AccountId: 011433970860
ContactId: f8c19179-77cc-496e-b79b-4722501b785a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 774900 ms
Total Talk Time (AGENT): 373914 ms
Total Talk Time (CUSTOMER): 329838 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/f8c19179-77cc-496e-b79b-4722501b785a_20250224T22:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I was on the phone. I thought with [PII], but it may have been you.
[CUSTOMER][NEUTRAL] Uh, I was calling because, um, I had, I went into the emergency room back in February.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And I received a letter, uh, a huge bill from
[CUSTOMER][NEUTRAL] The facility
[CUSTOMER][NEUTRAL] Uh, and then I was, and then I, I believe they sent the claim to you guys regarding on my behalf.
[CUSTOMER][NEUTRAL] Uh, on [PII] I received a letter saying that total benefits paid was 0 and I'm just totally confused as to what's going on.
[AGENT][POSITIVE] OK, we could definitely get that claim pulled up and see what's going on with that um what was your name?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII] The last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Got it OK thank you and then can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you and then do you have your policy number?
[CUSTOMER][NEUTRAL] OK, so this is the part I'm confused because on my uh insurance, insurance ID has a number, but the the letter from you guys has a different policy number and a claim number. So I gave her, I gave the previous, yeah, go ahead.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, go ahead. No, no, you're fine.
[CUSTOMER][NEGATIVE] Uh, the previous person I spoke to on the phone before I got disconnected or before I disconnected the call, uh, I gave them my, what, what it says on my insurance ID card, but she said that was too long.
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] So I'm, I'm not understanding that, yeah.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] Most of the time, um, does it begin with a D by chance on your card?
[CUSTOMER][NEUTRAL] GI you mean?
[AGENT][NEUTRAL] Uh, a D.
[AGENT][NEUTRAL] D as in Delta.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I have PACS limited benefits plan.
[AGENT][NEUTRAL] Mhm, OK, I'm not sure but yeah you can give me that information that um if you've got that claim number that's perfect.
[CUSTOMER][NEUTRAL] OK, 356 3.
[CUSTOMER][NEUTRAL] 039.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I was able to find you. I'm just gonna uh verify some information really quick if you don't mind, can I get your date of birth please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. The last thing I need is the email address that we've got on file for you. uh, looks like it is a Gmail account.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Um, I've got something different.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Are you saying it's uh
[CUSTOMER][NEUTRAL] Because I have 5 different uh.
[CUSTOMER][NEUTRAL] For work and what have you.
[AGENT][NEUTRAL] Oh well this is for it does say that it's a Gmail um I just wanna make sure that we have the right one it's I've got um in [PII].
[CUSTOMER][NEUTRAL] Yeah, that's my, that's the other other email too. I have that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that OK to use?
[CUSTOMER][POSITIVE] Yes, absolutely. Mhm.
[AGENT][NEUTRAL] OK cool just wanted to make sure thank you for verifying that. OK, so for this claim number that you gave me, it is showing that it is a duplicate claim so give me just a moment let me try to find the original.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, I do believe I've found that original claim. bear with me just a moment let me take a look at these notes. OK, yes, so, um, and I can give you this claim number if you need it or I can send you the um EOB just so you've got it for your records if you'd like. Um, we did pay a benefit of $200 towards this which met the maximum uh for this date of service so per your policy that was the maximum amount we uh could pay.
[CUSTOMER][NEUTRAL] So I guess this, this is the part I'm totally confused. I have the insurance for over 3 years and um
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, this was sort of an emergency visit. I couldn't breathe. I, I ended up having um RSV virus.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And so I don't understand how they can only pay my hospital bill was 10,000 something, uh, the, the hospital said if you don't have insurance, we could reduce it and they made it, I think it was close to 5000. And then I did receive a letter from you guys saying, you know, we paid 200, but I had no idea what that was referring to because I didn't make the claim, the, the university hospital made the claim on my behalf.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, right, yes.
[CUSTOMER][NEUTRAL] So does, I guess, does that make sense as to like how little the coverage is for something like this?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because this is a limited indemnity medical plan is the kind of plan that this is, so it is limited in the benefits that it does pay. So for um emergency room treatment, that's what this was, that maximum benefit amount is $200 and now it is possible I don't know that you might have other um insurance coverages maybe through your employer.
[AGENT][NEUTRAL] Um, most, most of the time with these kinds there are multi plan like you said, um, that card that you had that's not our policy number that they said was too long, um, that might be a completely different kind of plan, so what I would do is I would contact your employer or your HR department, um, just so that they can let you know what all kinds of policies they do offer, um, and what you might have in addition to this.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, um, so I, I, I'm self, I was self-employed at the time, um, so I am the one who
[CUSTOMER][NEUTRAL] Somebody did a sales call to my work and um they were, they were selling me this plan and uh I guess it was only like $500 a month. And so, but they, they went over the details and I remember I, I do recall him saying that emergency um visits are covered um because I'm relatively healthy. And so only healthy people go to this plan is what I was told.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, I guess, um, when I called the claims department, they gave me your number and then I did receive the letter from you guys for the payment of 200. But is, um, when I look at my policy, there's like multiple types of coverages and different uh carriers that cover. Um, so maybe the
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I understand the confusion absolutely and since you said that I do apologize I do see that the group that you're with is uh BWA which is Business Workers of America so that is you know for self employed uh individuals so they might offer you different things but what I.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Can do just to kind of alleviate any confusion that you might have because I'm not sure what you might have been told I can send you a copy of just this policy that you've got with APL um which is the it's hospital indemnity plan again is that limited indemnity um and you can kind of give it a look and make sure that it is something you know that does fit your needs um and if it's something you decide you don't want then you can make that educated decision.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the policy is very easy to read. It's not just a bunch of jargon. It does go through, um, what is and is not covered dollar amounts, frequencies, things like that. Did you want me to go ahead and send this to you?
[CUSTOMER][NEUTRAL] Sure, that's, that'd be very helpful. Um, so, while on the line, um, is it possible that, uh, with my BWAmericare plan, that there's multiple coverages, not just from your, you as a carrier, but other insurance people within the plan? Is that possible? I mean,
[AGENT][NEUTRAL] OK. Go ahead.
[AGENT][NEUTRAL] I would think so. I would definitely think so um because this is the only plan you have with us so if you did have any other kinds of coverages, it would definitely be through a different carrier, um, and I'm not sure who you spoke with, um, previously, but I can give you uh BWA's information um if you'd like to try to give them a call.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Yes, please, um, because, um, the agency that sold me the policy has been quite just frankly rude and just hangs up on you when you're trying to get information so I am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] Oh gosh, well I sure hope it's not them.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] Yeah, I'm just floored as to the unprofessionalism of this, um, yeah, so.
[AGENT][NEUTRAL] I don't blame you.
[AGENT][NEUTRAL] Like you don't remember who that was?
[CUSTOMER][NEUTRAL] Yeah, it
[CUSTOMER][NEUTRAL] Uh, [PII], uh.
[CUSTOMER][NEUTRAL] I have I have their um email that I've been exchanging with uh.
[CUSTOMER][NEUTRAL] But they're the one who sold me the policy.
[AGENT][NEUTRAL] Hm, OK.
[AGENT][NEUTRAL] OK, well, as I, I can't apologize enough because that's, you know, not very good representation of us if that's what they're selling our product, um, but that's I am gonna go ahead and send this to you so you can see clear cut and dry what this policy does and does not cover, um, and then, you know, of course I'll get you connected with BWA to look at what other plans you could possibly have as well, um, really quick, did you want me to just email you this policy?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, that's how it looks fast, yeah, mhm. I'm sure that you're already.
[AGENT][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] It just, just from the, your, um, you know, professionalism and your uh knowledge. I feel like you're already explaining, so I don't really need to double check it, but I do, I would like to know if uh DW Americacare plan 2 is what I have, if that has other coverages.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][POSITIVE] Yeah, I think that's what I need to find out more really, OK.
[AGENT][NEUTRAL] Definitely, yes, and I'll get that information but that way I'm, I'm really sending this to you just so that you have it obviously you need to know what it is that you are paying for, um, and what it does and doesn't cover and then of course if there are other uh policies that you have through different carriers you can kind of compare I mean it's possible they could work well with one another, um, but that's all we'll we'll cross that when we get to it. um, is this [PII]. Is that where you'd like me to send this to?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. Mhm. Yeah, I, I, I got a personal email, so yeah, that'll be fine.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Sure, alright, OK, I will get that sent to you and then I will go ahead and give you their phone number and then I can transfer you as well if you'd like.
[CUSTOMER][NEUTRAL] Now this is BWA and they're not they're affiliated with you but it's not part of your company.
[AGENT][NEUTRAL] Right, yes, so this is considered the group um that would that your policy falls under is uh they're the ones that you essentially send your payment to them they send that payment to us for the premium does that make sense?
[CUSTOMER][POSITIVE] Yeah, yeah, that's. OK, perfect. Yeah, yeah. Yeah, if I can get that uh phone number, that'd be great.
[AGENT][NEUTRAL] Of course, alrighty, so that is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And I've also got an uh email address did you want me to give you that as well?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][POSITIVE] OK, it's customer [PII].
[AGENT][NEUTRAL] At
[AGENT][NEUTRAL] The number 4.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Customer [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Correct, yes, uh, did you want me to go ahead and transfer you now?
[CUSTOMER][POSITIVE] Oh, sure, that'll be great. Thank you so much for your help and clarification, yeah.
[AGENT][POSITIVE] OK, you are very welcome and I cannot apologize enough for all of the confusion, but let us know if there's anything else we could do to help.
[CUSTOMER][POSITIVE] Will do thank you.
[AGENT][POSITIVE] Alrighty, of course I'm just gonna put you on a brief hold while I get them on the line for you. Hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Thank you