AccountId: 011433970860
ContactId: 4ee1b487-3b6b-4da9-ac36-cd470873d10a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1486819 ms
Total Talk Time (AGENT): 660448 ms
Total Talk Time (CUSTOMER): 535879 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/4ee1b487-3b6b-4da9-ac36-cd470873d10a_20250415T13:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. It's [PII]. How are you?
[AGENT][POSITIVE] Hey, I'm good. How are you?
[CUSTOMER][NEUTRAL] I'm good. It's still weird calling the care team. Um, I mean y'all calling me. Um, so, but I have an insured, um, that's wanted to check on some claims.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] No, go ahead. I'm not used to this either.
[CUSTOMER][NEUTRAL] Uh, her name, her name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And her policy is 260.
[CUSTOMER][NEUTRAL] 7142.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She is fully verified. I updated her email address and the phone number she gave me as a callback number is the same that's in the system.
[CUSTOMER][NEUTRAL] And she said that she's been noticing like some of our clients have been open and closed, open and closed, open and closed, and so she's just wondering what's going on.
[AGENT][NEUTRAL] And she
[AGENT][NEUTRAL] She must be talking about from her primary. OK, you can send it through. We've only processed one claim for her and it's for her husband, and we just finished it yesterday, but I can, um, I can, yeah, she must be talking about primary, but I can help her.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I think there was some issue with her husband not showing up on this policy for some reason, um, because she said that it was denied first or whatever because they said he didn't have coverage. I don't know, but I'm showing that he's been on here, so you're right, she might be thinking about major medical, but yeah, um, but anyway, thank you so much. Here she comes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][POSITIVE] You're welcome. OK.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.
[AGENT][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm on the customer care team. How are you?
[CUSTOMER][NEUTRAL] OK, how are you?
[AGENT][POSITIVE] I'm doing good. Um, so memory was saying that you needed some help with claims for Mr. [PII]?
[CUSTOMER][NEGATIVE] Yeah, I, I had submitted some and were declined and closed and then I called and was told claims was gonna call me back and they never did and then another one was open and then closed and like I didn't open or close them but they were being opened and closed and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, so let me look at your previous policies because this active one just has the one that we finished yesterday for Mr. [PII], but let me look and see if maybe it was some, is it, are these older claims?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No, like, uh, uh, your side has been opening claims on my account, so I don't know what's going on. Like there's claims I did not open today. A new one was opened and it says in progress, and then there's one pending that was opened on [PII].
[AGENT][NEUTRAL] OK, let me go to the old policy.
[AGENT][NEUTRAL] OK, here goes 4:10. OK.
[AGENT][NEUTRAL] So let me see.
[AGENT][NEUTRAL] So you're saying that you didn't file these claims?
[CUSTOMER][NEUTRAL] Yeah, I didn't
[CUSTOMER][NEGATIVE] No, so I had an issue with one claim where I was being told that [PII] was not on the account, which I said, well, things have paid out this year, um, and it shows when I log in that we're both on the account um and then so I was told that claims was gonna call me back because it kept getting denied and then it said something about.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You were waiting for more information from my employer.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then.
[AGENT][NEUTRAL] Uh-huh, I see that.
[CUSTOMER][NEUTRAL] Then they were closed and then there were a bunch open I guess to like make up for the one that was closed. I don't really know how your sys like your system is weird.
[CUSTOMER][NEUTRAL] So I don't know what is happening with my claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so here we go, reactivated.
[CUSTOMER][NEUTRAL] And there's no
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][POSITIVE] What's that? I'm sorry.
[AGENT][NEUTRAL] I'm just looking through the notes so I can try to get caught up, but I do see at the end of March where they reactivated Mr. [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Because he wasn't, they didn't reactivate him when the policy was reinstated. OK, so that's taken care of.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] They definitely did because I got paid out on claims that I submitted this year before March so.
[CUSTOMER][NEGATIVE] I, I, that's why I'm like beside myself. I don't understand what is happening.
[CUSTOMER][NEUTRAL] I have claims that were paid out in [PII] before March on him, so it's.
[CUSTOMER][NEUTRAL] Like, like for blood work. So it's weird that all of a sudden I was told he no longer was covered.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this happened to me last year too, all of a sudden he was off the account.
[CUSTOMER][NEUTRAL] After I'd already filed claims so.
[CUSTOMER][NEUTRAL] It seems like a yearly thing.
[AGENT][NEUTRAL] No, something is not right. Um, do you mind if I place you on just a brief hold? I'm just going through the notes.
[CUSTOMER][POSITIVE] Sure, thanks.
[AGENT][NEUTRAL] OK, hold on one moment. You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, I gotta concentrate.
[AGENT][NEUTRAL] Insured call regarding clients saying the husband should be active submitted. We
[AGENT][NEUTRAL] Anyway.
[AGENT][POSITIVE] Correct the coverage to couple coverage.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So this is back in [PII], which she said it happened last year too. OK, so let's just get to the claim status for 10.
[AGENT][NEUTRAL] Clay da da da da.
[AGENT][NEUTRAL] Is that the
[AGENT][NEUTRAL] This is research. Is that the 410 claim?
[AGENT][NEUTRAL] Is it for the insured?
[AGENT][NEUTRAL] 6146. OK, let's reprocess and pay under claim. What? OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Please note required claim pending as deal is outside of policy grace period.
[AGENT][NEUTRAL] It's just about how to inform of saying what?
[AGENT][NEUTRAL] Call back to insure as instructed by hub to inform of the oh, they put the hub to call.
[AGENT][NEUTRAL] OK, so this one is the one and it's waiting for eligibility. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Miss Miss [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. So I apologize for that wait. I, I hope I'm all caught up. So the claim for um that was received on [PII], that's the one that is pending the eligibility from your employer, and that's just, um, that's any of our um benefit with a in a card um policies because they just have to let us know if you were eligible for services at that time, so.
[AGENT][NEUTRAL] they, they do it all the time. They're aware of that process, but once we receive it, we'll go ahead and continue processing the one for [PII], and then there is one currently on your active um.
[CUSTOMER][NEUTRAL] Wait, wait, wait, wait, wait, wait, wait.
[CUSTOMER][NEUTRAL] You're trying to find out so I have an account in here but you're trying to find out if I'm eligible.
[AGENT][NEUTRAL] It's not just you, it's not just you, it's every account that has this, that's benefits in the card and the reason is sometimes when you, it's a benefits in a card to us is like a um
[CUSTOMER][NEGATIVE] And that doesn't make any.
[AGENT][NEUTRAL] How can I explain? It's like a
[AGENT][NEUTRAL] Their benefits can change. So we have to make sure that you were eligible at that time for services. Why that happens, I'm not sure that's just how the contract is, and we just have to do it for each account that's under them. So they're aware of the process, they've been we've been doing it for years. They just let us know, hey, she's good, and then we continue processing. But let me make sure that's
[AGENT][NEUTRAL] Hold on one second.
[CUSTOMER][NEGATIVE] Yeah, like you know who that was sent to? because I already reached out to my HR and they're like I don't understand what is going on and I've never experienced this before and like I said, I don't even think I opened that claim my claim I opened in February and a bunch of stuff kept getting closed and then like the first time I let me see, I submitted this 325.
[CUSTOMER][NEGATIVE] And it was declined and then I open it looks like another.
[AGENT][NEUTRAL] Right, so that it's the same thing.
[AGENT][NEUTRAL] So, the original claim was received back in March.
[AGENT][NEUTRAL] But whatever was going on with the um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Adding and deleted. I don't, whatever was happening with your husband with the adding him back and and um putting him on the account, that, that claim from March was denied and then this claim here in April is open, it's the same claim.
[CUSTOMER][NEGATIVE] And I have 2 more claims that I don't know where they came from or what they are for on my account.
[AGENT][NEUTRAL] OK, what, um,
[CUSTOMER][NEUTRAL] I have, I have
[CUSTOMER][NEUTRAL] Open claims right now.
[AGENT][NEUTRAL] OK, do you have
[CUSTOMER][NEGATIVE] And he was never off the account. He's been on the account since the beginning, so I don't know why there's any issue with him being on and then taken off and then put back on. Like I don't.
[CUSTOMER][NEUTRAL] And again, like I said, this happens every year. He's been on the account. He was never I log in, he's there.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEGATIVE] Like, I don't understand.
[AGENT][NEGATIVE] Unfortunately, the, the representative that transferred you to me memory, that's the department that handles the
[AGENT][NEUTRAL] Adding and deleting and all of that. So I hope that she helped you with that part. I'm here to help you with the claims. I, I don't want to send you back to her, but if you're looking for an answer to why he was added or deleted, I can't answer that, but I can get you to the department who can, but I can help you with the claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I just don't want to give you the wrong information because I, I don't know, I just don't know, but she, we can get you back to customer service if you need a direct answer for that because I don't understand that part either.
[CUSTOMER][NEUTRAL] But it'll do the claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No, I don't, but it's clearly, it's just, it, it's just clearly impacting the claims as well. So that's why it's like I, I'm just like why is this keep happening? But OK, so yeah, right now I'm showing that there are 3 open claims one pending and 2 in progress on my account. I did not submit any of them. I submitted the older one that was closed and I get it. One was reopened, but like I said, there's 3 open claims on my account.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So what open claims, um, what do you see like claim numbers, like what do you see on your side? because then I can pull it up on my side.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have two in progress. I can give you the claim numbers. One is 358-897-4.
[CUSTOMER][NEUTRAL] And then the other one is 358-896-0.
[CUSTOMER][NEUTRAL] Those are the two that are in progress and then I have one that's pending.
[AGENT][NEUTRAL] OK, so let me see, um, let me do it this way.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, this is a different policy 2607142, and then what policy, hold on one moment, I'm just getting everything together, 960.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] And it looks like just from what I see, it looks like that when you filed the claims, it's, it's, I don't know how it's all connected with the back and forth with whatever they were doing with the account, putting him on and off. It's like you filed the claim and then he wasn't on or at the time, he wasn't on there, so they denied that one and then opened other ones.
[CUSTOMER][NEUTRAL] But then I, but what I so when you submit a claim, you have to pick which person it's for.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] And he shows up every time and it asks you, it asks you which policy as well, so I have to pick him and the policy so if he's showing up on the account and then I'm being told he's not on the account, that doesn't make any sense.
[AGENT][NEUTRAL] So, because you see his name and the account on the online service center doesn't mean that the, the policy is on our end is active. Like you can be and I'm just explaining, it doesn't make sense, the back and forth. I'm just letting you know for this part.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] You may see his name and the policy numbers on the online, you will see it at all times because at one point he was on there. You know, he's supposed to be on there the whole time, but, so you'll see it, but that doesn't mean that on the actual policy, he's active at that time, which we know is an error. I'm just explaining what you see.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] So this one, OK, so the one ending in, so the 358-8974, that's the one that just finished processing yesterday. Um, it's a total of $2,194.24 and it looks, was that direct deposited? Hold on.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah, that's, um, well, it just finished yesterday, but you all do have direct deposit.
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] Yeah, yeah, OK, so that one, I don't even know.
[AGENT][NEUTRAL] So it'll go out [PII].
[CUSTOMER][NEUTRAL] It's weird though because like at this point I don't even know.
[CUSTOMER][NEUTRAL] I mean, I'm guessing it's for.
[AGENT][NEUTRAL] What it's for?
[CUSTOMER][NEUTRAL] Yeah like because now there's no like the files like there's no files associated with it because you guys opened it up and didn't put them so like I, I'm like I mean I guess I kind of know what it's for but it's like I have to go into like another claim and then open it up like it.
[AGENT][NEUTRAL] Right, OK, I understand. So this is for um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Date of service, so it's two dates of service. It looks like lab work on [PII].
[AGENT][NEUTRAL] And then, uh, maybe some type of surgery. I see Ridgedale surgery, uh, [PII]. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So that's what that [PII] is for, the lab work and the surgery and then let me see the second one.
[CUSTOMER][NEUTRAL] All right, that makes sense. OK.
[CUSTOMER][NEUTRAL] Yeah, because it's still on my end it usually says like process and then tells you the amount paid but on my end it just says in process still and amount paid 0 so I'm like OK.
[AGENT][NEUTRAL] This one I would, I would say to disregard the one ending in 3,588,960. It's not a true claim. It looks like because it's it, the received date is the [PII] as well, so I don't like there's nothing here when I click it it's blank. So I don't know if there was a glitch or what, but it processed that second claim.
[CUSTOMER][NEUTRAL] I guess it'll.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] So this is not a true claim, it's just, it's, I don't know what happened there. It's just blank.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then there's that pending one too, um.
[AGENT][NEUTRAL] So now, and I, and I misspoke earlier, I said it was for, I said it was for benefits and a card, they do have the same type of thing, but this is waiting for information from your employer. So it's the same type of thing, eligibility is just not big, which is what I said. So I apologize for that, but yes, we are waiting for the one that's pending. We are waiting for the um
[CUSTOMER][NEUTRAL] But what I know.
[CUSTOMER][NEUTRAL] I don't know what that's for like I didn't open that one either, so I don't know what that's for. It's the same date as the one that you're saying has been processed and it's gonna be paid out and closed, but it, but it doesn't have any attachment, so I don't know what that one is even for.
[AGENT][NEUTRAL] Hold on, let me go back to that. I think that was on the other policy. Hold on one second.
[AGENT][NEUTRAL] 3442.
[CUSTOMER][NEUTRAL] Oh yeah, that's not a different why is that?
[AGENT][NEUTRAL] There it is.
[CUSTOMER][NEGATIVE] Bizarre.
[AGENT][NEUTRAL] Oh, so that's the one that we were talking about. This is the one that you you sent in in March, but whatever was going on with the account, that one was denied and then it reopened on [PII]. So that pending one is the same um data of service, it's the same date of service.
[AGENT][NEUTRAL] Maybe that's why it's not.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEGATIVE] Yeah, and it's like on the wrong policy number.
[AGENT][NEUTRAL] Are these the same charges?
[CUSTOMER][NEUTRAL] Yeah. That's why I'm like, I'm so confused, and it seems like
[AGENT][NEUTRAL] Oh, with all this back and forth, they're probably confused too. Hold on.
[AGENT][POSITIVE] Well, we're gonna get it together today though.
[AGENT][NEUTRAL] Is this the same, cause it looks like the same.
[CUSTOMER][NEGATIVE] I mean, I could have by mistake put things under the wrong.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, it can probably just be closed.
[AGENT][NEUTRAL] Yeah, OK, because that's the same dates and charges as the one.
[AGENT][NEUTRAL] The $2,194 payment y'all about to get.
[CUSTOMER][NEUTRAL] Yeah, it looks like it's on the wrong, maybe the wrong maybe I picked the wrong policy number. Hey, I'm not saying I'm, I'm innocent in this.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Well
[CUSTOMER][NEGATIVE] Maybe I picked the wrong policy.
[AGENT][NEUTRAL] So for this one, I'll just send this one to claims and let them look at it, do some research, and if it's not, if it's the same thing, they can go ahead and close it out, that may be what the holdup is because they're asking for information from the employee and the employer is like, what information do you need and the claim has already been processed. Now that makes a little more sense.
[AGENT][NEUTRAL] OK, I'll, I'll just send this one that's pending over to claims and have them look into it and if they need to close it out, they'll go ahead and close it out and if it is a true claim, we'll go from there.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I don't think it is though.
[CUSTOMER][NEUTRAL] And I'm pretty sure I can probably just be.
[CUSTOMER][NEUTRAL] Yeah, like if you're telling me the other one was processed and it shows the right policy number which like I'm looking and it does show the right policy number whereas the pending one is the wrong it's it's.
[CUSTOMER][NEGATIVE] I, I don't know if I picked the wrong one, not realizing, but it looks like I picked last year's policy by mistake or actually this one I didn't open. This one I did not open. Someone else like I think it was replacing one of the other ones that I opened, but that's.
[AGENT][NEUTRAL] One of the ones that were.
[CUSTOMER][NEUTRAL] Yeah, so if, if this newest one that you said was is getting paid out is getting paid out, that other one can be closed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'll send that to claims and then um so you'll see on your online service center you can just, um, you know, check it periodically, but you'll be able to see like if they close it out or if it's being.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Process for real, um, you know, because it'll change on the online service center, so you'll know what what they're doing, or did you want me to have somebody call you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I mean I I'll just pay attention to it and if something, if I see like something else weird happening I can always just call back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, we solved the puzzle. Was there, was there anything else I can help you with today, Ms. [PII]? Oh wait, did you want to go back to customer service?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] Are you OK?
[CUSTOMER][NEUTRAL] No, I mean, as long as he, as long as he's on there now and anything that you know was um done while he was apparently not on there as long as it's like retro then we should be good.
[AGENT][POSITIVE] And at any time if something because you know you can file the claims at any time. If there is something like this that happens and it's one of those, oh he's not active, but he's supposed to be, we will definitely, we can fix that and you can still file the claim in process um if he, if he's supposed to be active. I mean, I definitely apologize for all this back and forth.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEGATIVE] Um, I know that could be frustrating.
[CUSTOMER][NEUTRAL] Yeah, I mean, I think
[CUSTOMER][NEUTRAL] Yeah, I mean I think a lot of the things were closed because of.
[CUSTOMER][MIXED] Him not being on there. I don't know. I mean, like I said, I could have picked the wrong policy, like the old policy instead of the new or something because that, it looks like there might be some of those but um yeah, I was just really confused, but I think we're good now.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You sure?
[CUSTOMER][NEUTRAL] Yeah, yeah, I think so.
[AGENT][NEUTRAL] OK. Well, was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, Ms. [PII]. Well, thank you so much for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you for your help and you as well.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] You got it thanks bye bye.