AccountId: 011433970860
ContactId: 84fd30a6-2db3-4680-a513-dddfca8abe03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1520400 ms
Total Talk Time (AGENT): 582995 ms
Total Talk Time (CUSTOMER): 519603 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/84fd30a6-2db3-4680-a513-dddfca8abe03_20250609T20:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I am just calling to get a little information. I, uh, recently
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Um, emailed, oh no, I recently faxed some documents.
[CUSTOMER][NEUTRAL] For a claim
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I am trying to find my wallet so I can get my
[CUSTOMER][NEUTRAL] Card out of it.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Well, while you're looking for that, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh he
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and you, um, so you're wanting to know if the claim documents have been received that you faxed over?
[CUSTOMER][NEUTRAL] Um, it looks like they have been faxed over. I got a note, a letter in the mail stating that you received.
[CUSTOMER][NEUTRAL] My, uh,
[CUSTOMER][NEUTRAL] We received a claim on your policy and the review has been started.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess I'm just curious what the process is like.
[CUSTOMER][NEUTRAL] I do have my card if you need my card number.
[AGENT][NEUTRAL] Um, I will just so I can note the policy, um, but so it's 7 to 10 business days from the day that we received the claim. Um, I don't really, once we receive it, the claims examiner goes through all your documents, sees what benefits applies, and then they process the claim and then you'll receive um an explanation of benefits with the decision and the denial or payment, uh, depending on what the decision is.
[CUSTOMER][NEUTRAL] OK. Um, my member ID, are you ready for that?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] 683 4
[CUSTOMER][NEUTRAL] 16,030.
[AGENT][NEUTRAL] Oh, OK, hold on.
[AGENT][NEUTRAL] Can you spell your last name for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that 683 number um sounds like Business Workers of America. Hold on one moment.
[AGENT][NEUTRAL] I'm just waiting for the policies to come up here.
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] You said your first name is [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I just want to make sure this is correct. I believe I just located your policy. Hold on one moment.
[AGENT][NEUTRAL] Yep, here we go. And um, [PII], can you verify your date of birth and the mailing address on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And the, so the 683 number, that's the
[AGENT][NEUTRAL] Policy number for um Business Workers of America, your actual APL policy number, um, I can give it to you if you like. Well, I can still give it to you, but with Business Workers of America, you can either file your claims through Business Workers of America or you can file a claims with APL. If you are to file your claims with Business Workers of America, you use that 683 number that you have. Um, if you want to go straight through APL, I can provide your policy number with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll, I will write that policy number down through APL.
[AGENT][NEUTRAL] OK. It's 259.
[AGENT][NEUTRAL] 0804.
[CUSTOMER][NEUTRAL] 259-080-4
[AGENT][NEUTRAL] Yes, that's your APL policy number.
[CUSTOMER][NEUTRAL] OK, when I got this policy, I was told that
[CUSTOMER][NEUTRAL] I was told that it was called managed care.
[CUSTOMER][NEUTRAL] Uh, preference-based pricing, medical bill repricer, and it was health services.
[AGENT][NEUTRAL] Right, but that's not the insurance company though. That's all through Business Workers of America, which is why you have that 683 number. That's their, that's basically their policy number. We just can't use it in our systems because we're, it's a different company.
[CUSTOMER][NEUTRAL] I was never told that it was business of America.
[CUSTOMER][NEUTRAL] So when you said that, I was like,
[CUSTOMER][NEUTRAL] How come I never heard that before?
[AGENT][NEUTRAL] Oh, OK. Um, Business Workers of America, managed care, that that's all the same thing. It'll say managed care to the top left and then right under it, it'll say like the plan name, it might say BWA something something depending on the plan you picked, but that BWA is Business Workers of America.
[CUSTOMER][NEUTRAL] Uh, it's just
[CUSTOMER][NEUTRAL] It says um basic core plan name basic core.
[AGENT][NEUTRAL] OK, well, managed Care and Business Workers of America is the same company.
[CUSTOMER][NEUTRAL] I guess so far,
[CUSTOMER][NEUTRAL] Oh, OK. I, I was not aware of that. Um, so far, uh,
[CUSTOMER][NEUTRAL] For all the care that I have received.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I had um
[CUSTOMER][NEUTRAL] I had cancer and I had a nephrectomy and so I had to stay in the hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] My office visit was denied.
[CUSTOMER][NEGATIVE] And it looks like so far all of my care is being denied, so I'm like, my insurance isn't covering anything, and I was told that this policy is accepted by all places that take Medicare and Medica.
[CUSTOMER][NEUTRAL] And the hospital takes Medicare and Medica, and I asked them to look up the doctor who performed the surgery before having surgery to see if they were in network and I was told yes.
[CUSTOMER][NEUTRAL] So I'm confused as to why.
[AGENT][NEUTRAL] So the first
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] So the first thing we need to see is if they filed the claim, because you only have one claim here with APL and we paid out on that claim. So I'm not sure if they haven't uh from our end, it looks like they haven't filed anything with us. We received one claim on [PII] and we paid out $700 on [PII].
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] So I, and that's coming to you.
[CUSTOMER][NEUTRAL] Who was it for?
[AGENT][NEUTRAL] Um, just
[CUSTOMER][NEUTRAL] Who was it for?
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] Um, the first one, so there's several dates of service. This looks like [PII]. It was a hospital stay. Um, there's a Dr. [PII] on here, a physician assistant [PII], Doctor [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that's the only plan we have, so I can't.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't know about the.
[CUSTOMER][NEUTRAL] And that is still in process?
[AGENT][NEUTRAL] No, this has been paid. This has
[CUSTOMER][NEUTRAL] Is that still in
[AGENT][NEUTRAL] No, this claim finished processing on, go ahead.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, I'm just curious, how much did the insurance company actually pay?
[AGENT][NEUTRAL] We paid a total of $700.
[CUSTOMER][NEUTRAL] And do you, do you have, um, do you have a bill of how much it was for?
[AGENT][NEUTRAL] Let me see if there's a way to total this. Hold on one second.
[AGENT][NEUTRAL] Oh, this is hospital indemnity, so it's not going to give me the total bill. Hold on one second, I can total all the charges. Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Oh, that's all right.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I've not going anymore. Is this it?
[AGENT][NEUTRAL] Like
[AGENT][NEUTRAL] Oh yeah, this is it. What were the other ones denied for?
[AGENT][NEUTRAL] T E R.
[AGENT][NEUTRAL] Uh oh.
[AGENT][NEUTRAL] I'm trying to get to my notepad.
[AGENT][NEGATIVE] No surgical procedure benefits.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is your benefit.
[AGENT][NEUTRAL] And what's the other one?
[AGENT][NEUTRAL] Uh, DE.
[AGENT][NEUTRAL] Oh, they both are 89, OK.
[AGENT][NEUTRAL] Let me pull up her benefits too because she's not gonna like that answer and I'm gonna need some backup. Hold on one moment. 279-0804.
[AGENT][NEUTRAL] Uh, why would the policy, sir, be available?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let me do this. Let me open up and let me get another thing because I need that breakdown too.
[AGENT][NEUTRAL] And what was I doing over here? Getting the benefits.
[AGENT][NEUTRAL] Oh gosh.
[AGENT][NEUTRAL] So let me get Business Workers of America number up now because she's gonna want to talk about her coverage.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. So the total of the claim was $66,942.35.
[CUSTOMER][NEUTRAL] OK, so the total claim was $66,995 and some cents.
[CUSTOMER][NEUTRAL] And my insurance only paid $700 for that and I'm responsible for all the rest.
[AGENT][NEUTRAL] If there's no other insurance plan, then it could be patient responsibility. It depends on if they can discount it or sounds like you need their
[AGENT][NEUTRAL] With Business Workers of America, it sounds like you need to see if there's a different type of policy with more benefits. This is a hospital indemnity policy. So this is a limited medical.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] It means that it's a limited
[CUSTOMER][NEUTRAL] You know, I wasn't told any of that. That's not what they told me at all.
[CUSTOMER][NEUTRAL] I explained I was having surgery that I was gonna be staying in the hospital, and this is the policy they sold me.
[CUSTOMER][NEUTRAL] And we looked up to see if the doctor was covered.
[CUSTOMER][NEGATIVE] I'm shocked.
[AGENT][NEUTRAL] I, I can get you over to Business Workers of America to see if you can change your benefits.
[AGENT][NEUTRAL] My hands are kind of tied because I'm kind of in the middle.
[AGENT][NEUTRAL] As far as APL, like, um, yeah, those are the benefits, unfortunately.
[CUSTOMER][NEUTRAL] Oh, I know you're just doing your job.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] But there are other plans, so I don't know if they just didn't under it's hard for me to speak because I'm not really sure what happened on the call, but
[AGENT][NEUTRAL] Um, I just, I mean, I'm definitely sorry that they didn't give you what you needed. I don't know other than to get you to them so we can try to fix it because this is what they sent over for us to enroll in.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] At first I was told I was being enrolled in an 80/20 plan.
[CUSTOMER][NEGATIVE] And then that didn't even happen. I didn't even get notified that that didn't happen after I had my first claim, then I found out I didn't get that policy, the one that I had signed up for. They put me on supposedly a 70 $30 plan. It's that's not even 70/30, $700. That's like, what percentage would that be? 10? Not even 10. I mean.
[AGENT][NEUTRAL] Let's see if maybe.
[CUSTOMER][NEUTRAL] What's, do you know how, do you have a phone number for Business of America?
[AGENT][NEUTRAL] Mhm. I have the phone number and I can transfer you as well. But I was gonna say let's, yeah, let's reach out to them and see if maybe, maybe they sent over the wrong thing because this policy itself like it's only $9.78 a month. So I
[CUSTOMER][NEUTRAL] No, it's $169. My policy is $169 a month.
[AGENT][NEUTRAL] OK, so what's coming from to APL is $9.78. I again, I'm not, I don't know what happened at setup. I'm just letting you know what I see now.
[CUSTOMER][NEUTRAL] That's strange.
[AGENT][NEUTRAL] Do you have other types? Let me see. No, this is the only policy with APL.
[CUSTOMER][NEUTRAL] No, I have no other insurance.
[CUSTOMER][NEUTRAL] That's my insurance. The reason I signed up for that insurance is because this gentleman told me that it was an 80/20 policy that it was open access and that I would be able to, um, we looked at my doctor and that she was in network.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And that I shouldn't have any problems having the surgery and having it covered at 80/20.
[CUSTOMER][NEUTRAL] And that's not at all what happened.
[AGENT][NEUTRAL] And how much are you paying a month?
[CUSTOMER][NEUTRAL] And I paid once, I paid.
[CUSTOMER][NEUTRAL] 169.
[AGENT][NEUTRAL] 160. I'm just taking notes so I can.
[CUSTOMER][NEUTRAL] It's automatically taken out every month.
[AGENT][NEUTRAL] OK, I'm just taking notes so that I can forward this on because if we're only getting $9.78 I don't know. I don't, that doesn't sound right to me. So I'm getting ready to send.
[CUSTOMER][NEUTRAL] Yeah, where's the rest of the cash?
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] So if you um like, I can give you the number to Buss Workers of America and I'm sorry?
[CUSTOMER][NEGATIVE] I canceled the policy.
[CUSTOMER][NEGATIVE] I do need a phone number, but yeah, 2 days ago I canceled the policy. I canceled it because none of my claims are being taken care of and here's.
[CUSTOMER][NEGATIVE] I just feel like there's something totally wrong with the policy. Something happened in the process.
[AGENT][NEUTRAL] Yeah, I'm not sure what the disconnect is, but I
[CUSTOMER][NEUTRAL] So I currently don't.
[AGENT][NEGATIVE] Because that doesn't even make sense.
[CUSTOMER][NEUTRAL] Yeah, there's something wrong because
[CUSTOMER][NEGATIVE] Yeah, I'm paying $169 for the last several months for nothing, you know what I mean, except I got $700. That's all I'm getting for my 6 $6000 bill.
[CUSTOMER][POSITIVE] I was just like, wow, I cannot believe it.
[AGENT][NEUTRAL] Because like this
[CUSTOMER][NEUTRAL] I first realized something was wrong when they didn't pay anything for my office visit with Doctor [PII].
[CUSTOMER][NEGATIVE] And they said to me, um, no, the policy, the claim was denied. We sent it in and it was denied.
[CUSTOMER][NEUTRAL] And I received the EOB.
[CUSTOMER][NEGATIVE] That they were gonna pay $281 on that office visit and I was responsible for $250. So I paid my $250 and I handed in the EOB to the clinic so they could see that no, the insurance company is going to pay this much. They refused it.
[CUSTOMER][NEGATIVE] I had to pay the whole bill.
[CUSTOMER][NEGATIVE] They said that's not, that's not accurate. We sent it in and you were denied you're responsible for the whole bill. That's when it when something's wrong with my policy.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That's when I found out I didn't get 80/20. She said, oh, it looks like he was gonna sign you up for 80/20, but something happened and he put you on the 70/30 plan.
[CUSTOMER][NEGATIVE] And I'm like, why didn't someone tell me that or ask me if that was all right.
[AGENT][NEUTRAL] And [PII] doesn't know anything about this.
[CUSTOMER][NEUTRAL] And she didn't have an explanation.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] I said, and I'm just looking through the notes and I don't even see anything about it. So this is what we'll do. I, um, I'll give you the two numbers that I have for Business Workers of America and then I will, um,
[CUSTOMER][NEUTRAL] Yeah, I'm, I don't know what to do about this.
[AGENT][NEUTRAL] Get you over to them. I'll get a representative, of course, but I'm gonna speak with them as well and see because that just doesn't.
[AGENT][NEGATIVE] I don't know. I'm going, I'm gonna send this over to my team because it just doesn't, I, I don't understand. And if this is the only policy, then where is the
[AGENT][NEUTRAL] Remainder going and what's it for?
[CUSTOMER][NEUTRAL] Yeah, where's the, so if you're only getting $9 out of my $169.
[CUSTOMER][NEUTRAL] What's happening?
[AGENT][POSITIVE] Exactly.
[CUSTOMER][POSITIVE] It goes, it's automatically charged on my Bank of America card every month.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let's call Business Workers of America, so we don't, um, so we can get some answers. Did you want their phone number also? It's two different numbers. I'm gonna try. OK, so the first one is [PII].
[CUSTOMER][NEGATIVE] And 2 days ago I canceled it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The second one is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And again, Ms. [PII], I don't know what's going on, but we'll definitely figure it out and I'm so sorry for this confusion.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And experience. You're welcome. Um, if you don't mind, I'm just gonna place you on a brief hold and call on the other line, OK?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] What in the world because that's what Visa takes going to be like get a portal information. No, that's not what I'm looking for.
[CUSTOMER][POSITIVE] Thank you for calling member services.
[CUSTOMER][NEUTRAL] All calls are recorded for quality assurance.
[CUSTOMER][NEUTRAL] Our hours of operation are Monday through Friday [PII] Central Standard Time.
[CUSTOMER][NEUTRAL] If you know your party's extension, you may dial it at any time.
[CUSTOMER][NEUTRAL] For customer support, press 2. For agent support, press 3. For claim support, press 4.
[CUSTOMER][NEUTRAL] For provider support, press.
[CUSTOMER][NEGATIVE] We have not received a valid response. Please try again.
[CUSTOMER][NEUTRAL] You are currently caller number 6 waiting to speak with a representative. The estimated hold time is currently 5 minutes. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 5 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 4 waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] You are currently caller number 3, waiting to speak with a representative. Thank you for your patience.
[CUSTOMER][POSITIVE] Your call is now first in line and will be answered by the next available representative. Thank you for your patience.
[CUSTOMER][NEUTRAL] This is [PII]. Can I help you?
[AGENT][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from American Public Life. How are you?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][MIXED] I'm doing well. I have a member on the other um line that would like to speak with someone. She's upset because the policy she thought she signed up for is it what she signed up for and she's paying.
[AGENT][NEUTRAL] Like $170 but her premium with us is only $10. So she's trying to figure out what's going on because a lot of her claims are being denied, but we've only received one. can you look into this for me?
[CUSTOMER][NEUTRAL] Yeah, do you know that member ID number?
[AGENT][NEUTRAL] Yes, it's 683-410, I'm sorry, 416,030.
[CUSTOMER][NEUTRAL] OK, let's see here.
[CUSTOMER][NEUTRAL] And then do you know her date of birth?
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] It's November, I'm sorry, that's the effective date. Sorry, [PII].
[CUSTOMER][POSITIVE] Alright perfect and if you wanna pass her on through to me.
[AGENT][NEUTRAL] All right, hold on one moment.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you so much for holding. I have [PII] on the line from Business Workers of America and she's going to be assisting you further, OK?
[CUSTOMER][NEUTRAL] OK, and I did have one question. I wanted to make sure that my address was listed correctly. It has to have a PO box or I won't get any.
[AGENT][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] Thing from you.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Um, yes, the PO box that you verified was correct that we have on file the 8:32.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Is that correct? You're welcome. Well, thanks for calling APL and I hope you have a good day.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] You're welcome bye bye.
[CUSTOMER][NEUTRAL] Hi Ms. [PII], my name is [PII]. How can I assist you?
[CUSTOMER][NEUTRAL] Um, I'm not sure. I have a lot of questions about my policy.