AccountId: 011433970860
ContactId: e26d6a89-3d5d-41f0-a06b-f64213d11eb4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2207830 ms
Total Talk Time (AGENT): 564606 ms
Total Talk Time (CUSTOMER): 547436 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/e26d6a89-3d5d-41f0-a06b-f64213d11eb4_20250421T15:44_UTC.wav
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[AGENT][POSITIVE] Thank you for calling. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII]. I have the insurance through you guys and um I've gone to see the doctor, I think about a month ago and I got a bill from them, so I was wondering uh what you guys were able to cover from that, uh, doctor's visit.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, let's see. I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yes, it's done on file. [PII].
[AGENT][NEUTRAL] Thank you. Now, I need your policy number, please.
[CUSTOMER][NEUTRAL] Let's see, policy number is 02411054.
[AGENT][NEUTRAL] And please verify your first and last name again and your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK. Thank you. Now please verify your mailing address and your email address.
[CUSTOMER][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] That's how some City, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And email address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the date of service and bill charges on the claim you're calling about?
[CUSTOMER][NEUTRAL] Date of service
[CUSTOMER][NEUTRAL] And they charges.
[CUSTOMER][NEUTRAL] Let me see if I can pull it up again here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] stupid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me just a second, I have to log in again here.
[AGENT][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Um, OK, let's see here.
[CUSTOMER][NEUTRAL] Uh, date is [PII].
[AGENT][NEUTRAL] OK, I'm not showing that claim on file, so they'll still need to file a claim with us.
[CUSTOMER][NEUTRAL] OK, so there's there's no claim at all?
[AGENT][NEUTRAL] No claim on file, not for that date of service. You do have one claim on file, but it's not for that date of service.
[CUSTOMER][NEUTRAL] On my account?
[CUSTOMER][NEUTRAL] What claim do I have on file?
[AGENT][NEUTRAL] Um, the one for 324, 25, we paid $75 on, which is the benefit amount under your policy for office visits.
[CUSTOMER][NEUTRAL] Uh, let's see here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's the one. Is that for the total primary care?
[AGENT][NEUTRAL] Let's see. Yes, sir, total MD physician group, yes, sir, for data service 324 25, it paid out for $75. Yes, that's the only claim I'm showing on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Yeah, I mean I had some
[CUSTOMER][NEUTRAL] As some like annual checks done blood work.
[CUSTOMER][NEGATIVE] And that doesn't seem to be um paid so they sent me an invoice for $833 so.
[CUSTOMER][NEUTRAL] How do I get you guys to get that claim?
[AGENT][NEUTRAL] Well, they would need to file the claim with us. We don't reach out to the provider and ask them to file. What you can do, um, and is call and let them know that you've contacted us and let them know that um we don't show this claim on file and have them to file the claim. Just make sure that you provide them with the um policy number and our phone number just in case they need to call first to verify your benefits and let them know that you have insurance so they can file the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so all they need is your phone number and my policy number.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There's no email address, it's just phone number.
[AGENT][NEUTRAL] Right, just the phone number to call to verify the benefits.
[CUSTOMER][NEUTRAL] OK, because I know they called on the day I, I got there, so maybe they didn't call after I was done, or?
[AGENT][NEUTRAL] Well, I can check the notes to see if they call. One moment.
[AGENT][POSITIVE] And I'm waiting on my system. Thanks for your patience.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, I'm not showing any notes on file where they called to verify benefits.
[AGENT][NEUTRAL] So yeah, so just make sure that they know that you actually have health insurance, so they'll contact us if they need to and get the claim filed.
[CUSTOMER][NEUTRAL] Yeah, I mean it, it, it does show on the statement that American Public Life did pay $75.
[AGENT][NEUTRAL] For, for the date of service that you gave me?
[AGENT][NEUTRAL] Because I'm only showing again one date of service on file and we did pay $75 on that for $324.25 dollars.
[CUSTOMER][NEUTRAL] Yeah, that's the only one.
[CUSTOMER][NEUTRAL] Um, that's the only time I've used this insurance. So,
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] So did they call and then you guys paid $75?
[AGENT][NEUTRAL] No, they filed a claim with us and we paid $75.
[CUSTOMER][NEUTRAL] OK, so they filed a claim for the doctor's visit?
[AGENT][NEUTRAL] For the doctor visit on [PII]. Yes, sir.
[CUSTOMER][NEUTRAL] But then
[CUSTOMER][NEUTRAL] Uh-huh, so they didn't file a claim for
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] All of the testing that they did.
[CUSTOMER][NEUTRAL] Is what you're saying.
[AGENT][NEUTRAL] Well, for, did they do testing for the date of service in April that you gave me? They did testing on that day because they didn't file the claim for that date of service.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, no, it's, it's, it's for the date that I visited them, the same day, the same visit where you guys paid $75. So if that was what you would say [PII].
[AGENT][NEUTRAL] For, for 3 24 25.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I do show some testing done on that day and yeah, we paid $75 for that because under your policy for services provided in office, including testing, we only cover up to $75 per visit.
[CUSTOMER][NEUTRAL] So it, it
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] And you get, yeah, and you get 5 visits per calendar year. So this is one visit um that we paid um so far this year.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] For $75.
[CUSTOMER][NEUTRAL] So you guys don't pay for any of the doctor services you only pay for a visit?
[CUSTOMER][NEUTRAL] Position fee or
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] Yeah, but whatever charges that were charged to you for that date of service, that's what we pay we pay up to $75.
[AGENT][NEUTRAL] So I'm showing that under this um claim, the physician fee, yeah, that was $250.68. So, yeah.
[AGENT][NEGATIVE] Only the physician uh fee was paid towards on this claim and the rest of the charges looked like they weren't paid for.
[CUSTOMER][NEUTRAL] So does that mean that if I'm sick and I go to the doctor and they they test for or they do some blood testing or any testing they need to figure out what's wrong with me?
[CUSTOMER][NEGATIVE] You guys don't cover any of that.
[AGENT][NEUTRAL] It will be covered. Um, yes, sir. It's just, just happens that under this claim, the office visit fee was $250 so that took up most of your $75 there.
[AGENT][NEGATIVE] Those services been denied because they were for testing, they denied because um on the claim, the office fee was billed first, so that wiped out $75.
[CUSTOMER][NEUTRAL] So whatever the sickness or the testing that is done when I go to go to the doctor, you guys only pay $75.
[AGENT][NEUTRAL] Yes, sir, under this policy for your office visit fee.
[CUSTOMER][NEUTRAL] So under this policy,
[CUSTOMER][NEUTRAL] No sickness for
[CUSTOMER][NEUTRAL] Hospital and doctor services are covered, only the physician fee.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] The, the physician fee is covered and services provided in office. Um, I told you this, just under this claim, the physician fee was billed first and that wiped out your $75.
[AGENT][NEUTRAL] If one of these lapses came up first, then.
[AGENT][NEUTRAL] Who knows, that probably would have took up to $75 and then your physician um fee would have been left unpaid.
[AGENT][NEUTRAL] We pay in the order that we received the services. And under this claim, the physician fee just happened to have been listed first.
[CUSTOMER][NEUTRAL] So if there was no physician fee.
[CUSTOMER][NEUTRAL] Let's say if all the other services popped up first, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] For $883 how much would you pay from that?
[AGENT][NEUTRAL] We would, we would have paid $75 towards that.
[CUSTOMER][NEUTRAL] OK, so regardless of what services I go for.
[CUSTOMER][NEUTRAL] At a doctor or hospital, you guys will pay $75 only.
[AGENT][NEUTRAL] For any outpatient visits. Yes, sir. For any outpatient visits and you get 5 outpatient visits per calendar year.
[CUSTOMER][NEUTRAL] Under this plan.
[CUSTOMER][NEUTRAL] So you're telling me what is covered out of the year for this plan regardless of what happens to me.
[CUSTOMER][NEUTRAL] Medically.
[CUSTOMER][NEUTRAL] It's 75 x 5.
[CUSTOMER][NEUTRAL] That's $375 a year.
[CUSTOMER][NEUTRAL] Is the only thing you guys will pay any time I, I need to.
[AGENT][NEUTRAL] Well, that's just, that's, that's just for services, that's just for services. That's just for outpatient services. You said for anything that happens to you, there are other different benefits like for inpatient services and right.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so for outpatient services, if I get sick, if I, if I catch the flu or.
[CUSTOMER][NEUTRAL] If I have a headache or, you know, if, if I cut my finger or something and I go into the, to the doctor's office or to the hospital to get stitched up.
[CUSTOMER][NEUTRAL] You guys will only pay $75.
[AGENT][NEUTRAL] Yes, for, for an outpatient visit. Yes, sir.
[CUSTOMER][NEUTRAL] So out of the year my only benefit for outpatient services.
[CUSTOMER][NEUTRAL] It's $375.
[AGENT][NEUTRAL] Yes, sir, for outpatient business.
[CUSTOMER][NEUTRAL] That's the monetary benefit.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and how, how much have I been paying in my policy? Can you look that up?
[AGENT][NEUTRAL] OK, the system is actually not giving me that information. Did you sign up through your HR department?
[CUSTOMER][NEUTRAL] No, somebody called me directly from.
[CUSTOMER][NEUTRAL] APL
[CUSTOMER][NEUTRAL] And asked me if I wanna sign up. I'm a truck driver.
[AGENT][NEUTRAL] OK. Well, you can speak with.
[CUSTOMER][NEUTRAL] I drive a truck for a living
[AGENT][NEUTRAL] You can speak with someone in the billing department. Would you like for me to transfer you to billing?
[CUSTOMER][NEUTRAL] Yeah, absolutely. I'd like to know how much I've paid so far in my, in my health insurance and if uh.
[CUSTOMER][NEUTRAL] If you guys don't cover any health services.
[CUSTOMER][NEUTRAL] And only physician fees that
[CUSTOMER][NEGATIVE] Yeah, I don't think I'll need this.
[CUSTOMER][NEGATIVE] Sure, it's not helpful.
[AGENT][NEUTRAL] You, health, health services are covered, sir. I told you under this claim, the physician fee was uh paid because it showed up first, but health services are covered.
[CUSTOMER][NEUTRAL] Well, the health services they billed me for, they're $883.
[CUSTOMER][NEUTRAL] For the testing that they did.
[CUSTOMER][NEUTRAL] So, and you said those were denied by APL.
[AGENT][NEGATIVE] They were denied because the office fee came up first and it wiped out your $75. If um the physician fees would have came up first, we only would have paid, well, if those services, the fees for those testing came up first, we would have only paid $75 for that and then you still would have been billed for the rest of the testing and the physician fee.
[CUSTOMER][NEUTRAL] And that's what I'm saying.
[CUSTOMER][NEUTRAL] That's what I'm saying.
[CUSTOMER][NEUTRAL] I'm not sure if you're understanding me or if you're understanding each other is that the only monetary benefit I get.
[CUSTOMER][NEUTRAL] From this insurance company is for outpatient services is $375 regardless of.
[CUSTOMER][NEUTRAL] What happens to me, medically.
[CUSTOMER][NEUTRAL] For outpatient services $375 that's it a year is what you're telling me, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But as long as you understand that, that we cover physician fees and we also cover other services done in office also.
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] It just happened to be under this claim, only physician fees were covered. That's what I was thinking that you were uh thinking that we only pay for physician fees and that's
[AGENT][NEUTRAL] We pay for other services too, that just happens to be what we pay for under this claim.
[CUSTOMER][NEUTRAL] No, you guys just pay $75 regardless of what the services are.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Right, exactly.
[CUSTOMER][NEUTRAL] That's, yeah, that's, that's the bottom line. For me it's, it's, it's the monetary benefit, that's, that's why I pay into this every week.
[CUSTOMER][NEUTRAL] For the monetary benefits so that I'm covered if I'm sick and I need health services and I get health services, and then I get medicine and all that stuff, that a lot of that is covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][NEGATIVE] The major part of the bill does not fall fall on me because the insurance company is insuring me my help, but it doesn't seem like you guys are.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Out of the monetary benefit standpoint.
[CUSTOMER][NEGATIVE] It's not beneficial to me.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I don't know if you understand what I'm saying.
[AGENT][NEUTRAL] Yes, I understand what you're saying, sir. And actually, my system is working now and your premium amount has come up. I'm showing that your monthly premium is $161.29.
[CUSTOMER][NEUTRAL] I mean, does it, does it
[CUSTOMER][NEUTRAL] OK, 161 and I've been paying this for how long?
[AGENT][NEUTRAL] Um, let's see. Effective date was [PII].
[CUSTOMER][NEUTRAL] OK, [PII], so [PII], that's one year.
[CUSTOMER][NEUTRAL] That's quite a bit of money.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Yeah, um.
[AGENT][NEUTRAL] What would you like to do, sir? Are you needing to cancel your services or?
[CUSTOMER][NEGATIVE] Yeah, cancel them if all you guys are gonna pay.
[AGENT][NEUTRAL] What other, what other way that I can help you?
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Said what are mhm.
[CUSTOMER][POSITIVE] Um, I would love for.
[CUSTOMER][POSITIVE] I, I would love for.
[CUSTOMER][NEUTRAL] If I go to a doctor.
[CUSTOMER][NEUTRAL] And they say, OK, let's do some testing, right? Do you have insurance? I say, yes, I have insurance.
[CUSTOMER][NEUTRAL] And here's the insurance number and insurance policy.
[CUSTOMER][NEUTRAL] And you can call them and they call and they say, does he have insurance? Yes, he has insurance. OK, how much do I have to pay now? They say only $75 which you have to pay. I said, OK, I pay $75. They do the testing, they say, OK, you know, reach out to insurance. Great. And then my insurance gets the claim and they say, oh, OK, well, yeah, I have an insurance we he is insured under us.
[CUSTOMER][NEUTRAL] And so we'll pay, you know, 75%, or we'll pay, you know, 80% of whatever this is, or if the plan allows 100% of everything because.
[CUSTOMER][NEUTRAL] He's a member of our insurance company. He pays in every week, every month on insurance so that his health visits and health costs are covered.
[CUSTOMER][NEGATIVE] But it, it does not appear that my health costs are covered even though I am paying for health insurance.
[CUSTOMER][NEGATIVE] It seems like you guys are just paying the doctors but not paying for the services that they're providing me.
[CUSTOMER][NEUTRAL] So, what I would like is
[CUSTOMER][NEUTRAL] For this bill to be paid.
[CUSTOMER][NEUTRAL] By my health insurance that I pay into every month.
[CUSTOMER][NEUTRAL] The $883 that they charged me for.
[CUSTOMER][NEUTRAL] All the testing that they did to see if I'm OK.
[AGENT][NEUTRAL] OK. Well, going forward, the way that your policy is set up now, sir, that's all we're gonna pay is $75. Now, if you want your policy to be updated or changed, do you remember who you spoke with when you enrolled in insurance?
[CUSTOMER][NEUTRAL] The health services that they provided me.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No, I do not remember.
[CUSTOMER][NEUTRAL] Can you tell me uh in on the which plan will.
[CUSTOMER][NEUTRAL] Health services be
[CUSTOMER][NEUTRAL] Covered
[AGENT][NEUTRAL] Um, no, sir. You would need to, you would need to speak with, right, you would need to speak with another broker again. And what you'll do um is call the [PII] number, the same number that you called for me to get, well, actually, you're under Universal Trucking.
[CUSTOMER][NEUTRAL] And not just a blanket $75.
[AGENT][NEUTRAL] Let me get you their number. One moment.
[CUSTOMER][NEGATIVE] It makes absolutely no sense.
[CUSTOMER][NEUTRAL] How much did you say I pay a month?
[AGENT][NEUTRAL] I'm showing that your premium is $161.29.
[CUSTOMER][NEUTRAL] $151.21.
[AGENT][NEUTRAL] 29 cents.
[CUSTOMER][NEUTRAL] 16129.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], 15.
[CUSTOMER][NEUTRAL] I was [PII] and big.
[CUSTOMER][NEUTRAL] OK, so I've paid in about $2,419.95 so far.
[CUSTOMER][NEUTRAL] Maybe a little more because I pay weekly.
[CUSTOMER][NEUTRAL] Oh, and you guys only cover $75 OK.
[CUSTOMER][NEUTRAL] Yeah, give me that number and if you can transfer me to.
[CUSTOMER][NEUTRAL] A manager or somebody.
[AGENT][NEUTRAL] Well, you would need to speak with someone who's over universal trucking, and they'll be able to further assist you. One moment.
[CUSTOMER][POSITIVE] I would greatly appreciate it.
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, sir. I'm still here. One moment. I'm gonna place you on a brief hold. One moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, Mr. [PII], thanks for your patience. Um, I was trying to transfer you over to Universal Trucking where they could further assist you where they process the claims for universal trucking, and they could further assist you, but I'm not getting an answer. So if you would like to continue to hold, um,
[AGENT][NEUTRAL] Or try to give them a call back later if you would like to continue to hold, I'll continue to try to transfer you.
[CUSTOMER][POSITIVE] Yes, I will continue to hold.
[AGENT][NEUTRAL] OK, one moment, sir.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Just in case we get disconnected and just in case we get disconnected, what is their phone number?
[AGENT][NEUTRAL] Um, it's the [PII], but when you call, you would have to use a, choose a different option. Um, what option did you select to get me? Did you select claims?
[CUSTOMER][NEUTRAL] I selected option 2. I, I don't remember what it said.
[AGENT][NEUTRAL] OK. Well, um, when you call back, make sure that you select the option for claims.
[AGENT][POSITIVE] If you need to call back. Hopefully, I can get someone on the line to further assist you.
[CUSTOMER][NEUTRAL] OK, I'll hold.
[AGENT][POSITIVE] OK, one moment, sir. Thank you.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Um, hi, [PII]. This is [PII] Claims. Um, I have a member on the line who's calling to check on the status of his claim. Well, I've, I've, I've assisted him with the status of the claim, but he's upset about how it paid. It's an outpatient claim and it only paid $75 and he's upset about that. So, and he continues to ask me a lot of questions and
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Now he's saying that he may want to cancel his um service because he didn't know that outpatient services only paid $75 and it's also a universal trucking claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Ah,
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, um, so if that, if he's wanting to cancel that would be through universal trucking I believe.
[AGENT][NEUTRAL] OK. And do you have their number? Cause normally um when we verify benefits for universal trucking, their 800 number will pop up and um I had, that's why I hadn't wrote it down. Do you have their number where I can give it to them?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Oh, for the, yes, give me just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me get that.
[CUSTOMER][NEUTRAL] Mm mm mm that is um so it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 472.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. [PII]. OK. All right. That's what I need, [PII]. Thank you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right thanks bye.
[AGENT][NEUTRAL] Bye.