AccountId: 011433970860
ContactId: 80908f2c-4cf6-42a5-8284-a79c6884ccd6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 894630 ms
Total Talk Time (AGENT): 366319 ms
Total Talk Time (CUSTOMER): 255108 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/80908f2c-4cf6-42a5-8284-a79c6884ccd6_20250617T19:36_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, this is [PII] over on the care team how are you?
[AGENT][POSITIVE] I'm good and you?
[CUSTOMER][NEUTRAL] Doing all right thank you um so I've got a member on the line who I get looks like we've been going back and forth with her like crazy and frankly I'm not sure if this is something.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For you or not, uh, long story short, their policy, it's showing that it terminated [PII]. Um, she has a claim that was denying that date of service was [PII], but she's arguing that she had COBRA during that time and that she'd been speaking with [PII] and [PII], um, and she sent all the documents to us and I guess it was resubmitted but it was processed as a duplicate, so I'm not quite sure.
[AGENT][NEUTRAL] OK, what's your policy number?
[CUSTOMER][NEUTRAL] Yes, that is uh 1912737.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We um on
[AGENT][NEUTRAL] And is it for
[CUSTOMER][NEUTRAL] So we are speaking with uh [PII] the part two. The claim in question is for part 3.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you can send her on over.
[CUSTOMER][POSITIVE] OK I appreciate your help thank you.
[AGENT][POSITIVE] Alright, no problem.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Good good afternoon. Thanks for calling ATO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. [PII] put me on hold. She was trying to check um something that's going on with uh the plan.
[CUSTOMER][NEUTRAL] For quite a few claims. I don't know if you, she's there.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, she transferred you, uh to me to see if I can help you, uh, further with your uh with your questions.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK, [PII]. So this is what's going on. Um, we submitted a few claims and one of the claims that we submitted, I got uh an EOB from APL saying that I'm gonna read exactly what it says.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It says these services were rendered after coverage was terminated. OK, we, my husband's, uh, he changed jobs, they sold his uh previous employer sold the business, so my husband stayed with the same plan through COA. We paid the COA plan until [PII], and then until [PII], we started with a new plan.
[CUSTOMER][NEUTRAL] So this data service is 111-2024. So for some reason when I spoke to the last agent that I spoke on [PII], they told me that the reason was they never updated the COBRA benefits in your system. So they were supposed to fix. They asked me to fax the documents, the benefits letter from the COBRA stating that we had APL and.
[CUSTOMER][NEUTRAL] Humana as our primary. I did, I faxed and I emailed all of those documents, including also the EOBs from Humana and the doctor's notes and the medical, everything. I emailed and faxed to you guys. Never heard back from the agent from APL, so I decided to call back again today, and [PII] was really super nice, but she put me on hold. I didn't know if she was gonna transfer me. So that's the issue that we're having.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like the claims were denied.
[AGENT][NEUTRAL] Uh, of course, as you stated because there was no coverage after for that data service, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it looks like someone was speaking with you.
[AGENT][NEUTRAL] Uh, there's like the group terminated business with us and uh they're no longer in business.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And so they were unable to reach out to the group.
[AGENT][NEUTRAL] To to even see if they sent anything over to us because the group would have had to send the information over to us. So who did you pay when you were paying Cobra you were paying it to the group, is that correct?
[CUSTOMER][NEUTRAL] We were, we were paying to the, I mean, whoever gave us the documents, you know, to fill out for Humana and for APL. And we had coverage through Humana just fine because I sent the EOBs from Humana for that data service. So Humana had no issues at all, and they were supposed to send you, you know, the same documents.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so it looks like Idly we did not get uh that information.
[AGENT][NEUTRAL] And so that's why your policy is only paid through [PII] and until we can verify.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you know, the payment for.
[AGENT][NEUTRAL] The month of January there would be nothing that we can do at this time.
[CUSTOMER][NEUTRAL] But I sent you proof. I sent you the documentation stating that it was paid and I send you the employee benefits, the information to contact them.
[AGENT][NEUTRAL] Uh, looks like she did try to contact the company but the company is no longer they're closed permanently.
[CUSTOMER][NEUTRAL] Employee Benefits Corporation?
[AGENT][NEUTRAL] Mhm. Let me.
[CUSTOMER][NEUTRAL] I spoke to them last week, so they're not close.
[AGENT][NEUTRAL] Uh, let's see, let me see if I can contact [PII] to see who did she contact, but she called.
[AGENT][NEUTRAL] The company, one second.
[CUSTOMER][POSITIVE] Of course. Thank you.
[AGENT][NEUTRAL] OK, can I put you on hold just one moment?
[CUSTOMER][POSITIVE] Of course. Yes, yes. Thank you, [PII].
[AGENT][POSITIVE] Alright thank you so much.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi [PII], how are you today?
[AGENT][POSITIVE] I'm good.
[AGENT][NEUTRAL] The, this is [PII] over in the claims department.
[AGENT][NEUTRAL] And can you look at some something with me please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the policy number is 191.
[AGENT][NEUTRAL] 273 7
[AGENT][NEUTRAL] And uh the the insured's wife is on the phone. It looks like Ms. [PII].
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Alright, just a second I was working on the phone.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] That's OK, uh, 191.
[AGENT][NEUTRAL] 2737.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And if you have the.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And so she's calling, uh, of course because she stated they uh the policy is on the page the [PII] and she's stating that they should have had coverage through the month of January, uh, because they were on COBRA and so it looks like that you explained to her that the group terminated with us and that the company closed permanently and she stated that the company did not close she talked to someone last week, uh, I, I don't know if that was with the group or what.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] So what would she need to send in or or how would we.
[AGENT][NEUTRAL] What we need to do to get her.
[AGENT][NEUTRAL] Uh, information.
[AGENT][NEUTRAL] Let's see because she said she sent in.
[AGENT][NEUTRAL] OK, I do remember.
[AGENT][NEUTRAL] Um, so.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] We can't um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] to the
[AGENT][NEUTRAL] They
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Any
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So uh do you know if anybody tried to call the cover administrator?
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Do you know if they will be reaching out again? And if she does, will she put something in notes that she tried to reach out?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] what
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I have
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] OK, alright.
[AGENT][NEUTRAL] OK, do you know if you are received because she faxed over some information from Employee Benefits Corporation.
[AGENT][NEUTRAL] Um, I guess where it looks like that she did pay for her pay through date is [PII]. I know that we can, we can't do anything until we actually get it.
[AGENT][NEUTRAL] Uh, the information.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] When
[AGENT][NEUTRAL] Uh, looks like it came over on let's see.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEGATIVE] OK, unfortunately, um.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] from there.
[AGENT][NEUTRAL] Because we do have to have that.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well I mean this is just something that she sent in to us showing proof that she paid uh that she paid and so that's why she's I guess I was trying to see if we're gonna try to contact them to see if we can get whatever.
[AGENT][NEUTRAL] You know, because she has been calling several times.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] She
[AGENT][NEUTRAL] Um, is there
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, I will do that.
[AGENT][POSITIVE] OK thank you I appreciate it.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] But
[AGENT][NEGATIVE] OK. All right, cause uh you know she's calling us and there's very little that we can tell her on this side and I don't wanna keep saying that somebody's trying to call cause now she's gonna be mad.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, alright, but let me, uh, get back to her and I let her know that we are trying to reach out to the covert administrator.
[AGENT][NEUTRAL] To verify that payment.
[AGENT][POSITIVE] OK alright thank you so much [PII].
[AGENT][POSITIVE] You're welcome you have a You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] Hi, Miss, uh Ms. [PII].
[CUSTOMER][NEUTRAL] Yes, yes, I'm here.
[AGENT][NEUTRAL] Thank you so much for holding and I do apologize for the wait. OK, I was speaking to someone in our customer service department and um they have been trying to reach out to the covert administrator so that they can verify that payment and try to get that payment sent over uh as of today they have not been able to reach anybody, uh, so they're gonna try to uh contact them again.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So maybe give us that I mean I know you're trying to get your client paid, but give us to the end of the week to see if we can try to contact somebody and uh to see if we can get something to get them to try to send something in.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Do you by any chance have the number that I've been trying to call?
[AGENT][NEUTRAL] I do not because I'm not in that department.
[CUSTOMER][NEUTRAL] OK. Is it possible for you to give me the information to that department so I can call them directly the next time?
[AGENT][NEUTRAL] OK, uh, you can just call the same number that you called.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And then instead of trying to instead of claims um just select I'm not sure what number it is for policy services.
[CUSTOMER][NEUTRAL] For policy?
[AGENT][NEUTRAL] Yes ma'am policy services.
[CUSTOMER][POSITIVE] Service. OK. Very good. Yeah. I'll find the number, um, the, the number to dial for th[PII]. OK. Very good, [PII]. Thank you so much. OK. So I'm just gonna wait a few more days, a couple of days, and then just give them a call then.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, was there anything else I can help you with on today?
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][POSITIVE] That was all. Thank you so much for your help. You have a wonderful afternoon.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You as well and thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] All right. Thank you.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.