AccountId: 011433970860
ContactId: b036720c-9d0a-4a4a-a696-27da4da718b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 976919 ms
Total Talk Time (AGENT): 296533 ms
Total Talk Time (CUSTOMER): 400291 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/b036720c-9d0a-4a4a-a696-27da4da718b8_20250129T14:41_UTC.wav
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[AGENT][NEUTRAL] [PII], this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I need some.
[CUSTOMER][NEGATIVE] Answers as to why my phone has been declined. I've worked with MAU for just right at 6 months. February is my anniversary date, uh, for the 6th year.
[CUSTOMER][NEUTRAL] But I have been with them and I've had insurance through this company.
[CUSTOMER][NEUTRAL] I guess since I was first able to have it, I guess after the first month of working with MAU. So, uh,
[CUSTOMER][NEUTRAL] I had an infection in my
[CUSTOMER][NEUTRAL] Ankle, which I had to leave work because my
[CUSTOMER][NEGATIVE] and I couldn't walk. And so I could not continue to perform my job because I could not walk. So, um, they put me on a cart, golf cart and he got me as close to my car as they could. I went to prompt here thinking that's all I needed and stuff. Well, it turns out they said I had to go to the emergency room because I could go into toxic shock and die.
[CUSTOMER][NEUTRAL] OK, so I went to the emergency room. I was there 8 days and then they
[CUSTOMER][NEUTRAL] Uh, that I needed mobility stuff, you know, so I could get around because I couldn't use my arm, my left arm on my right leg. OK, so,
[CUSTOMER][NEGATIVE] That was denied. The medication was denied. Now, I'm getting a letter stating that my services are denied. So I've paid on this insurance for right at 6 years. I've asked HR to cancel it immediately, and I will not let you have not even one more time of my money because the one time I needed to use your services and I'm being denied.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you just want to check to see why those claims were denied?
[CUSTOMER][NEUTRAL] Yeah, I see why people get shot.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] And you're just calling just to see why those claims were denied?
[CUSTOMER][NEUTRAL] Right, right. It says, uh,
[AGENT][NEUTRAL] And may I ask who I'm speaking with?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] OK, and in case this call is disconnected, may I have your call back number?
[CUSTOMER][NEUTRAL] I have a policy number or reference number.
[CUSTOMER][NEUTRAL] My what?
[AGENT][NEUTRAL] In case this call is disconnected, may I have your call back number?
[CUSTOMER][NEUTRAL] Certainly [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have your policy number, please?
[CUSTOMER][NEUTRAL] Uh, on this piece of paper I have in front of me, it's 02586493. And I will say this, I had some coverage.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Initially, and I was able to go to just a regular doctor so I could get my high blood pressure medicine. Well, then,
[CUSTOMER][NEUTRAL] I went to a higher tier, I thought, which would give me more benefits or whatever and it costs more. And then when I went to the doctor, um, my coverage for just a regular doctor's appointment wasn't covered. So then when open enrollment came, I asked to go back to the lower tier of insurance cause at least I was able to go to a doctor.
[CUSTOMER][NEGATIVE] So I wind up having to pay $174 out of pocket then. And again, as I mentioned, I had to pay for all of my prescriptions once I got out of the hospital. And now I'm gonna be stuck paying this whole claim. What the hell's, what's needing insurance? I want all my money refunded.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'll take a look and just so I can verify that I got the correct policy number and that was 025864993.
[CUSTOMER][POSITIVE] Yes it was thank you.
[AGENT][NEUTRAL] And Ms. [PII], in case, just for verification purposes, can you verify your mailing address?
[CUSTOMER][NEUTRAL] [PII], that's in [PII].
[AGENT][NEUTRAL] And can you also verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And for our records, can you verify your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So let me take a look. It looks like this is your hospital indemnity coverage.
[CUSTOMER][NEUTRAL] And uh there's not many labs, like I said, I just opted to go back to the different coverage I had, so I at least be able to go to a doctor's appointment. So I don't know what is it one will let you go to the doctor and the other you can go to the emergency room or
[CUSTOMER][NEUTRAL] I don't, I, I that's something else too. I ask if I can have a booklet so I can read up on what to choose, you know, you're given just a short window of time to select your coverage. Well, you know, if I don't have a booklet, how do I know what to select or what to do?
[AGENT][NEUTRAL] In order to get a uh to retrieve your policy certificate, if you're not, are you currently um signed up online?
[AGENT][NEUTRAL] For your, do you have your account registered. If you register, you can access that information and I can give you the information to get you registered. Once you sign up and get registered, you'll be able to access a copy of your policy certificate and all that information.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] OK, well, nobody gave me that information at my job.
[CUSTOMER][NEUTRAL] So y'all might need to share that with the HR peop[PII] so they know what to tell the employees.
[AGENT][NEUTRAL] Yeah, you can just simply go to and I can give that information to you when you're ready if you wanna jot it down to get your account set up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, if you can, you, you just go simply to [PII].
[AGENT][NEUTRAL] And then there will be an option to register and you'll just follow the steps to register as a new user and then you'll be able to access your account information, policy certificate, and that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like
[CUSTOMER][NEUTRAL] You said the [PII]?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] No, it's [PII]. So you'll go to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I show on the initial claim that was processed, it looks like it was for a data service of [PII].
[CUSTOMER][NEUTRAL] Nope. [PII].
[AGENT][NEUTRAL] So during the [PII].
[CUSTOMER][NEUTRAL] OK, I was, I guess, yeah, because it was like [PII] or so.
[CUSTOMER][NEUTRAL] I think when I finally went to the top here, I came home from work.
[CUSTOMER][NEUTRAL] I'm on [PII] thinking how to just take some.
[CUSTOMER][NEUTRAL] I see them in a friend and ibuprofen and sleep it off and then I woke up and um
[CUSTOMER][NEUTRAL] Hot and then a lot of pain and so I went to Propcare. They said that emergency room.
[CUSTOMER][NEUTRAL] I went to one emergency room and next thing I know, I'm waking up in a different one.
[CUSTOMER][NEUTRAL] Which is kind of bizarre, but whatever, I guess I want to spread the money around.
[AGENT][NEUTRAL] So it looks like your coverage didn't begin until [PII]. So on this particular claim for the [PII], that's why it was not, nothing was payable because it's like service.
[CUSTOMER][NEGATIVE] Wait, no, no, no, no, no, no, no
[CUSTOMER][NEUTRAL] No, no, no, no, no, no, I've had coverage since the day I could have it, so it shouldn't be no lapse and if there's a lapse, I wanna know why.
[CUSTOMER][NEGATIVE] Y'all taking money out of my check every week, every week. So there should not be no damn, y'all didn't uh have no lapse in taking money out of my check. So I shouldn't have no lapse in coverage.
[AGENT][NEUTRAL] OK, so as far as it, it's premium, then you'll need to contact your employer in regards to your coverage because it's like your effective date with your group was [PII] of 13 of 25 for this particular coverage. I show you previously had coverage, but it looks like on that coverage.
[CUSTOMER][NEGATIVE] There should have been a lapse. You didn't make a lapse, taking money out of my check.
[AGENT][NEUTRAL] Looks like your coverage has changed.
[CUSTOMER][NEGATIVE] So I need to talk to the supervisor. I need to talk to somebody that can uh find out what the hell's going on. I need whoever your boss is.
[AGENT][NEUTRAL] It looks like you changed your coverage.
[AGENT][NEUTRAL] And that coverage termed 15 of 25, and then you begin the new coverage effective 113 of 25.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well, so whatever coverage I had on that date needs to be covering this.
[CUSTOMER][NEUTRAL] I have not gone without any kind of coverage, so you better check whatever coverage I had and take it from there.
[AGENT][NEUTRAL] Give me one moment and I'll take a look a little further. Give me one moment. I'm gonna put you on a brief hold.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII].
[AGENT][NEUTRAL] Hi [PII], this is [PII].
[CUSTOMER][NEUTRAL] How may I help you?
[CUSTOMER][POSITIVE] Hey [PII], how are you, honey?
[AGENT][POSITIVE] Good. How are you? I am needing your help. I have an insured
[CUSTOMER][NEUTRAL] I'm fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm thinking your answer is gonna be, they need to call their employee, but I have it insured. Um, do you mind pulling up the policy number?
[CUSTOMER][NEGATIVE] No, not at all.
[AGENT][NEUTRAL] It's on policy 2586493.
[AGENT][NEUTRAL] And the last name is [PII].
[CUSTOMER][NEUTRAL] I was just thinking there we go. OK. Eee y'all.
[AGENT][NEGATIVE] Yes, [PII] the urge. So I have her on the phone and she's upset. So, cause we've denied some claims because they were prior to the effective date. I noticed she previously had.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] A hospital indemnity plan, but I show that looks like she switched coverages. So she previously had one under another policy.
[AGENT][NEUTRAL] Which is the HR 17 from 21323 to 1525.
[AGENT][NEUTRAL] But she's saying that there should be no lap in her coverage. Would that be a question for her employer that she need to contact her employer directly?
[CUSTOMER][NEUTRAL] She'll need to contact Vic directly.
[AGENT][NEUTRAL] Big, OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Because that they they're the ones who submit the payment and do everything.
[AGENT][NEUTRAL] OK, so I need to get her what benefits in the car and talk with him.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that's why I just wanna make sur[PII]
[CUSTOMER][POSITIVE] OK, that's good. You're welcome, honey. Have a good day.
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] You too bye.
[CUSTOMER][POSITIVE] Thanks bye bye.
[CUSTOMER][NEUTRAL] Welcome to Benefits in a card.
[CUSTOMER][NEUTRAL] For English, press one.
[CUSTOMER][NEUTRAL] Para espanol pres.
[CUSTOMER][NEUTRAL] Your call may be recorded for quality control purposes.
[CUSTOMER][POSITIVE] Hi, good morning. Thank you for calling Benefits in a card. My name is [PII]. Who do I have the pleasure of speaking with?
[AGENT][NEUTRAL] Hi, [PII], this is [PII] with American Public Life, and I have an insured on the line that has questions regarding their coverage. Um, I have their policy number with us, or if you need their social to pull them up.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Yes, sorry you can go ahead and put him through.
[AGENT][NEUTRAL] Do you want their policy number cause she, she's upset cause she's saying that there should be no gap in her coverage, but I show her coverage with us and begin to [PII].
[CUSTOMER][NEUTRAL] Um, OK, I will, no, you can go ahead and put her through because there's a couple of different reasons why that could happen, um, so I just really need to go there. It's fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me, I'll click her back over. Give me one moment.
[AGENT][NEUTRAL] Thank you for holding, Miss. [PII]. I have a lady on, I have a representative on the line that can assist you as far as explaining to why your coverage is.
[AGENT][NEUTRAL] How it's currently set up with the changes of the coverages. Do you mind speaking with her and she can explain it to you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I will put her online. Her name is [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] [PII], [PII], I have her on the line, and this is Ms. [PII], and she, and [PII] is gonna assist you moving forward. Is there any other questions that you have for me?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] OK, thank you for calling APO you have a good day.
[CUSTOMER][POSITIVE] Uh-huh, appreciate it.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Hi, good morning, my name is [PII] with Benefits in a card.