT][POSITIVE] Hello [PII], Miss [PII] is gonna assist you better with your um accidental policy, but thanks for calling APL and you have a great weekend, OK?
[CUSTOMER][NEUTRAL] Hello? Uh-huh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah. Thank you, you too.
[AGENT][POSITIVE] You're welcome. Goodbye.