AccountId: 011433970860
ContactId: 30c7ffda-1199-452a-82e9-cb9c81191a84
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1443930 ms
Total Talk Time (AGENT): 635849 ms
Total Talk Time (CUSTOMER): 585065 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/30c7ffda-1199-452a-82e9-cb9c81191a84_20250116T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] over in customer care. How are you doing today?
[AGENT][POSITIVE] Doing good. How are you?
[CUSTOMER][POSITIVE] Good. Um, I, I have an insured on the line that needs some help. Hopefully you could help her out. Can I give you the policy number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, her policy number is gonna be 021-71067.
[AGENT][NEUTRAL] OK, give me just a second while I pull it up.
[CUSTOMER][NEUTRAL] And it
[CUSTOMER][POSITIVE] No worries, it should come up for a Tresa [PII].
[AGENT][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] OK, so when she originally came on the line she asked to speak to [PII] in customer service and I reached out to [PII]. She said she's on the phone, hopefully somebody else in customer service could help. Um, what she explained to me that is that she's saying that she has the wrong plan, that she's supposed to have the high plan and that she spoke to web TPA yesterday.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that web TPA is saying that they need something from APL confirming the plan type I guess um she says that she recently had a claim processed for like a hospital stay and the plan paid like $100 but she was supposed to have the higher plan which was 3 or she said $800 a day or something.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's kind of the information I've gotten.
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] Uh, OK, this is gonna be a hard one. I'm not quite familiar with these type of policies, but I guess, OK, she elected this plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] She said
[CUSTOMER][NEUTRAL] Yeah, and she said, yeah, she said she, I guess I've been talking to [PII] yesterday, but.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, OK. So they are requesting us to send something with the plan that she currently has.
[AGENT][NEUTRAL] Um, OK, give me just a second. I'm gonna see if we have any correspondence from her application.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I think we do have something from her.
[AGENT][NEUTRAL] Actually yesterday.
[AGENT][NEUTRAL] Uh, no facts.
[AGENT][NEUTRAL] Um, insurance.
[AGENT][NEUTRAL] OK, it was the claim.
[AGENT][POSITIVE] OK, you can go ahead and um send her over. I will take care of it.
[CUSTOMER][POSITIVE] All right, thank you so much for your help. I appreciate you.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Here she comes.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Good morning, Ms. [PII].
[CUSTOMER][POSITIVE] Good morning.
[AGENT][NEUTRAL] Hello this is [PII] in customer service. Um, I apologize that Ms. [PII] is not available currently, um, but from the information I was provided, um, just want to make sure I have everything correct. Um, you are meant to be in the highest planned with your.
[AGENT][POSITIVE] Policy, that is correct.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you already discussed with Ms. [PII] about um that you were supposed to be enrolled with this high plan.
[AGENT][NEUTRAL] Um, have you already talked with um your pro, um,
[AGENT][NEUTRAL] Let's see, is it YouTube, yes, with them about it?
[CUSTOMER][NEUTRAL] We web CTA it's
[CUSTOMER][NEUTRAL] Yeah, I talked to UTBA and he verified, I spoke with [PII] and [PII]. They verified that I'm in the high plan and then they also spoke with
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] At um APL and she verified it also so when I call with TPA back and I told him I said when I was in the hospital in [PII], y'all paid $100 a day for the hospital indemnity and it was supposed to be $800 a day.
[CUSTOMER][NEUTRAL] And they're saying that they have me on the low plan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But even if I was on a low plan, you still, the low plan is $300 a day, but they claim they have me on a low plan, so they say I need to get something, APL I need to send something to Web TPA so they can adjust that claim from [PII].
[AGENT][NEUTRAL] OK, so that will be a claim adjustment. Um, the money sent out from us was less than it should have been. All right, I got it. Because, yes, indeed I see that your plan here is marked as the highest, um, our base plan. I will have to get a couple of minutes to look into what is your benefit amount, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not quite seeing much here.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, I do see the high plan here.
[AGENT][NEUTRAL] Um, I have the benefit amount. It is correct. All right. Um, let me
[AGENT][NEUTRAL] If you don't mind, I'm gonna go ahead and if you're OK with it, I'm gonna place you on a brief hold. I will reach out to someone into claims because this must have been somewhere where the claims department um got somewhere and that's why they issued the certain amount of money that you received. um I'm just gonna check with them really quick. Um, are you OK if I place you on a brief hold?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, I'm, I'm off work for the next month. I'm good. I can hold.
[AGENT][POSITIVE] All right. Uh, I'm gonna try to um be as as I can. All right, I will be back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] It did say in.
[AGENT][NEUTRAL] You'll be careful.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[AGENT][NEUTRAL] Good morning [PII]. This is [PII] in customer service. I have an insured on the line, Ms. [PII] with policy number 21.
[AGENT][NEUTRAL] 71.
[AGENT][NEUTRAL] 067.
[CUSTOMER][POSITIVE] Perfect. And let me get that pulled up real quick, Miss [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. And um what are, what is [PII]? What do you need today?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so we have her on the high plan. I'm not sure if I'm with the correct department or not. Um, she's on the highest plan, but her, uh, her claim was paid with the lowest plan apparently she only received like 100 and something dollars.
[AGENT][NEUTRAL] Um, and she was supposed to receive 800. I'm not sure if the claim was paid incorrectly or that's what, um, she got paid based on whatever the procedure she had, um.
[CUSTOMER][NEUTRAL] OK, yeah, so it looks like um.
[AGENT][NEUTRAL] Can you look into it, please?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, unfortunately, the care team doesn't do the hospital indemnity, but you might reach out to the hospital indemnity queue.
[CUSTOMER][NEUTRAL] Um, I'm so sorry. I like to look at the claim, but I don't process them, so like I would hate to like try to just struggle through it when there might be somebody who can better help you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No, you're good.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] All right, no, sounds perfect. Thank you.
[CUSTOMER][POSITIVE] My pleasure. Best of luck, Miss [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][POSITIVE] Good morning, [PII]. This is [PII] in customer service.
[CUSTOMER][POSITIVE] Good morning.
[AGENT][NEUTRAL] Uh, I have Ms. [PII], uh, policy 21.
[AGENT][NEUTRAL] 71067.
[CUSTOMER][NEUTRAL] That was 21.
[AGENT][NEUTRAL] 71
[CUSTOMER][NEUTRAL] 71067
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] All right, she's reaching out to us because um she was recently paid a claim um apparently with the lowest uh plan, but I see here in our sys that she has the highest plan. um I think she only received like $100.
[CUSTOMER][NEUTRAL] We don't handle these claims. This is, this is, um, web TPA.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so that will go direct.
[CUSTOMER][NEGATIVE] Should have to be transferred to web TPA.
[AGENT][NEUTRAL] Well, she already did, and they, and they sent her to us so that we correct that claim paid to her.
[AGENT][NEUTRAL] Uh, so I'm not sure.
[CUSTOMER][NEUTRAL] Yeah, any claims processed by web TPA will be handled by them. We don't process their claims.
[CUSTOMER][NEUTRAL] We don't have access to the claims system for web TPA claims. I can't see any of that on my end. What comes up on my end is a, a, a warning sign that um claims are handled by web TPA.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did she, what type of claim did she say the only thing that I see, she, her her hospital indemn me is through Web CPA. She has a disability, a group term life policy, and a dental policy.
[AGENT][NEUTRAL] Um, the one, I have here, it's only the, uh, where would it be the accident, no.
[CUSTOMER][NEUTRAL] She gave you a claim number?
[AGENT][NEUTRAL] Well, we were first revi um reviewing her plan because she was paid as lowest plan, so she thought she was enrolled with the lowest with us. Um, but looking into her policy, I see that she has the highest. So that's when I, um, we kind of deduct that it was a claim that went wrong there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, it sounds like that must be under her, her um hospital indemnity, but those claims are processed through web TPA so we can't see those that claim information on our end.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We tra we transfer them to web TPA.
[AGENT][POSITIVE] All right, I got it.
[CUSTOMER][NEUTRAL] Do you want me to give her the, do you wanna give her the number? Because when you give it to me, I'm just gonna transfer over to web TPA.
[AGENT][NEUTRAL] Yes, um, can you provide it to me, please?
[CUSTOMER][NEUTRAL] Yeah, the number is 18669759458.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, just make sure
[AGENT][NEUTRAL] 86.
[CUSTOMER][NEGATIVE] You keep cutting out.
[AGENT][NEUTRAL] OK, can you hear me?
[CUSTOMER][NEUTRAL] Yeah I can hear you now.
[AGENT][NEUTRAL] OK, 866.
[AGENT][NEUTRAL] 9759458.
[CUSTOMER][NEUTRAL] 975.
[CUSTOMER][NEUTRAL] 9458, yes, yeah, we transfer them to one of their representatives over there and they handle it.
[AGENT][POSITIVE] All right, I got it.
[AGENT][POSITIVE] All right, I got it. Thank you.
[CUSTOMER][POSITIVE] OK. You're welcome.
[AGENT][NEUTRAL] Thank you for holding, Ms. [PII]. Um, I'm so sorry for the wait. So, um, from I got from our end, um, as we kind of deducted already, this was probably an error within the claim, um, because again, you are enrolling to the highest plan.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Um, unfortunately, APL doesn't process. I was told that APL doesn't process the claims for web TPA. Uh, I was provided with the phone number that we can reach out. I can go ahead and reach out to them, um, let them know the issue and transfer you to them. Does that sound good to you?
[CUSTOMER][NEGATIVE] Yeah, but all they gonna do is transfer me back to y'all cause that's what they do all day.
[AGENT][POSITIVE] Oh my goodness, I'm so sorry about this, but I mean,
[AGENT][NEUTRAL] Uh, I'm not sure what else to do. Yes, they are the ones who process the claims, so, um, there's nothing we can do about, about the rest because we, we already have you into that highest plan. Um, would you like me to at least try it and see what we can get?
[CUSTOMER][NEUTRAL] I know, they process the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Alright, I'm gonna go and place you on a brief hold.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the limited benefit health insurance program underwritten by American Public Life Insurance Company. If this is an emergency, please hang up and dial [PII].
[CUSTOMER][NEUTRAL] If you are a member calling about your premium billing or need to make changes to your account such as an address change, add or drop a dependent, or wish to modify your coverage in any way, please call American Public Life at [PII]. If you are a physician or hospital calling to verify medical eligibility, please press [PII]. For information and phone numbers for the Beach Street PPO network, please press [PII].
[CUSTOMER][NEUTRAL] For questions concerning pharmacy services, you may contact Caremark at [PII]. To speak to a customer service representative regarding any other issues, please press [PII] now or simply stay on the line and someone will assist you. Thank you.
[CUSTOMER][NEUTRAL] Please note your call may be monitored or recorded for quality assurance. The information provided during this call is only a description of benefits and is not a guarantee of payment. Benefits are based upon eligibility at the time services are rendered and all plan provisions.
[CUSTOMER][POSITIVE] Thank you for calling customer service. My name is [PII]. How may we assist you today?
[AGENT][NEUTRAL] Good morning Miss [PII]. This is [PII] in customer service from APL.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I have an.
[CUSTOMER][NEUTRAL] Do you have a, do you have an ID number [PII]?
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Uh, no, I have an insured on the line actually, um, Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With policy number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 21
[CUSTOMER][NEUTRAL] Alright, go ahead.
[AGENT][NEUTRAL] Mhm. 2171067.
[CUSTOMER][NEUTRAL] OK. Uh, [PII], birthday [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, let me see really quick.
[CUSTOMER][NEUTRAL] You know that name looks familiar. Let me look something up, OK?
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I talked to her yesterday. I know it looked familiar. I sent her to APL because we have the wrong eligibility, and I've transferred her late yesterday. Uh, she says she has the high plan, but our eligibility that we got from APL says she has 11 I'm sorry [PII] birthday, right? So, uh, we have the wrong eligibility and we're waiting for that to be sent to us. Did she not tell you about that?
[AGENT][NEUTRAL] Oh right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I see, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you show that she has a high or low plan?
[AGENT][POSITIVE] She has a high plan.
[CUSTOMER][NEUTRAL] Is there a way that uh can I go ahead and get your uh area code and phone number please?
[AGENT][NEUTRAL] Um, yes, give me just a second.
[AGENT][NEUTRAL] That will be um one.
[AGENT][NEUTRAL] 601
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 519.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0174, that will go directly to me.
[CUSTOMER][NEUTRAL] OK, I don't think, uh, uh, APL has a tax ID, do you?
[AGENT][NEUTRAL] Uh, we don't.
[CUSTOMER][NEUTRAL] Yeah, OK, I didn't think so. OK, so, uh, what we're gonna wait for is for 88 American Public Life to send us a copy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of the eligibility update so we can correct that and show right now uh she has the low plan but she tells me she has high and so do you but we need a report so we can correct it from American public law so we can go out there and correct a claim that processed with the wrong benefits that's what's going on, OK? But right now we can't do anything until we get the eligibility showing the high plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because we show the low plan, OK?
[AGENT][NEUTRAL] Showing
[AGENT][NEUTRAL] Oh is it?
[CUSTOMER][NEUTRAL] And it should be the high plan, right?
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] OK, I got it. Just a small recap, um, we have to send a copy of her eligibility showing her high plan so the so the claim can be corrected.
[CUSTOMER][POSITIVE] You got it, and she really acts like that's really important, and I don't blame her.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes. All right, I'm gonna go um get back to her and
[CUSTOMER][NEUTRAL] Tell her that once that that eligibility hits it at web TPA uh and whoever you give that to just remind them there's a hospital claim that needs to be adjusted when that's updated so they could do maybe a priority on that, OK?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It needs to be adjusted. All right, is there any email that this has to be sent to, um, that I can write down?
[CUSTOMER][NEUTRAL] I was hoping they could. I was hoping they could send it to someone at the top and get that sent by email that's what I'm hoping for.
[AGENT][NEUTRAL] OK. Is there any email address that you have that I can take?
[CUSTOMER][NEUTRAL] I don't have it, but somebody there at APL like [PII] or someone that works with the higher up, they'll have it, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'm gonna try to get with Ms. [PII]. All right. Thank you very much, Miss [PII].
[CUSTOMER][NEUTRAL] Oh, you're welcome. I don't think I've ever talked to you before.
[AGENT][NEUTRAL] Yeah, I'm in the customer service I guess you talked a little bit more with um the people in the care team that handles the claims and all the benefits.
[CUSTOMER][NEUTRAL] Yeah, I think I do. I think that's what happens, yeah, [PII] and who else? Oh yeah, [PII]. Oh my goodness. See, I've been on American Public, yeah, well, I've been talking to [PII] ever since I've been with the company, which is 20 years, OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Ms. [PII]?
[AGENT][POSITIVE] Oh, nice. All right, Ms. [PII], I'm gonna go ahead and um get back with the customer. Thank you very much. I appreciate your help.
[CUSTOMER][POSITIVE] Yeah thank you tell her, you know, you know, I know that she's in good hands, [PII], and y'all always take care of everything and we appreciate you, OK?
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yeah, you're welcome you take care now.
[AGENT][NEUTRAL] You too, bye bye.
[CUSTOMER][NEUTRAL] Mm
[AGENT][POSITIVE] All right, Ms. [PII], I got the solution.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you still here? OK. All right, so what I'm gonna do right now is gonna go ahead and reach out back to um our department. Um, I'm sure they are a lot familiar with it's going on. Um, they will be reaching out to WebTPA and sending um the confirmation that you are indeed with the high plan um and from there, um, with TPA will go ahead and adjust your claim, um.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I will try to mark this as an urgent request. Um, they should be sending um any confirmation about the changes uh to you uh let me look at it really quick.
[AGENT][NEUTRAL] Oh, let's see
[CUSTOMER][NEUTRAL] I'm so glad you did it because they was gonna send me in all kinds of circles. It's, it's like they don't wanna answer the question or they don't know the answer. They'll just tell me to call APL or they give me the APL number 20 times a day. It's been going on since last week.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Oh my goodness.
[AGENT][POSITIVE] Well, I'm glad that I I've been having help here. Uh, let's see. OK, your email, um,
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] I love big trucks.
[AGENT][NEUTRAL] OK, I got it at [PII]. Um, I will go ahead, I will have an eye on this um issue and I will be checking on how it goes. Um, what about a call back tomorrow?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] What that work?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, so should I call back or you gonna call me back?
[AGENT][NEUTRAL] Um, let's see, I can call you back.
[AGENT][NEUTRAL] If you would like me to do so.
[CUSTOMER][NEUTRAL] Yeah, cause I wouldn't know who to ask for. Yes, please.
[AGENT][NEUTRAL] Yes, alright. OK, let me look at callback number [PII].
[CUSTOMER][NEUTRAL] Mhm, yes ma'am.
[AGENT][NEUTRAL] All right, Ms. [PII], I will go ahead and work in that request for you and mark it as urgent, and I'll be calling back you tomorrow afternoon if that works.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All right. You're welcome and I hope you have a nice day.
[CUSTOMER][NEUTRAL] OK, you too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye bye.