AccountId: 011433970860
ContactId: f96c22ed-4091-48db-9396-034d1efd54dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461059 ms
Total Talk Time (AGENT): 206996 ms
Total Talk Time (CUSTOMER): 142841 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/f96c22ed-4091-48db-9396-034d1efd54dc_20250225T16:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yeah, I have a question. I filed a claim for under my son, my daughter, and myself for last year when I had the insurance for 3 months.
[CUSTOMER][NEGATIVE] Um, I only got a $100 check out of all the medical bills I turned in.
[AGENT][NEUTRAL] May I have your
[CUSTOMER][NEUTRAL] I'm curious if that's all I'm getting.
[AGENT][NEUTRAL] May I have your policy number and I'll pull it up for you.
[CUSTOMER][NEUTRAL] Policy number, it says 02503589.
[AGENT][NEUTRAL] May I have your first name and a good callback number?
[CUSTOMER][NEUTRAL] Um, carry, uh, my telephone number is [PII].
[AGENT][NEUTRAL] Thank you, [PII], can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] [PII] mailing address is [PII] and my email is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim.
[AGENT][NEUTRAL] So this is a hospital indemnity plan. It is a limited benefit plan. Do you have the claim number?
[CUSTOMER][NEUTRAL] Um, 35.
[CUSTOMER][NEUTRAL] 665-05
[AGENT][NEUTRAL] OK, one moment, I'll get this pulled up.
[AGENT][NEUTRAL] It looks like data service 72324 looks like it was for labs.
[AGENT][NEUTRAL] And let me see what the benefit amount allows.
[AGENT][NEGATIVE] These plans are very limited.
[AGENT][NEUTRAL] Oh, that's
[CUSTOMER][POSITIVE] And what's funny is when I called and got this insurance, the gentleman I spoke to said we'd be covered for everything.
[AGENT][NEUTRAL] Not on these hospital indemnity plans, they are very limited.
[CUSTOMER][NEGATIVE] Well, the representative is given false information.
[AGENT][POSITIVE] And I do apologize for that.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Especially saying one of my kids is disabled.
[AGENT][POSITIVE] And I do apologize. I'm sorry.
[CUSTOMER][NEGATIVE] And I ended up with a $10,000 medical bill from Children's.
[AGENT][NEUTRAL] Is that for [PII]?
[CUSTOMER][NEUTRAL] No, that was for [PII]. Um, I got none of that got turned in because I got that covered under a different program which I only owe 2000 on.
[AGENT][NEUTRAL] I do apologize. The system is slow. I'm trying to verify which benefit they processed this one under.
[CUSTOMER][NEUTRAL] I mean, are they all gonna get processed different and not at once or?
[AGENT][NEUTRAL] I believe that they're based on the services. For instance, if you had a physician's office visit, that benefit would allow $75. If you would have had an emergency room, that benefit would have allowed up to $500 max 2 days per calendar year.
[AGENT][NEUTRAL] It just depends on which benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like this.
[CUSTOMER][NEUTRAL] Oh I see right here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, it looks like under this benefit, it only allowed $100 because it looks like the charge was.
[AGENT][NEUTRAL] 939.40 and the benefit only allow $100.
[AGENT][NEUTRAL] Under this benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So these plans are very limited.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEGATIVE] Yeah, because all everything I get back from you guys are all going for the medical bills.
[CUSTOMER][NEGATIVE] I am so medically in debt from last year.
[AGENT][MIXED] Oh, I totally understand. And I wish they would explain the policies better.
[CUSTOMER][NEUTRAL] Unreal.
[AGENT][NEUTRAL] So that the insurer can understand exactly which plan they're choosing.
[AGENT][NEUTRAL] So for the one.
[AGENT][NEUTRAL] Looks like for [PII], this was 72 of 24.
[AGENT][NEGATIVE] For $217 the policy did not pay.
[AGENT][POSITIVE] It has to be a sickness or injury. So it looks like this was a well visit.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that the policy didn't cover that one either.
[AGENT][NEUTRAL] It has to be a sickness or injury.
[CUSTOMER][POSITIVE] Oh wow, because the guy when I went.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Something's gotta get better with their representative because he told me well this and that we're covered.
[AGENT][NEUTRAL] Now, was that through American Public Life or was that through IMA which is the administrator to the policy?
[CUSTOMER][NEUTRAL] Um, that was through, hold on.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have it written down in.
[CUSTOMER][NEUTRAL] Where did it go?
[CUSTOMER][NEUTRAL] I got this insurance through, it's ADRO IT Health Group.
[AGENT][NEUTRAL] OK. And I'm not sure who that is, but what I can do.
[CUSTOMER][NEUTRAL] The agent was [PII].
[AGENT][NEUTRAL] OK, so that came directly to the employer or through the agent.
[CUSTOMER][NEUTRAL] They're the agent.
[AGENT][NEUTRAL] Oh, yes, OK. So what I can do is put you over to IMA and give them the information just to see if you do have wellness on that side. On this side, we don't have wellness, but you may have wellness on the other side.
[AGENT][NEUTRAL] Which is the actual administrator to the policy. So I'll give you that phone number, but I'll also transfer you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's that phone number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], hold on, my, my, hold on, my pin quit working. That's always great.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] An[PII] I'll transfer you over and see if they can assist you. Maybe you have wellness on that side. It's just not on this side.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is there anything else I can help you with before I transfer you?
[CUSTOMER][NEUTRAL] Um, nope, I'll just wait for the rest of the claims to come in.
[AGENT][POSITIVE] Well, [PII], thank you so much for calling American Public Life. Have a great day. One moment.
[CUSTOMER][POSITIVE] You too thank you ma'am.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.