AccountId: 011433970860
ContactId: 86959b77-b529-4115-97ff-b4873ea5a588
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 891799 ms
Total Talk Time (AGENT): 380655 ms
Total Talk Time (CUSTOMER): 449037 ms
Interruptions: 6
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/86959b77-b529-4115-97ff-b4873ea5a588_20250414T18:08_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] in customer service. How are you, dear?
[AGENT][POSITIVE] I'm doing good, Ms. [PII]. How are you doing today?
[CUSTOMER][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?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is 245.
[CUSTOMER][NEUTRAL] 9557.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] Fresh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, OK, Ms. [PII], she requested a 1095, but this is not a major medical.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She's doing her taxes and she needs something that shows, uh, I don't know if I'm calling, even calling the right area, honey. I'll be honest, I'm just starting somewhere I need help. She needs something that shows everything she paid for the year, you know, like in medical and prescription and things like that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Who would that be?
[AGENT][NEUTRAL] Um, sounds like she needs a 10.
[AGENT][NEUTRAL] 1095 I think is what she's needing. Let me look in guru real quick.
[CUSTOMER][NEUTRAL] That is what she said she wanted was a 1095. Well, so my guru doesn't work. I, I am [PII]. I need to get back with her about it, um.
[CUSTOMER][NEGATIVE] Um, I know y'all, she swamped, y'all are all, we're all swamped.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so a 1095 comes.
[CUSTOMER][NEUTRAL] But uh, you know, I'm thinking of 1095 is strictly for major medical.
[AGENT][NEUTRAL] It is, and she will have to get that from her major medical carrier or her HR department.
[AGENT][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][NEUTRAL] Because we're not a major medical insurance.
[CUSTOMER][NEGATIVE] I don't think she's even with them anymore.
[AGENT][NEUTRAL] She can contact them still though.
[CUSTOMER][NEUTRAL] Yeah, uh, she's not even with she's so, OK, so she had to go to her HR the the the the.
[CUSTOMER][NEUTRAL] The group contact to get that right?
[AGENT][NEUTRAL] or her major medical insurance.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well, she doesn't have major medical. Everything she's used has been on this one policy.
[AGENT][NEUTRAL] So she can ask for it for, for the year that she needs it when she was covered.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] From who? From her?
[AGENT][NEUTRAL] Major medical.
[CUSTOMER][NEUTRAL] The HR from where she was.
[AGENT][POSITIVE] Probably easier, yeah.
[CUSTOMER][NEUTRAL] OK, yeah, I don't think she has made.
[CUSTOMER][NEUTRAL] I don't think she has major medical. I think all she had was this last year.
[AGENT][NEUTRAL] Was just the HI OK yeah oh I see what you're saying.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, she can go to her employer then.
[CUSTOMER][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, alright, let me go back to her darling and tell her that thank you.
[AGENT][NEUTRAL] HR department.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][POSITIVE] I'm glad I was able to help you. Do you want me to talk to her? Or do you want to just snip it in the bud?
[CUSTOMER][POSITIVE] Alright dear, have a good day.
[CUSTOMER][NEUTRAL] Uh, um,
[CUSTOMER][NEUTRAL] Well, let me just put it on there and we'll both just stay here. How about that?
[AGENT][POSITIVE] OK. Sounds perfect.
[CUSTOMER][NEUTRAL] OK, uh, uh, maybe I can get her to, uh, let me just put her on here.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh God, let me go back to her name because it doesn't show. I can't ever remember anybody's name. Alright, Miss [PII], OK.
[CUSTOMER][NEUTRAL] Miss [PII], this is still [PII] in customer service. Alright, I have [PII] on the phone, and Miss [PII] is gonna try to explain.
[CUSTOMER][NEUTRAL] A little bit is but you know what she can for you on this 1095.
[AGENT][NEUTRAL] OK. Hi, Ms. [PII], this is [PII]. So, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi [PII].
[AGENT][NEUTRAL] You, 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.
[CUSTOMER][NEUTRAL] 1095, you mean?
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] 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.
[AGENT][NEUTRAL] OK, uh,
[CUSTOMER][NEGATIVE] I mean this is insanity nothing was covered.
[AGENT][NEUTRAL] OK, I understand.
[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?
[AGENT][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] Yeah.
[AGENT][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 a claim back in on February to us that we paid $50 on and let me just use it as an example, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you went through Express care and the benefit amount for the procedure that you had was $50 so we paid $50.
[AGENT][NEUTRAL] And not saying that 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.
[AGENT][NEUTRAL] Um,
[AGENT][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?
[AGENT][NEUTRAL] Through
[AGENT][NEUTRAL] That was the group that um.
[AGENT][NEUTRAL] That you were employed with that took out the benefits, Business Workers of America.
[CUSTOMER][NEUTRAL] I wasn't employed.
[CUSTOMER][NEUTRAL] But I wasn't employed.
[AGENT][NEUTRAL] OK, on the policy that I
[CUSTOMER][NEUTRAL] I was retired.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] But the benefits and the policy was taken out through the group Business Workers of America.
[AGENT][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] OK.
[AGENT][NEUTRAL] And maybe get some answers about your policy and and then also ask for the 1095.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but before we do that, can I ask you something on APL?
[AGENT][NEUTRAL] Sure, yes.
[CUSTOMER][NEUTRAL] 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 Parlet 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?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] That made no sense to me and now I'm stuck, you know, $206 to pay for, you know, two immunizations.
[AGENT][NEUTRAL] OK.
[AGENT][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.
[AGENT][NEUTRAL] I am
[AGENT][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.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Can you tell me what PHC stands for?
[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.
[AGENT][POSITIVE] Yes, BWA is Business Workers of America. So you must have gotten that plan through Business Workers of America also.
[CUSTOMER][NEUTRAL] OK.
[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.
[AGENT][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] 00 my God.
[CUSTOMER][NEUTRAL] OK.
[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.
[AGENT][NEUTRAL] OK.
[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.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Did you get a copy of your policy?
[CUSTOMER][NEUTRAL] Um, I asked for it. I don't know that I ever did.
[AGENT][NEUTRAL] OK. Um, I can give you your, well, your policy number, uh, which is 2459557. That's with APL.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that's through us, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when I filled.
[AGENT][NEUTRAL] Now, I can request 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?
[AGENT][NEUTRAL] 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].
[AGENT][NEUTRAL] OK, so our fax number for claims, let me give that to you real quick.
[AGENT][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 [PII].
[AGENT][NEUTRAL] Now, you were also
[CUSTOMER][NEUTRAL] 877
[AGENT][NEUTRAL] 3659423.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And, and because you were through Business Workers of America.
[AGENT][NEUTRAL] I will need to transfer you over to them so that they can further help you because.
[AGENT][NEUTRAL] They have, um.
[AGENT][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.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK [PII], ready.
[AGENT][NEUTRAL] OK, that number is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] 886 8.
[CUSTOMER][NEUTRAL] OK, should I ask them the question about if I need to resubmit these claims to this fax number and ask that question? OK.
[AGENT][NEUTRAL] Yes, you can ask
[AGENT][POSITIVE] Yes, you can ask them. Yes, ma'am, you can.
[CUSTOMER][POSITIVE] Oh boy. OK. Thank you very much, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, well, it's gonna be.
[AGENT][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, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, got it, thank you.
[AGENT][POSITIVE] All right. You have a wonderful day. Thank you, Ms. [PII], for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for calling member services.