AccountId: 011433970860
ContactId: 8179ef02-ed5d-4400-bc5c-b091946a013d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533020 ms
Total Talk Time (AGENT): 203667 ms
Total Talk Time (CUSTOMER): 198453 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/8179ef02-ed5d-4400-bc5c-b091946a013d_20250320T13:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you doing?
[AGENT][NEUTRAL] Overwhelmed this morning. How about yourself?
[CUSTOMER][POSITIVE] Oh, man. I'm sorry. I'm about to, I'm sorry.
[AGENT][NEUTRAL] No, it's so it's so fine. It's fine. It's just other folks are in some meetings and I'm like the only one on the phones right now, so it's just one after the other.
[CUSTOMER][NEUTRAL] I'm so sorry. I got a bad one.
[AGENT][NEUTRAL] What's up, love?
[CUSTOMER][NEUTRAL] So I called customer service and we looked at it and they're like, oh my [PII], we gotta call group billing. So can you look at this with me?
[AGENT][POSITIVE] Absolutely. What's up?
[CUSTOMER][NEUTRAL] OK, so it's 242.
[CUSTOMER][NEUTRAL] 5420.
[CUSTOMER][NEUTRAL] Um, but really, so is that one and then the policy that's active.
[CUSTOMER][NEUTRAL] So there's some issues with her payments, overpayment, the group paying.
[CUSTOMER][NEUTRAL] And the policy that I gave you is showing it lapsed [PII].
[CUSTOMER][NEGATIVE] But, and the next policy doesn't become active until September. She has a claim that's being denied saying that the coverage wasn't effective.
[CUSTOMER][NEUTRAL] But this looks like this policy was supposed to be.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And we're trying to figure out what the billing issue.
[CUSTOMER][NEUTRAL] So we can know if this is supposed to be active or not, so we know if we need to reprocess the claim.
[CUSTOMER][NEUTRAL] But can I check back with her cause I asked her if she wanted me to call her back and she wants to hold.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yeah, let me look while you're doing that.
[CUSTOMER][NEUTRAL] OK, hold on one second, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello [PII].
[AGENT][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] Hey. She ended up um saying, yeah, you can call me back. At first, she was like, baby, I'm on spring break, do what you gotta do.
[AGENT][POSITIVE] Oh good.
[AGENT][POSITIVE] Oh, I love people like that.
[CUSTOMER][NEUTRAL] I said, OK.
[AGENT][NEUTRAL] OK, so it looks like on the notes on that first one you gave me that um it was lapsed due to uh being overdue.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me take a look at um the other one, the, the one that's open now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Because you want me, actually they say you want me to wait.
[CUSTOMER][NEUTRAL] I don't wanna mess up what you're looking at.
[AGENT][NEUTRAL] Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll see higher.
[AGENT][NEUTRAL] So it looks like she lapsed and then picked back up. So, but that was 8:24. I'm sorry, what were you gonna ask?
[CUSTOMER][NEUTRAL] So she, uh, OK, so it's her and her daughter. The claim that was denied was for her daughter. She also has a claim the same, um, she also has a claim, and she's saying that claim was paid too, but hold on, actually, before I say that, go ahead, do what you're doing. I'm sorry. I'm gonna look at that data service cause she's like, well, my claims are paid, but just because you sent them in on the same day doesn't mean it's the same day of service.
[AGENT][NEUTRAL] Right, it's the date of service, yeah.
[CUSTOMER][NEUTRAL] So let me make sure first.
[AGENT][NEUTRAL] It looks to me like she lapsed in 24.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then on their open enrollment, she
[AGENT][NEUTRAL] She got a new policy. At least that's what it looks like to me.
[CUSTOMER][POSITIVE] So this is right.
[AGENT][NEUTRAL] Well, the only thing I, I wonder about is, um, let me go back to that other one. The, the one that she, the first one you gave me that, uh, 542, the old one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The notes
[AGENT][NEUTRAL] It says, oh.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Labs insure, it says that she called in August, insured called to verify if we received her correct banking information for premium.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But that wasn't like mid August, so.
[AGENT][NEUTRAL] It was probably during the open enrollment where she wanted to make sure we had the right information.
[AGENT][NEUTRAL] No, that was the old one, [PII].
[AGENT][NEUTRAL] I don't know, we, we lapsed it in August.
[AGENT][NEGATIVE] Due to um overdue, being overdue.
[AGENT][NEUTRAL] Let me see if we have anything in suspense for her. I don't.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] And there's nothing in individual suspense.
[AGENT][NEUTRAL] 8
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He are [PII].
[AGENT][NEUTRAL] Oh gosh.
[AGENT][POSITIVE] That's all right. I got it.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] Oh good, great, there's a lot in suspense for this group.
[AGENT][NEUTRAL] Let's see, [PII].
[AGENT][NEUTRAL] I don't have anything like that can be applied to her policy. So we, we're not just holding on to anything that maybe it was an over or underpayment or while it was lapsed or anything.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It appears that she allowed it to lapse in um mid [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then it's around, it says April we pay it was paid too and she allowed it to lapse and then we we lapsed it because of nonpayment and then
[AGENT][NEUTRAL] The effective dates of all of her policies are in September so something that's their open enrollment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um she, her new policy started in [PII].
[AGENT][NEUTRAL] So I'm thinking she allowed it to lapse.
[CUSTOMER][NEUTRAL] Wait, wait, wait, wait, wait.
[AGENT][NEUTRAL] Because it was definitely.
[CUSTOMER][NEGATIVE] OK, [PII] April, something ain't right, because
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's lapsed.
[CUSTOMER][NEUTRAL] Sorry, I'm looking at, she keeps, when I, I'm just trying to prepare for when I call her back.
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, because she, she keeps saying like, but it was never lapsed, and I'm like, and, and you paid my claims, so I'm trying to, I'm just trying to get out.
[AGENT][NEUTRAL] What were the dates of service love?
[CUSTOMER][NEUTRAL] So these are [PII].
[AGENT][NEUTRAL] Well, that should be covered.
[AGENT][NEUTRAL] Because her her new her policy that she has now, um, it started in [PII].
[CUSTOMER][NEUTRAL] Yeah, but I'm on the
[CUSTOMER][NEUTRAL] Hold on. I don't wanna confuse myself.
[AGENT][NEUTRAL] Wait, let's see, that's group, uh, cancer? Is that cancer? 37,270, yeah, so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] No what
[AGENT][NEUTRAL] First, the
[AGENT][NEUTRAL] I don't know what that covers.
[CUSTOMER][POSITIVE] Oh, I got it. I got it.
[CUSTOMER][NEUTRAL] So, OK, I got it. So yeah, if everything, I just want to make sure everything is correct on our end. So,
[CUSTOMER][NEUTRAL] Policy was lapsed from April to September. Her claims, the ones that we did pay out on were correct because they were on the new.
[CUSTOMER][NEUTRAL] This new policy, yes, they were on the new policy.
[CUSTOMER][NEUTRAL] And it's December. Her daughter's is July, and I mean that just happens to be in that little break.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yep, that's exactly what it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, and if she gives me any pushback, I will just take it from there, but it makes perfect sense to me now.
[AGENT][NEUTRAL] Yeah, so she, they allowed her, her old policy to lapse and like you said, there's the, there's a time frame where that she had no policy and that's where her daughter's claims lie.
[CUSTOMER][POSITIVE] OK, we just want to get some clarity with all the payments and overpayment and blah blah blah, so thank you.
[AGENT][POSITIVE] No problem. I'm glad I could help.
[CUSTOMER][POSITIVE] I hope you have a good day.
[AGENT][POSITIVE] Thanks, you as well.
[CUSTOMER][NEUTRAL] All right. Bye-bye.
[AGENT][NEUTRAL] Bye bye.