AccountId: 011433970860
ContactId: ab6677ee-e1a9-4371-9857-9d2ea64aadea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 615080 ms
Total Talk Time (AGENT): 250693 ms
Total Talk Time (CUSTOMER): 323460 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/ab6677ee-e1a9-4371-9857-9d2ea64aadea_20250304T17:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], are you in the billing department?
[AGENT][NEUTRAL] No, but I can get you to billing. I
[AGENT][NEUTRAL] Are you a provider?
[CUSTOMER][NEUTRAL] I think that would be the
[CUSTOMER][NEUTRAL] No, I'm a broker.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have your name?
[CUSTOMER][NEUTRAL] I have a client that has a group, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's going on with the group?
[CUSTOMER][NEUTRAL] I have a client, it's House of Deer Hair Salon Inc. The group number is 25315.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they have had the owner gets a check for about $600.
[CUSTOMER][NEGATIVE] And she lost the most recent check that y'all sent and [PII] asked if she knew the check number, and I just spoke with [PII] and she just told me she did not know the number because she lost the check. So she did tell me that it, she gets, uh, it feels like she's getting the same amount every month. So she didn't know if that was for a reimbursement for medical or if that was a reimbursement for overpayment on premium.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's the mystery and whichever one it is she wants a replacement check if that makes sense.
[AGENT][NEUTRAL] It does. And OK, so is this for the replacement check for the group or a particular member in the group?
[CUSTOMER][NEUTRAL] That's the mystery. We don't know what the checks are for.
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] She said that she's consistently been getting checks around the same amount every month.
[AGENT][NEUTRAL] And the she, who is the she, [PII]? I, I was thinking it was a uh employee, I'm sorry.
[CUSTOMER][NEUTRAL] OK, OK, [PII] is the accountant, but the owner is [PII] dear, and it's [PII] who gets the checks and [PII] is telling me, I lost my last check and she is, by the way, why am I getting these checks? Is it an overpayment for premium or is it for someone's cobra? I have no idea. I said, let me find out what I can find out.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and [PII], I have the um group here. I just need you to verify your email address for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And do you mind if I place you on just a brief hold? I'm just gonna reach out to group billing because I'm looking at the notes and I don't see a reasoning for the, you know, like a 6, you know, just something saying what it was for. I don't see anything in the notes, but I can definitely get group billing for you.
[CUSTOMER][NEUTRAL] That'd be great and if you can see like where she's been getting checks, she thinks it's been for about 6 months. She said the first one they sent 2 and then it was like 1, and I started thinking maybe it's for [PII] and then I remembered [PII] never enrolled in Gap.
[CUSTOMER][NEUTRAL] And I have her old policy certificate number. It's 02161405.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I know she took Cobra for medical, but I don't believe she took it for gap.
[CUSTOMER][NEUTRAL] We have a third party administrator that handles that, so.
[CUSTOMER][NEUTRAL] I'm sorry, I'm not as.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] On top of it.
[AGENT][NEUTRAL] She left message twice.
[AGENT][NEUTRAL] I'm looking under hers to see now I don't see anything. Hold on one moment.
[CUSTOMER][NEGATIVE] I don't think she enrolled. I don't think she wanted to pay the premium, but
[CUSTOMER][NEUTRAL] I don't even remember what her amount was. Let me look.
[AGENT][NEUTRAL] In the, you're saying in the um like the meddling policy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It was 24, hold on, I just looked at it and it, it just switched screens, 281 58.
[CUSTOMER][NEGATIVE] And that doesn't make then then $600 is not, that doesn't make sense. I have no idea why [PII]'s getting these checks unless it's for her own personal reimbursement for medical for her and or her partner um [PII].
[AGENT][NEUTRAL] Let me go to her.
[CUSTOMER][NEUTRAL] Maybe she has claims and she didn't realize when she gives both um ID cards to provider, maybe it's something that's getting processed.
[CUSTOMER][NEUTRAL] Um, that way if that makes sense, I can give you her personal number.
[AGENT][NEUTRAL] It does. I'm looking under her um policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just looking to see in the notes if I see anything and you said $600.
[CUSTOMER][NEUTRAL] Yeah, and her certificate 02161391.
[AGENT][NEUTRAL] 5.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, wait a minute. Now hers.
[AGENT][NEUTRAL] 36,260.
[AGENT][NEUTRAL] That's 7:25.
[CUSTOMER][NEUTRAL] I know that um [PII] was in the hospital recently and I thought well maybe it's a reimbursement for um like a $1 benefit reimbursement for a medical expense, maybe on [PII].
[AGENT][NEUTRAL] And so [PII] is, OK, here it's [PII].
[AGENT][NEUTRAL] But the, but the actual check itself was for $600 right? Because the amount I'm seeing differ from that I'm looking for.
[AGENT][NEUTRAL] 600. Yeah, I don't wanna um
[AGENT][NEUTRAL] Yes, I'm gonna go ahead and get group billing because I'm looking at [PII], like her, her most recent two claims, I've just looked at, um, they don't total 600 and then when I looked to see how much the premium was, it was like 372. So like I did double just to see, um, of course, it was over the 6, so I'm not sure where the 600 is coming from and there's no notes to tell me, so I'd rather just uh have them explain it and and get you a direct answer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and maybe, maybe looking at the last few checks cut I'm sure maybe I'll link that to what the purpose is maybe we can just kind of start working backwards.
[AGENT][NEUTRAL] Backwards.
[AGENT][NEUTRAL] OK, um, and so, [PII], before I get a um group billing representative on the line for us, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, I just gotta figure this out for [PII] and, and just you've already been helpful just looking, so thank you.
[AGENT][NEUTRAL] Well, you're very welcome, and we're definitely gonna figure it out. Let me put $600 check. I was just looking at my notes so I know what to tell group billing. Um, hold on one moment, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Referring.
[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][POSITIVE] Hey [PII], I'm good. How are you?
[AGENT][NEUTRAL] I'm doing good. Um, I have a broker on the other line. She needs some help, but I think they may have been speaking with you. Um, it's for group number 25315.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, the broker is [PII]. She said the owner, [PII] keeps getting checks from us for $600 and she, she lost the last check, so she doesn't have that, does that sound familiar? Because they mentioned [PII]. OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I remember that yeah I I responded to a hub request and I asked her to provide us with the check number because I can't see where we've refunded anything so I don't even know if that's a billing check, um, but you can send her over to me and I can see if I can get the check numbers from her um.
[AGENT][NEUTRAL] OK, well, let me tell you now, she said she doesn't have the check number because she lost the check.
[CUSTOMER][NEUTRAL] Lord. Well I'm supposed to help her.
[CUSTOMER][NEUTRAL] Goodness. OK. I don't know.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Because I mean I can't see anything that we refunded um Lord.
[AGENT][POSITIVE] Well, that makes me feel a little better because I was like looking through the notes and stuff. I was looking to see if there was a claim paid out. I'm like, I don't see anything.
[CUSTOMER][NEUTRAL] Exactly. That's.
[CUSTOMER][NEUTRAL] So did you see any claim information?
[AGENT][NEGATIVE] Well, not for this, right. Mhm.
[CUSTOMER][NEGATIVE] Nothing that would have been refunded?
[CUSTOMER][NEUTRAL] See, I can't find any billing, so I don't know what and I'm, I looked at on base. I couldn't find any checks. um, I, I just have to let her know she gonna have to try to get them check numbers. I don't know what to.
[AGENT][NEUTRAL] Lord, or maybe if she has the
[CUSTOMER][NEUTRAL] I don't know what else to do.
[AGENT][NEUTRAL] Well, I don't know if she lost the whole check. You know how you can rip the check off and then the top part still has the, that's the part you keep? Maybe, does that have a check number on it?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, right, I'll ask her if she has that then it might have some information, some more information on it um I'll just see if she's got anything I mean because if she don't have anything I, I, I don't know what to do because I don't see anything yeah.
[AGENT][NEUTRAL] That we can use
[AGENT][NEUTRAL] We can't pull it, right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] But yeah, to me and I'll see what we can I'll see what I can help her with.
[AGENT][NEUTRAL] All right, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the, for that wait. Um, I have [PII] on the line and she's um going to be helping you further. She, this is the same [PII] you were um asking for. I didn't know she was gonna answer yes.
[CUSTOMER][POSITIVE] And the emails thank you.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Hi, [PII].
[CUSTOMER][POSITIVE] Hi [PII], thank you for jumping on.