AccountId: 011433970860
ContactId: 6d88e7ca-3609-49a8-88c8-ebfadde0892e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453890 ms
Total Talk Time (AGENT): 163432 ms
Total Talk Time (CUSTOMER): 173567 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/6d88e7ca-3609-49a8-88c8-ebfadde0892e_20250408T18:09_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII]. Um, I have a question. I have a group, let's see I've got [PII] on the line, so it's one of their groups, it's group 25906. Um, he's asking on their HI policy which I pulled up a policy number for one of their people. It's 2,330,590, and he's asking if there is a pre-existing provision on.
[CUSTOMER][NEUTRAL] For HI policy I see the policy has it listed in there but it doesn't have a look back period or anything like that. It says to refer to the schedule and it doesn't have anything on the schedule of benefits.
[AGENT][NEUTRAL] OK, um, let's see.
[CUSTOMER][NEUTRAL] So I just wanted someone from claims to double check me.
[AGENT][NEUTRAL] And you're looking at um [PII]?
[AGENT][NEUTRAL] La [PII] or something like that, OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] Thank you. I just wanna make sure we're on the same page. All right. And um, so you're looking for preexisting, mm, let's see. I believe there is, but let me just double check, OK.
[CUSTOMER][NEUTRAL] Yeah. Yes, yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, and the provision, it says it on the definitions, but it didn't give a look back period, so I was like.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I would think there would be, but he was thinking that there wasn't.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Well, it's not showing, but I know there is one. Why is it not showing.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I don't know. That's why he's thinking that there wasn't one on there, so, um, I don't know, it's weird.
[CUSTOMER][NEUTRAL] I'm gonna put you on hold for just one second. I'll be right back. I'm gonna ask him a question real quick.
[AGENT][NEUTRAL] Yeah, sure. Yeah, go ahead.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] Hey [PII]. What's her name? the lady's name that's on the phone or that you're asking for when we look at, look at her policy. Oh she's she's she's just hired we're, we're actually the one her new hire stuff. OK, OK, new hire OK perfect that's all I needed hold on just one second. Yeah ma'am.
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] I'm here, yes, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thought it was a new person, yes.
[AGENT][NEUTRAL] So she's gonna be a new hire, um.
[CUSTOMER][NEUTRAL] Yeah, a new hire.
[AGENT][NEUTRAL] Yeah, I know I know there's a pre-existing condition on this type of policy. I don't see it, uh, I don't see where it's marking that it is, but I know there is one. usually one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. I know they always have, go ahead, I'm sorry.
[AGENT][NEUTRAL] Uh-huh, go ahead. I'm sorry, no, go ahead.
[CUSTOMER][NEUTRAL] No, no, I just know it's not Russell branch or grower group, so sometimes I know they have some special provisions, so I wasn't sure, um, I can do some more checking on our side too just to see how it was set up maybe because I just wasn't, he's, he's, he was going, I think they don't have it and then when you're reading in there there's a preexisting clause in there.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then it says to refer to the schedule of benefits for the look back period and there wasn't anything on the schedule of benefits so I was like well I don't know now I'm confused.
[AGENT][NEUTRAL] It says um if there's any exclusion, there's none. So basically if there's no no exclusions and it it will be based off what the certificate is saying. So if there is a um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, it's, yeah.
[CUSTOMER][NEUTRAL] Let's see the exclusions and see what it says.
[AGENT][NEUTRAL] Let me go one more place.
[CUSTOMER][NEGATIVE] My patients and exclusions, no benefits are payable, even if they're payable. OK, that's hernia or dental, but she's got Crohn's disease. That's what they're worried about.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah let me look here.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let me look at the other uh this is an HI 17 uh uh HP OK, one moment, one moment, let me.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Let me see if I can find more information.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] 57.
[AGENT][NEUTRAL] What did I say HP.
[AGENT][NEUTRAL] Mhm. OK. Um.
[AGENT][NEUTRAL] Let me check one more thing.
[AGENT][NEUTRAL] for relaxing oh.
[AGENT][NEUTRAL] Not even a special group let's see.
[AGENT][NEUTRAL] Uh yeah I approve and blah blah bla yeah that doesn't tell me anything uh not OK uh let me do one more search, um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Let's see what I got here.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, I'm just gonna try to clean.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's really strange that it's not showing up.
[CUSTOMER][NEUTRAL] That's OK. I can do some more research on our side too. I just think there's, I have a feeling there's something weird about this one because normally it would list it right on the schedule of benefits. It would say the pre X time frame.
[AGENT][POSITIVE] Uh correct.
[AGENT][NEUTRAL] Mhm, yes. Yeah.
[CUSTOMER][NEUTRAL] OK, so I'm thinking there probably isn't. I'm just.
[CUSTOMER][NEUTRAL] OK, I'm gonna double check on our end too just to make sure on how it was set up and I'll just tell him at the moment it doesn't look like it, but I just w[PII] double check before I say yeah or nay because I don't wanna mislead this lady and give her the wrong answer.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and I'm gonna go ahead and check it and if I find anything I'll go ahead and let you know, OK.
[CUSTOMER][NEUTRAL] Okey dokey.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much bye.
[AGENT][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.