AccountId: 011433970860
ContactId: 39d230ab-40f6-4b29-9046-f908e1c41210
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 405970 ms
Total Talk Time (AGENT): 191639 ms
Total Talk Time (CUSTOMER): 169087 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/39d230ab-40f6-4b29-9046-f908e1c41210_20250121T21:44_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Fortune Insurance. How are you?
[AGENT][POSITIVE] I'm doing wonderful. How about yourself today?
[CUSTOMER][NEUTRAL] I'm doing pretty good so I, I'm calling on behalf of one of our um group Centurian restaurant group's employees, um, she says that her um doctor's office is quoting an incorrect inpatient benefit for the one she elected with APL. I went online and I'm showing she's on the correct plan.
[CUSTOMER][NEUTRAL] Um, is there any way that you could check just to make sure your system shows that she is on the correct time because they're saying she's got a $4000 inpatient benefit and really she has a $5000 inpatient benefit.
[AGENT][POSITIVE] Yeah, I can definitely help take a look at that, ma'am. Do you have the policy number handy?
[CUSTOMER][NEUTRAL] I do. This is for [PII]. Her policy number is 2273102.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 227-3102
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and.
[AGENT][NEUTRAL] Sorry.
[AGENT][NEUTRAL] OK, I'm not showing a [PII] come up underneath that number 22703102, right? I typed in 1302.
[CUSTOMER][NEUTRAL] Yeah, yeah, 227-3102.
[AGENT][NEUTRAL] OK, perfect. [PII], and can you verify her date of birth for me, please?
[CUSTOMER][NEUTRAL] Yes, of course, it's [PII].
[AGENT][NEUTRAL] Thank you. And um just to make sure I'm understanding correctly, um you're calling on behalf of the insured are you with the employer group or with the broker's office or with the doctor's office?
[CUSTOMER][NEUTRAL] With the
[CUSTOMER][NEUTRAL] I am sorry, I'm with the broker's office fortune Insurance.
[AGENT][NEUTRAL] OK perfect so let me pull up just um that broker verification real quick if you don't mind.
[CUSTOMER][NEUTRAL] No, I don't mind.
[AGENT][POSITIVE] Perfect. And would you be able to verify for me, please, your email address?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Beautiful and then the only other thing I need is just a quick call back number in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. I really appreciate that. So I am looking at her benefits and I am seeing
[AGENT][NEUTRAL] It says $5000 but then when I look at it, it looks like it's typed in at $4000 in coverage. Um, let me pull up her policy document real fast.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She switched this year, so I don't know, I, I believe during opening, let me see, no, she has the definitely the buy up option which is the $5000 plan.
[CUSTOMER][NEUTRAL] And it looks like she's getting billed for that one.
[CUSTOMER][NEGATIVE] Oh, no.
[CUSTOMER][NEUTRAL] You know what?
[CUSTOMER][NEUTRAL] I see something weird here. I pulled the membership report from APL.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the APL report shows inpatient benefit, the correct one of $5000 but her premium is the premium for the $4000 but she clearly elected the $5000 plan during open enrollment.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, let's
[CUSTOMER][NEUTRAL] I don't know if that has anything to do with the problem we're having here.
[AGENT][NEUTRAL] Probably it.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm looking to see if there was like any calls that came in that said like hey we need to drop down but I'm not showing any notes saying that that was requested.
[CUSTOMER][NEUTRAL] Oh, no, this group is set up on that, the group is set up on EDI feeds.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Um, this one's funky. What I'm gonna do, if you don't mind, [PII], is I'm going to, um, put in an escalation request to have somebody look into this and, um, and give you a call back typically within 24 hours. Is that OK?
[CUSTOMER][POSITIVE] Yes, that's OK. That's perfect.
[AGENT][NEUTRAL] And while I'm getting that request filled out um.
[AGENT][NEUTRAL] Will you read me your callback number one more time? I wanna make sure I have it correct.
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Yeah, I think there's definitely a problem here because I'm showing some employees um that have the correct deduction or or premium based on the $5000 and I'm seeing a few uh and this is the enrollment, the group detail report that you download from the APO website.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So there's definitely something funky going on here.
[AGENT][NEUTRAL] So it looks like it's happening for more than one employee then too.
[CUSTOMER][NEUTRAL] Yup. Mhm.
[AGENT][NEUTRAL] OK perfect um yeah I'm absolutely going to escalate this. I'm gonna have somebody take a look at it. I'll make sure they know that it's from that group detail report from the APL site so they know exactly what we're looking at that they're elected the $5000 but their premium benefits are showing for the $4000 and you said your last name was [PII], is that correct, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, perfect. I am going to have somebody take a look into that, figure out what exactly went wrong, how we can fix it, and give you a call back at the [PII] and.
[CUSTOMER][POSITIVE] All right, awesome.
[AGENT][POSITIVE] I really appreciate you bringing that to our attention so we can get it looked out for you.
[CUSTOMER][NEUTRAL] Yep, yup, of course. I'm sorry, one more time, do you mind giving me your name?
[AGENT][NEUTRAL] Oh, absolutely. It's [PII], and then the first initial is [PII] for my last name.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Alright, awesome thanks I appreciate you researching this because yeah, there is definitely an issue from what I could see.
[AGENT][POSITIVE] Yes, OK, we're gonna take, I'm, I'm gonna take a look at that and I'll let them I'll flag it as urgent so we can get that moved on for you, OK?
[CUSTOMER][POSITIVE] Awesome. Alrighty, thank you so much. Have a great rest of your day.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Oh, it's my pleasure thank you as well.
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] Bye bye.