AccountId: 011433970860
ContactId: b45b00ad-d12f-4036-9616-0e30647e0395
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 528260 ms
Total Talk Time (AGENT): 274288 ms
Total Talk Time (CUSTOMER): 278752 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/b45b00ad-d12f-4036-9616-0e30647e0395_20250109T17:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with the care team. How are you doing today?
[AGENT][POSITIVE] Hey [PII], I'm good. How are you?
[CUSTOMER][NEUTRAL] Hey, I'm doing great. Hey, I got a quick question. I'm not really sure where to go and what direction to take for a call I have, and so I'm not sure what to do. I'm just gonna give you the whole spiel. I'm looking at policy number 251-9478.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I have the insured called. He's no longer on the line with me. Um, the insured called and he asked, uh, he had a claim that came through and it was it was denied because it said that his coverage was terminated like before the date of service, right? So it happened after his coverage was terminated. He doesn't understand how his coverage was terminated because he has a letter from Cobra stating that his coverage would be active until [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and I told him that we had a note that um to cancel his policy with the effective date of [PII] from the group.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I see that in here, um, and he doesn't understand how they can retroactively cancel his policy. He was employed till the [PII]. He has his COR letter stating his insurance would last till the [PII], um, and then he went on to tell me about how like he was wrong. I don't know, he claims to be wrongfully terminated. He feels like his group is doing something shady and so I'm just wondering like what do we do from here? What do I have him do, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, OK. So let me take a look. Um, I do see that he's lapsed, so I'm gonna look and see if the group, um,
[AGENT][NEUTRAL] I'm gonna look and see what we got the term this policy and then see if they're paying this policy because cover premiums are still supposed to be paid by the group um so let me see.
[CUSTOMER][NEUTRAL] You bet you, and I don't know if he elected to keep Cobra or if his letter just stated that he had his coverage until [PII] and he could elect to continue it after that with Cobra.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I mean it would probably be something that he's gonna have to talk to his employer about because they would, they should be able to handle the COR election for him and then you know I believe that that information get should get sent to us um let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Here it looks like this is the term notice let me see.
[AGENT][NEUTRAL] OK, yes, so we did get an email from it looks like somebody with the agent's office who um told us to term the policy effective [PII], um, and that was received back in October, so that's why we terminated the policy um we can always check with somebody in customer service and see if they've gotten any cover notification to set the policy up on COR um customer service would handle that.
[CUSTOMER][NEUTRAL] So I did talk to customer service before I called you. They don't have anything about a Cobra notice for him, um, but they did recommend because the lapse was put in through billing to give you a call and to see um what you all knew so.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, so since they didn't get anything for COR then we would just refer him back to his group and just let him know, you know, we don't have anything showing that, you know, you should be on COR and we're not receiving premiums from the group, um, and just refer him back to his HR department and that's something that he would have to handle through them.
[CUSTOMER][NEUTRAL] OK, and then would I like, and maybe I can call claims and ask them to verify this, would I let him know that he always has the right to appeal 180 days after his claims denial date if he um disagrees with the reason on the claim and that it could be reviewed from the an appeal department?
[AGENT][NEUTRAL] Um, I believe that is accurate, but I would just double check with claims just because I'm not 100% sure on that, um, but I do believe he, he should be able to.
[CUSTOMER][NEUTRAL] No worries. This is the first time I've had anything like this come through where they weren't just like, oh yeah, I was terminated, and he's just like, I've got a letter saying I still have coverage, you know what I mean? So like I wanna make sure he doesn't think it's on like I don't, we're not trying to screw him over, you know what I mean like.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh right. I wonder, oh yeah. Did he happen to say who the letter was from? I wonder if
[CUSTOMER][NEUTRAL] The letter was from Cobra offering it to him letting him know his coverage would discontinue [PII], and so that's why he doesn't understand why if if Cobra saying your coverage is active until [PII], why we're saying your coverage was termed at 1001.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so ultimately they would somebody would have had to send us something alerting us that he would be on COBR and the group would still have to send the premium in so I would just suggest for him to start with his HR department, um, and then I don't know even if the letter that he got if it's got a phone number of someone he can contact um you know if if they don't seem to be any help to him um just that's where I would go.
[AGENT][NEUTRAL] Um, that's just where I would start is have him contact his employer and maybe he can get some more information from them or his former employer I guess.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So to contact the former employer.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And just inform them that he got that COR letter but that you know APL is saying they haven't received any notification of of COR.
[CUSTOMER][NEUTRAL] OK, and I guess I don't know exactly how COR works, and I don't expect you to know necessarily either. Um, when they get the COR letter, do they, they have like the choice, right? It's like, hey, you can extend your coverage with us through COR.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and then is that like if they don't choose to extend it they, they don't get it right, but if they do choose to extend it, um, we would, we would be notified that they're choosing to extend it. So when he's saying he got the letter saying like he can extend, but he was active until [PII] if he chooses not to extend, does that mean that he's not gonna be like I guess that's what I'm curious about.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I right, I believe that's what that should mean because, um, you know, his employer terminated him effective the [PII] and it seems like to me from the letter that he got that Cobra was offering him, you know, an additional month, but he still has to pay for that.
[AGENT][NEUTRAL] So, um, they're suppo his group, his former employer supposed to collect the premium from him and so the letter I would imagine, I mean I don't know exactly what it looks like but I would imagine it would have instructions for him on how he should pay for that premium I mean because it's it's, you know, he still has to pay for it so um.
[AGENT][NEUTRAL] I would imagine if he did not choose to do so then his policy, you know, it's not gonna be extended through the the uh end of that month.
[CUSTOMER][POSITIVE] OK perfect and then I will.
[CUSTOMER][NEUTRAL] Oh gosh, I wish I could read the letter. That would make it so easy, you know what I mean? um.
[AGENT][MIXED] I know, I know. It does. It helps a lot and unfortunately, I don't know.
[AGENT][NEUTRAL] I don't know unless he forwards that over to us but you know I don't know that we could.
[CUSTOMER][NEUTRAL] And that's where I feel like maybe the appeal department like hey please send your last page up and your cobra letter and any information you think is relevant to our appeals department and let them take a look at that.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah, that might even help too, um.
[AGENT][POSITIVE] Yeah, that, that would be a good good thing to recommend for him just in the meantime while he's contacting his employer, you know, he could also do that that would be great.
[CUSTOMER][NEUTRAL] Yeah, OK, perfect. I will recommend for him to contact his employer and I'll recommend for him to, um, the appeal information's at the bottom of his EOB, so I'll let him know to just follow that direction and to send any relevant copies, not originals without any relevant information, um, to the appeals department and let them, um, reassess, yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Review that yeah yeah I think that's great I think that's great advice to give him and we'll just kind of go from there and hopefully you know and of course you know he can also advise his group to reach out to us and if they need to talk to us then we can you know we can talk to someone with their with his group if we need to.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] OK perfect uh.
[CUSTOMER][POSITIVE] I, I so appreciate your help. I like I just did not know. I was like, let me get information and get back to you. Um, perfect. Thank you so much, Ms. [PII]. I like really no, that's not your name.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I know that's one of those tricky ones.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] It's [PII]. It's OK.
[CUSTOMER][NEUTRAL] [PII], I talked to [PII] the first time and I wrote her name down, and I was looking at it, but I knew as soon as I said it that that was wrong.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's OK. That's OK. Yeah, sometimes it takes a couple of us to help figure something out, so.
[CUSTOMER][POSITIVE] OK, thank you so much I really appreciate you. I'm going to uh I'm gonna reach back out to him.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Bye.
[CUSTOMER][NEUTRAL] Bye bye.