AccountId: 011433970860
ContactId: 9089613e-c632-4ee6-af18-648f2e66509f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1391430 ms
Total Talk Time (AGENT): 716887 ms
Total Talk Time (CUSTOMER): 472836 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/9089613e-c632-4ee6-af18-648f2e66509f_20250224T22:35_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] in the customer service department. How may I help you?
[CUSTOMER][POSITIVE] Hey [PII], this is [PII]. I'm so glad I've got you.
[CUSTOMER][NEUTRAL] I've got um I've got Miss [PII] on the phone and she is the broker for group number 18296.
[AGENT][NEUTRAL] Which yeah.
[CUSTOMER][NEUTRAL] She is calling about policy number 2426917 [PII].
[AGENT][NEUTRAL] Give me the number again.
[CUSTOMER][NEUTRAL] It's 242-691-7.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII] passed away.
[CUSTOMER][NEUTRAL] [PII]'s sister has been calling because she wants to file a claim.
[CUSTOMER][NEUTRAL] It's showing that the policy lapse date is [PII], so she's being told she can't file claims.
[CUSTOMER][NEUTRAL] After [PII], but he actually passed away on [PII] and [PII] on the other line with the broker's office is wondering if we can change that laps date because it's causing a lot of confusion with um the insured sister who is on the policy as a power of attorney and she's gone back to the school district and has complained to them.
[CUSTOMER][NEUTRAL] And [PII]'s trying to be the in between person so that.
[CUSTOMER][NEGATIVE] We don't get the school district up to that.
[AGENT][NEGATIVE] It's not paid because it's not paid current. It looks like it was supposed to term. We can't do, we can't change that, but I'll tell her we can't change none of that. They gotta pay premiums. Premium's not here, so I don't know what to tell her that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK all right thank you, [PII].
[AGENT][NEUTRAL] All right, what's her name again?
[CUSTOMER][NEUTRAL] Her name is [PII] and she's with the broker's office.
[AGENT][NEUTRAL] Yo, what's your call back number?
[CUSTOMER][NEUTRAL] Her callback number is [PII].
[AGENT][POSITIVE] OK, got you. Thank you.
[CUSTOMER][POSITIVE] All right, thanks [PII] bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.
[AGENT][NEUTRAL] Good afternoon, Ms. [PII]. This is [PII] in the customer service department. How are you doing today?
[CUSTOMER][POSITIVE] Hey [PII], I'm doing well. How are you doing?
[AGENT][POSITIVE] I am doing good, thanks for asking. Got the information pulled up um.
[AGENT][NEUTRAL] Ms. [PII] was explaining to me you were inquiring about the policy for, let me see, give me just a second. [PII].
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, from what she explained to me is that um.
[AGENT][NEUTRAL] There's a dilemma because he passed away on [PII] and I guess um Ms. [PII] is trying to submitting claims and they're being denied because of what he basically, what we have it basically paid to. Is that what I'm understanding?
[CUSTOMER][NEUTRAL] Well, I don't know that that's the case yet. um I think my understanding so far is that and it just happened to me so I'm assuming that definitely happened to her as well. She initially called to get a file a claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I don't know that she was told that it was, you know, I don't know, I'm making an assumption that his chemo and radiation may have been even prior to [PII], but when I just called and spoke um with the lady that transferred me, she basically told me that his policy terminated [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She did not, I guess, see or look further that he re-elected their open enrollment is [PII] every year and so yes, his original policy term then, but he elected a new policy. So it could be that that's what happened when [PII] called is she's being told that his policy turned a year before, um, so I don't know if that's, that's the problem. I don't know if it's the [PII] date versus the [PII] when he died, um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEGATIVE] The district is just reaching out to me because they're they're super frustrated because [PII] keeps coming back to them and she's saying she's having issues.
[CUSTOMER][NEUTRAL] Uh, my email that I got from APL today stated that you all received a um death certificate and a power of attorney and we're just like when did [PII] send that? Like how long have y'all had that? Is it been processed, you know what, just kind of where we are so we can try to help his sister understand what to do because she feels like she is not getting anywhere.
[AGENT][NEUTRAL] OK, so I think the dilemma in all of this was that the group, the state of [PII] went through two different transitions, one last year and one the year before that. Initially, Mr. [PII] has a 912021 GC4 policy um that was issued [PII].
[AGENT][NEUTRAL] That one did terminate 92023, 91 of 2023. But when it did, he picked up another policy verbatim. It's just we had to, I think what it was is we had to basically redo some of the terminologies on there. So the product and benefits and everything was the same. It's just the certificate language is different, but we had to redo a product code and that product code did get set up for 91 of 2023.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, that policy is showing paid to 81 of 2024.
[AGENT][NEUTRAL] And then it terminated and it looks like it terminated because we issued another policy because again they transitioned the group was leaving us so everybody that was, you know, decided they weren't gonna take the plan over we gave the insured the opportunity to convert everything um to an individual plan basis and that one did.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Get issued, but I guess because he passed away and we received the death certificate, it got canceled, but he does have coverage on the 242-6917. Um, that one was effective [PII] and it's paid [PII]. There is notes that it should have been canceled [PII], but it looks like because we didn't get that August premium.
[AGENT][NEUTRAL] That's why that one's not canceled as of [PII].
[CUSTOMER][NEUTRAL] OK, um, yeah, that, that makes sense, um, so.
[AGENT][NEUTRAL] Is that
[CUSTOMER][NEUTRAL] Obviously somewhat I don't know how many notes you can see, so when did you guys receive a power of attorney and a death certificate? Like how long back?
[AGENT][NEUTRAL] Let me see that
[AGENT][NEUTRAL] OK. Give me just a second.
[CUSTOMER][POSITIVE] OK thanks.
[CUSTOMER][NEUTRAL] We're just trying to figure out how [PII] got that to you guys but nothing else. We're just trying to uh wrap our head around this thing.
[AGENT][NEUTRAL] She probably send it to our customer service department, um.
[AGENT][NEUTRAL] Yeah, let me see how she sent it for sure. And it does look like we did get medical records or they requested medical records, claims did.
[AGENT][NEUTRAL] I think
[AGENT][NEUTRAL] Let me look at something real quick.
[AGENT][NEUTRAL] She sent the death certificate to our claims department on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm assuming that's something you guys require?
[AGENT][NEUTRAL] We ask for it if they're notifying us um that they're no longer, you know, they're.
[CUSTOMER][NEUTRAL] Oh wait.
[CUSTOMER][NEUTRAL] Yeah, she sent that [PII].
[AGENT][NEUTRAL] We do ask
[AGENT][NEUTRAL] The death certificate?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] No, it looks like claims has it documented that it came out on [PII], but she did call.
[CUSTOMER][NEUTRAL] Oh that, OK.
[AGENT][NEUTRAL] Yeah, she did call in [PII] and submitted in a power of attorney uh to us. It doesn't look like it was a death certificate, but it was the power of attorney is what she sent to us last year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, maybe she just says getting around to filing everything this year, um.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEGATIVE] Do you show notes where she was told that there was no benefit? because I think what I'm concerned about is that just like when I called they told me his policy term 91-2023 because they were only seeing that initial policy and they didn't see the second one that was issued at the same date.
[CUSTOMER][NEGATIVE] So I'm just trying to help her not get a person again that's going to tell her there's no benefits because they're looking at the original.
[CUSTOMER][NEUTRAL] Certificate versus the reissued 19123.
[AGENT][NEUTRAL] I wonder if her claim she submitted in were for 23.
[CUSTOMER][NEUTRAL] And well, no, I don't think so. I think he didn't die until [PII] and so I think she said and I think it was cancer, um, so I'm pretty sure everything is from [PII]. Has she even submitted a claim or do you just have the medical records and the power of attorney?
[AGENT][NEUTRAL] Let me see, the power of attorney. I know we got it too. Let me go back and see what claims. So they're two separate notes from two departments. Give me just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it looks like claim forms were received in [PII] and [PII], and that's why the POA.
[AGENT][NEUTRAL] Came about, um.
[AGENT][NEUTRAL] But according to her notes.
[AGENT][NEUTRAL] They received what they needed from the providers, but they needed more information. And then the policy terminated as [PII]. But if, as long as it was something prior to that.
[AGENT][NEUTRAL] Date that [PII] we should still be able to review and see if it's payable. Now the way that the information is scanned in here in the system on our customer side is that they had added both policy numbers.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] When they scanned it into the system, but I'm not sure if she might be just if she's sending it under one policy number unfortunately it may inadvertently just be getting processed under one and it's not being called that it's another one out there if it's something that happened in [PII].
[CUSTOMER][NEUTRAL] So do I need to instruct her the 242-6917 should be the only thing listed if as long as the claims are between 9123 and 8124?
[AGENT][NEUTRAL] Right, it should be the only thing listed in the, the policy prior to that, um, it was enforced for [PII] all [PII] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, so I'm
[CUSTOMER][NEUTRAL] And what policy number do you have that one just so I can note that down in case somebody needs it.
[AGENT][NEUTRAL] Yes, ma'am. It's 207-842-2.
[CUSTOMER][NEUTRAL] 22, OK.
[AGENT][NEUTRAL] Yeah, and I think the claim did get put on that one as well because I now I'm just looking, it might have been that a claim did come in and they put it on the wrong one and they realized they redid it.
[CUSTOMER][NEUTRAL] OK, so from what you can tell, oh, go ahead.
[AGENT][NEUTRAL] Under the right one.
[CUSTOMER][NEUTRAL] And so are we in like is that something you can resubmit under the 917 to see if you have all the documentation or did you guys already reprocess it under the 917 and you still need more information?
[AGENT][NEUTRAL] Let me see if they're the same. Give me just a second.
[AGENT][NEUTRAL] I'll have to pull them up individually.
[CUSTOMER][POSITIVE] OK, thanks.
[CUSTOMER][POSITIVE] Thank you for your help with this. Oh gosh.
[AGENT][POSITIVE] Oh, no problem. I just wanna make sure we get everything straightened out for you guys.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] I think they may in fact be different.
[AGENT][NEUTRAL] I'm gonna have to see.
[AGENT][NEUTRAL] If I can get somebody in the claims department to tell me either way, they look like.
[AGENT][NEUTRAL] The same claim, but it's.
[AGENT][NEUTRAL] The dates of services are different. That's what's throwing me off. One of them has one of [PII] and one of them has [PII]. And that's the, that policy number I just gave you. That's the one that has the [PII]. So I'm wondering if he, if he was sick before he passed and she was trying to send something in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] During that time as well.
[CUSTOMER][NEUTRAL] Mhm and if she has that old number on there and for anything during that year it would be incorrect.
[AGENT][NEUTRAL] Right. As long as it, but if it was something that happened during [PII], she would need to submitted under the old number. Does that make sense?
[CUSTOMER][NEUTRAL] Well, prior to [PII], correct?
[AGENT][NEUTRAL] Right. Anything prior to that would have to be submitted under that. Um, give me just a second.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] She submitted an authorization from
[AGENT][NEUTRAL] From the provider's office, so we did ask for medical records.
[AGENT][NEUTRAL] OK. Let me see if I can get somebody on the claims side cause they, they know how to read these screens a little bit better than I do and see if you can um explain to me whether or not if it was the same claim, and that'll probably clarify everything that we need to know. If you'll just bear with me one moment, Ms. [PII], I'm gonna place you on a brief hold.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, awesome thank you so much.
[AGENT][POSITIVE] No problem thank you.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Calling APL, this is [PII]. How may I assist you today?
[AGENT][NEUTRAL] Hey [PII], this is [PII] in the customer service department. I've got an agent on the back line and she's trying to help this insured's sister file claims cause he passed away. I need you to look at the policies, two policies for me and tell me if they're the same claim because
[AGENT][NEGATIVE] Apparently, she's reporting back to them that we keep denying claims because it's not effective [PII], but he had two policies and they, they just kind of overlapped.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's um 207-842-2.
[AGENT][NEUTRAL] There's a claim out there for 725 or 24.
[AGENT][NEUTRAL] And then he had, he had a new policy that was issued effective at [PII], and that was 242.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] 691 7.
[AGENT][NEUTRAL] And there's a claim that was submitted on [PII]. I'm thinking it's the same one, but I wanna make sure.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] The one that was submitted [PII] was the power of attorney information, so that's the only thing that's on that claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So it wasn't nothing. OK. And then the other one that I gave you?
[CUSTOMER][NEUTRAL] That one,
[CUSTOMER][NEUTRAL] Let's see what we got.
[CUSTOMER][NEUTRAL] Pile of attorney paperwork.
[CUSTOMER][NEUTRAL] The first one
[CUSTOMER][NEUTRAL] Power of attorney paperwork. That's the only thing that they have. Let me look again. Well, like that's the only thing they've been sending is power of attorney paperwork.
[AGENT][NEUTRAL] So, OK, I'm confused now.
[AGENT][NEUTRAL] Cause there's a note in here saying that medical records were advised. Is that because of the power of attorney?
[CUSTOMER][NEUTRAL] But I'm about to
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Let me look at the notes.
[AGENT][NEUTRAL] Oh no, she said [PII] called wanting to verify if we received medical records.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] So, OK, I get it now. So she ain't said nothing, so then why is she telling me that? I
[CUSTOMER][NEUTRAL] Let me, um, I'm about to look because it looks like the only thing they're sending this power of attorney paperwork, but
[AGENT][NEGATIVE] Or maybe she's calling and they're pulling up the old policy, and they're thinking it's no benefits provided after [PII], and they don't know she's got the new one.
[AGENT][NEUTRAL] Well, she doesn't have it. Her brother had the new one.
[AGENT][NEUTRAL] Maybe that's what it is.
[AGENT][NEUTRAL] She because she keeps saying there's no coverage past [PII].
[CUSTOMER][NEUTRAL] Oh, OK, let me see. I'm looking at what was submitted.
[CUSTOMER][NEUTRAL] When did he pass?
[AGENT][NEUTRAL] She said in August, and there's a note in here that we received the death certificate, but I can't find it.
[AGENT][NEUTRAL] Or maybe she's thinking.
[CUSTOMER][NEUTRAL] I don't know why.
[CUSTOMER][NEGATIVE] Why are they sending power of attorney? I mean, power of attorney doesn't.
[AGENT][POSITIVE] I know once they, once they perish, that's why I was, maybe she's thinking it's a life policy, girl, who knows? All right, when you explain what I needed. Let me go back and let her know. Thank you. Have a good day.
[CUSTOMER][NEUTRAL] Do anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. You're welcome. You too. Bye.
[AGENT][NEUTRAL] Mm bye.
[AGENT][NEUTRAL] Ms. [PII], I apologize for the wait. OK. Um, I did manage to get someone on the line and she did research it for me a little bit further. The documents that we received on both policies was just power of attorney.
[CUSTOMER][POSITIVE] Oh, no problem.
[AGENT][NEUTRAL] So she never submitted any claims to us. And I was actually trying to go through the legal documents to make sure, cause there was a note about a death certificate, but we're not seeing that that information was received either. So give me just a second, let me make sure.
[CUSTOMER][NEUTRAL] OK, yeah, because I think you said [PII] is and I know she called that same day last Thursday.
[AGENT][NEUTRAL] Yeah, and it said, OK.
[AGENT][NEUTRAL] She, for some reason.
[AGENT][NEGATIVE] She submitted in paperwork to change the beneficiary on it, but she can't, she can't do that. You can't change the beneficiary on a policy once somebody died. I don't know if she realizes it, but it's a cancer policy. So unless he had a cancer illness and sought medical attention.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Then we would help provide benefits for the claim on that, but it's not a life policy. She's not gonna get anything off of it unless there's medical bills to be paid.
[CUSTOMER][NEUTRAL] Yeah, uh, we're assuming he died from cancer and he definitely had chemo radiation, things like that. So how will y'all determine who that's paid through the, that's where the power of attorney will come in?
[AGENT][NEGATIVE] No, the power of attorney is actually void after somebody passes away. Um, that's why I'm not understanding why she kept sending that in, um.
[AGENT][NEUTRAL] We do have her listed as legal. Maybe it was because we were dealing with her before he passed away. But once that happens, but he, it looks like he did fill some information out. Let me check the date on this. He has her listed as beneficiary, which, like I said, we do have it to where we can list beneficiaries. However, yeah, he did it right before he passed. It was done in July.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So basically, if there, if, if she, he sought treatment and it's within the policy limits, she will get the benefits for the chemo, radiation, initial diagnosis as long as everything pans out. OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, and especially if she submits them in, but from what she told me there was nothing submitted in as far as paperwork. Um, so like I said, if it was anything that was done after [PII], it would be that 242-6917 policy.
[CUSTOMER][POSITIVE] OK, OK, well I will see that she understands that she needs to get a claim form and all of those things over to you guys and maybe I can help her with all of that and I do tell me your name again.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] All right, [PII], I should have remembered that's my sister's name.
[AGENT][POSITIVE] No problem. Um,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Oh no, I was just gonna say thank you for your help and I'll go from here and see if I can't get her squared away, bless her heart.
[AGENT][POSITIVE] No problem at all. Is there anything else I can help you with before you go?
[CUSTOMER][NEUTRAL] I don't think so. I might have more questions, but I'll just call customer service back if so.
[AGENT][POSITIVE] All right. Well, thank you for calling APL Ms [PII] and you have a wonderful day as well.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] You're welcome.