AccountId: 011433970860
ContactId: 0d2b0eba-be65-46e3-850b-6810623f64cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1510560 ms
Total Talk Time (AGENT): 333686 ms
Total Talk Time (CUSTOMER): 563784 ms
Interruptions: 9
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/0d2b0eba-be65-46e3-850b-6810623f64cd_20250515T20:26_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I just have some insurance questions I guess.
[AGENT][NEUTRAL] OK. Um, may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And Mr. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Do you have a policy, Mr. [PII]?
[CUSTOMER][NEUTRAL] I have an insurance card do you guys?
[AGENT][NEUTRAL] OK, do you have the number with you that you can provide to me?
[CUSTOMER][NEUTRAL] I can get it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02581460.
[AGENT][NEUTRAL] Thank you, Mr. [PII]. And for security, may I have your date of birth, mailing address and email address on file?
[CUSTOMER][NEUTRAL] Um, date of birth [PII].
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have no idea if the company used my personal email or my work email.
[AGENT][NEUTRAL] Yes, um, yeah, it looks like we don't have one, so it's OK. Um let me have your mailing address.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Greeley, Colorado.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And how may I assist you today, Mr. [PII]?
[CUSTOMER][NEGATIVE] I just wanted to see if um it says employing children or child or something like that, but my, it says that my child, like when I give them my insurance card, it says that my child is not on my insurance.
[AGENT][NEUTRAL] Mhm. Let me check and see what type of product you have. OK, one moment.
[AGENT][NEUTRAL] So the coverage is single parent. Um, the card that you have, does it have single parent on the card?
[CUSTOMER][NEUTRAL] No, it says.
[CUSTOMER][NEUTRAL] Employee and child.
[CUSTOMER][NEUTRAL] Coverage employee and child.
[AGENT][NEUTRAL] OK. And
[AGENT][NEUTRAL] OK. So by saying that it's employee and child, it means that you have a dependent added to your policy. Um, are they needing to see the name or what exactly is your question, Mr. [PII]?
[CUSTOMER][NEGATIVE] And they just so when I give them the insurance card, they say that my child is not under my coverage.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Who has said that?
[CUSTOMER][NEUTRAL] Uh, his doctor.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] And what is the child's name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, um, what is the last name? Is it [PII]?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] How do you spell the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Let me look at the paperwork of your policy, Mr. [PII]. Do you mind holding for me?
[CUSTOMER][NEUTRAL] Yep
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] Hello, can you hear me?
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] in customer service. How may I help you?
[AGENT][NEUTRAL] Hi, [PII], can you hear me?
[CUSTOMER][NEUTRAL] I can. I apologize. It was my headset. I can hear you, but I guess you couldn't hear me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, yeah, I, I know, I wasn't able to hear you. I'm like, OK, what happened? OK. Um, well, I have a question. Um, I'm here under the guru, the guru section, but I, it's it's unclear to me what, what to do with this. I know in the past we used to just, uh, you know, get the information, transfer, or whatever, but right now I'm not sure how to handle this. Um, so the policy number I have is 2,581,460.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and it's the group calling you said?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, no, I have the insured on the line, Mr. [PII].
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, give me just a second, let me pull that up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. [PII], OK.
[AGENT][NEUTRAL] Mhm. Yes, and I went ahead and pull again on through the guru to see what to do, but I, I'm just not clear on what to do. Um, so basically he has a single parent policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which um I'm not sure about, you know, the information that is listed because it looks like it's the same age, so it's kind of confusing. Anyways, um, that's not the reason.
[AGENT][NEUTRAL] Um, he said he, that his son is not listed and he should have been listed and um he gave me the name and date of birth and everything, but he's, I'm not sure if we need to get additional information or what or if he's supposed to be added and we just forgot to add it or
[AGENT][NEUTRAL] You know, it could be many scenarios, so I'm not really sure how to handle this one right now because it's a single parent, you know, it's not like we're making this change to the product, it's more like the the pendant is missing, so yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, what I think happened is the person that's listed as the dependent currently is his wife, probably um due to that birthday and somehow she got misplaced she got placed on there instead of the dependents. So is his wife supposed to be on there too or just his son?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] He didn't say anything about the wife, but he said he has the card and the card is a um insured and child. So he's like my child's supposed to be added.
[CUSTOMER][NEUTRAL] Yeah, that's because she's listed as a dependent, yeah, um, hold on, let me check on base and see if there's an original application. I don't know how this group, let me see if this group is on the file feed.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see 19874.
[CUSTOMER][NEUTRAL] I'm doing like three things at once I'm pulling up the group and I'm checking to see if he has an original application 1460.
[AGENT][NEUTRAL] Oh, OK, it's OK.
[CUSTOMER][NEUTRAL] OK, the group is on a file feed, so and there's no application in on base. OK, so do do do do do do let me check something else. Let's see.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It could be that it's sent out an exception report.
[CUSTOMER][NEUTRAL] This is a [PII] group.
[CUSTOMER][NEUTRAL] OK, so I'm gonna check the exception reports and the file fee to see.
[CUSTOMER][NEUTRAL] Yeah, who's all supposed to be on there? Let's see.
[AGENT][NEUTRAL] That
[CUSTOMER][NEUTRAL] See.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and all.
[AGENT][NEUTRAL] OK. I'm gonna put you on a brief hold. I'm just gonna go back to him just to let him know that we're still working on it, OK?
[CUSTOMER][NEUTRAL] All righty. So, yeah.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me Mr. [PII]. I do apologize for that long wait. We're trying to get this resolved, OK? We wanna make sure that your dependent is listed, OK?
[CUSTOMER][POSITIVE] Oh no, you're good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I'm back.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] So according to the file feed, it's actually supposed to be an individual policy.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh, but he has the card and I pulled the card and
[CUSTOMER][NEUTRAL] Let me check on.
[AGENT][NEUTRAL] It, it does say child.
[CUSTOMER][NEUTRAL] Yeah, now the card's gonna reflect what we have in lion.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] So the card is gonna reflect whatever the policy has been issued as so but that's not necessarily means it's correct.
[AGENT][NEGATIVE] Gotcha.
[AGENT][POSITIVE] Oh, got you, got you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me check some of the older exception report files and see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now that group billing messaging you need me to change a pay due date. OK, let's see.
[CUSTOMER][NEUTRAL] Church.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so both of the most recent file feeds are showing him as individual no dependent.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Listed.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I'm wondering if we have an exception out there waiting to be worked. I doubt it's gonna be in my folder.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And I can't see everybody else's. Um, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Let me check this policy number and see if it just happens to be in my dashboard.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] Come on, don't play with me today.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah it is in my dashboard OK.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] So, um, heard the file feed, um, it is supposed to be an individual policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I don't know if that's something that started when is their open enrollment, the first, OK, 11 I wonder.
[CUSTOMER][NEUTRAL] Oh, I think they got set up for a file feed after the first of this year because that's all I'm seeing.
[CUSTOMER][NEUTRAL] Why does this have to be so complicated? OK.
[CUSTOMER][NEGATIVE] Let me check one more thing. No, I don't wanna save anything.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm I know.
[CUSTOMER][NEUTRAL] OK, I'm checking all the way back to the first.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So yeah, I mean all the way back to January this was supposed to be an individual policy. I don't know how that dependent got put on there but I'm pretty sure that's probably his spouse.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm, yeah, it seems to be the spouse. I, I really didn't even mention her or not. I didn't mention anything. I just said, OK, let me check and see. I, uh, yeah, so I didn't say who was listed, who was not. I didn't even say if the, the clan, the clan or the baby's name or the son's name is there or not. I just said, let me check on it, so yeah.
[CUSTOMER][NEUTRAL] Um, is this the only policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I went in CUI NQ and I looked at his previous policy and she is the spouse listed on his previous policy, so he must have elected to change this policy to individual and the new policy when the new policy got issued for some reason, um, the spouse was put on there as a dependent.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, in error?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And so that person should not even be listed though based on the file so I'm going to have to change that and we're gonna have to issue actually.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Yeah, I'm gonna have to do that because uh we're gonna have to issue refunds to the group for overpayment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, do you wanna speak to him and explain to him what's, what's gonna happen?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, because this is, yeah, this is a little bit more complicated than just saying oh we fixed it, you know.
[AGENT][NEUTRAL] Yeah, I know. I'm gonna say, oh yeah, he's gonna be like, but what, what do you mean?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'll be like, wait, let me get the milk.
[CUSTOMER][NEUTRAL] Right. Yeah.
[AGENT][NEUTRAL] All right, well, I did fully verify him and the callback number is the same one in the system, um, so here he comes and have a good afternoon, Mr.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Put him in thank you.
[AGENT][POSITIVE] Thank you for holding and being patient for me Mr. [PII]. I've got Miss [PII] on the line. She is in the customer service department and she's gonna assist you from here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Hi Mr. [PII], my name is [PII]. How are you doing today? Good. Good, how are you?
[CUSTOMER][POSITIVE] I'm good thank you so much for asking. I do apologize for your wait um I was trying to look over everything um and see what was going on, um.
[CUSTOMER][NEUTRAL] I was looking at your previous policies uh due to the group having they added a second plan this year at open enrollment in January um so.
[CUSTOMER][NEUTRAL] When you signed up for your open enrollment, did you add your dependent on there? or did you just sign up for individual this time?
[CUSTOMER][NEUTRAL] He wasn't born when we did our open enrollment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me see, so.
[CUSTOMER][NEUTRAL] OK, and is your spouse still listed on your major medical?
[CUSTOMER][NEUTRAL] Uh, I have no idea what that means. OK.
[CUSTOMER][NEUTRAL] Um, so this policy is a gap policy, so basically like it covers your deductible for your major medical.
[CUSTOMER][NEUTRAL] Um, let me see, so if she is, uh, do you still have United Healthcare for your major medical?
[CUSTOMER][NEUTRAL] I have no idea what my insurances are. I only have that one insurance card that's you guys. I don't know about another insurance.
[CUSTOMER][NEUTRAL] I might have a United Healthcare.
[CUSTOMER][NEUTRAL] OK, so yeah, our Medlink policy is just the gap policy. It's not major medical insurance, so whenever you go to a doctor or something like that, you'd still have to have your major medical insurance. Um, a lot of insurance companies are no longer sending out ID cards, um, so you may have a virtual ID card that you actually have to sign into your um account to get. You may need to check with your HR person.
[CUSTOMER][NEUTRAL] Uh, regarding that, um, but yeah, so ours is not a major medical, you cannot just use it by itself, you'd have to have.
[CUSTOMER][NEUTRAL] That other medical information.
[CUSTOMER][NEUTRAL] Um, previously, since, uh, [PII], it has been a couple policy so it's been you and your spouse, um.
[CUSTOMER][NEUTRAL] So, uh, but according to our files that we received from your employer, um, you're only enrolled in individual coverage.
[CUSTOMER][NEUTRAL] I do not see your spouse listed um as coverage and so what happened in our system um you were couple coverage before and when they changed their plans at the first of this year we had to issue you a new policy.