AccountId: 011433970860
ContactId: 619ec700-8cb6-43f6-94f5-0efad2da7861
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2519129 ms
Total Talk Time (AGENT): 668147 ms
Total Talk Time (CUSTOMER): 950175 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/619ec700-8cb6-43f6-94f5-0efad2da7861_20250128T15:00_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Hi, thank you so much for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Good morning. I am just calling to get an update on my claim.
[AGENT][POSITIVE] OK, yeah, I'd love to do my best to help you with some claim status today and may, I'm so sorry, may I have your name please and a good policy number?
[CUSTOMER][NEUTRAL] [PII]. Oh, I don't know the policy number.
[AGENT][NEUTRAL] OK, um, and then I can search for your policy for you, ma'am, with your social security number if you'd like.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] All right, and Ms. [PII], would you be able to verify for me, please, your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Wonderful. And do you mind if I snack a quick call back number just in case we get disconnected please?
[CUSTOMER][NEUTRAL] [PII] and the claim is for my son [PII].
[AGENT][POSITIVE] OK, perfect, thank you, thank you. And give me one second to get all that information pulled up for you, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and are we looking at?
[AGENT][NEUTRAL] The one that we just recently received.
[AGENT][NEUTRAL] Earlier this year
[CUSTOMER][NEUTRAL] Um, they were submitted [PII] and [PII].
[AGENT][POSITIVE] Perfect. OK.
[AGENT][NEUTRAL] All right, so I do see that those.
[AGENT][NEUTRAL] Are like so close to done processing um.
[AGENT][NEUTRAL] They're in their final stages and they should, I should be able to give you an answer tomorrow I can't see any of it quite yet but it is like I can see that it's in its last stage of processing.
[CUSTOMER][NEGATIVE] So I know you all are supposed to process within what, 2 weeks? It's been a month.
[CUSTOMER][NEGATIVE] So what's going on that is not complete.
[AGENT][NEUTRAL] OK, um, it looks like on our side it didn't start being reviewed until [PII].
[CUSTOMER][NEUTRAL] So I've called before on this claim and someone else, I think maybe last week told me that it was done, but that it was pending payment and I questioned that because my payments for my policies are automatically drafted from my account. So I'm getting different information and I'm really just trying to get a resolution and find out what's really going on.
[AGENT][NEUTRAL] OK yeah absolutely so the policy here is in the last stage of processing, so it has been processed, it's not pending anything it's just in that last stage.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, why is it taking so long when it's when your policy is to have it done within?
[CUSTOMER][NEUTRAL] I want to say 10 calendar days or something like that.
[AGENT][NEUTRAL] Our goal is 10 calendar dates and that's our average but um but we don't have a set policy on like how quick a claim is resolved um our average turnaround time is 10 to 15 days yes um but some things do take a little longer and some things happen quicker sometimes it's done in one day, um, and so.
[AGENT][NEUTRAL] I am really sorry we definitely have an average turnaround time, but it's not always.
[AGENT][POSITIVE] It's not always perfect. It's not always flawless and it doesn't always happen within that time period, and I'm really sorry.
[CUSTOMER][NEUTRAL] So for clarity, you're not showing that it's being held because
[CUSTOMER][NEGATIVE] The policy hasn't been paid. It's not giving you a reason why it hasn't been processed yet.
[AGENT][NEUTRAL] I'm showing that it is in the final stage of processing typically it's the final review so it's been processed by one person and it just goes to final review.
[AGENT][NEUTRAL] And so it's typically once it's in that stage by tomorrow it will have a yes or a no.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but it is like it's in that last page so it will be done today. So if you call tomorrow, it will have an answer.
[CUSTOMER][NEUTRAL] So if I want, if I um if
[CUSTOMER][NEUTRAL] So if I wanna file a complaint or a grievance about the the this process, who do I speak with?
[AGENT][POSITIVE] Yeah, absolutely, um, I can, I can put you on a quick hold and reach out to a supervisor if you'd like.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][POSITIVE] OK, absolutely.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Do I, do I
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, Ms. [PII], are you still there with me?
[CUSTOMER][NEUTRAL] Yes, I am.
[AGENT][NEUTRAL] All right, I am still waiting on a supervisor and I'm really sorry about that, but I just hate keeping people on hold for so long and not checking back in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I did just wanna let you know that I have reached out and I am, I am just waiting for someone to reach back out to me and.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I just check in on you because I don't know, 3 minutes on hold is a long time it feels like so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect, um.
[AGENT][NEUTRAL] I'm going to.
[AGENT][NEUTRAL] I'm so sorry. I wish I had somebody like immediately and I could just.
[AGENT][NEUTRAL] Tell you that I had someone ready for you but.
[AGENT][NEUTRAL] While we're waiting for a supervisor, is there any other questions or anything else I can help you with?
[CUSTOMER][NEUTRAL] No, I'm, I'm just pretty preserved that it's taking so long and I keep getting different information.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Customer service needed in the cosmetic department.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's 4 people you don't let go. They tell us to date.
[CUSTOMER][NEUTRAL] Yes, for [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] No, she has medicated.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The 3 of them.
[CUSTOMER][NEUTRAL] It should be [PII], and I can't think of the third one offhand.
[CUSTOMER][NEUTRAL] Oh, [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I'm sorry, say that
[CUSTOMER][NEUTRAL] have.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right now uh.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I got it like
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][POSITIVE] Hey, good morning.
[AGENT][POSITIVE] I'm really sorry about your wait, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you mind if I put you on a brief hold again? I'm have I wanna maybe call my claims department and see if they have somebody available.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm sorry. One second, my friend.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII] with the care team. How you doing today?
[CUSTOMER][POSITIVE] I'm doing well, [PII] thank you how are you?
[AGENT][POSITIVE] Hey, I'm doing so well. I do have a quick question. Um, it's just my luck that there's no supervisors available on the all colleague meeting day, um.
[AGENT][NEUTRAL] I just want clarification. Am I allowed to sell tell somebody payment details when it tells me 1900 for the year? Like the claim hasn't finished processing?
[CUSTOMER][NEUTRAL] Um, I'm sorry, can, can I have you repeat that? You, are you a.
[AGENT][NEUTRAL] Yeah, yeah, so, um, I'm looking at particularly policy number 218443773 I'm sorry, um, and I'm looking at the claim and it just finished processing today. The date on it is like the [PII] and it does have benefits payable, um, but I was told in my training that when it says 1900 for the date to not give payment details because nothing's finalized.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEGATIVE] And to only give payment details when it has an actual date on it for processing, so I told her that it's in the final outcome it's in the final stages and that um at this stage that there would be a resolution tomorrow like a yes or no, um, and then we'd be able to give her details and she's really upset because last time she called it was pending big and why are we taking so long? We somewhere along the way told her it takes 10 days and she's just really upset um and so.
[CUSTOMER][POSITIVE] Got you, right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I I talked to her as well, [PII], um, so what happened with this particular person is she left her, I believe she separated from employment and she was on a, um, uh, they paid in arrears, so she continued her policy paying in arrears and the problem was that claim came through and we couldn't pay it until she paid her premium because she went to mode of payment uh too I think it's 2, right?
[CUSTOMER][NEUTRAL] Um, which she self paying, so that's the problem, and, and I guess back in the notes too a while, a few months back it was we did explain that to her that it's in arrears. So if she wants to change her date so it's not paid in arrears, that's on her, but she said she would think about it and call back and now she's been calling for this claim like for two weeks straight.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, and I tried to tell her like it was processed today. We'll have a final outcome on on tomorrow, but I'm just trying to figure out, can I tell her that it's been paid and then maybe get her call back information and have a supervisor call her back? Or is that like a tried and true thing like when it says 1900, we don't get payment details.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Well, it hasn't been released yet. This particular claim looks like it's an audit. So what that, so that's kind of the difference sometimes you'll see them where if I just process the claim you'll see that why there and even if they have direct deposit it'll still show in that check column but until it processes overnight it's not gonna update.
[CUSTOMER][NEUTRAL] Um, and this particular claim looks like it's actually an audit, so the auditor has to release it. That's why there's no why next to the check because it hasn't been, it is in the, it truly is in the final processing stage right now. This claim is going through audit though.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it you know I mean I think you could be OK to tell her that that it's you know and it's in the final processing stage and it has to pass audit um and then it will update overnight um and we'll have a final um a final uh you know uh claim decision basically.
[AGENT][NEUTRAL] OK, so that is definitely what I told her, and I didn't know that was true. That's what I tell everyone when I see a 1900. That's my go to answer is that it's in finals processing. Um, all our claims go through a secondary audit, and at this stage it's usually overnight once we are here and we'll have an answer tomorrow and so that's my, my flat out go to, um, and so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah and that's correct and I know she's upset but really a supervisor isn't gonna be able to tell her anything different, um, and you know I think she is set up for direct deposit so I would just tell her to um you know she could just monitor her um bank for once it clears that final decision, you know, like I said, usually what happens is later today probably the auditor will release the claim um I don't see any reason why it wouldn't be released, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that claim will be finalized and then like I said tomorrow it would show that direct deposit went through.
[CUSTOMER][NEUTRAL] Like it does for her rest of her claims she's submitted and you know in the past.
[AGENT][NEUTRAL] OK awesome so I'm just going to let her know that I spoke to you and that you just reiterated what I said was that it is in final stages. It's going through that final process where it goes through that second set of hands and typically at that point there's an answer tomorrow, um, and then as far as getting her a supervisor, I mean at this point I put in the request 15 minutes ago so I might just, uh, I might just have somebody you try to get a callback number and see if someone can call her back.
[CUSTOMER][NEUTRAL] OK, I mean I can try to call her if you'd like if that will I mean.
[CUSTOMER][NEUTRAL] If you want me to, um, like I said, it's just, um, she.
[AGENT][NEGATIVE] She just wants to file a claim. She wants to file a grievance about the process. Um, she's really unhappy with the process, so.
[CUSTOMER][NEUTRAL] Well, like I said, if you, she's, it's been explained to her before about that.
[CUSTOMER][NEUTRAL] Um, premium, like I said, she's paying in arrears so and so that means that if she doesn't like the payment we had was for December so it didn't take her through March, you know, I'm, I'm sorry, January and that so she used to pay with the group in arrears so her claims would get paid because we got that premium even though it was paid in arrears we knew that group was gonna, you know, well we assumed the group was gonna pay those premiums.
[CUSTOMER][NEUTRAL] So we allowed them that grace period and that arrears to um take effect. However, when she switched to self pay, you can't have a grace period and unfortunately it's not in arrears anymore we don't look at that because she's paying the premium now so we could pay that claim out and then she doesn't pay your premium and then we're just kind of, you know.
[CUSTOMER][NEUTRAL] In that place
[AGENT][NEUTRAL] OK, yeah, no that makes a lot of sense. um, I will, I mean, I, I don't know if it'll really do me much good to, um.
[AGENT][NEUTRAL] But I will, I will at least explain to her where her claims at. I'll offer to call her back tomorrow, you know, with what the outcome was, um, and then I will ask her if she wants me to give her name and phone number for a supervisor to reach back out to her to talk about that process and go from there. Maybe she'll be happy with an offer to have someone call her back tomorrow with a decision.
[CUSTOMER][POSITIVE] OK, and um if you need any assistance, [PII], let me know. I'll be happy to help any way I can.
[AGENT][POSITIVE] Hey, I am actually really grateful for you just filling me in on the history on this, and that really helps me so thank you.
[CUSTOMER][POSITIVE] Sure, oh, you're welcome any time.
[AGENT][POSITIVE] Take care.
[CUSTOMER][POSITIVE] Alright thanks you too have a good day.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Hey, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, thank you for your patience so I did just talk to somebody in claims, and they did tell me that, you know, just the same thing I saw here was just that it's going through its final stage of processing. Um, they didn't have a supervisor available that I could send you on over to, but just the same thing that it was in that final stage of processing going through that second set of hands, um.
[AGENT][NEUTRAL] If you would like, I'd be more than happy to give you a call back tomorrow and let you know what the outcome was on that claim if that's something you'd like, I can definitely do a call back for you, um, and then I still have not heard back from a supervisor if you'd like, I can also get your name and phone number and well I have your name and I have your phone number but I can submit a request for somebody to give you a call back if you'd like.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK perfect and would you like me to give you a call back tomorrow morning and let you know about the claim?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, would [PII] tomorrow be a good time for you, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, it would.
[AGENT][NEUTRAL] OK perfect and I'll even check it at the end of my day today. If anything changes before I leave, I'll call you tonight, but if you don't hear from me tonight, I'll call you at [PII] tomorrow morning, OK?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] It's my pleasure. I'm really sorry that I know it's been a long process for you and I definitely understand how you're feeling about that so um.
[AGENT][NEUTRAL] I
[AGENT][POSITIVE] I don't know, but I, I understand so I'm really sorry for your frustrations. I would love to give you a call back and I will pass your your contact information on um for somebody to give you a call back because I know you wanna talk about that claims process.
[CUSTOMER][NEUTRAL] Yeah, that and, and I also had a question about um.
[CUSTOMER][NEUTRAL] Major organ failure cause my son had a heart transplant. However, his body is rejecting the heart. So I just wanna know what information they need in order to process the claim for major organ failure as well.
[AGENT][POSITIVE] Oh yeah, let me look into that for you, Ms. [PII], and I'm so terribly sorry that you and your family are going through that right now. That sounds.
[AGENT][POSITIVE] Unfathomable, and I'm, I'm just really sorry to hear that.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Let me see
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, you can
[AGENT][NEUTRAL] And I'm just pulling up your policy information. It looks like
[AGENT][NEUTRAL] Um, I don't want to misquote anything.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] do
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You can
[CUSTOMER][NEUTRAL] Just now.
[CUSTOMER][POSITIVE] Yeah I do.
[CUSTOMER][NEUTRAL] How you
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Alright, so Miss [PII], I actually do have um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] And then I actually do have a supervisor available that I can get you on the line with um and then if you want while you're talking with her I can.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I thought he
[AGENT][NEUTRAL] Um, continue looking up what information we need because I also see you have a critical illness policy with us, so I can do some research into that for you a little bit and see what your benefits are between the hospital indemnity policy and the critical illness policy and let you know what's needed to file a claim and I can send you out an email to your email address that has claim forms that you might need any and then any information you might need. Is that something you'd like me to do while you're speaking to my supervisor?
[CUSTOMER][NEUTRAL] So I walked inside of there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK perfect I'm gonna put you on one more hold so I can get you on the line with the supervisor and while you guys are chatting I'll look into the two different policies and see what benefits I think could um help you out in the situation and get you an email sent out your way, OK?
[CUSTOMER][NEUTRAL] This is the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Alright, perfect. One more second, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] This is [PII]
[AGENT][NEUTRAL] Hey, this is [PII] how you doing?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Hey, so I have Miss [PII], um, she's not on the line with us she's on hold, but, um.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Do you want the whole story?
[CUSTOMER][NEUTRAL] How long did you wait? How long did she wait?
[AGENT][NEUTRAL] Since I first
[AGENT][NEUTRAL] Since I first put in the request at like [PII].
[CUSTOMER][NEUTRAL] No no what? You mean?
[AGENT][NEUTRAL] Oh, on the claim? she submitted it.
[CUSTOMER][NEUTRAL] No, no, no, no, no. What was her turnaround? What was her turnaround?
[AGENT][NEUTRAL] Um, she submitted her claim like [PII] and [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's just now, 20 days later.
[AGENT][NEUTRAL] Yes, so what happened is she switched from like employer pay to self pay and she pays in arrears and so it pended so long because her payment date for January wasn't until the middle of January and that was explained to her so that's why the process took so long. They offered to have her pay ahead instead of in arrears and she said that she would think about it and get back to us, but she never chose to do that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So it's because of the change.
[AGENT][NEUTRAL] Yeah, yeah, because when you're with a group, they have the grace period, but when you're self paid they don't have the grace period.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] OK [PII] send her through but stay on the line with me and you can type in that escalation if she adds something because I've got her up here but I, I mean I don't know how to, I don't know how to get to anything so I'm just gonna listen and if you hear anything you can answer just type it in that escalation.
[AGENT][POSITIVE] OK, absolutely will do, and I did tell her that when I was, um, she has some other questions about her son, her, her son, this is, it's never the one problem, it's always something else has major organ failure and is rejecting his transplant heart, um, so I told her I'd get together some information on her critical illness policy and see if she has benefits there and so I will also continue to work on that for her throughout the day if she brings that up.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, very good. All right, we'll transfer through and stay on the line with me, OK?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] You bet you and I'll introduce you when we join, OK?
[CUSTOMER][POSITIVE] OK, great. Thank you, [PII].
[AGENT][POSITIVE] Hey, my pleasure.
[AGENT][NEUTRAL] Hi there, Ms. [PII], are you still with us?
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][POSITIVE] All right, I have Ms. [PII] on the line. She's my supervisor and um I'm really sorry it took a while to get um to be able to get her on the line, but she definitely would love to hear your concerns.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm sorry, what was your name again?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK. Hello, Ms. [PII]. How can I help you today? So I just had a question about why it's taking so long to process this claim as I.
[CUSTOMER][NEUTRAL] Submitted 1 [PII] and another [PII], um, as I told the representative that was assisting me initially I was told it was because my premium hadn't been paid. However, my premium is automatically drafted from my bank account and it was, I mean, you know, it's, it's always paid.
[CUSTOMER][NEGATIVE] So, just have concerns about the processing time.
[CUSTOMER][NEUTRAL] And then also had a question about.
[CUSTOMER][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][POSITIVE] I'm sorry. You go ahead. I'm, I'm so sorry. I, I overspoke.
[CUSTOMER][NEUTRAL] And then also I had a question about um what documentation you needed regarding my son's care. Um he had a heart transplant and his body is rejecting the heart. So um just had a question about what information you need for that.
[CUSTOMER][POSITIVE] Absolutely, um, Ali is getting that together for you and she be giving you a call back. Um, what I can tell you about the process, um, did you make, did you, did you happen to make a change, um.
[CUSTOMER][NEUTRAL] On direct pay, was it direct pay?
[CUSTOMER][NEUTRAL] Yeah you got $4.
[CUSTOMER][NEUTRAL] No, I didn't make any change regarding payment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I, I, I think there was a change in, in the draft day and so um with that that delayed the payment but normally our process um we try very hard to get a turnaround within 10 days.
[CUSTOMER][NEUTRAL] I mean it's not a guarantee, but, um, most normally say within our turnaround time of 10 days, um, so you said there was a change with the drafting. I don't understand what you mean.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hold on just a moment.
[CUSTOMER][NEUTRAL] Uh, when you left the school, um, you were moved to self pay.
[CUSTOMER][NEUTRAL] Correct. And I believe it was, yes, and I believe that was the change that caused the delay, but that's a one time uh issue so so the next claims, uh, you know, now your payments are processed in the in arrears.
[CUSTOMER][NEUTRAL] So that shouldn't be a problem again.
[CUSTOMER][NEUTRAL] You said now my payments are in arrears?
[CUSTOMER][NEUTRAL] So your payments are, your payments are fine.
[CUSTOMER][NEGATIVE] But because when you left the school, right, and you moved to self-pay, that caused a bit of a delay, but now moving forward, I'm sorry, I'm sorry to cut you off because I left the school in May of last year, so why 7 months later is it causing a delay? I don't understand that.
[CUSTOMER][NEUTRAL] Um, you know what, um, I'm not in the claims department, so I'd have to get with the, uh, subject matter exporting claims.
[CUSTOMER][NEUTRAL] I can only tell you what's in the system so um I mean moving moving forward you should be fine.
[CUSTOMER][NEUTRAL] Is this the only thing you submitted?
[CUSTOMER][NEUTRAL] Mm, I mean, I've submitted several since I've left the school, um.
[CUSTOMER][POSITIVE] You know, like I stated, my, my son had a heart transplant, so he's often going to the emergency room, especially since he's in rejection. Oh yeah, absolutely.
[CUSTOMER][NEUTRAL] So have you had um.
[CUSTOMER][NEUTRAL] Has there been um a turnaround issues before or is this the first time?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] There was a time before when they told me the same thing that it was about the, the um premium being paid and I told them the same thing. I'm like it's automatically drafted from my account. So I just don't understand how that's an issue. Like how, how is it ever paid late if it's drafted from my account? Like if I need to change the date of the draft, then no one has advised me to do that.
[CUSTOMER][NEUTRAL] But yeah so I see, yeah, I, I understand your frustration absolutely. So for each month that you submit a claim, um, it looks like you'll have to wait until the [PII] of each month before a payment is processed.
[CUSTOMER][NEUTRAL] Um, if you change the date, um, then that might help.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So if you wanna wait, if you just understand that payments aren't gonna be processed until the [PII] of each month.
[CUSTOMER][NEUTRAL] You know, then maybe, you know, I mean maybe the expectation, um, you'll understand better that you know we are gonna process your payments around the [PII] of each month so is that is that OK that that that we explain that or do you wanna change the date? No, no one explained that to me that's why I wasn't understanding like what do you mean the payments are my payments are late they're automatically no no they're not late.
[CUSTOMER][NEUTRAL] Yeah, no, no, I'm sorry, um, it's not late, so it's not that you're late, it's just that because of the date that it's, um, drafted from my account, any time I file a claim, it will have to be processed around that same date.
[CUSTOMER][NEUTRAL] Yes. Am I understanding you correctly?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that OK? Do you, I mean, it's
[CUSTOMER][NEUTRAL] I mean that's OK, that's that's your policy so.
[CUSTOMER][NEUTRAL] I just wanna make sure that you understand that that you know there is a process date of around the [PII] so um.
[CUSTOMER][NEUTRAL] So what may I suggest this.
[CUSTOMER][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] So with the claims that's being processed, are you able to tell me the status were they denied or is there a payment pending? Like what's going on with that?
[CUSTOMER][NEUTRAL] Um, hold on just a moment.
[CUSTOMER][NEUTRAL] I'm sorry ma'am. I was getting in my car. I didn't hear you. Oh, that's OK. I said hold on just a moment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so the only claim we have is in a final review.
[CUSTOMER][NEUTRAL] Um, and typically the turnaround is, uh, the next day for, for you.
[CUSTOMER][NEUTRAL] So, um, I believe [PII]'s supposed to call you tomorrow with a paid amount.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Yeah, so I think you're OK. Yeah, just a little confusion there, but you know what I, what I was gonna suggest a minute ago is let's, what do you think about just going with this understanding that the [PII] is usually your uh payment process day and if that is not good for you for this next one.
[CUSTOMER][NEUTRAL] Uh, for these next claims, then, uh, we can change that date for you, but, um, I'd like to go with this just for another, another instance and let's see how that works.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does that sound good?
[CUSTOMER][NEUTRAL] Yes, that's fine.
[CUSTOMER][POSITIVE] OK great well listen uh you are in the best hands with [PII] she is extremely thorough she'll find out more information that we need to send in and she'll call you tomorrow, OK?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] All right, well you have a wonderful day and thanks for doing business with APL. We really appreciate you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] See you later.
[CUSTOMER][NEUTRAL] Bye-bye. Bye.