AccountId: 011433970860
ContactId: 5dbd36ef-566b-4e4e-89eb-80bb94eadee2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 661000 ms
Total Talk Time (AGENT): 285973 ms
Total Talk Time (CUSTOMER): 284550 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/5dbd36ef-566b-4e4e-89eb-80bb94eadee2_20250219T23:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, sure. Can I give you a policy number, please?
[CUSTOMER][NEUTRAL] Um, for you to check.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, you can give me the policy number.
[CUSTOMER][NEUTRAL] It is 245.
[CUSTOMER][NEUTRAL] 5513.
[AGENT][NEUTRAL] OK, and um what was your name? I'm sorry?
[CUSTOMER][NEUTRAL] This is uh [PII] and this is for [PII].
[AGENT][NEUTRAL] OK, are you a provider, [PII]?
[CUSTOMER][NEUTRAL] No, we are the beneficiary, I would say the employer, uh, employee relationship.
[AGENT][NEUTRAL] You are the beneficiary?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The employee
[CUSTOMER][NEUTRAL] Did I explain it right, or do you have a different
[CUSTOMER][NEUTRAL] Terminology. I know uh.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see, I don't see any of your information under this policy.
[CUSTOMER][NEUTRAL] 245 55.
[AGENT][NEUTRAL] Yeah, no, yeah, I've got the policy pulled up. I just don't see you listed as a beneficiary. um, what, what was it we could help you with though?
[CUSTOMER][NEUTRAL] Oh, you're talking about [PII]?
[AGENT][NEUTRAL] Yes, this is the policy for [PII]. What is it that we could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK, uh, my wife is here with me. Uh, we have submitted several claims, uh, basically 3 claims coming from Quest.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4935.
[CUSTOMER][NEUTRAL] 15 and 50 and you guys are mentioning that the reference claims uh are either uh duplicate or paid before. The thing is you guys are not saying when was the pay, uh, what was the claim that was paid on, we have looked under on the website, uh, we have spoken tou.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] And they have verified that you have no pay, not, not to us, not to them.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I understand. um, OK, and I'm sorry, did you say [PII] is there with you?
[CUSTOMER][NEUTRAL] Yeah, she's my wife.
[AGENT][NEUTRAL] OK, am I able to speak with her, um, just to verify her information?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi [PII], how are you?
[CUSTOMER][POSITIVE] Fine, thank you.
[AGENT][POSITIVE] Glad to hear it. I'm just gonna verify some information really quick. Um, can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Uh, your address, the physical address. Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that um and really quick, can I get a good call back number from you in in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, what is this one your phone [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let me get my.
[AGENT][NEUTRAL] OK thank you and then we do have uh your permission to speak with [PII] on your behalf?
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Yes, can you add him to to this unauthorized.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Actually, you know, I'm, I'm trying to, uh, pinpoint the confusion I think with this claim, um, because it looks like the date of service from Quest was [PII] and this policy terminated [PII]. You currently don't have an active policy with us.
[CUSTOMER][NEUTRAL] Oh, OK, my husband, so you can talk to him, to him, no.
[AGENT][POSITIVE] Yes, so, and I did find, I'm sorry.
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] You can talk to my husband now.
[AGENT][NEUTRAL] Uh I can, yes.
[CUSTOMER][NEUTRAL] OK, hold on.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK thank you I appreciate that you were mentioning that.
[AGENT][NEUTRAL] Hi [PII], yes, no.
[CUSTOMER][NEUTRAL] That the policy, the one I just gave you, the 245-551-3.
[AGENT][NEUTRAL] 513. Yes, sir.
[CUSTOMER][NEUTRAL] Terminated in [PII].
[AGENT][NEUTRAL] Yes, that's correct, and I did find the original claim sent in from Quest, um, so that's going to be why we were unable to pay a benefit as the services were rendered after the policy terminated.
[CUSTOMER][NEUTRAL] OK, well, if that the case, then we're, um, OK, because these claims were for prior to, uh, hold on for a second, no, you're saying you lied. Uh, she, she resigned from the company, um, [PII], uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, how come you guys show that it was, uh, July?
[AGENT][NEUTRAL] Um, I can definitely take a look for you. I am showing that from the claim number that you gave me, [PII], that shows that it was a duplicate, that date of service shows, uh, [PII]. So by that, that would be after.
[CUSTOMER][NEUTRAL] OK, that's what, that's.
[CUSTOMER][NEUTRAL] That, that was one, but you are saying that the coverage got terminated on July, right? And then you are saying it was not process because it was saying after the termination day. It is.
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It was the date of service so the coverage was not active at that time.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] OK. How can you guys say that it was not active when she was a Platina employee until [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, that's what I will look at. I will take a look. It could be something to do with the group or the employer might have changed the coverage, um, so that's what I'll look to see why it did terminate when it did. So bear with me just a minute, [PII]. I'm gonna take a look a bit closer at this.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Actually, if you don't mind it probably goes a bit quicker um because I, I kind of just see surface level if it's all right with you [PII], I'm just gonna put you on a brief hold and reach out to our customer service department, um, just so that they could actually provide me some accurate and quick information for you.
[CUSTOMER][POSITIVE] Oh yes
[CUSTOMER][POSITIVE] I'll be here. Don't worry, I'm gonna.
[AGENT][POSITIVE] OK appreciate it thank you so much I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] over on the care team. How are you?
[CUSTOMER][POSITIVE] I'm good how are you?
[AGENT][NEUTRAL] I'm doing all right thank you. I've got a member on the line and apparently they were unaware of when their policy terminated. It does say that it terminated uh July the first of last year and they don't understand why as I guess she left the employer in August, um, so I don't know if I could get a definitive answer as to why it's that date if you could tell me that.
[CUSTOMER][NEUTRAL] OK, what's that policy number?
[AGENT][NEUTRAL] It is 245-551-3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's 1:30.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm, they didn't pay the, the premium for July, the group.
[AGENT][NEUTRAL] OK, that's what I, I don't know again I'm just not quite sure, you know, I know it could have been anything whether she left the employment at that time if they just stopped it early or.
[CUSTOMER][NEUTRAL] Yeah, because I see there is a future lapse date of September, um, you might wanna get with billing to see if I've got premium.
[CUSTOMER][NEGATIVE] And maybe it just didn't get posted or something.
[AGENT][POSITIVE] OK OK alright I appreciate it thank you I'll give them a call.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] All right, thanks.
[AGENT][POSITIVE] Alright thanks bye.
[CUSTOMER][NEUTRAL] Mm goodbye.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling ATO. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] over on the care team. How's it going?
[CUSTOMER][POSITIVE] Good, how are you?
[AGENT][POSITIVE] Doing good thank you so I've um.
[AGENT][NEUTRAL] Got a member on the line and long story short their policy termed July the first of last year they don't know why as I guess her employment ended like around the end of August um I did call customer service and they said that you know they're not sure as they didn't receive premium from that date but they saw future lapse date for September um so they just want to know why I don't know if you can help me with that or not why it turned July the first.
[CUSTOMER][NEUTRAL] Yeah, what's
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] It's 245-551-3.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Left overdue left for nonpayment [PII].
[CUSTOMER][NEUTRAL] And you said it was supposed to turn what date? the.
[AGENT][NEUTRAL] Um, so I spoke with uh customer service. They saw the group's future lapse date I guess was September.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not 100%. I know they could the term date could be determined to by a lot of different things.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, what's their name?
[AGENT][NEUTRAL] Um, so we're actually speaking with, um, [PII]'s husband [PII], um, and, uh, I was able to speak with her and verify her info and get permission and all that, um, [PII] just speaks, uh, better English.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, you can go ahead and transfer him.
[AGENT][POSITIVE] OK, I sure appreciate your help thank you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Alright, bye.