AccountId: 011433970860
ContactId: b81c0e4f-e7bc-474f-b121-09463631ac89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1175359 ms
Total Talk Time (AGENT): 275367 ms
Total Talk Time (CUSTOMER): 839960 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/b81c0e4f-e7bc-474f-b121-09463631ac89_20250321T22:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm gonna give you, uh, I guess my policy or certificate number. Is that what you need?
[AGENT][POSITIVE] Yes ma'am, your policy certificate number would be good, thank you.
[CUSTOMER][NEUTRAL] OK. 02.
[CUSTOMER][NEUTRAL] 56.
[CUSTOMER][NEUTRAL] Hold on a minute, I gotta get some light here. Let me start over. 02560051.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me look up your policy real quick, Ms. [PII].
[AGENT][NEUTRAL] OK. Can you please verify your date of birth for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and then what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] I recently had to change my phone number, but the old phone number is area code [PII]. I can give you the new phone number if you'd like to change that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I can change that for you. What is the new number?
[CUSTOMER][NEUTRAL] And my uh
[CUSTOMER][NEUTRAL] [PII] area code [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] My address is 2, my address is [PII] and what else did you need?
[AGENT][NEUTRAL] Your email address please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. I appreciate you verifying your policy for me, Ms. [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Well, I just pulled out my card. I didn't notice this before, and my effective date is [PII].
[CUSTOMER][NEGATIVE] Now, I had an emergency situation on [PII] where I thought I was having a heart attack while I was driving home.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I stopped at the first urgent care I found, which happened to be a providence which was out of your network.
[CUSTOMER][NEGATIVE] They took me in because they took my blood pressure and it was so high that they told me legally, they could not let me go.
[CUSTOMER][NEUTRAL] So they took me back, not not knowing what was going on.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They gave me a nitroglycerin pill because we thought I was having a heart attack.
[CUSTOMER][NEUTRAL] They called an ambulance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Because they would not allow me to drive.
[CUSTOMER][NEUTRAL] They called an ambulance and drove me from [PII] to [PII] to [PII], uh.
[CUSTOMER][NEUTRAL] It it's legacy health Mounthood.
[CUSTOMER][NEUTRAL] They put me in the emergency room.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was there for approximately 3 hours.
[CUSTOMER][NEGATIVE] What I was having was a panic attack. I have severe anxiety and had it previously, but because I was under an extreme amount of stress in that month, I actually had a panic attack.
[AGENT][NEUTRAL] Oh my.
[CUSTOMER][NEUTRAL] So after that emergency room visit.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I was given and I contacted your insurance company to get providers covered under the insurance that I pay for weekly out of my paycheck.
[CUSTOMER][NEUTRAL] I went to Salmon Creek, Washington because that was the only appointment available within 30 days.
[CUSTOMER][NEUTRAL] I saw a doctor there.
[CUSTOMER][NEUTRAL] He prescribed me medication.
[CUSTOMER][NEUTRAL] The medication that he prescribed me, my body didn't react to it.
[CUSTOMER][POSITIVE] So I transferred locations, found a doctor closer to my home that was willing to see me. He's within 2 miles of my home versus going 20 miles to Salmon Creek.
[CUSTOMER][NEUTRAL] So I went and saw this other doctor one time. So I have had 3 visits, 3 days, 4 different facilities, plus I had gone because I have vision coverage on my account.
[CUSTOMER][POSITIVE] I had gone to America's best. They ran my insurance, told me that my eye exam was covered.
[CUSTOMER][NEUTRAL] Now, I'm receiving all of these bills from APL and all of the people in 4 visits.
[CUSTOMER][NEUTRAL] They're telling me that my maximum benefit has been met.
[CUSTOMER][NEGATIVE] They paid out $50 to the ER. They gave me a check for $22 for the Province. I'm still getting bills from the Vancouver Clinic. Can you tell me what I pay out? Uh, oh, on top of that, I received two medications that I paid out of pocket.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have insurance coverage. I have an individual health plan. I have, uh, vision. I have paid all of these premiums or monthly charges to have coverage with your company, but I just received a $622 bill.
[CUSTOMER][NEUTRAL] From Legacy Mount Hood Emanuel Hospital for my emergency room visit.
[CUSTOMER][NEUTRAL] Why?
[AGENT][NEUTRAL] OK, so I understand that you're upset because you've received bills from the facilities that you went to, um, and you're wanting to know why we only paid $50 is that correct?
[CUSTOMER][NEGATIVE] I want to know why you're not paying any of my bills. Basically what you're doing is paying my copayment. I'm paying the bills.
[AGENT][NEUTRAL] OK, so your policy pays based on how your policy is written, and this is just to verify your benefits. It's not a guarantee of payment. So your ER visits, how your policy is written is the maximum payment is $50 and you get $2 a year. This is a limited hospital indemnity plan.
[AGENT][NEUTRAL] It's not major medical.
[CUSTOMER][POSITIVE] OK, so this is what I want.
[CUSTOMER][NEGATIVE] This is what I want you to do right now. I want you to cancel every policy I have with your company. Every single policy do not any longer take any money out of my paycheck for any coverage.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEGATIVE] I paid for health insurance. My understanding is health insurance pays for the majority. I don't have a problem with paying partial, but when you're going to pay $50 and I'm stuck with the balance and I pay you $120 a month, I'm paying out paying you more than what you're paying out. How is that logical for health coverage?
[AGENT][NEUTRAL] OK, I unders
[AGENT][NEUTRAL] Right. And
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. And I understand that you're upset.
[CUSTOMER][NEUTRAL] What are you covering?
[AGENT][NEUTRAL] I understand you're upset and I'm not on your policy. I'm showing you're paying $11.08 a week. We do not take your premium from your check that's done by benefits and a card through your employer Versatilla Aterra Services.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So in order for you to cancel your policy, you'll have to do it through benefits and a card, which I can help you get over to benefits and a card so you can do that.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so I pay $11 for my medical coverage. How much do I pay for my prescription?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Your prescriptions.
[CUSTOMER][NEUTRAL] That's weekly, so that
[CUSTOMER][NEUTRAL] So that's $44.
[AGENT][NEUTRAL] I don't know how much you pay for your prescription.
[CUSTOMER][NEUTRAL] So, so that's $44 a month that I pay you for my medical and all you pay is $50 on one claim.
[CUSTOMER][NEUTRAL] So I have had coverage since October, November, December, January, February, March, April, May, we're we're April, we're going on April. So for the last 7 months, just for my medical alone, I have paid you $44 a month times 7 and all you pay, I've received $77.
[CUSTOMER][NEUTRAL] So what kind of coverage are you providing?
[CUSTOMER][NEGATIVE] I'm not understanding the logic of this.
[CUSTOMER][NEGATIVE] I'm paying out more with the balance then you're paying with the premium you're receiving.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Right. I understand. I understand your frustration. Um, I do show that since you've had your, your insurance with us, we've paid $200 towards claims.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That have occurred since that were reported as of [PII]. Uh, if you would like to cancel your policy, that is fine, and I can help you do that by getting you two benefits and a card that way they can stop the payroll deductions for you.
[CUSTOMER][NEUTRAL] I'm not going to.
[CUSTOMER][NEGATIVE] Yeah, yes, I want that because I will go to an outside agency rather than have this this mess that you claim to be health coverage and I'm also gonna take this to the health to the insurance commissioner and explain to me why I am under the assumption.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That I am paying for health care, healthcare coverage, and in 7 months, I've had 4 visits for one condition, 1 emergency room, 1 urgent care, 2 appointments, and 1 optical exam in 7 months.
[CUSTOMER][NEGATIVE] And you're showing you paid out $200 so with my prescription that I'm paying, I pay for my prescriptions. I pay over $50 a month for the prescriptions I'm paying you to cover.
[CUSTOMER][NEGATIVE] On top of that, I have to pay $21 because I was told I had a $100 eye exam coverage. Evidently, you only pay $78 but they called your company for or whoever the company is to make sure I had coverage, but did you pay for it? No, you did not.
[CUSTOMER][NEGATIVE] I faithfully make my payments every single week for what you're claiming to be healthcare coverage, but you're not covering not even 50%.
[CUSTOMER][NEUTRAL] Of my expenses. So where is that fair and how do you claim to have health care coverage?
[AGENT][NEUTRAL] Well, ma'am, the policy that you have is not a major medical plan. It's a limited hospital indemnity plan.
[AGENT][NEUTRAL] We don't have your major medical or your vision insurance with us.
[CUSTOMER][NEUTRAL] OK. So when I applied for your benefits, the individual plan that was available to me was this.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I chose the individual plan and that's what was offered.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Under the assumption, under the assumption that it was medical coverage. What, what, what do you cover under your limited for a band-aid? I mean, if I go to a doctor, I've got an office visit, then I'm, I have to pay for whatever medication.
[CUSTOMER][NEUTRAL] So what do you pay out of that office visit unlimited medical? What do you, what is your definition of limited medical?
[CUSTOMER][NEUTRAL] $20.
[AGENT][NEUTRAL] OK, so, um, per your policy c certificate.
[AGENT][NEUTRAL] And this is again just to verify your benefits, it's not a guarantee of payment.
[AGENT][NEUTRAL] This policy only pays $50 for ER urgent care center or physician's office, and you're limited to 2 visits per year for ER and 4 visits per year for your urgent care or your uh physician's office.
[CUSTOMER][NEUTRAL] OK, so under urgent care or physician 4 times, I've only gone twice. What percentage do you pay of that?
[AGENT][NEUTRAL] We don't pay a percentage. It's an indemnity plan. An indemnity plan means a set amount for a covered procedure.
[AGENT][NEUTRAL] So it's a set amount of $50.
[CUSTOMER][NEUTRAL] I think that you need to clarify that.
[CUSTOMER][NEUTRAL] OK, totally understand now that what you advertise and what you, the understanding that you give people is not clear on what you pay.
[CUSTOMER][NEGATIVE] Because I'll tell you, I would never have agreed to pay for what I was under the assumption of health care coverage for that limited amount, why would I pay you a total of all the plan that I had, that I, that I chose, the vision, the prescription, the health, all of that.
[CUSTOMER][NEGATIVE] $28 something a week comes up to roughly $115 a month. So why would I be stupid enough?
[CUSTOMER][NEGATIVE] To pay you $115 a month for two emergency room visits that you're only gonna pay $50 and then 4 doctor's appointments per year, but I'm paying you how much money? Tell me where the logic is in that.
[CUSTOMER][NEGATIVE] I'm paying you more than what you are covering.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So tell me that is not fraudal.
[AGENT][NEUTRAL] Yes, ma'am. I unders understand.
[AGENT][NEUTRAL] I understand your frustration and I, I am very sorry that you are disappointed in the insurance, but this policy, the way that your contract is written,
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] is an indemnity plan. And even if you went to, even if you went to the doctor and they only charged you $10 we would have still paid the $50.
[CUSTOMER][NEUTRAL] Oh, I don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I don't know very many doctors.
[AGENT][NEUTRAL] Because it's a it's an indemnity plan.
[CUSTOMER][NEUTRAL] That I don't know of very many doctors that you could walk into their office even without insurance.
[CUSTOMER][NEUTRAL] And pay only $10 because office visits are.
[AGENT][NEUTRAL] Well, that was just an example.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] I was just using that as an example.
[CUSTOMER][NEUTRAL] So you being in the health industry are very well aware that an office visit could be anywhere between $40 and $100.
[AGENT][NEUTRAL] But
[CUSTOMER][NEUTRAL] Every time, so 4 times we're gonna say on the on the low end we're gonna say $40 so you're gonna pay $20 but how much am I paying you a month for only getting 4 visits on that limited indemnity.
[CUSTOMER][NEGATIVE] You are receiving more money per person than you are paying out so to me that is a fraudulent business. I will be contacting the insurance commission and explaining exactly what you just told me a limited indemnity what you charge per month.
[CUSTOMER][NEUTRAL] Versus what you pay out per year.
[CUSTOMER][NEUTRAL] You tell me that that is fair to a consumer.
[AGENT][NEUTRAL] OK, and I'm, again, I'm very sorry you're not happy with the insurance. If you would like, I can go ahead and transfer you on over to benefits and a card so they can further assist you with getting your policy canceled.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] This will be canceled today. Like I said, if I have to go to the governor, the senator, the congressman, this will change.
[AGENT][NEUTRAL] OK, it's gonna
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, I understand.
[AGENT][NEUTRAL] It's gonna be a brief hold while I transfer you on over so that you can get further assistance, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome and you have a good weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] You have a good weekend also.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEUTRAL] You won't have a company work for very long.
[CUSTOMER][POSITIVE] Welcome to benefits in a.