AccountId: 011433970860
ContactId: 000ea60e-b40b-4ae3-862b-677f45e3efa0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249279 ms
Total Talk Time (AGENT): 144530 ms
Total Talk Time (CUSTOMER): 54383 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/000ea60e-b40b-4ae3-862b-677f45e3efa0_20250514T19:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Um, hey, [PII], it's [PII] on the care team. I wanted to see if you could help me with a claim.
[AGENT][POSITIVE] Sure, [PII], I'd be glad to help.
[CUSTOMER][NEUTRAL] Uh, let's see, it's policy 00921397.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just give me one moment please.
[AGENT][NEUTRAL] For a [PII].
[CUSTOMER][NEUTRAL] Yes, um, it's the most recent claim on there 3572082 for him.
[CUSTOMER][NEUTRAL] It says pending waiting big eligibility, but this isn't a big group.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEGATIVE] That is definitely not the correct remark code.
[AGENT][NEUTRAL] Um, let me just take a look here.
[CUSTOMER][NEUTRAL] Sure, what happened?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I think the adjuster just used the incorrect remark code, but let me check some information bear with me for just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so actually this isn't the incorrect from our code. It does say not for B.
[AGENT][NEUTRAL] Um, on the remark code it's pending for the premium, and what that means is that we haven't received the premium there must not be. Let me just check some information.
[AGENT][NEUTRAL] So it's it's not for big, yeah, I was when I was looking at that code I'm like wait a minute, usually the BIC is 5, I see 00567. I think they are 05 06 and 07, and then the 01 02 03 and the reason why they're in sequence like this because they send that first notice if it was changed to a 2 would be the second notice and so on and so forth. So let me just check some information here though, so it is pending for that premium.
[CUSTOMER][NEUTRAL] Oh, not for big. OK, sorry, my bad.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Do I
[CUSTOMER][NEUTRAL] Do I tell them to contact their employer?
[CUSTOMER][NEUTRAL] Is that, I guess what I would tell them?
[AGENT][NEUTRAL] Yeah, I'm checking some information to see it's not they don't pay in arrears, so, um, I was just checking to make sure that I wasn't overlooking anything. So yes, what happens is, and a lot of times they're gonna say, well, I'm not sure if he's a, he's not a self pay, right? Do we know?
[CUSTOMER][NEUTRAL] I don't know what to tell them.
[AGENT][NEUTRAL] Uh [PII]
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Because they'll have that designation that they're paid for it by the group, so the group is obviously they probably have it taken directly out of their paycheck and a lot of times that's what they're gonna say, but unfortunately yeah we're waiting for the group to uh uh pay their premium if he's not paying it says mode of payment one so.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] Yeah, that's true, so, OK.
[AGENT][NEUTRAL] Yeah, so we're just waiting for the group to, uh, send the premium and because as of right now the only it's only paid to date is [PII] and because this data service is, uh, obviously it's past that 11, there is not a, um, they don't pay in arrears. Some groups pay in arrears so we can go ahead and push that claim through but in this situation it looks like we do need that premium before we can continue processing for that date.
[CUSTOMER][NEUTRAL] OK, OK, I'll tell her to contact the human resources then. OK, perfect, thank you for looking at that. Sorry, I, I'm sorry I didn't look closer, sorry about that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No, that's perfectly fine.
[AGENT][NEUTRAL] We're all learning
[AGENT][POSITIVE] Every day is a learning opportunity definitely you too.
[CUSTOMER][POSITIVE] Thank you so much have a great day.
[CUSTOMER][POSITIVE] I, I'm telling you, that's right. Thank you. Bye bye.
[AGENT][NEUTRAL] Bye.