AccountId: 011433970860
ContactId: 93751668-f0ac-4b15-8ac0-5d7c61810ef0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 598359 ms
Total Talk Time (AGENT): 281926 ms
Total Talk Time (CUSTOMER): 239916 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/93751668-f0ac-4b15-8ac0-5d7c61810ef0_20250213T19:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, did you say [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, hi [PII]. My name's [PII], and I got something in the mail from American Public Life Insurance Company.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, and it's saying that this they said it might be a duplicate one. It said that the procedure wasn't covered.
[CUSTOMER][NEUTRAL] OK, um, this was back in [PII].
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] OK, [PII], let me get the policy number and the claim number.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Uh, the policy number?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's 022-91468.
[AGENT][NEUTRAL] OK, and do you have the claim number?
[CUSTOMER][NEUTRAL] Uh, the claim number, yeah, it's 3559584.
[AGENT][NEUTRAL] OK, thank you. What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] I'm calling from my home phone [PII].
[AGENT][POSITIVE] Thank you, give me a moment to pull up your file.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And [PII], verify your date of birth, your mailing address, and then your email address for me, please.
[CUSTOMER][NEUTRAL] Um, your my email you don't have, but I do have my address is [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And what else did you need?
[AGENT][NEUTRAL] And what is the zip code?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what was your question regarding the claim?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Yeah, cause this was for Capitol Health.
[CUSTOMER][NEUTRAL] Did you pull up?
[AGENT][NEUTRAL] I'm looking at it.
[CUSTOMER][NEUTRAL] And what's it say?
[AGENT][NEUTRAL] Mhm, I have it. This is a duplicate, the one that the policy, the claim number that you gave me is a duplicate, so let me locate that data service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's what it says on here too. It might be a duplicate. Yeah, you, it, it didn't cover anything, um, but they did have my, my my um insurance. I had, I had UnitedHealthcare. They had my medical card. They had that. I don't have um I had UnitedHealthcare.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, that just means that we received the claim before and then received it again and it died so I see the original claim that we processed. Let me pull that one up, um, it's gonna be under claim number 345.
[CUSTOMER][NEUTRAL] Yeah, this
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 084.
[CUSTOMER][NEUTRAL] Claim number 3.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The claim number here you need a claim number?
[AGENT][NEUTRAL] No no no I'm, I'm, I located the original claim.
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] And it has a different claim number.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And I was giving you that claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 345.
[AGENT][NEUTRAL] 0847, each time we process a claim, it'll be assigned a different claim number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because I got this through my workplace.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Apple green.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But I didn't take it this year.
[CUSTOMER][NEGATIVE] I took it last year, but every time I try to use it, it didn't pay for anything.
[AGENT][NEUTRAL] OK. Uh-huh.
[CUSTOMER][NEUTRAL] So I just didn't use it anymore.
[AGENT][NEUTRAL] OK, so the claim in question.
[CUSTOMER][NEUTRAL] So this year, when I had to do my medical choices from um Apple Green, I did not take this.
[AGENT][NEUTRAL] Yeah, this date of service is for a date of service in [PII] for March, yeah, so your providers may still submit claims from a prior year.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, and that looks like what may have happened.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For whatever reason they sent it to us again.
[AGENT][NEUTRAL] And of course we'll automatically send you an explanation of benefits letting you know that we did receive a claim and we just denied it as a duplicate.
[CUSTOMER][NEGATIVE] OK. Yeah, cause every time I tried to use it, it said, oh we don't cover that. Oh, we don't cover that.
[AGENT][NEUTRAL] That's what that is.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I was like, well
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, this is a limited hospital indemnity policy and certain items are covered under the plan.
[CUSTOMER][NEUTRAL] Yeah, because I had, I, when I did get this through my company.
[CUSTOMER][NEUTRAL] um
[CUSTOMER][NEUTRAL] Yeah, I got a hospital.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] And I tried to submit a claim and they said, no, that's not covered. Oh no, that's not covered.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Nothing was covered.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, yeah, it, it, yeah, it is, uh, yeah, it is a limited policy.
[CUSTOMER][NEGATIVE] Uh, it was disappointing.
[CUSTOMER][NEUTRAL] So I didn't take it this year at all.
[AGENT][NEUTRAL] OK, I see that it it it turned the end of December of last year.
[CUSTOMER][NEUTRAL] Mhm, yep.
[CUSTOMER][NEUTRAL] OK, so just ignore these.
[AGENT][NEUTRAL] Yes, ma'am. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. That's all. I wanted to get straight.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, OK, thank you.
[AGENT][NEUTRAL] Yeah, sometimes the providers will still send claims even if it's for a previous year and we'll just process accordingly, um, you know, and, and you're right, you do not have coverage with us anymore so don't be alarmed about that it's for prior dates of service before your policy term when you had it with us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Now what happens if it never covered anything? What happened to that money?
[AGENT][NEUTRAL] Yeah, let me look
[CUSTOMER][NEUTRAL] It just sits in the pot.
[AGENT][NEUTRAL] Yeah, it's just, yeah, what's your benefits, you know, yeah, exactly um if uh claims submit.
[CUSTOMER][NEGATIVE] And it never covered anything.
[AGENT][NEUTRAL] Yeah, cause it looks like you had a hospital admission benefit, so like an inpatient benefit. Um, you had a benefit for like if you had surgery in a hospital setting or um in a specialist or physician's office, there was a benefit for that.
[AGENT][NEUTRAL] There is an emergency room benefit under the policy. If you report it to the urgent care, there's a benefit for that.
[AGENT][NEUTRAL] Um, if you had any type of covered treatment in like your primary care or specialist doctor's office, there was a benefit for that.
[AGENT][NEUTRAL] Physical therapy covered under the plan and then you did have some health screening uh benefits under the policy, but it covers certain tests and I think the tests that we received were not the ones that are covered under the policy that you had.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see, let me go back. I'm gonna pull up your policy real quick.
[AGENT][NEUTRAL] See.
[AGENT][POSITIVE] So, I mean, it did have quite a few benefits. I think the diagnostic tests that were sent in.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Like you had an echocardiogram orography, um, that type of test is not covered under the policy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see what else.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you submit like a vision claim or a hearing claim?
[CUSTOMER][NEUTRAL] No,
[AGENT][NEUTRAL] Or dental treatment?
[CUSTOMER][NEGATIVE] I think for dental, I did try cause it did say it covered some dental. That's what the person told me on the phone and then when I gave them that card and my uh my other dental card from my employer, they said, oh no, that don't cover that. So I just said, just take that off, erase that, that American public life. It doesn't work.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You know, if it was, if it was a, as a result of like an accident.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you know your tooth was broken or anything like that. I believe that that is um is considered under this policy, but just regular dental services, cleanings, except those are not covered under the plan, under this medical plan, a medical policy.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] All right, cause, um, yeah, cause I did have both from use and every time I try to use it, like they told me no, doesn't cover it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, unfortunately certain items, yeah.
[CUSTOMER][NEGATIVE] I did not get it here at all. I, I didn't.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have my medical and that's it.
[AGENT][NEUTRAL] OK. Who do you have your medical through now? Who is it with?
[CUSTOMER][NEUTRAL] Oh, for the state of [PII], get covered New [PII]. Mhm.
[AGENT][NEUTRAL] It's the state of [PII].
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] All right, well, did you have any other questions?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] OK, well thank you for calling ATL Edwina. Have a good day, OK?
[CUSTOMER][NEUTRAL] Oh, wait a minute, let me ask you a question. So it did say I didn't take this from my employer again.
[AGENT][NEUTRAL] Oh, yes. Sure, sure.
[CUSTOMER][NEUTRAL] When we had to do our um our um renewal.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of our insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We went and we get covered New [PII].
[AGENT][NEUTRAL] Oh, OK. I see. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right. We didn't take, I didn't take this.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] All right, well, um, you have a good day, [PII], and thank you for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, you too, thank you, bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.