AccountId: 011433970860
ContactId: 89c1a680-2280-48b0-b9a5-4f241798bfde
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1751569 ms
Total Talk Time (AGENT): 715393 ms
Total Talk Time (CUSTOMER): 644182 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/89c1a680-2280-48b0-b9a5-4f241798bfde_20250320T13:28_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was, I had a question.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I submitted in a wellness claim for my daughter.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I was trying to see um had it been looked at if it's gonna be processed.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, how does it work?
[AGENT][POSITIVE] Well, I can definitely help you with the claim status. May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, Ms. [PII]. May I have a good contact number in case we're disconnected and your policy number?
[CUSTOMER][NEUTRAL] [PII] and the policy number is 2526414.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] All right, now I have you here. I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] Date of birth [PII]. The mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. Let me see what's going on with the claim. So it looks like we received 12.
[AGENT][NEUTRAL] 3 claims on the [PII]. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm, I'm just looking for the one for [PII].
[AGENT][NEUTRAL] Oh I'm sorry, I didn't go over to her. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what is hers, I see it here.
[AGENT][NEUTRAL] OK, it says the charges submitted are not payable because the services were rendered prior to the policy's coverage, effective date of coverage. Let me see what the data coverage is.
[CUSTOMER][NEUTRAL] And it couldn't go under the old policy or it has to be under the new policy?
[AGENT][NEUTRAL] Well, I'm gonna see what this data service I'm pulling up both of the, I'm pulling up the documents and the um I'm trying to see what the effective date was. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I want to get a service.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] So the date of service on this, the dates of service on this claim.
[AGENT][NEUTRAL] Um, it's [PII] and [PII], but the policy didn't become effective until [PII]. Did you have, uh, but you had a previous, Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I had a previous mhm.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait a minute.
[AGENT][NEUTRAL] No 24.
[AGENT][NEUTRAL] So then why didn't they just process it under the active policy?
[AGENT][NEUTRAL] She
[AGENT][NEUTRAL] There was no, OK, wait.
[AGENT][NEUTRAL] Can you do that?
[AGENT][NEUTRAL] Hold up.
[AGENT][NEUTRAL] 91 2023 4 15 2024, so there was a lapse in coverage.
[AGENT][NEUTRAL] From April to September.
[AGENT][NEUTRAL] Is she saying?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Let me go to this policy.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And then look and see if there's some notes there to see if it.
[AGENT][NEUTRAL] Was supposed to that policy.
[AGENT][NEGATIVE] From overdue.
[AGENT][NEUTRAL] OK, so something has been going on.
[AGENT][NEUTRAL] Something has been going on.
[AGENT][NEUTRAL] OK, so now the question is, do I need, do I need customer service?
[AGENT][NEUTRAL] Her group billing because she was on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] She was on.
[AGENT][NEUTRAL] What am I trying to say mode of payment one so that would be group billing. Oh right.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] All right, let me check back with her, tell her what I just, what I'm doing.
[AGENT][NEUTRAL] And then I'm gonna just start with
[AGENT][NEUTRAL] I'm gonna start with customer service.
[AGENT][NEUTRAL] Hello Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So I went to the old policy and I see some notes here. Um, so I, it's like there was something going on with your bank and you called a few times to see if we have the right bank information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm gonna reach out to customer service and see if this policy was supposed to be active or just to get an update because from what it looks, from how it's looking on how what I see, there's a lapse from [PII], so if that wasn't supposed to be, we need to fix that and reprocess this claim.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so, OK, I, OK, so I think the banking thing had was something totally different on me.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] I like the stuff that I put in for the [PII] about me it already went through for my bank.
[CUSTOMER][NEUTRAL] The stuff that I'm talking about for [PII].
[CUSTOMER][NEUTRAL] That's what I'm asking about for, mhm, mhm.
[AGENT][NEUTRAL] I understand your question. The, the, the reason of the denial is saying that the policy wasn't wasn't active, so I need to go back and figure out why the why her part of the policy wasn't active, but that's not my department, that's customer service.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, because that that's another question. OK, so.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] I had my daughter, my oldest daughter on my insurance because she was [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And she got drunk, she's [PII], she's [PII] now.
[CUSTOMER][NEUTRAL] How do I go back?
[CUSTOMER][NEUTRAL] So if she wants to claim some of her stuff from the old policy, can we do that or no?
[AGENT][NEUTRAL] Oh, yes ma'am. I'll just give you the policy numbers. You can file a claim at any time. We don't have a timely filing limit. So it would just, I'll give you the claim numbers and um the date, I'm sorry, not the date. I'll give you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do I do it or does she do it?
[AGENT][NEUTRAL] It doesn't matter. We won't know who's sending it in. I mean, she's gonna have to sign.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But she has
[CUSTOMER][NEUTRAL] Yes, she, but OK, so this was from all the way from [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I guess [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So if she had claims where she went to the doctor or where she um had checkups or whatever, can she get that or no, that wasn't affecting you. OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So that would be your very first policy. So I was saying I'm going to give you the policy number and the date that the dates that the policy was effective, so then you can look on her dates of service and, you know, to make sure that the policy was active on the date of service and you can file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so that policy number is 121.
[CUSTOMER][NEUTRAL] Uh-huh, I have it up here.
[AGENT][NEUTRAL] Oh, you got it? OK. So yeah, you can file.
[CUSTOMER][NEUTRAL] Alright, I have it up here. OK, but you're trying to figure out why Addison is not.
[AGENT][NEUTRAL] Right, so what I'm doing now, because you want to know the update on [PII]'s claim, so the, the denial reason on her claim is that the charges were submitted um before the policy was active. So I got to go back and see why it's not active for her because
[CUSTOMER][NEUTRAL] Active
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This says this new policy was active from [PII]. Was she on the old policy as well or just this policy?
[CUSTOMER][NEUTRAL] Yes, she, she's been on she's been on the [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, she was on the [PII] and then this one that's [PII].
[AGENT][NEGATIVE] Right, so I went back to see, well, why is her her part of the policy not active, but I can't answer that question. I need customer service because I just don't do that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm gonna reach out to customer service and, and so they can explain this to me because it looks like
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] From [PII], there was no between your two policies, there was no coverage. So I need to know if this is an error and we need to fix this and reprocess the claim or if this is right, but I need them to explain it to me.
[CUSTOMER][NEUTRAL] OK, but I'm looking at her name and I'm paying every month for her, so.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] So I need to see why her because even on, I mean it does say [PII], but if she's active, hold on, let me do this.
[CUSTOMER][NEUTRAL] I've been paying for Addison. I've been, I, for like I said [PII] I paid for it.
[CUSTOMER][NEUTRAL] For essence.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Myself and Addison.
[AGENT][NEUTRAL] Oh, and it says, yeah, I think this might be it. Let me reach out to customer service because even on the, the policy that was active before this one, it does say effective date [PII]. So I don't know, but I'm about to figure it out for you. Did you, do you want me to, are you OK with holding or do you want me to give you a call back?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Whatever helps you out. I'm, I'm, I'm right here. I, I'm on spring break. I don't have nothing to do.
[AGENT][NEUTRAL] You OK?
[AGENT][NEUTRAL] OK, um, well, hold on one moment. I'm just gonna call customer service on the other line and try to get some clarity, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, cause I don't know.
[AGENT][NEUTRAL] Let me make sure.
[CUSTOMER][NEUTRAL] Sing
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Thank you for calling the EPL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Yes, thank you, [PII]. I'm so glad I got you. How are you?
[CUSTOMER][POSITIVE] I'm good, dear. How are you?
[AGENT][NEUTRAL] I just shot my hands and like touchdown.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] It's so funny.
[AGENT][NEUTRAL] Um, so I need some help. Can you look at this policy with me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can, I can. This is [PII], right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, OK. I just went blank all of a sudden, oh, you know, we talked with so many people all day long, girl. Lord have [PII], especially y'all. You know, what's that number, dear?
[AGENT][NEUTRAL] Yes, it is
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So it's 252-6414.
[CUSTOMER][POSITIVE] Thank you, Miss [PII], let's see what we got going on here.
[AGENT][NEUTRAL] OK, but go to CUI and Q though.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me go there too.
[AGENT][NEUTRAL] OK, so there's a claim on the active policy for part 2.
[AGENT][NEGATIVE] That's being denied because it says the policy wasn't effective on the data coverage, which technically it wasn't because this policy didn't become effective until [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] There had to have the policy, I mean above it, that lapsed in April, so it's a little lapse there. Is this a true lapse because she's, I looked in the notes, there was some issues with the
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, so I don't know if this is a
[AGENT][NEUTRAL] Because the mom is like, well, I've been paying. She, I wasn't laps, she shouldn't have been lapsed and I'm like, well, hold on, let me try to figure this out.
[CUSTOMER][NEUTRAL] See, there's a future lapse in that policy of 912, 91.
[CUSTOMER][NEUTRAL] 2024 if you go to the um.
[CUSTOMER][NEUTRAL] To the one that turned 4-15-2024.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It has a future lapse save 912, but it got lapsed.
[CUSTOMER][NEUTRAL] They got laps from over [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You go back and look.
[CUSTOMER][NEUTRAL] I'm wondering
[CUSTOMER][NEUTRAL] Oh gosh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I believe this is going to be a billing issue this policy and premium is right we are received the correct.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Premium now she did not want any surprises.
[AGENT][NEUTRAL] Oh Lord.
[CUSTOMER][NEUTRAL] Let's let's go back 66.
[CUSTOMER][NEUTRAL] So it got 82 and she called to verify if we received her correct banking info for premium.
[CUSTOMER][NEUTRAL] says that MOP was one transferred her to group billing.
[CUSTOMER][NEUTRAL] And that was 81, I mean 812.
[CUSTOMER][NEUTRAL] A 24
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] I, I didn't know if I should call group billing or because of this particular policy if I should call customer service, but.
[AGENT][NEUTRAL] You see what I see?
[CUSTOMER][NEUTRAL] And wanted to be sure she wasn't going to end up owing later on the year for the correct monthly premium.
[CUSTOMER][NEUTRAL] And let her
[CUSTOMER][NEGATIVE] No, the premiums being overpaid.
[CUSTOMER][NEGATIVE] And we have sent her a refund for this.
[CUSTOMER][NEUTRAL] Did let her know it looked like the group has recently corrected.
[CUSTOMER][NEUTRAL] Advise her to double check with her employer to be sure.
[CUSTOMER][NEUTRAL] another.
[CUSTOMER][NEGATIVE] Oh my gosh, it's this poor woman's policy being overpaid on and then that term for not being paid on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] See overpayment 1080 if you go like to April 1080, 1080.
[AGENT][NEUTRAL] And you saw the one for 1820?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So why
[CUSTOMER][NEUTRAL] Oh my God.
[CUSTOMER][NEGATIVE] Yeah, this is, I hate to tell you, Miss. [PII].
[AGENT][NEUTRAL] No, it's fine. I didn't know which one. It's fine.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] That bank info added for policy was that bank info added for the payment or let's look at her bank info, see if she should have been being drafted or.
[CUSTOMER][NEUTRAL] Sometimes stuff gets put in there if it's, you know, for the um
[CUSTOMER][NEUTRAL] Payment from claims or whatever, but people really want a bank draft.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I'm not seeing
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Oh God. Yeah, check if I am so wrong, I am, I am so sorry if I am wrong, but I really believe this is going to be.
[AGENT][NEUTRAL] Group billing?
[CUSTOMER][NEUTRAL] Group billing you should know.
[AGENT][NEUTRAL] Yeah, I, I was between the two. I, yeah.
[AGENT][MIXED] I get it, it's OK because I'm confused.
[CUSTOMER][NEGATIVE] The group needs to send back that, those refunds and get this policy called.
[AGENT][NEUTRAL] So, so after, so
[AGENT][NEUTRAL] OK, um
[AGENT][NEUTRAL] So I'm gonna go to group billing. Group is group billing gonna be able to tell me if this
[AGENT][NEUTRAL] If the lapse policy was supposed to be active?
[CUSTOMER][NEGATIVE] Well, it should, the last policy should have been paid through to 9 what, even though I know the notes.
[CUSTOMER][NEUTRAL] Excuse me. The notes state that the term due to not being paid, you know, lapse from overdue report.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh my gosh.
[AGENT][NEUTRAL] Because if this, if the lapse policy is supposed to be active till [PII], then we do need to reprocess this claim.
[AGENT][NEGATIVE] Because we're denying it.
[CUSTOMER][NEUTRAL] Uh, it looks
[CUSTOMER][NEUTRAL] Yeah, it looks like it.
[AGENT][POSITIVE] I'm gonna go to, you want me to go to, don't worry about it.
[CUSTOMER][NEGATIVE] See this, well, I'm trying, I don't, I can't even think it out like it looks like the group should have been paying on it until [PII].
[AGENT][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEGATIVE] I'm sorry and I'm just tying you up because it's uh I'm not sure what's going on with this.
[AGENT][NEUTRAL] No, it's fine. I asked her if she wanted to hold her if she wanted me to call her back. She said, baby, I'm on spring break, do what you gotta do, so I'm gonna do it.
[CUSTOMER][POSITIVE] Oh bless her bless her. OK, talk with billing first and I again I do apologize if I'm wrong.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, it's no problem at all. You want me to let you know what happened?
[CUSTOMER][NEUTRAL] You can't
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you, [PII]. Good luck, my dear.
[AGENT][NEUTRAL] Alright, bye.
[AGENT][NEUTRAL] Alright.
[AGENT][POSITIVE] See, I really do love my job, billing.
[CUSTOMER][NEUTRAL] Referring.
[AGENT][NEUTRAL] We're gonna get this in. Oh, you know what?
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hey, [PII], this is [PII] on the care team. How are you doing?
[CUSTOMER][NEUTRAL] Overwhelmed this morning. How about yourself?
[AGENT][POSITIVE] Oh man, I'm sorry, I'm about to, I'm sorry.
[CUSTOMER][POSITIVE] No, it's so it's so fun. It's fine. It's just other folks are in some meetings. I'm like the only one on the phones right now, so it's just one after the other.
[AGENT][NEUTRAL] I'm so sorry. I got a bad one.
[CUSTOMER][NEUTRAL] What's up, love?
[AGENT][NEUTRAL] So I called customer service and we looked at it and they're like, oh my God, we got to call group billing. So can you look at this with me?
[CUSTOMER][POSITIVE] Absolutely. What's up?
[AGENT][NEUTRAL] OK, so it's 242.
[AGENT][NEUTRAL] 5420.
[AGENT][NEUTRAL] Um, but really, so is that one and then the policy that's active.
[AGENT][NEUTRAL] So there's some issues with her payments, overpayment, the group paying.
[AGENT][NEUTRAL] And the policy that I gave you is showing it lapsed [PII].
[AGENT][NEUTRAL] 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.
[AGENT][NEUTRAL] But this looks like this policy was supposed to be.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And we're trying to figure out what the billing issue.
[AGENT][NEUTRAL] So we can know if this is supposed to be active or not, so we know if we need to reprocess the claim.
[AGENT][NEUTRAL] But can I check back with her because I asked her if she wanted me to call her back and she wants to hold.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Yeah, let me look while you're doing that.
[AGENT][NEUTRAL] OK, hold on one second. OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hey, I'm still here. I'm just checking on you. I just finished talking to customer service, now I'm on the line with group billing, but I'm getting to the answer, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] You sure you want to hold or you you OK or you want me to call you back? I just don't want.
[CUSTOMER][NEUTRAL] Uh, you can call me back.
[AGENT][NEUTRAL] OK, and is the [PII], that's the best number to call you back on?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK. As soon as I finish talking to [PII] and I get the answer, I'm gonna call you right back, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All right, you're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Hey.
[AGENT][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.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][POSITIVE] Oh, I love people like that.
[AGENT][NEUTRAL] I said, OK.
[CUSTOMER][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.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So let me take a look at um the other one, the one that's open now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Because you want me to actually say you want me to wait.
[AGENT][NEUTRAL] I don't want to mess up what you're looking at.
[CUSTOMER][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I hire
[CUSTOMER][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?
[AGENT][NEUTRAL] So she, 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 because 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.
[CUSTOMER][NEUTRAL] Right, it's the date of service, yeah.
[AGENT][NEUTRAL] So let me make sure first.
[CUSTOMER][NEUTRAL] It looks to me like she lapsed in 24.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then on their open enrollment, she
[CUSTOMER][NEUTRAL] She got a new policy. At least that's what it looks like to me.
[AGENT][POSITIVE] So this is right.
[CUSTOMER][NEUTRAL] Well, the only thing I, I wonder about is, um, let me go back to that other one.
[CUSTOMER][NEUTRAL] The, the one that she, the first one you gave me that uh 542, the old one.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The notes
[CUSTOMER][NEUTRAL] It says, oh.
[CUSTOMER][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Labs and it says that she called in August insured called to verify if we received her correct banking information for premium.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But that was in like mid August, so.
[CUSTOMER][NEUTRAL] It was probably during the open enrollment where she wanted to make sure we had the right information.
[CUSTOMER][NEUTRAL] No, that was the old one, [PII].
[CUSTOMER][NEUTRAL] I don't know, we, we lapsed it in August.
[CUSTOMER][NEGATIVE] Due to um overdue, being overdue.
[CUSTOMER][NEUTRAL] Let me see if we have anything in assistance for her. I don't.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And there's nothing in individual systems.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hes are [PII].
[CUSTOMER][NEUTRAL] Oh gosh.
[CUSTOMER][NEUTRAL] That's all. I got it.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Oh good, great, there's a lot in suspense for this group. Let's see, [PII].
[CUSTOMER][NEUTRAL] I don't have anything like that can be applied to her po[PII], 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.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It appears that she allowed it to lapse in um mid [PII].
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And then it's around it says April we paid it was paid too and she allowed it to lapse and then we we lapsed it because of nonpayment and then.
[CUSTOMER][NEUTRAL] The effective dates of all of her policies are in September so I'm thinking that's their open enrollment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um she, her new policy started in [PII].
[CUSTOMER][NEUTRAL] So I'm thinking she allowed it to lapse.
[AGENT][NEUTRAL] Wait, wait, wait, wait, wait.
[CUSTOMER][NEUTRAL] Because it was definitely.
[AGENT][NEGATIVE] OK, [PII] April, something ain't right, because
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's lapsed.
[AGENT][NEUTRAL] Sorry, I'm looking at, she keeps, when I, I'm just trying to prepare for when I call her back.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][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.
[CUSTOMER][NEUTRAL] What were the dates of service, love?
[AGENT][NEUTRAL] So these are [PII].
[CUSTOMER][NEUTRAL] Well, that should be covered.
[CUSTOMER][NEUTRAL] Because her her new her policy that she has now, um, it started in [PII].
[AGENT][NEUTRAL] Yeah, but I'm on the
[AGENT][NEUTRAL] Hold on, I don't want to confuse myself.
[CUSTOMER][NEUTRAL] Wait, let's see, that's group, uh, cancer? Is that cancer? 37,270, yeah, so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] No what
[CUSTOMER][NEUTRAL] The uh
[CUSTOMER][NEUTRAL] I don't know what that covers.
[AGENT][POSITIVE] Oh, I got it. I got it.
[AGENT][NEUTRAL] So, OK, I got it. So yeah, if everything, I just want to make sure everything is correct on our end. So,
[AGENT][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.
[AGENT][NEUTRAL] This new policy, yes, they were on the new policy.
[AGENT][NEUTRAL] And it's December. Her daughter's is July, and I mean that just happens to be in that little break.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yup, that's exactly what it is.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, and if she gives me any pushback, I will just take it from there, but it makes perfect sense to me now.
[CUSTOMER][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.
[AGENT][NEUTRAL] OK. We just want to get some clarity with all the payments and overpayment and blah blah blah, so, thank you.
[CUSTOMER][POSITIVE] No problem. I'm glad I can help.
[AGENT][POSITIVE] I hope you have a good day.
[CUSTOMER][POSITIVE] Thanks you as well.
[AGENT][NEUTRAL] Alright, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.