AccountId: 011433970860
ContactId: 7fe4829e-c831-474a-807c-c1c9eaf5942b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 786159 ms
Total Talk Time (AGENT): 332980 ms
Total Talk Time (CUSTOMER): 324010 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/7fe4829e-c831-474a-807c-c1c9eaf5942b_20250224T22:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] My favorite person ever, Miss [PII]'s [PII] and claims. How are you?
[AGENT][NEUTRAL] I am fine, Ms. [PII]. How are you there?
[CUSTOMER][POSITIVE] I am wonderful now that you answered the phone.
[AGENT][POSITIVE] Oh, you're too sweet.
[CUSTOMER][NEUTRAL] Can you help me with a PIBFT screen, please?
[AGENT][NEUTRAL] I can do my best. What you got? What's the number?
[CUSTOMER][NEUTRAL] It's 246-711-3.
[AGENT][POSITIVE] Thank you, ma'am. Let me see if I can find that.
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] 246-7113. OK, here we go. I'm on.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII], yes.
[CUSTOMER][NEUTRAL] OK, so where I'm confused that is when you go into the PIBFT screen and I see that they have.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Couple and individual. So I'm looking at the outpatient.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEGATIVE] Come on, I'm sorry, my screen is slow.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So is mine.
[CUSTOMER][NEUTRAL] So the outpatient max, whether they had the individual or they had the couple has always been 2500. Is that correct?
[AGENT][NEUTRAL] Hold on 1 2nd.
[AGENT][NEUTRAL] Holy [PII].
[CUSTOMER][NEUTRAL] Yeah, the dates confused me.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, that's
[AGENT][NEUTRAL] The OP, OK, so it's a combined benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] With the IP.
[AGENT][NEUTRAL] And you're looking at the OPI, I say combined OP IMAX.
[AGENT][NEUTRAL] Yeah, yes, yes, both times it's 2500.
[AGENT][NEUTRAL] But it's individual.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, because the benefits stay the same, just say it looks like he just dropped a couple and, and, you know, went from.
[AGENT][NEUTRAL] Went from one, went from individual to couple in 2000.
[AGENT][NEGATIVE] I'm so confused what I'm looking at.
[CUSTOMER][POSITIVE] Well, good, I'm glad. I thought it was just me, cause I'm like, OK, was it uh starting in January and terminate in February, but I mean.
[CUSTOMER][NEGATIVE] My dates are backwards.
[AGENT][NEUTRAL] I don't know. Oh my gosh, let me go look.
[AGENT][NEUTRAL] Let me pull up another screen with notes.
[CUSTOMER][NEUTRAL] I've been scratching my head for too long. I said, nope, I gotta ask.
[AGENT][NEUTRAL] OK. I hate to tell you, but I think you got the wrong person. OK. What's the date of your claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 52924.
[AGENT][NEUTRAL] So it would have been the couple coverage.
[AGENT][NEUTRAL] What did they do here?
[CUSTOMER][NEUTRAL] And usually there's notes in my end to tell me, but I'm not seeing them. Maybe I'm missing them.
[AGENT][NEUTRAL] Reactivated spouse.
[AGENT][NEUTRAL] We'll send excuse me, we'll send request to group bill for termination.
[AGENT][NEUTRAL] And to remove from invoice.
[AGENT][NEUTRAL] Requests to terminate both insured and spouse.
[AGENT][POSITIVE] Goodness.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] Looks like they.
[AGENT][NEUTRAL] Goodness, [PII]'s notes go back and forth. Um, her hub from.
[AGENT][NEUTRAL] Requests from group email drops fouls effective [PII].
[AGENT][NEUTRAL] Then it comes back.
[AGENT][NEUTRAL] And says request to terminate both the insured and spouse.
[AGENT][NEUTRAL] 1 3125.
[AGENT][POSITIVE] Um, I'm sorry for proofing in your ear.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, you're fine. I think we need a vacation.
[AGENT][POSITIVE] Honey, I know we do. Oh Lord have [PII]. Um, all right, then we came back the same day.
[AGENT][NEUTRAL] 3 minutes later, reactivated spouse will send.
[AGENT][NEUTRAL] Not sure.
[AGENT][NEUTRAL] Looks like they had couple coverage from 200124.
[AGENT][NEUTRAL] From [PII].
[CUSTOMER][NEUTRAL] Cause I'm looking and I was just so.
[AGENT][NEUTRAL] I don't know why she got that second term on that one. OK. OK, what it is, she, she was changed it to individual then came back and
[AGENT][POSITIVE] It's that extra it's that extra.
[AGENT][NEUTRAL] Benefi date of [PII] my goodness. Let's see if we got a, if I said [PII] left at [PII]. Oh my [PII]. OK.
[AGENT][NEUTRAL] Wait, she's still available. Why is she still on the phones?
[AGENT][NEUTRAL] She leaves at [PII].
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Let's get.
[AGENT][NEUTRAL] Let me see if I can figure out how to join Ms [PII] to this call.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I just saw her picture, there it is.
[AGENT][NEUTRAL] OK, let's
[AGENT][NEUTRAL] And or phone.
[AGENT][NEUTRAL] All right, give me just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome, dear. Hold on one second, here we go.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello, thank you for calling APS. This is [PII].
[AGENT][NEUTRAL] Hey, [PII]. Hey, [PII], this is [PII]. Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can you get a policy with us, please?
[CUSTOMER][NEUTRAL] Sure. Give me just a second. Let me change it to
[CUSTOMER][NEUTRAL] Is call. OK, OK, what you got?
[AGENT][NEUTRAL] OK. Uh, 246.
[AGENT][NEUTRAL] 7113.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We are looking at the um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What am I trying to say? The uh PIBFT screen. Uh, [PII], I have her on the phone too from claims.
[AGENT][NEUTRAL] And are you still good too how somebody lose you.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Um, we are trying to figure out, um, on the OP IMAX for a claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] It's confusing because it looks like they dropped at it, dropped at it. We're not sure what we're looking at in PIBFT at the OP IMAX.
[CUSTOMER][NEUTRAL] So IMAX.
[AGENT][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Uh yes mhm.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Will you explain to your claim that you're needing once she gets that pulled up.
[CUSTOMER][NEUTRAL] Couple.
[CUSTOMER][NEUTRAL] Yes, I'm just trying to verify if the outpatient has always been 2500. We know sometimes they change. This is the Metlink 9, so these are the newer plans. The system is not calculate, so we have to manually calculate, so we wanna make sure.
[CUSTOMER][NEUTRAL] There was no change in benefits for outpatient is outpatients still 2500 because if you look at these dates you have a starting in [PII] and terminating [PII] we go individual we got couples so I'm just trying to verify that.
[CUSTOMER][NEUTRAL] On PIB.
[CUSTOMER][NEUTRAL] OK. Uh.
[AGENT][NEGATIVE] Yeah, it, I got hung up on the dates. I couldn't even get past that, so.
[CUSTOMER][NEUTRAL] Yes, it's kind of, um, it probably started as individual and then they made the change to add the spouse back uh like since the beginning of the coverage um I'm trying to figure it out as well. Let me see [PII], OK. And I think it's just the dates for me.
[CUSTOMER][NEUTRAL] OK, yes, it.
[CUSTOMER][NEUTRAL] The couple coverage was from [PII] until [PII]. Let me just verify, um, with the payment if this is correct. I have to take a look at it.
[CUSTOMER][NEUTRAL] What they were sending to us. Yes, it was all uh couple coverage, um, since [PII], like for a whole year. Now I will verify if they changed plan.
[CUSTOMER][NEUTRAL] So, so [PII] should just start dates like the second line I'm looking at [PII] to 24 and it's term 131 to 24 are those backwards?
[CUSTOMER][NEGATIVE] Um, yes, what happens is that they made the change, um, let me, I already lost the policy.
[CUSTOMER][NEUTRAL] Um, they probably made the change and sometimes the system gets a little bit um confused with those change dates and they make uh like they make another set of benefits even though they're dra drafted, sorry, dropped. Mhm. It's just an extra set of benefits, but they were not um.
[CUSTOMER][NEGATIVE] They were not effective.
[CUSTOMER][NEUTRAL] Let me, OK, it's this one.
[AGENT][NEUTRAL] It's almost like one of those lines needs to be gone and then the dates need to.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Be the like [PII] starting date [PII], end date [PII], you know.
[CUSTOMER][NEUTRAL] Yes, so
[CUSTOMER][NEUTRAL] Yeah, it's. Kind of.
[AGENT][NEUTRAL] Because the 3rd 1 turned a year before it even started. I'm like, oh my [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, it has that date. So, I'm pretty much saying that it never became effective. Um, that's what it is, but yes, the coverage was always in that, was it 25?
[AGENT][NEUTRAL] 25 so they were all should have always been couple coverage. They dropped the spouse and re-added, and they should have always been couple coverage regardless.
[CUSTOMER][NEUTRAL] 100
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes. Mhm. Yes, that is it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I, the dates were turning me around so bad. I couldn't move on to the 2500 but like I was just.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, I didn't know what, I wasn't sure what was happening here.
[CUSTOMER][NEUTRAL] So imagine trying to explain something I couldn't.
[AGENT][NEUTRAL] Right, yes, but yes, so we're going with the, the OP IMAX 01, I mean, I'm sorry, [PII] to [PII] 01 [PII] couple for 2500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just to get disregard the individual stuff altogether, right?
[CUSTOMER][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Mhm, yes, it will cancel um those weren't effective and also like if um you look at the payments in that BQPHI screen they have the 141 paid.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Since [PII], all the way to [PII], which means that the couple coverage was paid for a whole year.
[AGENT][NEUTRAL] Oh, I see that now. Yes, it never changed to end up to an individual, the rate never changed from couple. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it never changed.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Holy moly.
[CUSTOMER][NEUTRAL] I'm looking like, where y'all at? I don't have access.
[AGENT][NEGATIVE] I don't work these screens.
[CUSTOMER][NEUTRAL] I can't see that
[CUSTOMER][POSITIVE] OK well I appreciate you ladies.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Certainly, thank you, [PII] for helping us.
[CUSTOMER][POSITIVE] You're welcome. I'm glad to help you. You're welcome. I'm glad to help. Thank you.
[AGENT][POSITIVE] All right. You both have a good day.
[CUSTOMER][POSITIVE] You as well thanks, [PII] bye bye. Bye.
[AGENT][POSITIVE] Thanks, bye. Thank you, bye.