AccountId: 011433970860
ContactId: 972d3c8e-a2de-4103-b33d-df409e9dee52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 433880 ms
Total Talk Time (AGENT): 239110 ms
Total Talk Time (CUSTOMER): 193526 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/972d3c8e-a2de-4103-b33d-df409e9dee52_20250128T15:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with the care team. How you doing today?
[AGENT][POSITIVE] I'm doing well [PII] thank you how are you?
[CUSTOMER][POSITIVE] Hey, I'm doing so well. I do have a quick question. Um, it's just my luck that there's no supervisors available on the all colleague meeting day, um.
[CUSTOMER][NEUTRAL] I just want clarification. Am I allowed to sell tell somebody payment details when it tells me 1900 for the year? Like the claim hasn't finished processing?
[AGENT][NEUTRAL] Um, I'm sorry, can, can I have you repeat that? You, are you a.
[CUSTOMER][NEUTRAL] Yeah, yeah, so, um, I'm looking at particularly policy number 218443773 I'm sorry, um, and I'm looking at the claim and it just finished processing today. The date on it is like the [PII] and it does have benefits payable, um, but I was told in my training that when it says $1900 for the date to not give payment details because nothing's finalized.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] And to only give payment details when it has an actual date on it for processing, so I told her that it's in the final outcome, it's in the final stages and that um at this stage that there would be a resolution tomorrow like a yes or no, um, and then we'd be able to give her details and she's really upset because last time she called it was pending big and why are we taking so long? We somewhere along the way told her it takes 10 days and she's just really upset um and so.
[AGENT][NEGATIVE] Gotcha. Right.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I I talked to her as well, [PII], um, so what happened with this particular person is she left her, I believe she separated from employment and she was on a, um, uh, they paid in arrears, so she continued her policy paying in arrears and the problem was that claim came through and we couldn't pay it until she paid her premium because she went to mode of payment uh too I think it's 2, right?
[AGENT][NEUTRAL] Um, where she's self paying, so that's the problem, and, and I guess back in the notes too a while, a a few months back it was we did explain that to her that it's in arrears. So if she wants to change her date so it's not paid in arrears, that's on her, but she said she would think about it and call back and now she's been calling for this claim like for two weeks straight.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, and I tried to tell her like it was processed today. We'll have a final outcome on on tomorrow, but I'm just trying to figure out, can I tell her that it's been paid and then maybe get her call back information and have a supervisor call her back? Or is that like a tried and true thing like when it says 1900, we don't get payment details.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Well, it hasn't been released yet. This particular claim looks like it's an audit. So what that, so that's kind of the difference sometimes you'll see them where if I just process the claim you'll see that why there and even if they have direct deposit it'll still show in that check column but until that processes overnight it's not gonna update.
[AGENT][NEUTRAL] Um, and this particular claim looks like it's actually an audit, so the auditor has to release it. That's why there's no why next to the check because it hasn't been, it is in the, it truly is in the final processing stage right now. This claim is going through audit though.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it you know I mean I think you could be OK to tell her that that it's you know and it's in the final processing stage and it has to pass audit um and then it will update overnight um and we'll have a final um a final uh you know uh claim decision basically.
[CUSTOMER][NEUTRAL] OK, so that is definitely what I told her, and I didn't know that was true. That's what I tell everyone when I see a 1900. That's my go to answer is that it's in finals processing. Um, all our claims go through a secondary audit, and at this stage it's usually overnight once we are here and we'll have an answer tomorrow and so that's my, my flat out go to, um, and so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah and that's correct and I know she's upset but really a supervisor isn't gonna be able to tell her anything different, um, and you know I think she is set up for direct deposit so I would just tell her to um you know, she could just monitor her um bank for once it clears that final decision, you know, like I said, usually what happens is later today probably the auditor will release the claim um I don't see any reason why it wouldn't be released, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim will be finalized and then like I said tomorrow it would show that direct deposit went through.
[AGENT][NEUTRAL] Like it does for her rest of her claims she's submitted and you know in the past.
[CUSTOMER][NEUTRAL] OK awesome so I'm just going to let her know that I spoke to you and that you just reiterated what I said was that it is in final stages. It's going through that final process where it goes through that second set of hands and typically at that point there's an answer tomorrow, um, and then as far as getting her a supervisor, I mean at this point I put in the request 15 minutes ago so I might just, uh, I might just have somebody try to get a callback number and see if someone can call her back.
[AGENT][NEUTRAL] OK, I mean I can try to call her if you'd like if that will I mean.
[AGENT][NEUTRAL] If you want me to, um, like I said, it's just, um, she.
[CUSTOMER][NEGATIVE] She just wants to file a claim. She wants to file a grievance about the process. Um, she's really unhappy with the process, so.
[AGENT][NEUTRAL] Well, like I said, if you, she's, it's been explained to her before about that.
[AGENT][NEUTRAL] Um, premium, like I said, she's paying in arrears so and so that means that if she doesn't like the payment we had was for December so it didn't take her through March, you know, I'm, I'm sorry, January and that so she used to pay with the group in arrears so her claims would get paid because we got that premium even though it was paid in arrears we knew that group was gonna, you know, well we assumed the group was gonna pay those premiums.
[AGENT][NEUTRAL] So we allowed them that grace period and that arrears to um take effect. However, when she switched to self pay, you can't have a grace period and unfortunately it's not in arrears anymore we don't look at that because she's paying the premium now so we could pay that claim out and then she doesn't pay your premium and then we're just kind of, you know.
[AGENT][NEUTRAL] In that place
[CUSTOMER][NEUTRAL] OK, yeah, no that makes a lot of sense. um, I will, I mean, I, I don't know if it'll really do me much good to, um.
[CUSTOMER][NEUTRAL] But I will, I will at least explain to her where her claims at. I'll offer to call her back tomorrow, you know, with what the outcome was, um, and then I will ask her if she wants me to give her name and phone number for a supervisor to reach back out to her to talk about that process and go from there. Maybe she'll be happy with an offer to have someone call her back tomorrow with a decision.
[AGENT][POSITIVE] OK, and um if you need any assistance, [PII], let me know I'll be happy to help any way I can.
[CUSTOMER][POSITIVE] Hey, I am actually really grateful for you just filling me in on the history on this, and that really helps me so thank you.
[AGENT][POSITIVE] Sure, oh, you're welcome any time.
[CUSTOMER][POSITIVE] Take care.
[AGENT][POSITIVE] Alright thanks you too have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks