AccountId: 011433970860
ContactId: 06904f0a-c910-46f3-91d6-e54e324449d1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 806000 ms
Total Talk Time (AGENT): 254043 ms
Total Talk Time (CUSTOMER): 265012 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/06904f0a-c910-46f3-91d6-e54e324449d1_20250527T14:02_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] Good morning, [PII]. My name is [PII], and I'm calling because I submitted a claim. They requested more information. It's for my son, [PII]. I did, and they're getting back to me saying that the plan was terminated for that data service.
[CUSTOMER][NEGATIVE] I then uh went to the COA that we were paying at that time, pull out the benefits and the letters stating that the plan was still active for that data service, and they denied the claim once again. So I need to talk to someone because I've been doing everything online and it's not working.
[AGENT][NEUTRAL] May I have your policy number and I'll pull up this plan.
[CUSTOMER][NEUTRAL] Of course, absolutely. It's 01912737.
[AGENT][NEUTRAL] And may I have a good call back number for you?
[CUSTOMER][NEUTRAL] Yes, of course, [PII].
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] Just waiting on the system, one moment. Can you verify your date of birth?
[CUSTOMER][POSITIVE] Take your time. I'm not in a rush.
[AGENT][NEUTRAL] Can you verify your date of birth?
[CUSTOMER][NEUTRAL] Mine, it's [PII].
[CUSTOMER][NEUTRAL] Yes, mine is [PII].
[AGENT][NEUTRAL] Your mailing address and your email, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have an email address?
[CUSTOMER][NEUTRAL] Yes, it should be [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. And this was for [PII], correct?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, [PII], our [PII] son.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have the data service on that claim or claim number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, yes. It's 1-11-2024.
[AGENT][NEUTRAL] OK, let me get this pulled up.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I do apologize. The system is extremely slow.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Take your time, [PII]. I'm not in a rush.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] OK. So it looks like this was for an ER visit, pathology. Let me get it pulled up.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, let me see if there's any notes on the account. It looked like it was paid to [PII].
[AGENT][NEUTRAL] Let me see if there's any notes out here.
[CUSTOMER][NEUTRAL] Yeah. Actually, we paid for the cobra until the [PII], and I provided a copy of that letter as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is so weird because they
[CUSTOMER][NEGATIVE] On the denial that I got recently, they put, they put it as uh data service, 123123 instead of 11124. And that's where all the notes went. Whoever did that, they added a claim number 3603668, um, where they received 516, and it's, it has the wrong date of service.
[AGENT][NEUTRAL] Oh, OK, OK, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. I'm looking to see if they did any updates or anything like that. I do see a note.
[AGENT][NEUTRAL] Regarding this.
[AGENT][NEUTRAL] COR plan, but I'm not seeing where they actually updated the dates. That's what I'm looking for in our system.
[AGENT][NEUTRAL] So I'm not seeing anything on my end. So I'm gonna get you over to customer service.
[AGENT][NEUTRAL] And have them assist you with the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Dates in the Cobra, let's see, [PII].
[AGENT][NEUTRAL] OK, so on my end it's still showing that so I'll get you over to customer service and on the back end I'll go back and look at these claims and see if I can get these dates corrected for you on those.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Mm, thank you so much, [PII]. Do you see the one that I'm telling you where they put, instead of, you know, adding the right date of service, they added 1231 23 and it says process and that's where all my documents went.
[AGENT][NEUTRAL] OK, 12:31, let's see.
[CUSTOMER][NEUTRAL] Yeah, I see a claim with the claim number 3603668.
[AGENT][NEUTRAL] Let me get that one pulled up.
[CUSTOMER][NEGATIVE] That's wrong because that's the wrong data service.
[CUSTOMER][NEUTRAL] All of those documents should have gone to I mean, yeah, 111 2024.
[CUSTOMER][POSITIVE] [PII], sorry about that.
[CUSTOMER][NEUTRAL] Yeah I know.
[AGENT][MIXED] Good system is extremely slow.
[CUSTOMER][NEUTRAL] Or.
[AGENT][NEUTRAL] OK, 668, which is 523 processed.
[CUSTOMER][NEUTRAL] Mhm, that one.
[AGENT][NEUTRAL] And that was 12:31 so I'll get that one pulled up as well.
[CUSTOMER][NEUTRAL] The all that
[AGENT][NEUTRAL] I do apologize. Normally it doesn't take the system this long. I'm not sure what it's doing today.
[CUSTOMER][NEGATIVE] So now worry about it, money.
[AGENT][NEUTRAL] Let's see. OK, so this one was 15 pages and let me pull up the date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] yeah
[AGENT][NEUTRAL] OK, so what I'll do on this one is go ahead and get you over to customer service so that they can get you the information on this CR so they can get it updated in our system and I'll go back on the claim side and get those corrected for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you so much. I really appreciate it, [PII].
[AGENT][POSITIVE] You are so welcome. One moment and I'll get you over to the care team and you're on um.
[AGENT][NEUTRAL] The computer, so any updates, any changes, you will get a notification.
[AGENT][NEUTRAL] And a claim number with that one, OK?
[CUSTOMER][POSITIVE] Beautiful. Thank you.
[CUSTOMER][POSITIVE] Excellent. Thank you so much. I really appreciate it.
[AGENT][POSITIVE] You're so welcome. One moment and I'll get you over to the customer service one moment.
[CUSTOMER][NEUTRAL] Of course, yes.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Quick next.
[AGENT][NEUTRAL] Customer service.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hi [PII], this is [PII] making claims. How are you?
[CUSTOMER][POSITIVE] I'm doing good how are you?
[AGENT][POSITIVE] I am wonderful. I have an insured on the line and she's calling regarding her Cobra.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is under policy number 01912737.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I explained to her in our system I'm only showing.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] 11 of 24.
[AGENT][NEUTRAL] But she did send in the letter for her premium payment coupon and Cobra and all that, so we do have that in the system as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just don't know anything about Cora.
[CUSTOMER][NEUTRAL] All right. Um, and is it for [PII]?
[AGENT][NEUTRAL] The claim or the person?
[CUSTOMER][NEUTRAL] Uh, the person, the policy.
[AGENT][POSITIVE] Yes, yes, that is correct. I'm sorry.
[CUSTOMER][NEUTRAL] OK. OK. Mm. All right. Let me pull up the group really quick and see what's going on here. What's
[CUSTOMER][NEUTRAL] OK. Yes. Um, the change date should been all the way until
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] July
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you want me to go, uh go ahead and give you the information for the, if the cover is active or not, or do you want me to talk to the insured?
[AGENT][NEUTRAL] She wants to um explanation as to why we haven't. I guess updated our end.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. We do have it updated. We do, yes, we do have her CObra um dates. Um, what I would assume is the group labs.
[AGENT][NEUTRAL] With her cobra.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] So her policy is not lapsed 11 of 24?
[CUSTOMER][NEUTRAL] OK, yes, it is lapsed. Um, so the group is no longer active with us and since COBRA payments come, even though she set up for a COA, those payments go to the employer and the employer still send us those payments. Um, so if the group lapses with us, there's no way for us to obtain those payments because it doesn't come directly to us.
[AGENT][NEUTRAL] OK. Can you break that down?
[CUSTOMER][NEUTRAL] It has to go through the employer.
[AGENT][NEUTRAL] Can you break that information down to her?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Yes, I can.
[AGENT][POSITIVE] Thank you, I appreciate it.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Let me get her on the line one moment.
[AGENT][POSITIVE] Here she comes. Thank you.
[CUSTOMER][POSITIVE] You're welcome. Have a good one.
[AGENT][NEUTRAL] You as well. Bye-bye.