AccountId: 011433970860
ContactId: 1443041c-231b-4b28-9725-a7026d91c378
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1269060 ms
Total Talk Time (AGENT): 612848 ms
Total Talk Time (CUSTOMER): 436892 ms
Interruptions: 9
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/1443041c-231b-4b28-9725-a7026d91c378_20250610T15:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, uh, this is [PII]. How are you doing in the care team?
[AGENT][POSITIVE] Good. Good. How are you?
[CUSTOMER][NEUTRAL] I'm good. I just, this week is going so slow, I guess cause I'm taking off next week, but, you know, yeah.
[AGENT][NEGATIVE] Yeah, anxious to be off. I get it.
[CUSTOMER][NEUTRAL] Yeah. I bought a bunch of books this week uh last weekend. I was like, oh, I can have a whole week to try to read them. But um
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Oh awesome.
[CUSTOMER][NEUTRAL] But I have Miss [PII]. She's a group admin on our, uh, this group, and she has a question in regards to, she said that she had sent a census for uh their group to the broker and there's one person that was not added on to the group and she wants to know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, how to get them added on. Mhm. Oh, sorry.
[CUSTOMER][NEUTRAL] Who
[CUSTOMER][NEUTRAL] I told her she can send an email, but she's also saying well who is um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] If it's an error on the broker's part or what, but I was just trying to tell her she can just send an email but she.
[AGENT][NEGATIVE] Gotcha, gotcha.
[CUSTOMER][NEUTRAL] She is set up on the online service.
[AGENT][NEUTRAL] She wants to know where the error happened. OK. Oh, she is set up on OSC, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's what she said uh that she was able to sign on the OSC and I also told her that she can go from on that site and add um.
[AGENT][NEUTRAL] Mhm, yeah.
[CUSTOMER][NEUTRAL] An employee, but she's still kind of apprehensive because she said it happened uh last year and she was told and also she said there was a benefit that was supposed to be added as far as the office rider and I didn't I pulled up one of the employee's policy. I didn't see it but she's saying that it was supposed to be added and she was told.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Gotcha.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Wait a month before and it may show up in there so it's like I don't know.
[AGENT][NEUTRAL] OK, what's the group number? That sounds crazy, but we'll figure it out. Uh-huh.
[CUSTOMER][NEUTRAL] 22469, right?
[CUSTOMER][NEUTRAL] 22469.
[AGENT][NEUTRAL] Let me pull that up. Give me just a 2nd. 2249, Coral Leasing Incorporated.
[CUSTOMER][NEUTRAL] It's like she's asking me a bunch of questions. I don't know the answer. Yes.
[AGENT][NEUTRAL] You know, like, OK, yeah, I'll take it. I'll see if I can figure it out. What's your callback number?
[CUSTOMER][NEUTRAL] Um, that is [PII].
[AGENT][NEUTRAL] Is it the one on the screen?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is, yes, uh, that's the number.
[AGENT][POSITIVE] OK, got it. I got it right. OK, perfect. Well, I'll see if I can figure it out. Thank you so much. Have a good day. You too.
[CUSTOMER][POSITIVE] Thank you, ma'am. You rock.
[CUSTOMER][POSITIVE] Have a great, you too. Bye.
[AGENT][NEUTRAL] Mhm. Bye.
[AGENT][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, this is [PII] on our Broker Resources team. Uh, [PII] said that there was an issue with someone that didn't get enrolled that should have. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what is the name of that participant? She forgot to give me that information sorry.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Can you do more OK just a second.
[CUSTOMER][NEUTRAL] She's listed on the census that I sent to our broker.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But when I log in she's still not listed.
[AGENT][NEUTRAL] Yeah, I don't see her on here.
[CUSTOMER][NEUTRAL] And the information that [PII] gave me about our policy does not have the new office rider that we have opted to add.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, you guys chose that, OK. Well, let me pull up the, excuse me, my allergies are bothering me today. Um, let me pull up the information that came in for the group. So give me just one second.
[AGENT][NEUTRAL] See what we have.
[CUSTOMER][POSITIVE] I mean we've been with you for 5 years I think and we haven't had any issues until this one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] This one wasn't seamless and I don't know if it's maybe because of the update to your website or something happening about the same time, OK.
[AGENT][NEGATIVE] Shouldn't be.
[AGENT][NEUTRAL] When did you guys, when did you guys send it? When was it recently?
[CUSTOMER][NEUTRAL] Uh, it would have been a possibly the end of May.
[AGENT][NEUTRAL] End of May. OK, let me just.
[CUSTOMER][NEUTRAL] Because our
[CUSTOMER][NEUTRAL] It should have um changed on [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So you send it to the broker?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is it, is that [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Let's look and see what we have received for all of this. OK, I'm going to pull up the renewal information. Give me just a second.
[AGENT][NEUTRAL] OK, so we got the renewal paperwork showing that goes on the 3000 in hospitals, 2000 outpatient, uh, new benefit. Let you click the new benefits and click the new benefit box.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] indicate, OK.
[AGENT][NEUTRAL] Um, 3018. OK, that was all fine. I'm just looking over the paperwork.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Ok, document.
[AGENT][NEUTRAL] renewal. OK, hang on. Attached renewal document for cru leasing. Please confirm I marked the right box to add the office visit writer. So we did get that information.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't see the census on here, but that doesn't mean anything. Let me go.
[AGENT][NEUTRAL] Let me go look at this other folder. take a different folder.
[AGENT][NEUTRAL] That.
[AGENT][NEUTRAL] Just the system here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me search one other spot.
[CUSTOMER][NEUTRAL] And if I need to send you information, you know, that's fine too.
[AGENT][NEUTRAL] Yeah, yeah, let me just, I just wanna make sure that we don't actually have it and somehow it didn't get attached or sent over like it should have.
[AGENT][NEUTRAL] Look at this one little area. Let me look see.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Coral leasing [PII]. I'm just like, OK, so we did get an email on [PII] from [PII].
[AGENT][NEUTRAL] And I don't see this one is attached. I sent over the paperwork.
[AGENT][NEUTRAL] Um, so it looks like maybe that didn't get attached by accident. Maybe I don't wait, let me look at one other email. There's one on [PII]. Let me look at that one real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I don't see it. Can you forward that over to us? No, sorry.
[CUSTOMER][NEUTRAL] I don't think they, yeah, uh.
[CUSTOMER][NEUTRAL] I don't think that they asked for me to send it to them until closer to June and so I wondered if that was part of the reason, uh, yeah, but let me find that in my email.
[AGENT][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, yeah, it could be.
[AGENT][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] So she was supposed to be added with the right for the writer. I'll double check on the writer cause
[AGENT][NEUTRAL] I wanna like the policies issued. Let me just look at one of these policies and make sure that that got attached because
[AGENT][NEUTRAL] I been
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Oh, let me look at this other one.
[AGENT][NEUTRAL] So you wanted that updated for everybody that was insured, correct? You're adding that to the group, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the
[AGENT][POSITIVE] real quick.
[AGENT][NEUTRAL] OK, here we go this is the one that got newly added outpatient writer.
[AGENT][NEUTRAL] Um, cancer outpatient writer independent facility.
[AGENT][NEUTRAL] We're looking for the office visit right or right? I forgot which one it was. Was it the office visit? OK, OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And maybe you can explain to me a little bit about that if you're able to.
[AGENT][NEUTRAL] Yeah, like what were you wanting to know?
[CUSTOMER][POSITIVE] Uh, so if we go to the just a regular office visit for a cold or whatever that it covers, it helps cover that, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, cause right now it's like it covers the treatment and the office visit, but not the office visit, so you have to have the rider to get that part covered.
[CUSTOMER][NEUTRAL] OK, so let's say they gave us a shot or you know or something like that. So after we get our EOBs, could we just send them, send a claim to APL and then get reimbursed?
[AGENT][NEUTRAL] The office visit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, we'll need a copy of the primary, we need a copy of the bill, obviously with all the codes and everything for what you were treated for, the procedure codes, and then a copy of the primary health insurance explanation of benefits showing how it was processed. Yes, that, that's all that we would need, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the billing from the office that shows the billing codes is also required.
[AGENT][NEUTRAL] Yeah, because we have to see the treatment and what you're treated for and all of that. So yes, and then the primary insurance, um, explanation of benefits on how they processed it that way we know, you know, what went towards home insurance and deductible and all of that thing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, mhm.
[CUSTOMER][NEUTRAL] OK and so you only reimburse for things that insurance does not pay toward the doctor's visits? I mean, you know, to whatever they did?
[AGENT][NEUTRAL] Well, the med link, well, I wish I had the office right here in front of me. I don't have it in front of me at the moment. Hang on just a second, let me make sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the pol the way that this is a gap policy is what it's referred to. So technically what it does, it reimburses for any co-pays, hospital, um, um, what am I trying to say, co-insurance that you're responsible for, copays that you're responsible for, and deductibles that you're responsible for, um, so that's why we need the explanation of benefits because it goes off of, off of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and um may I have an email address for me to send this census.
[AGENT][NEUTRAL] Yes, yes, yes, send it to, let me see which one team which needs to go to. Give me one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm just forwarding what I sent to them.
[AGENT][POSITIVE] Mhm. Yeah, that's perfect, that's perfect. Mhm.
[CUSTOMER][NEUTRAL] And I made
[CUSTOMER][NEUTRAL] I made changes to it, but I kind of highlighted it in yellow and instead added.
[AGENT][POSITIVE] Perfect. Yeah, that's perfect. That should work, yeah, and um yeah, so just send it to [PII]
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's a good call back number for you if um I need to reach you for anything I'm gonna like I said, follow up on the office visit thing just to make sure it's going to be applied as expected.
[CUSTOMER][POSITIVE] Thank you uh
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEGATIVE] And um so I noticed for myself I tried to create a new a new log in for me personally and it it would not accept me and then I log in as the admin and it says I don't have an email address listed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so let's start. OK, OK, let's start off with the group. So you're OK, for the group, you're the group contact for the for corral leasing, um, so you need to set up the group account as well, correct?
[CUSTOMER][NEGATIVE] But I'm not able to add it.
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Because you haven't done that one? You did? OK, perfect. OK, good. Well, let me, OK, let me go look at it depends on what email we have on file too that may be part of it. So let me go pull up your personal account.
[CUSTOMER][NEUTRAL] I did set up the group account.
[CUSTOMER][POSITIVE] Yes, I do have that one.
[AGENT][NEUTRAL] There you are. I can see what's out here.
[CUSTOMER][NEUTRAL] And then maybe you can tell me another maybe you can tell me this other scenario so [PII] has been an employee with us for years. She's been on this policy supposed to have been on it for years. Well, somehow on the last census back in [PII], her name never, I don't know why, but it got omitted.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And, and it's my fault for not catching it because, you know, I look at that statement every month and somehow I just didn't realize, well anyway, so she injured herself and had to go to the hospital and get X-rays done.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I get it, yeah.
[AGENT][NEUTRAL] Got you. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And then I said, hey, don't forget to file a claim with APL and she said I don't even know what you're talking about and I said, OK, let me print you a uh uh ID card and so I went to print it and it she's not even listed as a person on our policy so of course I felt really bad.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, that's weird.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, so I've called APL on that and you know someone said well the only way we would be able to cover her is if you paid all of the back premiums, which I agree that that would be how it would be done, but her total she was billed $750 that's $300 for the co-pay and $450 toward the deductible.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm not asking you guys to cover this, but I am curious, would you, would APL cover the whole bill of $750? I mean, I, without knowing the codes, I'm going to reimburse her no matter what, but I'm curious, would it pay?
[AGENT][NEUTRAL] I mean, we, we have, we have to go off of how the primary insurance pay. That's what dictates how it's paid, so we would need the EOB showing what went towards deductible and that's the only thing we would be responsible. We would never pay 100% of the bill because, yeah, the deductible co-insurance and co-pays, yeah, OK, sorry, I'm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You only pay the deductible?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So you do pay.
[AGENT][NEUTRAL] Yeah, go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] I'm trying to determine how much I should pay her. Do you like you would normally pay like a copay or just a coinsurance?
[AGENT][NEUTRAL] I don't know.
[AGENT][NEUTRAL] Well, what type of, it depends on the type of treat what treatment is it? Was it an outpatient hospital bill or like what was it?
[CUSTOMER][NEUTRAL] It was an yes an outpatient hospital bill where she.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can't tell you how much we would, yeah, I can't, I, we would not be able to tell you unless you file the claim and it would be paid like I said, it goes off of her primary insurance explanation of Jet she would have to have her give you a copy of that to see if they applied all of it to the deductible because if they did, then maybe we would, but there's usually sometimes there's a discount that they write off for their charges. So there's so many things involved for us to be able to actually be able to say, you know, that we would or we wouldn't unfortunately. I wish I could give you any a definite answer.
[CUSTOMER][NEUTRAL] Had an X-ray.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so on your personal account we don't have an email address set up for you. There's not one on your account so what email address do you wanna add and then that will let you be able to set up your account.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So my email address is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. So that's [PII]wn, Christina, no period in between that, right, all together, [PII].
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, can you hold on one second while I get that updated? I'm gonna put you on hold for just a second.
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] OK, just a second.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Well thank you for holding. The lady, I, the lady that transferred you over here I was trying to get someone on her team to update your email address, but apparently they're, I'm on a hold for a while, so let me um shoot one of them an email to have this updated, and I'll follow up with them and then I will um.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Email you if that's OK. I can email you at this address and let you know that it that you're OK to go ahead and log in. I did get the census that you sent over. I grabbed it, so I'm gonna go ahead and get that over to uh our business team so they can get [PII] um added to the group 61, and then I'm gonna also follow up with our team regarding the set up and adding that writer and making sure that that does get added. So I'll be following up with you on those two things all three things.
[CUSTOMER][NEUTRAL] Yeah, yeah, please.
[CUSTOMER][POSITIVE] Excellent and is there a way that I can update email addresses for our employees?
[AGENT][NEUTRAL] It won't let you. That's something we have to do on our side. I wish, I wish people could do that, but it's just something to do with the system we, we can do that. I mean you can add and delete employees and things like that, but anything to do with their demographics, we have to change it on the side. So yeah, maybe one of these days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right, yeah, that would be ideal.
[AGENT][NEUTRAL] All right. Was there anything else? Yeah, for sure.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Can we do wellness claims?
[AGENT][NEUTRAL] Uh, let me see, let me see, let me see, I wanna say.
[CUSTOMER][NEUTRAL] Do you know that answer?
[AGENT][NEUTRAL] Let me look if I saw that policy.
[AGENT][NEUTRAL] Oh.
[AGENT][NEGATIVE] I don't think it covers wellness, but I'm just making sure I don't wanna.
[AGENT][NEUTRAL] Scroll through here just to see what's going on.
[CUSTOMER][NEUTRAL] Or I'm wondering if it does now that we're going to have the office writer.
[AGENT][NEUTRAL] It may on the office writer let me follow up on that because that may be it and I just don't have a copy of it so I can see what's included in it, but I will just scan in the outpatient. I don't see wellness on there, but it could be in that writer. So yeah, let me follow up on that. I'll add that to that and I will get back with you on all of that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. Was there anything else?
[CUSTOMER][POSITIVE] All right, very good, I appreciate your help. No, you've done excellent.
[AGENT][POSITIVE] Yeah. All right, well, I'll talk to you soon, [PII]. Thank you for calling and letting us know what was going on. Have a great day.
[CUSTOMER][POSITIVE] All right thank you.
[CUSTOMER][POSITIVE] Yeah you too bye bye.
[AGENT][POSITIVE] Thank you. Mm bye bye.