AccountId: 011433970860
ContactId: 05c8978c-83d3-4608-9630-f6567372ba33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 794679 ms
Total Talk Time (AGENT): 337615 ms
Total Talk Time (CUSTOMER): 348758 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/05c8978c-83d3-4608-9630-f6567372ba33_20250206T21:11_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] For the
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hi [PII], um, I was calling. I had talked to someone earlier today and got an update on the status of my claim, but they had, they had missed like amounts for my deductible, so she had to send it back to the.
[CUSTOMER][NEUTRAL] Somebody so that they could pay those as well.
[AGENT][NEUTRAL] OK, may I have
[CUSTOMER][NEUTRAL] And she told me just to
[CUSTOMER][NEUTRAL] Check back.
[AGENT][NEUTRAL] May I have your policy number?
[CUSTOMER][NEUTRAL] Sure. It is um 2, wait, let me think, 246-1873.
[AGENT][NEUTRAL] May I have your first name and a good callback number?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Sure, it is, uh, my mailing address is [PII]. Uh my date of birth is [PII] and my email address 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.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So it looks like data service 172025 for Frick Hospital.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, so it looks like this claim was processed today. It looks like patients responsibility was $4,841.23. The benefit amount paid $3000 which is the benefit allowed for outpatient.
[CUSTOMER][NEUTRAL] Correct, so I just wanna verify what she told me earlier too, so they did pay just one payment, not 350, and then another payment.
[AGENT][POSITIVE] Correct. It looks like it was 3 different.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like it was 123. So it was 3 different lines that added up to the 48 41.23.
[CUSTOMER][NEUTRAL] Yeah, there was
[CUSTOMER][NEUTRAL] Correct, but they like, so I'll get one direct deposit of $3000.
[AGENT][NEUTRAL] That is correct and let me see if there's direct deposit on your account. One moment.
[AGENT][NEUTRAL] And it is, so yes, it is set up and once it processed.
[CUSTOMER][NEUTRAL] Can I verify my account number with you too?
[AGENT][NEUTRAL] Um, let me see. I'm not sure if I can see that. Let me check something real quick. I might have to get you over.
[CUSTOMER][NEUTRAL] Can you do that?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] To a different department. I don't know if I can.
[CUSTOMER][NEUTRAL] Like it shows the right number if I go on to my payment preference.
[AGENT][NEUTRAL] OK, see, I do not have access to that. I would have to get you over to customer service. They can verify.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] No, it's OK. It says it if it says it in like if I log into my account and it says that in my payment preference, then it should be fine, I would think, right?
[AGENT][NEUTRAL] OK. Yes, ma'am. It's just we can't, we don't have access to it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, totally understand that. So here's my next question. I just wanna verify something that she had let me know then too, so.
[CUSTOMER][NEUTRAL] Um, my policy last year with you guys was for $3000.
[CUSTOMER][NEUTRAL] Um, when we had like in December, we had to, you know, we had open enrollment for this year's health insurance, and but we had different plans that we had to choose from than we had last year.
[CUSTOMER][NEUTRAL] So it was um
[CUSTOMER][NEUTRAL] I had a higher deductible this year, so I did a higher gap in the amount of $5000.
[CUSTOMER][NEUTRAL] So apparently, from what I'm understanding, they're still processing our
[CUSTOMER][NEUTRAL] Update with you guys for the new plan for this year?
[CUSTOMER][NEUTRAL] So they said it just continues with the old ones and, you know, we've continued paying and whatnot. But then once it
[CUSTOMER][NEUTRAL] Finishes processing so it shows my $5000 plan, then do I have to call back in for them to relook at this claim because then I can get the rest of my money back or do I have to resubmit it again?
[AGENT][NEUTRAL] Now that I am not sure of because
[AGENT][NEUTRAL] That would be a benefit or agent question.
[AGENT][NEUTRAL] Let me look and see if there's any notes on your account because it looks like this one is.
[CUSTOMER][NEUTRAL] Cause she said that they would be they would re-look at the claim.
[CUSTOMER][NEUTRAL] But I don't know if I have to call in and have them do that, or if they do it on their own or how that works.
[CUSTOMER][NEUTRAL] Cause my new policy should be like effective for the 5000 since [PII].
[CUSTOMER][NEUTRAL] So she said if it goes back to the date of service, which it should, then they would be able to relook at the claim.
[AGENT][NEUTRAL] Which that would make sense to us, but I want to see if I can get someone to verify that for you.
[CUSTOMER][POSITIVE] I appreciate all your help.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You're welcome. Let me see it looks like all the supervisors are all in a meeting. I just want to see who could answer that question because I'm just showing on my end in my notes that the policy is active. I don't show.
[CUSTOMER][POSITIVE] Right, that's what she said too. And I mean, I can check back later on that. I'm getting the bulk of it back right now, which is good because I put that money out for my income tax, so that that way I didn't get, cause I know they told me I was gonna get probably 1 or 2 more bills.
[AGENT][NEUTRAL] Any changes?
[AGENT][NEUTRAL] OK. Yes, ma'am.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] So I just wanted to
[AGENT][NEUTRAL] I'm not, yes, and I totally understand. I'm not seeing anything. So did they say when did they give you?
[CUSTOMER][NEUTRAL] Make sure
[AGENT][NEUTRAL] A roundabout date.
[CUSTOMER][NEUTRAL] Well, the, it should have been [PII], like our new health insurance policy went into effect [PII]. So I know.
[CUSTOMER][NEUTRAL] Like our agent submits all that information at the same time. And I guess they do have it there cause uh the other agent had to like put me on hold and call someone else and they do have it there, but they're still processing it.
[AGENT][NEUTRAL] Yeah, and I don't see anything. I'm gonna place you on a brief hold and let me see if I can reach out to someone in a different department and see if they have any updates with this group and see if they can give me an update on that. I'm gonna place you on a brief hold. I'll be right back, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, let me call Quick connects.
[AGENT][NEUTRAL] And call customer service.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] in claims. How are you?
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][NEUTRAL] I am good. I have a quick question. Would you know anything about a group change effective [PII] for Dream Life recovery?
[AGENT][NEUTRAL] She's she's questioning if the policy is scheduled to change on [PII], with her benefits go into effect? Do we go back and reprocess claims? I've never heard of this, but I don't know.
[CUSTOMER][NEUTRAL] Hm, OK. Do you have a policy number?
[AGENT][NEUTRAL] Yes, I have a policy number of 246.
[AGENT][NEUTRAL] 1873.
[AGENT][NEUTRAL] But she was told the group would go to a different deductible effect of 11.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 1873.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Middle.
[AGENT][NEUTRAL] I didn't see anything in my notes, so I'm like, let me check.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I wonder if we've received something we haven't gotten it done yet or.
[AGENT][NEUTRAL] She said she spoke with her agent who had to reach out to another agent and say, we have it, and it's supposed to go into effect 11, which changes her deductible.
[AGENT][NEUTRAL] So, basically she's saying right now her benefit cap is 3000, but it's supposed to go up to 5000.
[AGENT][NEUTRAL] Effective [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me look somewhere else.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Like.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, [PII] was their open enrollment but uh.
[CUSTOMER][NEUTRAL] Until it's been changed. I don't, I don't know what to tell her.
[AGENT][NEUTRAL] And that's what I was looking at cause normally I do see notes from you guys, but I'm not seeing anything. So I'll just tell her to check with her HR or her broker.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Let me check one more thing now see if I thought well maybe they, it would be a new policy and maybe they just forgot to lapse the old policy, but now there's not another one out there.
[AGENT][NEUTRAL] And that's I did that as well thinking oh maybe she got them confused, but no, she said last year, then she said open enrollment this year and it was supposed to be changing amounts. [PII], but we're still at 3000, so she knows what she's looking at, but I just did not know, so.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah and
[CUSTOMER][NEUTRAL] She's right, but um I don't know if we've gotten anything or not. That's that's the problem with we we get it in a a dashboard now so I can't see what anybody else has. I can only see what I have.
[AGENT][NEUTRAL] Oh, OK. OK.
[CUSTOMER][NEUTRAL] Yeah, let me see if maybe it might possibly be in there.
[CUSTOMER][NEUTRAL] Let's see, policy number 61873.
[AGENT][NEUTRAL] Now, what you're looking at
[CUSTOMER][NEUTRAL] No, it's not in mine so.
[AGENT][NEUTRAL] We don't have that, right?
[CUSTOMER][NEUTRAL] Right now.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK. Well, I'll tell her to check back with her agent because I'm not seeing anything as far as
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Her deductible plan changes going into effect.
[CUSTOMER][NEUTRAL] All right, OK.
[AGENT][POSITIVE] I appreciate you. Thank you.
[CUSTOMER][POSITIVE] All right. Well, thank you. Have a good day, [PII].
[AGENT][NEUTRAL] Bye bye. You too. Bye bye.
[CUSTOMER][NEUTRAL] Money, I'm sorry.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] OK, thanks for holding, [PII]. She was looking as well and she did not see any new information, any new plan changes on her side either. So we're not seeing anything as of today.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Anything
[CUSTOMER][NEUTRAL] OK. Well, I will talk to my employer about that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] That way I can get the rest of it covered.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Because unless we're notified, they, I'm sure they will not go back and say, oh yes, let's go back and update this one. So unless they get notification.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] The system won't automatically do it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So once I know that the, the, the new policy is in fact, I can just call you guys and either find out if I have to submit another claim or if I can have that one reopened.
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then that deposit is gonna be made today, you said?
[AGENT][NEUTRAL] It should process through nightly and it just, I'm not sure the time frame for direct deposit between banks.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I think it's either tomorrow or the next day it would hit.
[AGENT][NEUTRAL] OK. Yes, ma'am.
[CUSTOMER][POSITIVE] OK. I appreciate all of your help today. Thank you so much.
[AGENT][POSITIVE] You are so welcome and thank you for calling American Public Life, Angela. Have a great rest of your evening.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.