AccountId: 011433970860
ContactId: b43b8113-14ac-41a9-b529-c3b257b8817a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1741959 ms
Total Talk Time (AGENT): 610492 ms
Total Talk Time (CUSTOMER): 1073051 ms
Interruptions: 5
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/b43b8113-14ac-41a9-b529-c3b257b8817a_20250410T18:49_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], I was calling to see if you got some fax information for me yesterday on the claim.
[CUSTOMER][NEUTRAL] My claim number is 3581133. The name is [PII].
[AGENT][NEUTRAL] Hi Ms. [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um [PII] and my address is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And you said you faxed over some claims documents yesterday?
[CUSTOMER][NEUTRAL] Yes, I talked to the [PII] lady um, Monday.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And all of these um tests that I had done it said that they were not covered.
[CUSTOMER][NEUTRAL] And all of this was due to I had a car accident on [PII]. I was T-boned and um.
[CUSTOMER][NEUTRAL] All of my medical deals just my blood pressure started.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, escalating. I went to primary and I failed the EKG and they sent me to the cardiovascular group which I was using them to begin with, but I did call the claims department and asked.
[CUSTOMER][NEGATIVE] Do I need to try to find somebody else or not? And I was told, hey, you can go anywhere you want to go, just get an itemized bill and send it in. So to get this back, and I spent over $1500 from [PII].
[CUSTOMER][NEUTRAL] Up until [PII], I believe it was, with all these different tests and then I was told on Monday, you don't cover doctors uh visits when you go to the doctor and I was like, well, you know, all those kinds of things would have been nice to know, um.
[AGENT][NEUTRAL] Prior.
[CUSTOMER][NEUTRAL] When I first got this policy, I called and asked a lot of questions. None of these questions, none of these things came up it was like you can go wherever you want to go. My primary doctor does accept the managed care. I haven't had any issues with them, but the cardiovascular group, I've had to pay out of pocket and.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If I have to pay out of pocket, there's really no need for me to have insurance.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] Correct, that's true. I understand.
[CUSTOMER][NEUTRAL] So the young lady told me Monday.
[CUSTOMER][NEGATIVE] The lady told me Monday, she said, well, there was no indication that I had had a car accident and that's why they denied everything. So I, I went to cardiovascular group Monday. I got the notes from the doctor. Of course it was what I told her that I was in an accident on the [PII]. I noticed my blood pressure going up, my heart rate was increased after the [PII], and you know, I failed that stress test at the primary doctor and that's why they sent me over to.
[AGENT][POSITIVE] Excellent.
[CUSTOMER][NEUTRAL] Not stress test EKG. My EKG was not good. The day I went to them. I went to them on the [PII].
[CUSTOMER][NEUTRAL] [PII] somewhere up in there, but anyway, all of this is due to, I'm a fairly healthy person. I don't, I just got insurance because I felt like I needed to in case I needed insurance. But in paying a premium of $217 a month, and then I'm told that I can go anywhere I want to, there are no limitations then to have to pay out of pocket for this and it's a possibility I might not get any of my money back then.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What
[CUSTOMER][NEGATIVE] That's kind of disheartening. I'm, I'm just gonna be honest with you. That's disheartening. It really is.
[AGENT][NEUTRAL] And I can understand that. I mean, I have my insurance as well, so I, I definitely get it and I wish that it was explained to you um before. There are, I mean,
[AGENT][NEUTRAL] It wouldn't help the claim here, but I mean, moving forward, we can see if there's other policies that fit your need more, but for this particular, um,
[AGENT][NEUTRAL] Claim, I can definitely check and see if if the faxes have been received. Um, now I do want to let you know.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm gonna look and see if it's on here. Once you send it in, it goes to document management and then they upload it. So it takes about 24 to 48 hours to be up here. I'm going to check, but I don't, just because I don't see it right now, doesn't mean we haven't received it yet because you just sent it yesterday.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I, um, I don't.
[CUSTOMER][NEUTRAL] Uh-huh, yeah, I thought.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead. Uh uh, no, uh, go ahead.
[AGENT][NEUTRAL] No, no, you're fine.
[CUSTOMER][NEUTRAL] No, I was, I was just thinking that um.
[CUSTOMER][NEUTRAL] You know, if, if everything had been explained up front, then I possibly would have looked for somebody else to go to. But this, this is the cardiologist I had gone to for practically since I've been going to a cardiologist where I have been going. But if I had been told, you know, well Ms. [PII], you might want to try to find somebody that accepts the insurance, I would have done that.
[CUSTOMER][NEGATIVE] I would have done that, but I was told I could go with this plan, I can go anywhere I want to just, just get the itemized bill and send in a claim. I never really was told it's a possibility we might not pay. I was never told that.
[AGENT][NEUTRAL] See, and that's not.
[CUSTOMER][POSITIVE] And I would have liked to have had that.
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] I was just gonna say, and that's not even how we do things here I mean I I definitely.
[AGENT][NEUTRAL] Even when we tell, tell our members to send in the claim, we still let them know it's not a guarantee of payment. I see that you um how this policy was set up, so sometimes business workers of America um doesn't give the full story and I and I just hear that from other members, you know, in taking the calls. So I, I can't apologize enough for the experience because it kind of feels like.
[AGENT][NEGATIVE] I've been a little bamboozled like this isn't what I signed up for.
[CUSTOMER][NEUTRAL] I mean, I'm used to having insurance and if if it pays 80, 20 or 90 1075 pay something, you know, um, just to be honest with you, my husband had to pay for some of these tests. We're both retired now, but he still works and you know when you say.
[CUSTOMER][NEUTRAL] I felt like I was OK, but I knew the blood pressure was going up because I, I checked my blood pressure every morning. And on the [PII] accident was on the [PII]. On the [PII] I was like 143 over, I think it was 97. I have a log of it and it was going up every day and then the last time I went to the
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Medical doctor, that particular day it was 180/110. Well, my blood pressure was fine before the accident, so it's not like I'm trying to to finagle anything. I just, if I'm paying insurance, I want it to help me in some kind of way because I am paying it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] And you and I, yes, ma'am, and I look back at the claim and I do so once we receive.
[CUSTOMER][NEUTRAL] You know?
[AGENT][NEGATIVE] So this, I don't want you to feel like this.
[AGENT][NEUTRAL] So this claim wasn't paid because what was whatever was sent in didn't show the accident, but the paperwork that you're sending in now does show that it was truly an accident, right? Like, I don't want you to think that we're not, we don't believe you. We just have to have it on paper. So, so that's why we're asking for the, because the policy itself doesn't cover sickness at all. So we have to have something showing there was some type of accident, which is what you sent your, uh, you faxed in yesterday, right?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, and see when I, when I did the policy, nobody even told me it didn't, didn't cover sickness. I mean that's what it's health insurance, that's what.
[CUSTOMER][NEUTRAL] That's what I thought they covered, you know, I'm just saying, I asked a lot of questions before I proceeded with cardiovascular group. I called and talked to I didn't write down names and I should have, but I called and talked to people before I proceeded with these tests because I was trying to make sure that I could recoup some of my.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That it was, it wasn't gonna have no issues.
[CUSTOMER][NEGATIVE] Money after being told I could go anywhere. You know, I'm told you can go anywhere. There's no limitation to this policy, but in, in all honesty, yes there is. Yes there is. Because now I paid out $1500 even the doctor's visits were $160 and the young lady told me on Monday, she said, well, we don't even cover doctor's visits, and I was like, oh, MG.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Nothing, she said no. We don't, I was like, OK. I mean, I, I just, I don't know. I don't, I don't feel like it was fully explained, and if I had known that I needed to send it, I mean I can send in an accident report, and you will see my vehicle was, I was traveling north and when it stopped, I was headed south, going back home. I made a complete 180 and I'm very thankful that my vehicle didn't turn over.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] But I'm just saying, I, I just did a um.
[CUSTOMER][NEGATIVE] A wellness check like in December. Well, that was my primary doctor. They took the insurance. I didn't have to pay anything. I had lab work and everything and I'm thinking, oh well, you know, maybe this policy is whatever. I couldn't have known that I was going to have an accident and it was gonna affect my heart and blood pressure. I couldn't have known that in November when I got this policy, but yet and still.
[CUSTOMER][NEUTRAL] You know, now finding out all these different things about the policy, I just wish I would have known to begin with. Even when I called before the test, I was like, are you guys sure I can go to cardiovascular group, get these tests done, and then send in the itemized bill and and the claim, and you know I'll be OK and the the young lady was.
[CUSTOMER][NEGATIVE] That's how I've talked to have been women, so I don't know if only women work there or not. And she was like, yes ma'am, you'll be fine. But if, if she had even said, well, you know, what was the cause of these, why did you start getting these tests and I would have sent in that, yeah, I had an accident. I was hit, I was T-boned on [PII] and that's all this stuff happened after [PII], so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] I just really, yeah.
[CUSTOMER][NEGATIVE] I wish I had no.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] And I understand that now, working with, OK, so this is Workers of America is like a, I don't want to say it's a third party, but it's not APL directly. They do have their own like customer service and department that like helps with their claims and things and um I'm gonna definitely pass this on to my supervisor and let her know of your experience because to be honest, you're not the only one that I've heard.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Say this that have used this and if they're going to work with us, they need to be at the same, you know, level of standards that we hold, because we don't want our our members feeling the way that you feel right now, because the hospital indemnity policy itself is literally a limited medical benefit policy. So for them to say, you know, you can go anywhere and which
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] To an extent you can because there's no like network in terms of like PPO or like HMO, you know, that, those types of networks you have a list of providers. So in that sense, yes, you could go anywhere, but there, you know, it, it could have been explained more in detail so you know exactly what you're signing up for.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I didn't realize it was like a hospital indemnity. uh, I'm just thinking it's regular health insurance like uh Blue Cross Blue Shield. I've always had an HMO or PPO when I was working. I, I, I'm a former teacher, so, you know, I, no one really explained and I.
[CUSTOMER][NEGATIVE] I thought maybe I didn't ask all the questions I needed to, but I did ask the questions now before I went to cardiovascular group for these tests because I even asked the doctor. I said I think this is extreme. You mean to tell me this one test won't, won't answer all these questions? I mean one of those tests was $754 and I had to pay it upfront.
[AGENT][POSITIVE] Goodness.
[CUSTOMER][NEGATIVE] They will not even let me do a payment plan. They were like, no, you know, we'll get you the itemized bill, but you have to pay it upfront. And I mean I understand that too, but at the end of the day, if I'm told I can go anywhere I want to get an itemized bill and send in a claim, does that not sound like we'll pay something, it doesn't sound like we're not going to pay nothing.
[AGENT][NEUTRAL] Right, and even um.
[CUSTOMER][NEUTRAL] So, you know, that's just.
[CUSTOMER][NEUTRAL] I'm sorry, you can go, go ahead.
[AGENT][NEUTRAL] No, no, I was disagree, I was disagreeing with you. No, I wasn't saying anything though.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So now I want, I'm gonna be honest with you, I don't, I don't wanna pay the um I don't think I'm gonna continue with this insurance. I might have to try to find some private insurance that's really gonna be.
[AGENT][NEUTRAL] Because it's true.
[CUSTOMER][NEUTRAL] Because it sounds like this will pay if I go into the hospital it'll pay or?
[CUSTOMER][NEGATIVE] I, I mean, I don't even know what what it'll pay.
[AGENT][NEUTRAL] So let me
[AGENT][NEUTRAL] Let me pull up the benefits. Hold on one second.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK. So, um, just for the call, um, all the information provided is a verification of benefits, not a guarantee of payment. So the policy pays, yes, for hospital admission, so anytime you're admitted into the hospital, um,
[AGENT][NEUTRAL] Let me see if there's a max. It's usually like a one day per calendar year max. Um, there's also a confinement, confinement is anything over 18 now, anytime in the hospital after admission, 18+ hours is confinement. Um, you have that confinement as well. Um, and then you have like your outpatient.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Benefits. So that's where the urgent care, the physician office, the emergency room, um, physical therapy, but for this policy, it's outpatient accident treatment, so it's only in reference or in relation to an accident. Sometimes this is outpatient accident and sickness, then it would be, you know, it's both. It could be if it's in relation to an accident or if it's a sick visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This one specifies accident, so that's why that claim was denied because it didn't show.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Specifically an accident. So that's what um you're sending it now and that's going to be reprocessed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and, and then that's, that's pretty much what that, what this policy covers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now do I need to send the police report to or is is that enough and and this is the notes from me talking to the doctor I mean it doesn't say in the.
[CUSTOMER][NEUTRAL] OK, I'm gonna read it to you because just so you'll know, and I still have some kind of idea because um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so this is from [PII]. It says, um, history of present illness. Patient is a [PII] female followed by Doctor [PII]. She has not been seen in the office since [PII]. She has a history of hypertension and obstructive sleep apnea. She also has a history of hypo, uh, I think it has to do with cholesterol, which I do not, but uh anyway, she.
[CUSTOMER][NEUTRAL] She is seen today as a work in at the request of her primary care physician. Patient was involved, was in an automobile accident on [PII]. She has noted elevated blood pressure since that time. She reported symptoms of chest discomfort following her car accident, but states that that has resolved.
[CUSTOMER][MIXED] She has, she was seen in her primary care physician's office earlier today and had an EKG that was concerning for possible anterior ischemia. I don't really know what that means. Um, she states, she stopped her blood pressure medication last year because she felt, actually it wasn't felt, I was taking my blood pressure every day and it was good. So I don't like the fact that she put the word she felt. Her blood pressure was doing better but recently is running.
[CUSTOMER][NEUTRAL] In the 140s to 170s, denies having any, I don't know what this word is, exertional chest discomfort, no worsening shortness of breath, no PND orthopinal, uh, I don't, the rest of it is medical stuff. I don't, I don't know. But that information is in there about the accident. I don't know if that's enough. She just wrote what I said.
[AGENT][NEUTRAL] Typically we don't ask for the police report.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] But because of how that's written.
[AGENT][NEUTRAL] I would say to send that too.
[AGENT][NEUTRAL] Um, we just need to be able to show and it and it doesn't, um, I look back at the
[AGENT][NEUTRAL] Denial reason to see if it, I'm sorry, I have really bad allergies. So I look back at the denial reason to see if it asks for like a specific type of document, and it doesn't. Um, it just asks if you have any additional information that indicates an accident, please submit it for further review. So I will go ahead and submit that police report to.
[AGENT][NEUTRAL] Um, they may be able to get whatever they need from that doctor's note, but it doesn't really.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Clearly, you know, it doesn't really say she was in a motor. It's kind of like what, what she told me this, you know what I mean?
[CUSTOMER][NEUTRAL] Right, she
[CUSTOMER][NEUTRAL] It's what I said. Mhm. Right.
[CUSTOMER][NEUTRAL] So I need to submit the, the police report as well?
[AGENT][NEUTRAL] So I
[AGENT][NEUTRAL] Yeah, we usually don't ask for that, but just, just to be on the safe side rather than have more than what they need and not, you know, versus not enough because I
[AGENT][NEUTRAL] I don't know how they're gonna take that. They might, they might take it like us and like, well, was she in an accident or not, you know what I mean?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, um, at least if you submit the police report, there is no question. This is the police report from the accident and it's just asking for additional information that indicates an accident, so that's what the police report definitely does.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, well, I, I have one other question for you and, and I would appreciate your honesty. You tell me what you think. I, I'm not going to renew this policy, uh, I'm not paying it for this month because it's, it's not what I thought I signed up for. If I, if I stop, if I stop payment now, does, does my claims go away too, or will the claim still be looked at because it was when I had the insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You signed up for it, right?
[AGENT][POSITIVE] Right, anything up until whatever day you terminate will be covered. You can file a claim at any time as long as the policy was active on your data service. So this was active, you know, so you won't have any issues with that, that keeps going.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, I, I, I'll ask another question. Of course I, I ended up with the accident lawyer and I was seeing another, um, that's the last place I went when I had my the pain management clinic because this left me with um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][MIXED] Neck severe neck and shoulder pain. Um, no, no cuts, no bruises, no blood, no broken bones, and I'm most thankful for that, but I still have, I still have neck pain now, but if I do the exercises and stuff, it's good.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, with the information from going to the pain management clinic and that general doctor, would that help as well or just the police report? What, what do you think?
[AGENT][NEUTRAL] Uh, well,
[CUSTOMER][NEUTRAL] Because I was seeing them because of the accident.
[AGENT][NEUTRAL] I would do both.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I would do both in case, in case it needs to be like medical documentation, then you have them to back you and if it needs to just be anything indicating an accident, you have the police report there. So every all areas you're covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because that doctor's note doesn't really say anything. Like it's just like she's taking notes from what you're saying.
[CUSTOMER][NEUTRAL] Cover all areas, OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, after I got it and read it, I thought um this, this doesn't really, you know.
[CUSTOMER][NEUTRAL] This doesn't really say anything.
[CUSTOMER][NEUTRAL] Which it didn't, you know, it's just saying, she's just repeating what I said. Now I do have my um documentation of my blood pressure everyday after the accident, up until I started the medicine um 129. I started back on the triumtaine. But even, even that bit that she said about the blood pressure medicine, not being, uh, blood pressure not being well controlled, I took myself off the medicine because I was controlling my blood pressure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And of course you know doctors want you to be on medication, but I started some homeopathic things and it worked up until I had the accident. So, you know, I didn't want to be walking around with blood pressure 180/110 going, well I'm, I'm doing homeopathic. No, something, something either the stress.
[CUSTOMER][NEGATIVE] To the accident or the physical uh trauma to my body from the impulse, the impact of the accident, something caused my, caused my blood pressure to go up and my heart rate was was dropping. My heart rate was low and blood pressure was high, and this was all after the accident.
[AGENT][NEGATIVE] Mm, don't like it.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, and, and I told her that too, but you know I didn't read any of that to you. I told her that as well.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] I even showed her every day, every day that I took my blood pressure. I showed her the pictures that went through my phone every day, my blood pressure, the reading, and she was like, well gosh, look at your pulse. I was like, yeah, I was getting nervous about my pulse. It was dropping to 45 to 50. My pulse should be 100. I'm [PII] old.
[AGENT][NEUTRAL] Yeah, none of that was in there.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But none of this started happening to me until after I had the accident.
[AGENT][NEUTRAL] After the accident, mhm.
[AGENT][POSITIVE] Yeah, I would definitely submit that note too, just to make sure. Now they might not, they might be able to pull something from that doctor's note, but I would just rather you, I don't want anything to be denied and then you guys send more things. Let's just give them, you know, just give everything and you have more than what you need.
[CUSTOMER][NEUTRAL] Alright well I will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you. I appreciate this so much. I appreciate your honesty because I mean I'm, I'm not trying to get over on and I know it might not even pay 100%, but I do do hope that I can recoup some of my money, some of it.
[AGENT][NEUTRAL] Exactly right, and you're and you're paying your premium. I mean, this is my job, but I, I'm a consumer also, so I have to.
[CUSTOMER][NEUTRAL] You know, I don't.
[AGENT][NEUTRAL] I don't even have, it's not even, I mean, it's honest, but it's just, I understand. I have to call my insurance company too, but
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] I, I definitely understand it and I do, I'm definitely going to send this over, your concerns over to my supervisor because um this is not the first time I've heard that and, and we need to, um, you know, see if this is something we need to look into or if this is just a
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You know, we just need to bring some attention to it because we don't want, we're transparent and when they call APL that's what they get, as you can see and if if somebody else is working with us, they need to provide that same type of transparency. That's important.
[CUSTOMER][POSITIVE] Thank you. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I agree. Well, I will probably get my husband to fax the police report tomorrow. Um, I'll have to maybe I can get the um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The general doctor that I was seeing the um the, the injury doctor to uh send me notes and I can fax that over as well.
[CUSTOMER][NEUTRAL] So, um, yeah.
[AGENT][NEUTRAL] And I'm gonna put um some Pepsi.
[CUSTOMER][NEUTRAL] Yes. Would you give me your name again? I just, I'm, I'm trying to do better about when I talk to people who I talk to.
[AGENT][POSITIVE] Oh yes ma'am. Make sure you get our name.
[CUSTOMER][NEGATIVE] And I do appreciate not that.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] My name is [PII], yes ma'am.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, yes, so I'm just making a note of that and you know I talked to you on today, um, gosh, I'm putting 1468.
[AGENT][NEUTRAL] Yes ma'am, you have to keep your paper trail.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, alright, well I will get that police report because I, I have that, I have a copy of that, so I'll get that fax. My husband will fax it for me tomorrow and
[CUSTOMER][NEUTRAL] I will work on uh talking to the um.
[CUSTOMER][NEUTRAL] The medical doctors that I talk that I um pain doctors that I went to right after that and see if I can get theirs as well because every time I went to them as well, my, my blood pressure was elevated, so.
[CUSTOMER][NEUTRAL] Um, yeah, OK.
[CUSTOMER][MIXED] Well thank you so much [PII] I appreciate and I appreciate you listening to me I I I I hope you don't get this all the time but this is, you know, I just double checked everything before I went forth and so to be told, oh you can go anywhere you wanna go, just get that itemized bill, fill out that claim and you're good and that's not true, that's not true.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And if you're spending your money on it, you want it to be exactly I want what I'm paying for. I completely understand and I, I, if I was in your shoes, I don't know that I would keep it either because what I asked for, what I signed up for isn't what I received it, I mean, we have to understand that, um, which is another reason why I'm going to send this over to my supervisor because it's not us, but it's us. So we still have to take accountability for that. So for this experience, I definitely am apologize.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEGATIVE] OK, well thank you so much, but yeah, I, I think I'm gonna cancel this. I'm, I'm not gonna pay. I mean I'm paying for the premium, yes, you, when you work, you know, the money comes out, you pay for your insurance, but hey, I've always gotten what I paid for, and this is an instance where I'm not getting what I paid for.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So, you know, to say that um you know you can go anywhere you want to and then to deny the claim. Well, well, tell me when I got ready to do the claim with Miss [PII] why are you going to the, somebody should have asked me that. I didn't think to say I've been in an accident and that's why I've been going to the doctor. I mean, I didn't even think about that. I was just trying to get my blood pressure down and make sure my heart was OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yep, yep, yep.
[AGENT][NEUTRAL] Well, I have some pretty lengthy notes on your um policy, so if you have any questions or you think of anything, um, you can definitely give us a call, but I, I am going to forward this over to Ms. [PII] so that, um, just so that she can know your concerns in terms of um business workers of America, so we can bring that to the forefront when we have our meetings with them.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Well thank you I appreciate that. Yeah, this, this was not this was explained that this was just a regular health policy. I didn't have any and you know what got me was no deductible. I was like, oh that's great, you know, and I told him what I wanted to pay and and you know, you might say well you you you getting what you paid for, but I wasn't told that, that I wasn't getting regular health insurance, so yeah.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, let me call them because I'm about to cancel this and I will, I will fax over the police report on tomorrow and like I said I will have to um.
[CUSTOMER][NEUTRAL] Get in touch with the um.
[CUSTOMER][NEUTRAL] The general doctor that I was seeing uh and the chiropractor that I was seeing after the accident cause they were taking my blood pressure and everything. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well thank you so much Miss [PII] you have a great rest of the day. I really appreciate your help and listening ear.
[AGENT][POSITIVE] Thank you, Ms. [PII].
[AGENT][POSITIVE] You're very welcome. Was there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] You're welcome, as well.
[CUSTOMER][POSITIVE] No ma'am, no ma'am, I think that's it. I'm, I'm, we're good, mhm, OK.
[AGENT][NEUTRAL] Alright.
[AGENT][POSITIVE] Alright. Well, thanks for calling APL and you have a good day, OK?
[CUSTOMER][POSITIVE] Thank you, you too. You have a great one as well. Thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.