AccountId: 011433970860
ContactId: 92d38091-225f-4a2c-b954-2c99f075dac0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 640719 ms
Total Talk Time (AGENT): 316578 ms
Total Talk Time (CUSTOMER): 209825 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/92d38091-225f-4a2c-b954-2c99f075dac0_20250416T22:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, my name is [PII]. Um, can you send me a copy of the benefits that I had when I was employed with MAU?
[AGENT][NEUTRAL] OK, um, I can check for you, [PII]. Can I please get your, your callback number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Sure that is area code [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, sir. And then what is the policy number you had when you were with us, sir?
[CUSTOMER][NEUTRAL] See if I still got that.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEGATIVE] Actually y'all didn't send me a card. It was um.
[AGENT][NEUTRAL] OK, I can look it up with your social if you would like that.
[CUSTOMER][NEUTRAL] Paper that y'all email me.
[CUSTOMER][NEUTRAL] Yes ma'am, that is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and you're just wanting a copy of the policy, is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ma'am, um, the medical, the dental, and the vision if I had it.
[AGENT][NEUTRAL] OK, let me check real quick.
[AGENT][NEUTRAL] OK. [PII], I'll need for you to please verify your date of birth for me, sir.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then I'll also need for you to verify your address, phone number, and email address.
[CUSTOMER][NEUTRAL] Yes, the uh address on file should be [PII]. Um, the old telephone number is what you have, which is uh area code [PII]. And what else did you say, ma'am?
[AGENT][NEUTRAL] Your email address, sir.
[CUSTOMER][NEUTRAL] OK, I got 3 of those. Um, I'm assuming it's probably [PII].
[AGENT][NEUTRAL] It looks like [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, I have 3 iCloud emails, um, it's probably [PII].
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] Yes, sir. And the phone number that you gave me, um, Mr. [PII], is that your cell phone number?
[CUSTOMER][NEUTRAL] No, ma'am, it's not. No more.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you very much. OK, I do show that your policies are still active. Um, you've got an
[AGENT][NEUTRAL] Medical policy, a group accident, and a dental policy with us.
[AGENT][NEUTRAL] Let me give you our online service center that's gonna be the quickest way for you to be able to look at your policies.
[AGENT][NEUTRAL] If you go to secured, it's [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] You're gonna sign up as a new user?
[AGENT][NEUTRAL] And then you're gonna choose
[CUSTOMER][NEGATIVE] I'm confused, uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I'm no longer employed with MAU and it's been over 30 days.
[AGENT][NEUTRAL] It's still showing
[CUSTOMER][NEUTRAL] So how is my policy still active?
[AGENT][NEUTRAL] It's still showing active we haven't received notice from the group yet that the policy is no longer active.
[AGENT][NEUTRAL] You're still showing now that it could change quickly, but right now you're still active.
[CUSTOMER][NEUTRAL] OK, so you said go to secure at?
[AGENT][POSITIVE] Secured.
[CUSTOMER][NEUTRAL] That
[AGENT][POSITIVE] Yes, it's secured, [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you go in there and sign up as a new user.
[AGENT][NEUTRAL] And then the next option is you're an individual with a policy with APL.
[AGENT][NEUTRAL] And then just choose your username and password. You could pull up all three of your policies right there in that um portal. It's a direct portal to your to your policy.
[CUSTOMER][NEUTRAL] OK, APL.
[AGENT][POSITIVE] You're welcome and you can download them and print them.
[AGENT][NEUTRAL] From there also.
[CUSTOMER][NEUTRAL] OK, I believe I already done this process. Yeah, I have with my um my cell phone, just not my MacBook.
[CUSTOMER][NEGATIVE] OK, um, no thanks.
[AGENT][NEUTRAL] OK. Well, the
[CUSTOMER][NEUTRAL] And you said I'm going to download them.
[AGENT][NEUTRAL] Yeah, you can um open your policies and you can download them to your computer.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] From that site.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and so can you tell me what's the policy that I have um.
[CUSTOMER][NEUTRAL] In regards to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, that would be the group hospital one correct?
[AGENT][NEUTRAL] Yes, the hospital.
[CUSTOMER][NEUTRAL] It ends in 922.
[AGENT][NEUTRAL] Yes, sir. That's gonna be your hospital indemnity plan. Yes, sir. The 251-092-2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your, your group accident is the 251-092-3.
[AGENT][NEUTRAL] And then the next number 251-092-4 is your dental and we don't do the, the vision insurance for you. That's with another carrier.
[CUSTOMER][POSITIVE] OK, so I'm, I'm, I'm glad I'm able to look at it now. Um, it says that my maximum benefit for diagnostic, um, testing benefits and wellness exam was 250.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I'm, I'm a little confused like.
[CUSTOMER][NEGATIVE] It did not cover my um primary care physician at all.
[AGENT][NEUTRAL] Uh, was there a claim sent in that was denied? Is that what you're concerned about?
[CUSTOMER][NEUTRAL] There were several claims sent in and only paid out what $60 or $75 each claim.
[AGENT][NEUTRAL] OK, let me look real quick. I've got a claim right here I can look at.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, I'm showing that you had.
[AGENT][NEUTRAL] On data on um.
[AGENT][NEUTRAL] [PII], we paid a claim of $75 for AnMed Primary Care Family Medical Center.
[AGENT][NEUTRAL] For a procedure that was, I can give you the procedure number. It was 99213.
[AGENT][NEUTRAL] The charge was $160 after that $75 was paid towards that procedure, then the other.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim that was sent in for that very same date of service.
[AGENT][NEUTRAL] was denied because the total benefit for that date of service was $75. So physicians, let me look at your policy real quick. I think it's PI BFT. Let me look.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so you get 4 visits, you get 4 visits per year for outpatient sickness.
[CUSTOMER][NEUTRAL] And there is
[AGENT][NEUTRAL] To use at a physician's office and it only pays $75 each visit. Um.
[AGENT][NEUTRAL] Per day. So that's $75 on one day.
[AGENT][NEUTRAL] This is not a major medical insurance. This is a limited hospital indemnity plan. So you have limited benefits and it only pays a certain amount for a covered procedure.
[CUSTOMER][NEUTRAL] OK, so why would the employer, the company itself offer this as a major and this they only had two options, one for individual and then one for individual plus um dependents.
[AGENT][NEUTRAL] That's something you'll have to ask them, um.
[AGENT][NEUTRAL] I don't know why they would say it's a major medical insurance. It's a hospital indemnity plan.
[CUSTOMER][NEGATIVE] Leaving me financially responsible for medical bills at this point, really, to be honest.
[CUSTOMER][NEUTRAL] Because I have two primary care physicians, when I go for a medical condition that I'm stuck with for the rest of my life, and then another one is just, you know, outside of what my medical condition is.
[AGENT][NEUTRAL] Right, I understand. Yeah, according to this, I mean, I, I can only verify what the policy says to me.
[CUSTOMER][NEUTRAL] But I.
[AGENT][NEUTRAL] And according to what your policy reads.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's 4 visits per year at $75.
[CUSTOMER][NEGATIVE] OK. Well, thankfully I'm with Blue Cross Blue Ship now and I just need to contact the MAU and make sure they send that over to you guys to go ahead and cancel that policy and I just have to be stuck with that financially.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes sir, yes, if they, if they can send anything letting us know that you're no longer with the group, they can, we can cancel the policy, yes sir.
[CUSTOMER][NEUTRAL] And when I
[CUSTOMER][NEUTRAL] OK, and does that need to come directly from the benefits department?
[AGENT][NEUTRAL] No sir, they need to send an email to us to let us know that you're no longer on the group.
[CUSTOMER][NEUTRAL] OK, alright, well I'll reach out to them in the morning and get that taken care of.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, sir.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you so much and I hope you have a good rest of your day.
[AGENT][POSITIVE] I hope you do too, and I hope you have a happy Easter. Thank you very much for calling APL.
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] Bye bye.