AccountId: 011433970860
ContactId: 9f66f290-57c2-462f-92f7-4f8a00076d9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 625780 ms
Total Talk Time (AGENT): 255357 ms
Total Talk Time (CUSTOMER): 210739 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/9f66f290-57c2-462f-92f7-4f8a00076d9b_20250605T14:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I got permission from one of our clients to call and check on her claims. She received notice that her max benefits have been paid out, but she hasn't received any benefits off of the policy, so I was just trying to see what's going on there.
[AGENT][NEUTRAL] OK, and what is your name and your callback number?
[CUSTOMER][NEUTRAL] My name is [PII]. My callback number is gonna be [PII].
[AGENT][NEUTRAL] OK, and [PII], what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh, it's the broker's office. It's either gonna be under [PII] or RJ Blanchard Benefit Services.
[AGENT][NEUTRAL] OK and then can you please give me the um group number for?
[AGENT][NEUTRAL] The insured that the insured's on?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, it's 256-73.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] And that's peas in a pot.
[AGENT][NEUTRAL] OK, Ms. [PII], can you please verify the um agent's email address for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you ma'am and then also the address and phone number for peas in a pod.
[AGENT][POSITIVE] That's a cute name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me get it for you.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, it should be [PII].
[CUSTOMER][POSITIVE] Solid, I don't know what what it is.
[AGENT][NEUTRAL] OK. And then the phone number, please.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Trying to find theirs one second.
[AGENT][POSITIVE] Yeah, yes ma'am.
[CUSTOMER][NEUTRAL] OK [PII]?
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the member's name and policy number?
[CUSTOMER][NEUTRAL] Her name is [PII] and the policy number is 2480506.
[AGENT][NEUTRAL] OK, and then what is Miss [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Let me pull her up real quick.
[AGENT][NEUTRAL] OK, and then do you have the claim number, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, I don't.
[AGENT][NEUTRAL] OK, do you know the date of service?
[CUSTOMER][NEGATIVE] Well, the thing is is we filed and no benefits were paid out and now with the new system there isn't any claim showing like there says no open claims, no process claims there's no claim showing under under her at all.
[CUSTOMER][NEGATIVE] Like none of the claims actually went through. That's why I don't understand why they're saying max benefits have been paid out.
[AGENT][NEUTRAL] OK, let me look. I've only and is the claim for herself?
[CUSTOMER][NEUTRAL] No, it's for her children. We tried to file one for [PII] and we tried to file one for I think his name was [PII].
[AGENT][NEUTRAL] OK, I've got [PII] pulled up.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I do see that there was one reported on [PII] from the online service center.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEGATIVE] Well I tried submitting that one and she never received any payout.
[CUSTOMER][NEGATIVE] And then I called about it and they said max benefits were paid out. They were supposed to transfer me to someone to the claims department, but no one ever picked up. I just sat on the phone.
[AGENT][POSITIVE] Oh goodness gracious. Oh, I'm so sorry you had to do that. Um, what I'm gonna do is he had a claim.
[CUSTOMER][NEUTRAL] No, it's OK.
[AGENT][NEUTRAL] That was paid
[AGENT][NEUTRAL] For data service [PII].
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] I'm also going to need to transfer you on over to a claims specialist, but I'm gonna stay on the phone until somebody gets on the phone to help you, OK? That way you're not just sitting there again.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it's gonna be a brief hold while I transfer you over.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Deferring
[CUSTOMER][POSITIVE] Thank you for calling IPL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hi, [PII], this is [PII].
[AGENT][NEUTRAL] I've got a um a hi I've got a lady on the phone. Her name is [PII] and she's with the broker's office.
[CUSTOMER][NEUTRAL] Hey [PII].
[CUSTOMER][NEUTRAL] Ah
[AGENT][NEUTRAL] For, um, and I have verified the, the information. She is calling on policy number 248-0506.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She is calling um so.
[AGENT][NEUTRAL] The two children have claims out there.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] that were denied as benefits were exhausted.
[AGENT][NEUTRAL] That are on this policy um for.
[AGENT][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] Which is part 2 and part 3.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] On [PII], the claim number is oh gosh my computer's so slow um the claim number is 3605545.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] When I read the remarks to her, she said that's incorrect that um nothing has been paid out, so.
[AGENT][POSITIVE] The benefits are not exhausted.
[AGENT][NEGATIVE] And she wants to speak to somebody she said the last time that she got transferred she was put on hold for a very long time and nobody came to the phone.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] I'm gonna go back to her and let her know that I've got you on the phone and just because she got that bad experience before, so it's gonna be just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, but I'm getting it pulled up, yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Hi Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][NEUTRAL] OK, I just wanted to let you know that uh we have not forgot about you. I've got somebody on the other line right now she's pulling up the information.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] So that she can help you. So it's gonna be just a quick hold again, but I just wanna let you know that.
[AGENT][NEUTRAL] I've got somebody on the phone that way you you didn't feel like you were holding again and nobody came to the phone, OK? Alright, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, yeah, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] [PII], are you there?
[CUSTOMER][NEUTRAL] I am, I'm looking at the policy just so I can see how many are allowed.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] Right, and I'm gonna put, I'm gonna put you on a hold for just a second. Let me adjust my um Wi Fi real quick.
[CUSTOMER][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. Everything is so slow I don't understand if it's just the computer is thinking too hard or what's going on?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, so the thing is is that this is a 21 policy and it is per plan year not calendar year.
[CUSTOMER][NEUTRAL] So plan year is from.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The effective date to the day before.
[CUSTOMER][NEUTRAL] In the following year, so her plan year would be [PII] through 4:[PII], and [PII] and [PII] both have already had a screening during that time frame, so it is maxed out. It's not calendar year, so we're not gonna pay one per 2024 and one for [PII] and etc. it's, it's the plan year time frame and that is in her policy as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. Um, would you mind letting her know that, or do you want me to tell her?
[CUSTOMER][NEUTRAL] Um, what, what would you be more comfortable with?
[AGENT][NEGATIVE] I would be more comfortable with her hearing it from a claim specialist because that's who she had mentioned that she was supposed to talk to before.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, so I'm gonna release the call and let you thanks [PII]. I appreciate it bye bye.
[CUSTOMER][NEUTRAL] OK, yeah, I can let her know.
[CUSTOMER][POSITIVE] No problem.