AccountId: 011433970860
ContactId: af09d202-624e-4c86-a0d3-aaac2517380f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1075260 ms
Total Talk Time (AGENT): 648298 ms
Total Talk Time (CUSTOMER): 294631 ms
Interruptions: 8
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/af09d202-624e-4c86-a0d3-aaac2517380f_20250515T20:37_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello? Can you hear me?
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] in customer service. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Can you hear me?
[AGENT][NEUTRAL] I can. I apologize. It was my headset. I can hear you, but I guess you couldn't hear me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Yeah. I, I know, I wasn't able to hear you. I'm like, OK, what happened? OK. Um, well, I have a question. Um, I'm here under the guru, the guru section, but I, it's, it's unclear to me what, what to do with this. I know in the past we used to just, uh, you know, get the information, transfer, or whatever, but right now, I'm not sure how to handle this. Um, so the policy number I have is 2,581,460.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and it's the group calling you said?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, I have the insured on the line, Mr. [PII].
[AGENT][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Alright, give me just a second, let me pull that up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. [PII], OK.
[CUSTOMER][NEUTRAL] Mhm. Yes, and I went ahead and pull again on through the guru to see what to do, but I, I'm just not clear to what to do. Um, so basically he has a single parent policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which, um, I'm not sure about, you know, the information that is listed because it looks like it's the same age so it's kind of confusing. Anyways, um, that's not the reason.
[CUSTOMER][NEUTRAL] Um, he said he, that his son is not listed and he should have been listed and um he gave me the name and date of birth and everything, but he's, I'm not sure if we need to get additional information or what or if he's supposed to be added and we just forgot to add it or.
[CUSTOMER][NEUTRAL] You know, it could be many scenarios, so I'm not really sure how to handle this for right now because it's a single parent, you know, it's not like we're making this change to the product, it's more like the the pendant is missing, so yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, what I think happened is the person that's listed as the dependent currently is his wife, probably um due to that birthday and somehow she got misplaced she got placed on there instead of the dependents. So is his wife supposed to be on there too, or just his son?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] He didn't say anything about the wife, but he said he has the card and the card is a um insured and child. So he's like my child's supposed to be at it.
[AGENT][NEUTRAL] Yes, that's because she's listed as a dependent, yeah, um, hold on, let me check on base and see if there's an original application. I don't know how this group.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if this group is on a file feed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see 19874.
[AGENT][NEUTRAL] I'm doing like three things at once. I'm pulling up the group and I'm checking to see if he has an original application 1460.
[CUSTOMER][NEUTRAL] Oh, OK, it's OK.
[AGENT][NEUTRAL] OK, the group is on a file feed, so and there's no application in on base. OK, so do do do do do do, let me check something else. Let's see.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It could be that it's sitting out an exception report.
[AGENT][NEUTRAL] This is a [PII] group.
[AGENT][NEUTRAL] OK, so I'm gonna check the exception reports and the file fee to see.
[AGENT][NEUTRAL] Yeah, who's all supposed to be on there? Let's see.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and all. All righty. So, yeah.
[CUSTOMER][NEUTRAL] OK. I'm gonna put you on a brief hold. I'm just gonna go back to him just to let him know that we're still working on it, OK?
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK. Bye.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] So, according to the file feed, it's actually supposed to be an individual policy.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, but he has the card and I pulled the card and
[AGENT][NEUTRAL] Let me check on.
[AGENT][NEUTRAL] Yeah, now the card's gonna reflect what we have in lion.
[CUSTOMER][NEUTRAL] It, it does say child.
[AGENT][NEUTRAL] So the card is gonna reflect whatever the policy has been issued as so but that's not necessarily means it's correct.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Oh, got you, got you.
[AGENT][NEUTRAL] Let me check some of the older exception report files and see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now I got group billing messaging may need me to change a pay due date. OK, let's see.
[AGENT][NEUTRAL] Church.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so both of the most recent file feeds are showing him as individual no dependent.
[AGENT][NEUTRAL] Listed
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So I'm wondering if we have an exception out there waiting to be worked. I doubt it's gonna be in my folder.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, mhm.
[AGENT][NEUTRAL] And I can't see everybody else's. Um, let's see.
[AGENT][NEUTRAL] Let me check this policy number and see if it just happens to be in my dashboard.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] Come on, don't play with me today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah it is in my dashboard.
[AGENT][NEUTRAL] OK, so, um, per the file feed, um, it is supposed to be an individual policy.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I don't know if that's something that started when is their open enrollment, the first, OK, 11 I wonder.
[AGENT][NEUTRAL] Oh, I think they got set up for a file feed after the first of this year because that's all I'm seeing.
[AGENT][NEUTRAL] Why does this have to be so complicated? OK.
[AGENT][NEGATIVE] Let me check one more thing. No, I don't wanna save anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm I know.
[AGENT][NEUTRAL] OK, I'm checking all the way back to the first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So yeah I mean all the way back to January this was supposed to be an individual policy. I don't know how that dependent got put on there but I'm pretty sure that's probably his spouse.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, is this the only policy?
[CUSTOMER][NEUTRAL] Mm, yeah, it seems to be the spouse. I, I really didn't even mention her or not. I didn't mention anything. I just said, OK, let me check and see. I, uh, yeah, so I didn't say who was this to who was not. I didn't even say the, the clan, the clan or the baby's name or the son's name is there or not. I just said, let me check on it. So, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I went in CUI NQ and I looked at his previous policy and she is the spouse listed on his previous policy, so he must have elected to change this policy to individual and the new policy when the new policy got issued for some reason, uh, the spouse was put on there as a dependent.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mmm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Um, in error.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And so that person should not even be listed though based on the file so I'm going to have to change that and we're gonna have to issue actually.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, I'm gonna have to do that cause uh.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh we're gonna have to issue refunds to the group for overpayment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, do you wanna speak to him and explain to him what's, what's gonna happen?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, because this is, yeah, this is a little bit more complicated than just saying oh we fixed it, you know.
[CUSTOMER][NEUTRAL] Yeah, I know. I'm gonna say, oh yeah, he's gonna be like, what, what do you mean?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. Yeah.
[CUSTOMER][NEUTRAL] And I'll be like, wait, let me get the mail.
[CUSTOMER][NEUTRAL] All right. Well, I did fully verify him and the callback number is the same one in the system. Um, so here he comes, and have a good afternoon, Mr. You're welcome.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. I've got this memory on the line. She is in the customer service department and she's gonna assist you from here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Hi, Mr. [PII]. My name is [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Hey. Good, how are you?
[AGENT][NEUTRAL] OK, thank you so much for asking. I do apologize for your wait um I was trying to look over everything, um, and see what was going on, um, I was looking at your previous policies, uh, due to the group having they added a second plan this year at open enrollment in January, um, so.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] When you signed up for your open enrollment, did you add your dependent on there? or did you just sign up for individual this time?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] He wasn't born when we did our open enrollment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see, so.
[CUSTOMER][NEUTRAL] He was born after open enrollment.
[AGENT][NEUTRAL] OK, and is your spouse still listed on your major medical?
[CUSTOMER][NEUTRAL] Uh, I have no idea what that means.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so this policy is a gap policy, so basically like it covers your deductible for your major medical.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Um, let me see. So if she is, uh, do y'all still have United Healthcare for your major medical?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have no idea what my insurances are. I only have that one insurance card that's you guys. I don't know about another insurance.
[AGENT][NEUTRAL] OK, OK, yeah, so.
[CUSTOMER][NEUTRAL] I might have a United Healthcare.
[AGENT][NEUTRAL] OK, so yeah, our Medin policy is just the gap policy. It's not major medical insurance, so whenever you go to a doctor or something like that, you still have to have your major medical insurance. Um, a lot of insurance companies are no longer sending out ID cards, um, so you may have a virtual ID card that you actually have to sign into your um account to get. You may need to check with your HR person.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, regarding that, um, but yeah, so ours is not a major medical, you cannot just use it by itself, you'd have to have that other medical information.
[AGENT][NEUTRAL] Um, previously, since, uh, [PII], it has been a couple policy, so you, it's been you and your spouse, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, uh, but according to our files that we received from your employer, um, you're only enrolled in individual coverage.
[AGENT][NEUTRAL] I do not see your spouse listed on as coverage and so what happened in our system um you were couple coverage before and when they changed their plans at the [PII] of this year we had to issue you a new policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, due to the group having some changes, so we usually pull the information from your previous policy into the new policy and there was an error and your wife was actually placed on there as a dependent. So that's why your card has employee plus child because your wife was put on there in error as a dependent. I'm getting that corrected.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, but like I said, your employer is sending us what they're sending us is individual only coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so that's what I'm gonna have to change it to to correct it, um, if it is supposed to be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, couple coverage or family coverage, um, you probably need to speak with your HR department to get it fixed.
[AGENT][NEUTRAL] Um, and so that they can notify us to fix it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, I talked to my head HR lady and she told me to call the number on the insurance card. That's why I called you guys.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] I can change your coverage to individual because that's what the group is submitting to us.
[AGENT][NEUTRAL] Um, so the, the only thing I can do is change it to individual.
[CUSTOMER][NEUTRAL] Yeah, I'm not with
[CUSTOMER][NEUTRAL] Yeah, not with the girl that's on that was on my.
[CUSTOMER][NEUTRAL] Um, spouse.
[AGENT][NEUTRAL] Oh, so y'all aren't together anymore?
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] OK, and what was her name?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, yeah, [PII]he's the one that was listed on here. I'm gonna, I'm gonna drop her off because like I said she was put on here in error as a dependent, um, so I am gonna drop her off um and change you to individual coverage and if you need to add.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your child, um, you just need to go through your HR department to get them to send us that information because the file feed that they have is not showing a dependent currently and I just checked our most recent one that they sent us on the [PII].
[AGENT][NEUTRAL] And it doesn't show a dependent. So if your dependent is supposed to be on there, we just need them to to update the file or send us an email.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, and we can get it corrected. When was your, when were they born?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yeah, so if they're supposed to be on there, um, get with your HR department and tell them that they need to update the file feed or they need to send us notification to add the child, um, so if he or she is on your major medical, um, they should be on this policy so I would just check with them and see what coverage you have and if they are on your major medical then you need to tell them that they need to update their file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Or send us an email to notify us that the child needs to be added, but other than that I've fixed it to individual and I'm gonna send you a new card that says individual and also because it was listed as the wrong type of coverage um there is gonna be money owed back to your employer uh and I will issue a refund of the premium difference that they have been paying on your behalf, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, um, was there anything else I could do for you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][POSITIVE] Alright well thank you so much for calling APL and I hope you have a wonderful day. uh please let us know if you need any, any further assistance with this OK?
[CUSTOMER][NEUTRAL] You as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright have a good one.
[CUSTOMER][NEUTRAL] You sir.
[AGENT][POSITIVE] Thanks bye bye.