AccountId: 011433970860
ContactId: 85dbdcb0-5f82-4720-bd5f-421007be30b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 845799 ms
Total Talk Time (AGENT): 262013 ms
Total Talk Time (CUSTOMER): 319118 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/85dbdcb0-5f82-4720-bd5f-421007be30b9_20250514T18:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Well, they didn't have those other two. Hi, my name is [PII]. I'm calling to get some information on a claim that was denied.
[AGENT][NEUTRAL] OK, is it for yourself?
[CUSTOMER][NEUTRAL] No, my husband and he's on the line to get the OK.
[AGENT][NEUTRAL] OK. Uh, do you have your policy number?
[CUSTOMER][NEUTRAL] 921-397
[AGENT][NEUTRAL] OK, and can you verify your, is it for your, you said it's for your husband, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And then [PII], can you verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your address and email address?
[CUSTOMER][NEUTRAL] [PII]. Yeah, email, I don't know, try I do nails or Big Mike [PII] or um try [PII].
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Yeah, I've got the I do nails. OK, and then are you authorizing your wife to speak on your behalf?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, and then [PII], you have a good call back number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Bye bye. Bye.
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and do you have that date of service for uh [PII]?
[CUSTOMER][NEUTRAL] January.
[CUSTOMER][NEUTRAL] Oh my [PII], where did it just go? [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII], I think it's, yeah.
[CUSTOMER][NEUTRAL] Yes, it's an emergency.
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] Emergency room.
[AGENT][NEUTRAL] All right, let me get that pulled up. Give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Let me see if I can refund it. No, that would be too easy.
[AGENT][NEUTRAL] OK, looks like we got
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Should have been from owner Health.
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] Uh, let's see. So it looks like we were waiting on eligibility from the employer.
[AGENT][NEUTRAL] Um, to confirm that the policy was active.
[AGENT][NEUTRAL] Let me see what we got.
[CUSTOMER][NEUTRAL] Yeah, it should have been active till [PII].
[CUSTOMER][NEUTRAL] Wonder, wonder, wonder.
[CUSTOMER][NEUTRAL] Which I don't.
[AGENT][NEUTRAL] OK, yeah, I, it looks like that's what we were waiting on. We had, we were waiting from notification from benefits that a card.
[AGENT][NEUTRAL] Um, regarding
[AGENT][NEUTRAL] That the policy should be active through [PII] or [PII].
[AGENT][NEUTRAL] So it looks like we haven't received it yet. Once, once we get that, then we can continue processing the claim.
[CUSTOMER][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] Um, but that's what we're waiting on.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Is there any way that
[CUSTOMER][NEGATIVE] It can be resent.
[CUSTOMER][NEUTRAL] To them, so that it's more, you know, updated in their, in their face and then I'm gonna email the person.
[CUSTOMER][NEUTRAL] Also,
[AGENT][NEUTRAL] Um, I can, I can transfer you over to benefits in a card, um, because they do handle, you know, your, your policy being active. So, do you want me to do that and see if you can talk to someone that could help about getting that sent to us?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now they'll probably, well, now that I think about it, they're probably gonna need [PII] on the line.
[AGENT][NEUTRAL] Um, would you be able to get him back on the line if they need him?
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Hard to say. He's at, he's at work, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I, I, all I can do is cry.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] OK, OK, well let me uh let me get you transferred over there. Hold on one moment, OK?
[CUSTOMER][POSITIVE] OK, thanks.
[CUSTOMER][NEUTRAL] Welcome to Benefits in a card.
[CUSTOMER][NEUTRAL] For English, press one.
[CUSTOMER][NEUTRAL] Para espanol pres.
[CUSTOMER][NEUTRAL] Your call may be recorded for quality control purposes.
[CUSTOMER][NEUTRAL] Thank you for calling Benefits in a card. This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] Hi, um, this is [PII] with American Public Life, and we've got a mutual member together. They are, we haven't been able to process their claims because we're waiting on BI to confirm eligibility. So I wanted to check on that um and see what's going on.
[CUSTOMER][NEUTRAL] OK. So the only thing I could, the only thing I will be able to provide to you is the date of the.
[CUSTOMER][NEUTRAL] service
[CUSTOMER][NEUTRAL] The member was active um because the back office is the one that send out those files to you guys.
[CUSTOMER][NEUTRAL] Um, let's see, and who.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You the member work for.
[AGENT][NEUTRAL] Uh, I worked for.
[AGENT][NEUTRAL] Barnett's towing.
[AGENT][NEGATIVE] Oh, that's not right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is that one of your groups?
[CUSTOMER][NEUTRAL] It doesn't sound familiar, but let me check if I have any aliases on that on there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] White ne, is that right?
[AGENT][NEUTRAL] Yeah, [PII]'s towing, but
[CUSTOMER][NEUTRAL] I don't have any
[AGENT][NEUTRAL] OK, I'm looking at the.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] And at the date and I or the group number and it just not a big number. OK. OK, well, thank you so much.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] Thank you, bye-bye.
[CUSTOMER][POSITIVE] No problem. Thank you. Bye.
[AGENT][NEUTRAL] OK, uh, [PII], actually, let me, uh, I don't show, does he work for [PII]'s Towing, is that right?
[AGENT][NEUTRAL] Or did
[CUSTOMER][NEUTRAL] He did, yes. Yeah.
[AGENT][NEUTRAL] OK. OK. Well, I'm not sure why they put benefits in a card cause that's not related to that. So, um, let me check with our claims department real quick and see what's going on, if you don't mind holding just a little bit longer.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[AGENT][NEUTRAL] Um, hey, [PII], it's [PII] on the care team. I wanted to see if you could help me with a claim.
[CUSTOMER][POSITIVE] Sure, [PII], I'd be glad to help.
[AGENT][NEUTRAL] Uh, let's see, it's policy 00921397.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me one moment please.
[CUSTOMER][NEUTRAL] For a [PII].
[AGENT][NEUTRAL] Yes, um, it's the most recent claim on there, 3572082 for him.
[AGENT][NEUTRAL] It says pending waiting big eligibility, but this isn't a big group.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] That is definitely not the correct remark code.
[CUSTOMER][NEUTRAL] Um, let me just take a look here.
[AGENT][NEUTRAL] Sure, what happened?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I think the adjuster just used the incorrect remark code but let me check some information bear with me for just a moment.
[AGENT][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] OK, so actually this isn't the incorrect remark code. It does say not for B.
[CUSTOMER][NEUTRAL] Um, on the remark code it's pending for the premium, and what that means is that we haven't received the premium there must not be let me just check some information.
[AGENT][NEUTRAL] Oh, not for B. OK, sorry, my bad.
[CUSTOMER][NEUTRAL] So it's, it's not for big, yeah, I was when I was looking at that code I'm like wait a minute, usually the BIC is 5, I see 00567, I think they are 05 06 and 07, and then the 0102 03 and the reason why they're in sequence like this because they send that first notice if it was changed to a 2 would be the second notice and so on and so forth. So let me just check some information here though so it is pending for that premium.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Do I
[AGENT][NEUTRAL] Do I tell them to contact their employer?
[AGENT][NEUTRAL] Is that, I guess what I would tell them?
[AGENT][NEUTRAL] I don't know what to tell them.
[CUSTOMER][NEUTRAL] Yeah, I'm checking some information to see it's not they don't pay in arrears, so, um, I was just checking to make sure that I wasn't overlooking anything. So yes, what happens is, and a lot of times they're gonna say, well, I'm not sure if he's a, he's not a self pay, right? Do we know?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] No, uh.
[CUSTOMER][NEUTRAL] Because they'll have that designation that they're paid for it by the group, so the group is obviously they probably have it taken directly out of their paycheck and a lot of times that's what they're gonna say but unfortunately yeah we're waiting for the group to uh uh pay their premium if he's not paying it says mode of payment one so.
[AGENT][NEUTRAL] Yeah, that's true, so, OK.
[CUSTOMER][NEUTRAL] Yeah, so we're just waiting for the group to, uh, send the premium and because as of right now the only it's only paid to date is [PII] and because this data service is, uh, obviously it's past that [PII], there is not, uh, um, they don't pay in arrears. Some groups pay in arrears so we can go ahead and push that claim through, but in this situation it looks like we do need that premium before we can continue processing for that date.
[AGENT][NEUTRAL] OK, OK, I'll tell her to contact the human resources then. OK, perfect. Thank you for looking at that. Sorry, I, I'm sorry I didn't look closer. Sorry about that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that's perfectly fine.
[CUSTOMER][NEUTRAL] We're all learning
[AGENT][POSITIVE] Thank you so much. Have a great day.
[CUSTOMER][POSITIVE] Every day is a learning opportunity. [PII] you too.
[AGENT][POSITIVE] I, I'm telling you, that's right. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] OK, I'm so sorry about that. Um, thank you for holding. I appreciate it. Yeah, so it looks like that's what we are waiting on that actually is accurate. Um, we're waiting on the premium for January. So what I would suggest is when [PII] has some time to contact your human resources at Barnett's and see what's going on, yeah, we have, OK, yeah.
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Yeah, I'll, yeah, I can do that. Um, OK, so, so January.
[CUSTOMER][NEUTRAL] Uh, so you guys didn't receive the, the actual.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Oh my gosh, Premium.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, premium.
[CUSTOMER][NEUTRAL] OK, for January.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Alright, I'll, I'll email uh her and uh see what happened.
[AGENT][NEUTRAL] OK, OK, anything else I can help with today?
[CUSTOMER][NEUTRAL] Um, I don't think so.
[AGENT][POSITIVE] OK. All right. Well, thank you for.
[CUSTOMER][NEUTRAL] How much is the premium?
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] For that month.
[CUSTOMER][NEUTRAL] You know?
[AGENT][NEUTRAL] Uh, no, we don't keep the premium amounts on file, so you'll have to check with um the human resources, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. All right. I will, um, I will do that right now.
[AGENT][POSITIVE] OK, thank you so much. Thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too bye bye.