AccountId: 011433970860
ContactId: 5f11aa61-3228-471d-bf0b-64c1598ccb1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 858260 ms
Total Talk Time (AGENT): 272633 ms
Total Talk Time (CUSTOMER): 420736 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/5f11aa61-3228-471d-bf0b-64c1598ccb1e_20250219T23:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] over on the care team. How's it going?
[AGENT][POSITIVE] Good. How are you?
[CUSTOMER][POSITIVE] Doing good thank you so I've um.
[CUSTOMER][NEGATIVE] 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 [PII].
[AGENT][NEUTRAL] Yeah, what's
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] It's 245-551-3.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] [PII], left for nonpayment, [PII].
[AGENT][NEUTRAL] And you said it was supposed to turn what date? The
[CUSTOMER][NEUTRAL] Um, so I spoke with, uh, customer service. They saw the group's future lapse date I guess was September.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm not 100%. I know they could the term date could be determined to buy a lot of different things.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, what's their name?
[CUSTOMER][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.
[AGENT][NEUTRAL] OK, you can go ahead and transfer him.
[CUSTOMER][POSITIVE] OK, I sure appreciate your help thank you.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] Hi, this is [PII] in the billing department. Am I speaking with [PII]?
[CUSTOMER][NEUTRAL] I'm here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, so I understand that, uh, you were calling about the, um, dates of coverage for your wife's policy, is that correct?
[CUSTOMER][POSITIVE] It is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] All right. And when was her um last date of employment?
[CUSTOMER][NEUTRAL] Could you please repeat the question?
[AGENT][NEUTRAL] Yeah, when was her last date of employment with uh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Yeah, I was.
[AGENT][NEUTRAL] All right, so I think I see what's going on here. Let me.
[AGENT][NEGATIVE] It looks like we didn't receive payment for.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] July and August.
[AGENT][NEUTRAL] I want to see, let me make sure Y 26241.
[AGENT][NEUTRAL] OK. So I see what happened. Um, it looks like the group,
[AGENT][NEUTRAL] Uh, sorry, um, your wife's employer lapsed.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And we didn't receive any payments from them after they paid for June. So that's why since your wife's policy was only paid until July before the groups are for her employers stopped making payments, that's why her policy is uh lapsed effective [PII].
[CUSTOMER][NEUTRAL] So you are saying the employer did not make payments, is that what you're saying after June?
[AGENT][NEUTRAL] Correct. The last date we received, yeah, we didn't receive any payment from them, um, after June, so you would need to contact them and see if they deducted money from her paycheck for those um for.
[AGENT][NEUTRAL] Any period after that, um, if they sent it to you or anything like that.
[CUSTOMER][NEUTRAL] OK, so let me make a note here, so we are in the same boat.
[AGENT][POSITIVE] Yeah, no problem. Take your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So basically.
[CUSTOMER][NEUTRAL] You're saying that the employer, which is [PII], right?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] I'm showing her employer uh [PII].
[CUSTOMER][NEUTRAL] No, oh yeah, [PII], they go by both names. Yes, it.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So we're talking here.
[CUSTOMER][NEUTRAL] The [PII], uh.
[CUSTOMER][NEUTRAL] Last payment.
[CUSTOMER][NEUTRAL] Uh, what day was it? Excuse me.
[AGENT][NEUTRAL] Um, it was for June.
[CUSTOMER][NEUTRAL] What day on June do you have a specific day?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, it's for uh like the invoice so the invoice goes by month so it's not for a specific day, but the last payment we received was for the month of June.
[CUSTOMER][NEUTRAL] So you are saying they did not, they did not pay June going forward. So they did not pay June, July, August.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, they paid June. They didn't pay July. They didn't pay July on, so they paid for June. That was the last month that was paid. So that's why your wife's policy is paid to July the first, um, because we did receive payment for June, yes.
[CUSTOMER][NEUTRAL] Boom
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, they did not pay July, August, September, October, November, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] October.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, that's what you, that's what your system is showing, right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, alright, so being that the case then.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] There is one claim that issue has been paid.
[CUSTOMER][NEUTRAL] Two of them should be in pay.
[CUSTOMER][NEGATIVE] Uh, that, that's what we're talking about. So 2 claims out of the 3 that we submitted, you guys are saying that it, it, it was no uh cover. So do I speak this to you or do I gotta do I gotta go back to customer service? How, how do we do this now because uh this is, this is what is happening.
[AGENT][NEUTRAL] OK, so if you're, if you were supposed to have coverage like if they were taking money out of your wife's check after June, um, and you were supposed to have coverage.
[CUSTOMER][NEUTRAL] No, no, I'm talking about 4. I'm talking about before. They are two claims before uh June. So you are saying they pay uh January, February, March, April, May, and June, right? That's what you're saying. [PII] they will pay. So we have 22 claims, one in May.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] And also in June that they were supposed to be covered and you guys are saying it is not. So uh we would like to address this, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So was the first person that you were speaking to, OK, she was in customer service.
[AGENT][NEUTRAL] Um, yeah, you would need.
[CUSTOMER][NEUTRAL] Who did I speak?
[AGENT][NEUTRAL] Yeah, the person that I'm sorry, I was talking about the person that transferred you to me, uh, they were in customer service, but you would need to speak to claims, but they're closed, um, because they, uh, we close at [PII] central time.
[CUSTOMER][NEUTRAL] OK, so what are the working hours for, for, for the claims department?
[AGENT][NEUTRAL] It would be um between [PII] are you are you in [PII]?
[CUSTOMER][NEUTRAL] Yes, we are in [PII].
[AGENT][NEUTRAL] OK, so Eastern Time, uh, would be from [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, so that would be uh Eastern Standard Time, which is [PII], from [PII] Monday through Friday, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and, and, and, and the phone number to call would be the one that I just dialed the [PII]?
[AGENT][NEUTRAL] Yes, and make sure when you call to ask for ask for claims um so you don't have to keep getting passed around so you wanna ask for the claims department.
[CUSTOMER][NEUTRAL] But how do I do that? Because there is an automatic system that won't allow me to, to, to, to do that. Yeah, I was trying that and then, uh, you know, I kept going around. I, is there, uh, for example, press 1 for customer service, press 2. Is there a number for claims?
[AGENT][NEUTRAL] Uh, well, when the, when the person answers, so when customer service or when the care team answers your call, you'll just tell them that you wanna speak to someone in claims.
[CUSTOMER][NEUTRAL] Oh, so whoever the answers, I just gotta ask them to, uh, send me over to claims. All right.
[AGENT][POSITIVE] Correct, correct.
[CUSTOMER][NEUTRAL] OK, so we do so, uh, I will call tomorrow, OK. Um.
[CUSTOMER][NEUTRAL] Does it show overall in the in your computer that the the the month of January through June were pay or she's gonna do the same as we did now to be transferred over to you and then back to customer service? Uh, do they have access to the system just on your curiosity?
[AGENT][NEUTRAL] Yeah, they can see uh that it what your what the policy paid to so they can see that she's covered up to [PII] and I'm also as soon as I get off the call with you, I'll put notes about what we talked about and they'll have access to those as well.
[CUSTOMER][NEUTRAL] OK, so, so, basically, uh, the coverage, let's say for a second, uh, was on until [PII]. Anything prior to that day, it should be covered by uh your, your company, right?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, so, um, let's start tomorrow and, and then I take it from there. Okey dokey. That will do it. That was.
[AGENT][NEUTRAL] OK. All right. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, uh, unless, no, because you have no claims, right? Uh, basically.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, no, no, you, no, we, we, we, we, we cannot do anything here because as you say, uh, we got to speak to claim and then uh I have on my back quest, uh, requesting payment because they're saying they're sending the bill to you guys, uh.
[CUSTOMER][NEGATIVE] And you guys, uh, not paying and, and all that, uh, uh, you, you guys saying there's not, not being processed, uh, or saying that, you know, so I need to speak to claims, basically.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I will speak to you guys tomorrow then. I appreciate that. You have a good thing. What department are you by the way?
[AGENT][NEUTRAL] I'm uh in the billing department.
[CUSTOMER][NEUTRAL] Oh, in the bill in the park. And, um, and what is your name if they ask me to help you as a reference?
[AGENT][NEUTRAL] Uh yeah, my name is [PII].
[CUSTOMER][POSITIVE] Great. OK. How do you spell it? Excuse me?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII] OK, great. I appreciate that. Thank you. Uh, let's then let's speak to clients tomorrow. You, you have a good evening. OK dokey.
[AGENT][POSITIVE] No problem. It's a pleasure assisting you. Have a great rest of your night.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.