AccountId: 011433970860
ContactId: 5a873a64-a5a0-4f44-9d57-a6722b33bb60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1027670 ms
Total Talk Time (AGENT): 478754 ms
Total Talk Time (CUSTOMER): 377523 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/5a873a64-a5a0-4f44-9d57-a6722b33bb60_20250228T20:36_UTC.wav
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[AGENT][NEUTRAL] Customer service department. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm sorry who is this?
[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] [PII], hey, this is [PII] over on the care team. How are you?
[AGENT][POSITIVE] I'm doing good. How about yourself?
[CUSTOMER][NEUTRAL] Doing all right thank you um I've got a weird situation and frankly I'm not sure um if you can help or not um I'm speaking with a group admin and apparently what had happened was there was a couple, a husband and a wife that worked together that had individual policies. The intention was that she uh cancels her individual and gets on to his as a family.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and I don't know, I guess they lost track of where they sent the applications for that if they sent it to the broker they don't remember, um, but at this point she said you just need it fixed, um, because the spouse, um, her policy is terminated his, he's still the only one active on his policy, so I guess they don't know how to add her and make it a family policy.
[AGENT][NEUTRAL] We need an email, but I can talk to them. What's the policy number?
[CUSTOMER][NEUTRAL] Um, that is uh 163-739.
[AGENT][NEUTRAL] You cut out, huh. What was the last part, 39?
[CUSTOMER][NEUTRAL] They could just send that information to uh to the.
[AGENT][NEGATIVE] You're cutting out. You're cutting in and out.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, can you hear me OK?
[AGENT][NEUTRAL] Now I can hear you. You cut out when you were giving me the policy number and I got 3739 and that was it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][NEUTRAL] Sorry, OK, OK, it's uh 163-7396.
[AGENT][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] And so I just, I, I wasn't sure what um I think I've come across this before because typically on mode of payment one and I would just say get with your employee so they could just email um the care team that information.
[AGENT][NEUTRAL] If it's the group on the phone, if it's the insured, then they'll have to have the group call us uh well they have to have the group send it in to us, put it that way, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's really good to know. OK, so simply just laying out the situation and that could be handled that way.
[AGENT][NEUTRAL] Yeah, they just need to let him know what's going on and whatnot, but we just, we can't do anything over the phone. We've gotta have documentation and once we get that we'll.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, that's really good to know though. I, I appreciate you letting me know that. Um, did you wanna go?
[AGENT][POSITIVE] We try to honor the retroactive.
[AGENT][NEUTRAL] Dates sometimes too, so that, that helps us clarify too, but I can speak to them and let her know um that's not a problem. And you said it's the group, right?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Right, um, uh, [PII], she is the admin group.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the callback number is what's on the phone log ID.
[CUSTOMER][NEUTRAL] Um, [PII], yes.
[AGENT][POSITIVE] OK. All right, we're good to go. Thank you.
[CUSTOMER][POSITIVE] All right, I appreciate your help. Thank you.
[AGENT][POSITIVE] No problem. You're welcome.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Good afternoon, Ms. [PII]. This is [PII] in the customer service department. How are you doing today?
[CUSTOMER][NEUTRAL] I'm fine and yourself?
[AGENT][NEUTRAL] I'm doing well, thanks for asking, Ms. [PII]. I've got the information pulled up and the representative that transferred me indicated, or transferred you indicated that there was a discrepancy with a spouse that had a separate policy and should have been added to another employee's policy. Is that correct, Ms. [PII]?
[CUSTOMER][NEUTRAL] That something like that, yes.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] It's a little confused. Yes, [PII] should be a family plan.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] His wife and him had separate plans, but now she's no longer with us, so now, she, he has a family plan.
[AGENT][NEUTRAL] OK, we can definitely do that for you guys, um, but we will need basically a description via email on what you know, what needs to be done and when this, when should this take place? Was this during open enrollment or?
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] This should have been 101, effective 10-1.
[AGENT][NEUTRAL] OK, let me look at something.
[CUSTOMER][NEUTRAL] And she was with um her own, her own employee and child policy up to [PII].
[CUSTOMER][NEUTRAL] Does that make sense?
[AGENT][NEUTRAL] Yes, it just makes sense. Let me check one more thing real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I believe we can go back, but we're just gonna need.
[AGENT][NEUTRAL] OK, because you guys are voluntary in order for us to go back to 101, we'll need proof of payroll deductions and also proof that she's on major medical. And if you can email all that to us, we can definitely go back retroactive and sub bills.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You need, um, give me one second, let me write this down.
[CUSTOMER][NEUTRAL] So you need um payroll deductions proof um what do you want his pay stubs?
[AGENT][NEUTRAL] Yeah, just proof that you guys were payrolling, uh, deducting for the gap plan for family basically from October until now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] We, we have been paying um our monthly um bill with reflecting the family amount that we have been doing.
[AGENT][NEUTRAL] Oh, so you have submitted in premium for them?
[CUSTOMER][NEGATIVE] Yeah, I have been paying it. The thing is, I don't know where along the line, this has been confusing not only with APL but everybody else has had a really hard time.
[CUSTOMER][NEUTRAL] Putting, but we have been paying the
[CUSTOMER][POSITIVE] The premium for them.
[CUSTOMER][NEUTRAL] I could send you whatever you want, the information of proof that I've been deducting it from his paycheck. What else do you need?
[AGENT][NEUTRAL] And um just showing that she's covered on major medical too as a 101.
[CUSTOMER][NEUTRAL] OK, coverage of medical.
[AGENT][POSITIVE] And I'm gonna get you to send that to our care team.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna try to keep an eye out for it because I'm gonna check and see about the see if we've got money in house and if we do then we won't have to back bill you guys it'll just be should.
[CUSTOMER][NEUTRAL] OK, what's the email should I send it to?
[CUSTOMER][NEUTRAL] Yeah, no, that's been paid for.
[AGENT][NEUTRAL] Right. We'll, we'll check into that definitely. Um, but I do want you to send it to the care team, CARE.
[AGENT][NEUTRAL] [PII] [PII] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's all one word [PII] team at [PII] one word again, [PII].
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and I'll send that now, um.
[AGENT][NEUTRAL] And just basically state in the email that she, you know, you guys canceled her with the intention of her and her dependent to be added to Mr. [PII]'s policy effective [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I add the description. OK, I'll go ahead and I'll send that. I have another issue.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a, a previous employee that's on COBR. Um, on COR, he's elected, he's [PII] and older.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, he's paying the premium correctly. We're paying the [PII] and older premium, but it's not reflecting on the invoice.
[AGENT][NEUTRAL] What's the insured's name?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII] Last name [PII] I'm sorry, [PII]
[CUSTOMER][NEUTRAL] No S.
[AGENT][NEUTRAL] Oh no, you're fine, Miss [PII]. Bear with me. I'm just looking, pulling them up.
[AGENT][NEUTRAL] When did you guys place him on Cobra?
[CUSTOMER][NEUTRAL] He went on Cobra, um.
[CUSTOMER][NEUTRAL] I think it was in July, July, August.
[AGENT][NEUTRAL] Of last year?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I'm not sure if he had a birthday in the middle, but now he's [PII] and older.
[AGENT][NEUTRAL] OK. And you said it's [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the way you guys' gap plan is designed, it's basically grandfathered in at the age of issue.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what that means is he was under the age of [PII] when he first initially got with us.
[AGENT][NEUTRAL] And he was actually at age [PII], so he keeps that age bracket of premium continuously, unless he was to ever leave you guys and come back with us later and we had to re-enroll him with a separate group. But that premium doesn't increase just because his age increases. He is active and he's paid to [PII], but we're not showing that we've got any uh COR information for him.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, OK, so let me, let me make sure I understood this. Uh, let me set this as an example. If I'm
[CUSTOMER][NEUTRAL] If I just started working with Miami Arts, I'm [PII]. I continue working with Miami Arts for the next 10 years, now I'm [PII]. Because I started with
[CUSTOMER][NEUTRAL] You're with the group at the age of [PII], my premium never goes up?
[AGENT][NEUTRAL] Your premium never goes up. That's correct. You don't get an increase. The type of plan that you guys have is a medle select plan and basically you're issued an age of issue and grandfathered in with that, right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But we've had other employees that they've raised the premiums. [PII] as an example, he was one that was also raised.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Um, I've had a couple other employees that their premiums have been raised.
[AGENT][NEUTRAL] Bear with me, let me look.
[AGENT][NEUTRAL] OK, something happened in [PII].
[AGENT][NEUTRAL] Mr. [PII] had the same premium.
[AGENT][NEUTRAL] On here for the 6577 for individual at [PII].
[AGENT][NEUTRAL] He's had that same premium since [PII]. There's nothing that's been on him, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, but let me look
[CUSTOMER][NEUTRAL] It's not 5035 now. I think it was [PII].
[CUSTOMER][NEUTRAL] No one not
[AGENT][NEUTRAL] Let me um check the one you was talking about just a minute ago. Let me go back because he has couple coverage now, uh, [PII].
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's a 13154 for couple coverage, but let me pull up the brochure real quick and make sure I'm telling you right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know I need to go.
[CUSTOMER][NEUTRAL] No matter who comes, maybe.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEGATIVE] Away speed's moving really slow.
[AGENT][NEUTRAL] Who else were you thinking got changed?
[CUSTOMER][NEUTRAL] Trying to think. Give me one second. [PII] I think was it [PII]? Hold on, let me look at my, my spreadsheet. Hold on.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Whoever it was, they're not with us anymore, you think?
[CUSTOMER][NEUTRAL] I have to sit down and really think.
[CUSTOMER][NEUTRAL] Cause I have less people enrolled this year in in APL than in the previous years, but I remember.
[CUSTOMER][NEUTRAL] Because we were short, um.
[AGENT][NEUTRAL] Now, it does look like y'all had two plans at one time. Y'all had a 3000 plan, and then y'all went to the 6000 plan, and that's all y'all have now is the 6000 plan. So maybe that's why the rates changed. But from looking at the brochure, um, it's indicating that there are age of issue. So whatever they are at the time they're issued, that's what they continue. We don't increase it.
[CUSTOMER][NEUTRAL] Maybe
[AGENT][NEUTRAL] Um, they, there are two different age brackets, but again, if they're within that age bracket and, you know, as long as they're not new, they're not gonna have a different premium regardless of how they age throughout the years. And I was looking at the billing on some of them. I pulled up Ms. [PII], and it looks l[PII] she's had the same rate since [PII]. Uh, before that, she was individual, but she changed to single parent in [PII] and that's the same rate we've been billing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, that's me.
[CUSTOMER][NEUTRAL] Yeah, that's me. I have my, I have my children on it.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So I just, I'm trying to look at some older ones maybe to see let me pull up the.
[CUSTOMER][NEUTRAL] Yeah, cause we've had it for a while. Um, yeah, because we're paying the family, um.
[CUSTOMER][NEUTRAL] The family rate that we're paying, we're paying for 55 and older for the [PII].
[AGENT][NEUTRAL] It's gonna probably get refunded then um because he's gonna be 50 family rate.
[AGENT][NEUTRAL] So whatever the difference is we're gonna have to refund that back so as soon as you send that to me I'm gonna keep an eye out for it since I know what's going on. I'm gonna pull everything together. My name is [PII] and I'm in the customer service department. I'm gonna pull everything together and get it taken care of for you um I'm gonna have to check with the billing department, do some research as far as the premiums and get all that applied and then we'll be able to refund.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's your name?
[CUSTOMER][POSITIVE] [PII], that's right.
[AGENT][NEUTRAL] The difference, but it's definitely gonna be for what his age was, which was [PII]. And that family rate, if you don't already know, I can give it to you.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK, and also, what about um Perdomo?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] He's, like I said, he's active and he's effective, but the only thing is we don't have them on COR. If you can send us the COR information for him, we can have him on there and he is covered on COR, I believe for 18 months.
[CUSTOMER][NEUTRAL] We're gonna have
[AGENT][NEUTRAL] You said he wasn't on the bill.
[CUSTOMER][NEUTRAL] Yeah, he should be enrolled because we're getting billed for him.
[AGENT][NEUTRAL] Right, he is enrolled.
[CUSTOMER][NEUTRAL] And I show them active in my portable.
[AGENT][NEUTRAL] He is enrolled and he is active. It's just he's not showing that we've placed him on COR and all we really do is just go in here and put a note that he's on COR and um make sure that we follow up with it within 18 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I'll send a separate email on that for him, um, just so it doesn't get confusing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, no problem. I'm gonna notate our conversation on both of them too just in case, but again, Miss [PII], if you'll get that to me, I'll keep an eye out for it and I'll confirm with you. Um, it's probably gonna be Monday before I get to confirm as far as working out the premium.
[CUSTOMER][NEUTRAL] That's fine, that's fine. I, I'm, I'm gonna put everything together. I'll send it to you, I'll send it out on Monday.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna look over everything just to make sure that I, I don't do it rushed. So it's, you can understand whoever it goes to, they understand the mess.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Right. I understand. I definitely, no problem. I'll still keep an eye out for everything and I'm gonna notate both policies just in case, like you said, um, but I'm gonna be looking to kind of pick that up, make sure we get it taken care of for you. Is there anything else I can help you with before you go?
[CUSTOMER][POSITIVE] OK perfect
[CUSTOMER][POSITIVE] No, perfect, thank you so much [PII].
[AGENT][POSITIVE] Thank you, Ms. [PII]. You have a wonderful day and thanks for calling APM.
[CUSTOMER][POSITIVE] You too ma'am alright bye bye.
[AGENT][POSITIVE] Thank you bye bye.