AccountId: 011433970860
ContactId: 29c294f9-478e-4d14-adda-86b1a63e397c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 623500 ms
Total Talk Time (AGENT): 328494 ms
Total Talk Time (CUSTOMER): 93861 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/29c294f9-478e-4d14-adda-86b1a63e397c_20250221T22:25_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII] in customer service. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], how you doing?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm great, thanks for asking memory, could you look at a policy with me to verify the effective date?
[AGENT][NEUTRAL] Yeah, of course. What's the policy number?
[CUSTOMER][NEUTRAL] It is 228-1863.
[AGENT][NEUTRAL] Alright, give me just a second.
[AGENT][NEUTRAL] OK, for [PII].
[CUSTOMER][NEUTRAL] That's, that's who I'm calling about, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When was, I was trying to verify the effective date correct cause I see that the mother and father's date of effective date was.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then the children were held is [PII].
[AGENT][NEUTRAL] OK, let me take a look. Um, what it could have been is that they initially enrolled as couple coverage and then decided to add their children, uh, during open enrollment. Let me take a.
[CUSTOMER][NEUTRAL] But then I have claims on file for [PII].
[CUSTOMER][NEUTRAL] For data of service.
[CUSTOMER][NEUTRAL] [PII] and it was requesting diagnosis codes.
[CUSTOMER][NEGATIVE] But the one, but the date of service that I'm processing is not allowing me to process it saying that it occurred prior to the effective date.
[AGENT][NEUTRAL] Mhm. Let me see, hold on.
[AGENT][NEUTRAL] Change effective date, change to [PII]. Change date has to coincide with effective date.
[AGENT][NEUTRAL] She's already on the coverage was wondering.
[AGENT][NEUTRAL] Perpended report on pended. OK, so.
[AGENT][NEUTRAL] How was it changed? Is this group on file feed like?
[AGENT][NEUTRAL] Let me do some research.
[CUSTOMER][POSITIVE] Yeah thank you bye.
[AGENT][NEUTRAL] OK, no, they're not on the file feed.
[AGENT][NEUTRAL] So we would have had to have gotten a request, OK. Let me check the.
[AGENT][NEUTRAL] Home base in the policy and see if we have anything in there from a broker or something like that requesting that they be added because all I see is the note in there.
[AGENT][NEUTRAL] That they were added.
[AGENT][NEUTRAL] And then [PII] changed the added date and of course there's nothing in on base.
[AGENT][NEUTRAL] What happened?
[AGENT][NEUTRAL] OK, 228-1863. OK, let me check the hub and see if there's a previous request that was completed.
[AGENT][NEUTRAL] OK, let's see. There are some requests in here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see what they say.
[AGENT][NEUTRAL] OK, looks like we got a request from [PII] to add [PII].
[AGENT][NEUTRAL] To the policy, the note stated on [PII], unable to add dependent policy coverage is employee and spouse only, unable to make policy coverage or premium changes without agent or group backup information. They were not newborns, so they couldn't be added to the policy unless there was a qualifying life event or.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Unless it was during open enrollment.
[AGENT][NEUTRAL] So, let me see the next request.
[AGENT][NEUTRAL] Also from [PII].
[AGENT][NEUTRAL] Alright, can you please add the patient [PII]. Alright, [PII] we'll work on POBFT correction benefit termination dates are incorrect.
[AGENT][NEUTRAL] Uh, benefit is currently listed as family dependent family benefit, but only for [PII] to [PII] period, unable to activate the dependent policy coverage is couple.
[AGENT][NEUTRAL] OK, where are we getting this information? The group is not on a file feed, so there's no application.
[AGENT][NEGATIVE] This makes no sense.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] Yeah, I'm, I'm totally confused.
[AGENT][NEUTRAL] Do you have a collar?
[CUSTOMER][NEGATIVE] Mm mm, I'm processing the claim, but when I was in the middle of processing it's telling me to deny the claim because it wasn't active for that date of service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] I it start to effective date.
[AGENT][NEUTRAL] Let me see if this.
[CUSTOMER][NEUTRAL] But then when I checked history, they have days of service in here for
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and those are requesting diagnosis codes.
[CUSTOMER][NEUTRAL] Well, I don't, I have no idea.
[AGENT][NEUTRAL] OK, so they've had previous policies before, but all the previous policies have been cocal coverage.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And did not include, let me check Pine Am.
[AGENT][NEUTRAL] Yeah, all the policies previously have not included the children. It's only been couple coverage.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I'm asking [PII] now.
[AGENT][NEUTRAL] Yeah, I'm only showing couple. I don't know why they were added for that one month.
[AGENT][NEUTRAL] Because there's
[AGENT][NEUTRAL] Nothing in um in the hub from.
[AGENT][NEUTRAL] The group or from the agent [PII].
[AGENT][NEUTRAL] To add them.
[AGENT][NEGATIVE] And there's no application in on base.
[AGENT][NEUTRAL] Showing that there was a change to the policy in this group.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] It's not on a file feed, so we would have had to have gotten the request for a change from like per email or a fax.
[AGENT][NEUTRAL] And in which that would have been imaged.
[AGENT][NEUTRAL] In on base.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm just a little confused, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] This is [PII]'s state because this is [PII]. She's the one who added them with the second hub request, so but I think she's already gone for the day. Um, do you mind if I do some research on this Monday morning and call you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Of course, you can. I can paint it.
[AGENT][NEUTRAL] OK, good. What was your name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is it [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I thought so, but I don't know that just popped in my head when I heard your first name. OK. So I will, like I said, I'm gonna get with [PII] first thing Monday and try to figure out why they were added.
[AGENT][NEUTRAL] To begin with, because
[AGENT][NEUTRAL] They're not newborns, so they shouldn't have been added without a request from the agent or the group to add them. And their open enrollment period is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of, you know, [PII] of every year, so.
[AGENT][NEUTRAL] They shouldn't have been added in December without a qualifying life event or, I mean, that's basically the only way they could be added in December unless they're a newborn and neither one of these are newborns.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, I'm just a little confused.
[CUSTOMER][POSITIVE] Well, thank you.
[AGENT][POSITIVE] No problem, [PII]. I will, uh, I will get with [PII] first thing Monday and I'll give you a call.
[CUSTOMER][POSITIVE] Alright, thank you and have a good weekend.
[AGENT][POSITIVE] You're welcome. You too.
[CUSTOMER][POSITIVE] Thanks bye.
[AGENT][NEUTRAL] Mhm bye.