AccountId: 011433970860
ContactId: 02f74dd8-ca13-4aff-8bf3-a188953fdfb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 895119 ms
Total Talk Time (AGENT): 350390 ms
Total Talk Time (CUSTOMER): 479706 ms
Interruptions: 8
Overall Sentiment: AGENT=1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/02f74dd8-ca13-4aff-8bf3-a188953fdfb1_20250513T12:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[AGENT][POSITIVE] I'm good [PII] how are you doing?
[CUSTOMER][POSITIVE] I'm doing good. Um, I have a group.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well, a group admin, a group contact, and the CFO. They're all on the line.
[AGENT][POSITIVE] OK, well, that's good.
[CUSTOMER][NEUTRAL] Um, they're trying to understand like the billing and how the adjustments are made and who puts the comments on there. Like they just have a lot of questions about their bills and I.
[AGENT][NEUTRAL] Yeah, sure, what number?
[CUSTOMER][NEUTRAL] Um, it's 18005.
[AGENT][POSITIVE] Thank you ma'am and who am I talking to, honey?
[CUSTOMER][NEUTRAL] OK, so you have [PII], she's not on there, but they're about to send an email to add her. Um she's the CFO and then there's
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Um, that's the main person, Dar [PII], I believe her name is. She's on at um OSC admin. She verified.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] And um who's the other person on the phone? I think it's just them two now because the other person left.
[AGENT][NEUTRAL] OK, and that's [PII], right, huh?
[AGENT][NEUTRAL] Did you get, did you, did you get a callback number, honey?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm. It is [PII].
[AGENT][POSITIVE] Thank you, [PII], and I'm talking to [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] I'll be glad to help. Well, thank you so much.
[CUSTOMER][NEUTRAL] You're welcome. Oh, and I did not write your name down. I was about to call you [PII], and I know you didn't say [PII]. Can you tell me your name?
[AGENT][NEUTRAL] No, it's [PII], it's [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Is is the name of this group Place of Hope?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, alright, I got it thank you dear. I appreciate it.
[CUSTOMER][NEUTRAL] You good?
[CUSTOMER][POSITIVE] OK, hold on one moment. Have a good day.
[AGENT][POSITIVE] OK. You too, [PII]. Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hello [PII].
[CUSTOMER][POSITIVE] Hi there. Hey, thanks so much for holding. I have [PII] on the line with your billing, and she'll be assisting you further, OK? Super, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hi [PII].
[AGENT][POSITIVE] Hey, good, good morning, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I am well thank you how are you?
[AGENT][POSITIVE] Oh, I'm doing great, thank you so much for asking.
[AGENT][NEUTRAL] You have some questions about the billing process?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We do, we do. I was just explaining to [PII] there are times when we, you know, pull down an invoice and, and pay the bill and then we realized, um, sometimes a month later that invoice was actually changed to a different amount and I'm looking online right now and there it looks to um be some adjustments made for example to the invoice.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 638-4700 and curious who makes those entries when they make them um just to have better understanding of who has access and adjusting the bills in general.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, yes, OK, so you guys do have access to that, um, on the online service center if you need to make an adjustment for like a patients, uh, no patients, and insurance premium if that a coverage change or terminations.
[AGENT][NEUTRAL] You can go and do that as well online. We also have access to it. I see where on that invoice you're speaking about, you have some credits that we applied, so that's why the amount was different. Yes, ma'am. So if there's any ever anything that you need to change, you can go on there and do it yourself. Do you, are you set up to do that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Um, I do see it, but just so you're, um, you broke up just a little bit, but just, um, to confirm, that's OK, just to confirm that these adjustments were made on your end, how would we know who makes these adjustments?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Because we've never we've never utilized the portal that manner so we've never made adjustments so just curious how you receive information do you, um, like how do you know uh an employee has termed what the adjustment should be where does all that come from from your perspective?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You've never
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, OK, well, OK, now, we wouldn't know the termination unless you send us a termination. OK? Now, we can go on there and adjust that if there was some, some premium that was overpaid on the policy, we want you to reconcile your invoices, um, you could have sent in a different amount.
[AGENT][NEUTRAL] And we may not have known what that adjustment was, so we just applied what was sent in, OK? Um, I, do, do you guys go through and reconcile your invoices each month?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Do do you go through and reconcile your invoices each month?
[CUSTOMER][NEUTRAL] What was that?
[CUSTOMER][NEUTRAL] Yes, yes, that's what's bringing light to um to the adjustments, but what is causing a little, um, a few, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I guess more work than we feel should be, uh, you know, necessary. We're just finding that the invoices that have been paid already and we go back to that invoice, the invoice itself is changed and um.
[CUSTOMER][NEUTRAL] So you're what you're saying is you receive information from is it our HR department or are you connected to maybeanion OK, so you, you get when someone is termed and make the adjustments there so it just seems like maybe there's a timing OK OK issue, um.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, it could have been after you submitted a payment and they could have turned like prior month and we could apply a credit and that comes strictly from the HR department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] They would have to send it back.
[CUSTOMER][NEUTRAL] Um, it also looks like, right, so you wouldn't change like the next month and have like an adjustment. It looks like even if an invoice was paid, you'll go back and open that invoice and make the adjustments to that invoice. I think that's what's causing the discrepancy, one of the discrepancies on our end, but just confirming that's what's happening, OK, um.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. Does that make sense? I know it's kind of confusing.
[CUSTOMER][NEUTRAL] So it it yeah it makes sense it's just not not common on our end once an invoice is paid and closed, it's not common on our end to um make changes to a particular invoice typically we see that in maybe a future invoice that's not paid and you'll see like adjustment, OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. Well, it
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So, um, well, we're trying to avoid something like this happening, but I also heard you, um, say that, um, for example, uh, the invoice that we're looking at 6,384,700, this is for, um, the month of April so if we have someone um for example that turns mid month.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I understand that APL system does term dates at the end like for after the full month.
[AGENT][POSITIVE] That's correct. Yes, ma'am. We don't prorate it. You'll have coverage through the full month.
[CUSTOMER][NEUTRAL] Right, and what we do.
[CUSTOMER][NEUTRAL] Right, right, and what we do is we, um, our policy is that, um, it's our benefits are effective the first day and they end the last day of employment and you had mentioned that we were able to go in and make those adjustments.
[AGENT][NEUTRAL] You are on the OSC if one, if one is terminated. Yes, ma'am. Um.
[AGENT][NEUTRAL] I see that let's see there's 2 users that have access. I see 2 emails you can go in and select that invoice and you can select the insurer's name. There's a comment section to the right and you can put terminated in the date therefore.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that would let us know that that one needs to be terminated.
[CUSTOMER][NEUTRAL] OK, so, um, moving to let's see the current month, the month of May, I see, um, well, mine's pulling up right now, so, um, let's, for example, take [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm pulling it up. Let me see.
[CUSTOMER][NEUTRAL] So if I'm looking at a May bill that employee term in April.
[CUSTOMER][NEGATIVE] So how would we handle something like that because she shouldn't even be on a May bill because she termed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we did already received a notification that she turned um um in April, so it was effective [PII] that she was terminated.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So they must have sent us something that um but it's saying that the March premium is due for her.
[AGENT][NEUTRAL] Looks like that with me. That's why she's still on there.
[CUSTOMER][NEUTRAL] March
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I'm just gonna pull up her higher date because
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, I just wanna confirm that real quick.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so it does look like she was hired [PII], so what you're telling me is that she was not included in the March bill.
[AGENT][NEUTRAL] I'm looking, give me one moment please. OK, I have to go to a different system. Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this was Ms. [PII], correct? I go back and look. [PII], OK.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] I'm looking at the March bill. Give me just a moment. I wanna make sure I don't miss it, OK?
[AGENT][NEUTRAL] No, ma'am. She was not, she was not on the March bill. I'm looking at the March bill right now. No, ma'am, she was not on it.
[CUSTOMER][POSITIVE] Great thank you.
[CUSTOMER][NEUTRAL] So March, OK, so.
[AGENT][NEUTRAL] Yes, that's why she's still showing on the May bill. So we'll just, so that's what, um, that's why she's still showing on your May invoice.
[CUSTOMER][NEUTRAL] OK, so she was.
[AGENT][NEUTRAL] So once we receive that March premium, the policy will turn.
[CUSTOMER][NEUTRAL] OK, so she wasn't on March but she was on.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] April, let me just confirm that.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] That's correct. Let me go back and look just to verify. Give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] Thank you for your patience. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So 3:11.
[CUSTOMER][NEUTRAL] 25 to 4 2125.
[AGENT][NEUTRAL] Yes, ma'am. She was on your [PII]il, on your April invoice.
[CUSTOMER][NEUTRAL] On April, so how would you recommend because we do.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Pro rate, um, but I understand that going on your end so how would you recommend, um, we align a little bit better with um pro rating someone who is hired mid month and someone that's termed mid month.
[AGENT][NEUTRAL] Let me look at something.
[AGENT][NEUTRAL] Well, we're still gonna pay the to the end of the month no matter what the termination date is. So as, as far as.
[AGENT][NEUTRAL] Pro-rating it, we, it, we would still pay for the full month. Does that make sense?
[AGENT][NEUTRAL] We were still on the full month.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, I'm sorry, could you repeat that? for the.
[AGENT][NEUTRAL] Yes ma'am. So as far as pro rating, um, we would like if they, if they were returned on the [PII] of the month they would still have coverage to the end of the month.
[CUSTOMER][NEUTRAL] Right, but our policy is that, uh, the benefits begin the first day and they end the term date.
[AGENT][NEUTRAL] Let me get with one of my colleagues on that and because I'm not sure I won't be able to give you the right information, OK? Can I call you back on that? Let me find out. Would that be OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, that's fine.
[AGENT][NEUTRAL] OK. OK, and I've got [PII], is that right?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, great. Let me, let me make sure that I'm giving you the right information. I would like to confirm that. Do you mind if I give you a call back? OK. So what you want to know.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][POSITIVE] Um, that is no problem. Thank you.
[AGENT][NEUTRAL] You're welcome. So just to make sure that I'm correct, what you're asking me is how, how, how would we recommend that you prorate it if they were hired the first day of the month.
[CUSTOMER][NEUTRAL] That
[AGENT][NEGATIVE] And like, and they turned the [PII] of the month and you do not cover anything past the [PII], correct?
[CUSTOMER][POSITIVE] That is correct. That's our policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Your policy. OK, I got it. OK. Yes, ma'am. Let me find out and I'm gonna give you a call back if that'll be OK.
[CUSTOMER][POSITIVE] That's great just for reference, you do you know when I might expect your call back?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Just, just with, within, within the hour, if not before. I'm gonna find out if I can, yes ma'am, and I will give you a call back.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Oh super. OK, great, thanks so much, [PII].
[AGENT][POSITIVE] You're welcome. I'll talk to you soon, OK? You're welcome. Thank you. Bye.
[CUSTOMER][POSITIVE] Super, thank you.
[CUSTOMER][NEUTRAL] OK bye bye.
[CUSTOMER][NEUTRAL] Bye.