AccountId: 011433970860
ContactId: bfd9c1db-188e-4278-9f1c-d4892ba360c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 969119 ms
Total Talk Time (AGENT): 488985 ms
Total Talk Time (CUSTOMER): 448620 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/bfd9c1db-188e-4278-9f1c-d4892ba360c6_20250109T18:35_UTC.wav
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[AGENT][NEUTRAL] This is [PII] in Burger Resources.
[CUSTOMER][NEUTRAL] Hi, this is [PII] over in customer care. How are you today?
[AGENT][POSITIVE] I'm all right. How are you?
[CUSTOMER][NEUTRAL] I'm good thank you um I have a [PII] on the line with a group and she is calling about an employee that was supposed to be added for open enrollment and they're not on there and when I asked her she said that she they don't use the OSC for enrollment so I think that's something that maybe you guys help with is that right?
[AGENT][NEUTRAL] Um, no, not really. Um, what's the, uh,
[CUSTOMER][POSITIVE] Oh, OK, I'm sorry.
[AGENT][NEUTRAL] Well, what's the group?
[CUSTOMER][NEUTRAL] Uh, the group number is 16265.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So there's numerous places that they're using, if they're just sending in um the enrollment file template. Actually, this one is.
[AGENT][NEUTRAL] This one's under Capital Group, so it might be coming from the file feed from the call center at Capital Group.
[AGENT][NEUTRAL] Um, who's the person that was supposed to be added?
[CUSTOMER][NEUTRAL] His name is [PII].
[CUSTOMER][NEUTRAL] And I did check under the group number I didn't see him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Do you have her on the phone?
[CUSTOMER][NEUTRAL] Yeah, so I apologize. I thought I was calling the right department, um.
[AGENT][NEUTRAL] They're all right. It, it could be, I mean, if they're, if they're using the enrollment system that Capital Group uses, then it's coming from a file feed from Capital Group, so it's, we don't see it, it goes straight to the enrollment team.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if they are using, if they're sending it in just on an enrollment template then.
[AGENT][POSITIVE] We might have gotten it and it might have gotten gone straight to new business department so there's a number of ways this could be happening.
[CUSTOMER][NEUTRAL] Hm, OK.
[AGENT][NEUTRAL] I don't think those files are coming to us, but you can give it to me and I'll figure it out.
[CUSTOMER][MIXED] She did let me know that I guess their contact they originally had for the policy I guess no longer works for us so she was a little confu she didn't even know really where to go, you know what I mean, as far as who to reach out to so I appreciate you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I mean, I can take her.
[CUSTOMER][NEUTRAL] OK, do you want her callback number just in case?
[AGENT][NEUTRAL] Uh, I've got it.
[CUSTOMER][POSITIVE] OK awesome all right I appreciate you thank you so much.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Good afternoon. This is [PII] in Berger Resources. I understand you're trying to verify a new hire that should have been added at open enrollment and we're having a little trouble figuring out.
[CUSTOMER][NEUTRAL] Actually, actually it wasn't a it wasn't a new hire. He's had it previously in previous years. He's been a long term employee but he elected it to start [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, alrighty, um, so.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And your name again is?
[CUSTOMER][NEUTRAL] [PII], but my VP is [PII], so so I think her name is listed on there. I do have an account. I have access. I tried to put him in as a new enrollment on website, but it's saying because it's effective [PII], and he's paid for coverage. Um, it won't allow me to do that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Ah, I got you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah, got you. Yeah, you, you won't, you can't retro do it on the OSC, um, do you guys usually enroll through an enrollment platform or when you guys?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Through our invoice remittance, yeah, our in because I do the billing and the invoicing on this, so I go through, uh, miscounts and we do the remittance and stuff and we upload to the secure website, the invoicing so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so you guys are just, you guys are just adding them through the remittance files then.
[CUSTOMER][POSITIVE] Right there she does that I believe when we do the uploads.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it may be that these are coming from the um.
[AGENT][NEUTRAL] To a file fee from the enrollment platform because it doesn't look like they ever.
[CUSTOMER][NEUTRAL] Well, I thought that too it's PlanSource, you know, and PlanSource is our our administrator platform, you know, um, but we've had some issues with passive enrollments, so I knew some EDI files were kind of messed up, um, based on that, and I thought, well, he wasn't a passing enrollment so that didn't make sense and so he was listed on our platform as electing it.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And he has been paying for it since [PII], so I'm just trying to get him something to utilize this afternoon because he has an MRI so.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, yeah, um, so, and he's selecting at [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right, he's just, yeah, because he'd had a previous years but decided to start back with it, so, um, and it was effective [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what was his name again?
[CUSTOMER][NEUTRAL] [PII] Do you need the last four of his social or anything?
[AGENT][NEUTRAL] No, I don't think so. I think I can.
[AGENT][NEUTRAL] Look this up this way, so it sounds like maybe there's something going on in the EDI file that's coming over from PlanSource.
[CUSTOMER][NEUTRAL] See, that's what I thought too, you know, it's like, did none of our coverage for gap get sent up for like new enrollments or, you know, and then I thought, well, you know, I usually do the, the billing and invoice that I do is always on the [PII], so I always do the submission and the upload on the [PII] and I thought, well, I haven't hit the [PII] yet so maybe because he started in [PII], but I was under the assumption that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know, the EDI file from PlanSource should have shot that over to APL January or even December, the end of December, you know, I mean.
[AGENT][POSITIVE] Yeah, for sure.
[AGENT][NEUTRAL] Yeah, I don't know exactly when they when they send them because I don't process those EDI files, but I, I would think that it would have fed over by now um let me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Exactly, and I'm wondering how many others are missing. That's what I'm thinking.
[AGENT][NEUTRAL] Let me
[AGENT][POSITIVE] Oh my gosh. Well, then there could be some too.
[CUSTOMER][NEUTRAL] I know, right? That's what I said. We've got like 1800 employees. I don't know how many have elected. I haven't got a number on how many elected gap coverage, but I'm sure all the previous ones are probably still in there because it was, it was a roll over, you know, but I'm just wondering how many new ones are re-electing it as, you know, people they're missing, you know, and because he had an MRI and I only know this that this has happened.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Because he tried to call APL to get our group number for his member number because he has the MRI so and then they told me he wasn't even, you know, it doesn't even have it and that's like, well you've been paying for it so you've got it, you know, I mean.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Yeah, I just sent a message to my EDI specialist, so, um, I'm gonna see what she tells me about whether
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][POSITIVE] Oh, I'm so sorry that snuck up on me.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm gonna see if she's got one that for whatever reason hasn't gotten.
[AGENT][NEUTRAL] Process through, um.
[CUSTOMER][NEUTRAL] Well yeah maybe maybe that's not maybe they do an upload based on what our invoicing does. If not, that's kind of silly I wouldn't be doing it honestly so.
[AGENT][NEUTRAL] And it might be like all of them.
[AGENT][NEUTRAL] Yeah, uh, let's see.
[CUSTOMER][NEUTRAL] Who wants to type all that data in.
[AGENT][POSITIVE] Right, for sure.
[CUSTOMER][NEUTRAL] I can do an upload. I mean, honestly I could pull a report and do it as an Excel file, upload it as new people on that website, you know, that's like when you have the new enrollments if that lets me do a bulk, I've never looked into it honestly.
[AGENT][NEUTRAL] Yeah. Yeah, she's, she's typing, so she's looking for it right now. Um, and it may just be because
[CUSTOMER][NEUTRAL] If I needed to, you know.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] This group's what this group has the that the the participation renewal form, it doesn't look like we've gotten it yet for [PII]. Um, and so if this group's still sitting in that renewal not process phase, it'll cause that EDI file to hold, um, I mean, I can fill that out for you while I'm actually on the phone with you. That's not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] A big deal. I mean if you know how many are enrolled.
[CUSTOMER][NEUTRAL] So we they so our broker, our broker hasn't sent over that we deal with calling him and Butler. They haven't sent over our participation form for 25.
[AGENT][POSITIVE] I got you.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Hm, OK.
[AGENT][NEUTRAL] Um, let me just keep.
[AGENT][NEUTRAL] I want, OK. I don't know why.
[AGENT][NEGATIVE] I can't even see where it went.
[AGENT][NEGATIVE] It went out. That's not, that's not good. All right, maybe it just got filed in the wrong place.
[AGENT][NEUTRAL] Fingers crossed.
[CUSTOMER][NEUTRAL] Yeah, or I was thinking maybe they didn't think they had to do it over and over again, but, uh, every year we send participations with UMR and everywhere else so I can see whether that has to be done with you guys so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, no, I mean, it went out, so I.
[AGENT][NEUTRAL] Let me just see, has anything changed with the major medical carrier, any of that?
[CUSTOMER][NEUTRAL] Well, we have UMRs you mean major medical, you know, is that what you mean?
[AGENT][NEUTRAL] Uh, United Healthcare is who they who they've had in the past is.
[CUSTOMER][NEUTRAL] Right, UMR slash UnitedHealthcare, exactly, yes, uh-huh.
[AGENT][NEUTRAL] OK, and it's still running 1 January to January basically?
[CUSTOMER][NEUTRAL] Yes, uh-huh, uh-huh, yeah.
[AGENT][NEUTRAL] Um, and you're not making any changes to your gap plan?
[CUSTOMER][NEUTRAL] Nope.
[AGENT][NEUTRAL] It's a voluntary offering. Nothing changed on the deduct or the major medical out of pocket and deductible, any of that stuff.
[CUSTOMER][NEUTRAL] Um, as far as deductibles that has changed, you know.
[CUSTOMER][NEUTRAL] Wait a second.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'm looking my my VP just is responding to some emails about this gap thing, so let me see what she's saying right now.
[CUSTOMER][NEUTRAL] Because [PII], uh, of course, is, uh, we're hearing about it.
[AGENT][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Is not having insurance.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, now that's something she said this is telling [PII] that this should have no impact this afternoon. The gap plan is a reimbursement program when you file the claim against it, not the provider, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So he's taken care of, so he's got the claim form you can file against it so uh OK.
[AGENT][NEUTRAL] All right, so, so she said that that that file actually came in today.
[CUSTOMER][NEUTRAL] So now with us with the participation portion.
[AGENT][NEUTRAL] And it got processed, but I'm trying to figure out.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If we got anybody.
[AGENT][NEUTRAL] For [PII] effective because I don't see any [PII] effective date.
[AGENT][NEUTRAL] Um, I'm following, I just sent her a follow-up question.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And you just got the file feed from from PlanSource like today.
[AGENT][NEUTRAL] Mhm, yeah, so that file just came in today. Now there were some people that had, and these may be.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't know if maybe those [PII] elections haven't come because there were several that elected coverage for late in [PII].
[AGENT][NEUTRAL] Like [PII], effective, [PII].
[CUSTOMER][NEUTRAL] Yeah, which, um,
[CUSTOMER][NEUTRAL] That would probably be an open enrollment, yeah.
[AGENT][NEUTRAL] So I'm
[CUSTOMER][NEUTRAL] But everybody, everybody should be, you know, the effective [PII] he should be on that file feed, right? I'm assuming.
[AGENT][NEUTRAL] Um, well, I'm asking if he wasn't on there, and she's, she's looking for me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, no, fine, no problem.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And 2, can you, did you look to see if the participation is that there's something that's come in that you see on our file?
[AGENT][NEUTRAL] Um, it has not. It has not, but I mean, I've got this form right here. So as long as you haven't made any medical changes or changes to the gap, I, I can fill all this detail and if you can tell me.
[CUSTOMER][NEUTRAL] We haven't made any changes, but do you need do you need a signature on that?
[AGENT][NEUTRAL] I can sign it. It's not a big deal. Um, can you tell me how many total benefit eligible employees you have?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 00, eligible I would say about 1700.
[AGENT][NEUTRAL] OK, and do you know how many are enrolled in the medical plan?
[CUSTOMER][NEUTRAL] Uh, it's gonna be about 6:42 I believe.
[AGENT][NEUTRAL] And then how many should be enrolled in the gap um I've got.
[CUSTOMER][NEUTRAL] That I could not tell you I have to pull a report on the election on that, yeah, that's kind of hard.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] As of today, I have 237.
[CUSTOMER][NEUTRAL] Which sounds about a normal, you know.
[AGENT][NEUTRAL] Sounds around about normal.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that gives us participation at
[CUSTOMER][NEUTRAL] Because only only about a third of those have a 642 elect gap anyway, you know.
[AGENT][NEUTRAL] 36.
[AGENT][POSITIVE] Yeah, yeah, yeah, so that gives us 36% participation which is good.
[AGENT][POSITIVE] That meets participation, we're all fine there and I'll just sign off on this as having this conversation with you.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So that will get the renewal form taken care of. I've still got her looking um maybe I'm guessing maybe if the last file that we got was today it was the open enrollment file so if this guy just made an election for 11.
[AGENT][NEUTRAL] I don't know if it was a separate election and there's another it'll come on the next file. In the meantime, I mean, I could send you a, a template and you could just plug him into the template and we could add him manually if you will.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, just to get him in the system.
[CUSTOMER][NEUTRAL] OK, if you don't mind emailing that to me, could you email that to me?
[AGENT][NEUTRAL] Yeah, what's your email?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Got you. Alrighty.
[CUSTOMER][POSITIVE] I appreciate all your help.
[AGENT][NEUTRAL] No, no problem at all. And once you get this, if you'll just cut that demographic details.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So send me that. I'll plug in it on is it a regular Excel? It's a regular Excel, right? OK, so I can plug it in and send it back to the email address that you're sending it from?
[AGENT][NEUTRAL] Yeah, it's just a regular Excel file, and if you'll just
[AGENT][NEUTRAL] Yes, and then I'll take care of of trying to get it rushed through and get him at least get him in the system. I won't be able to get you, I don't think I can get you an ID card today, but I will, well at least get him a number and then his provider can call and verify benefits off the policy number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, that sounds good, that'd be great.
[AGENT][NEUTRAL] And then that should suffice for the providers, so.
[CUSTOMER][POSITIVE] OK, well I appreciate that then thank you.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And what your first name again was?
[CUSTOMER][NEUTRAL] With [PII]
[AGENT][POSITIVE] All right, [PII]. Give me a few minutes. I'll get this template over to you. I've got this participation form completed so we can get the renewal part through and done and then we'll get, we'll get Mr. [PII] taken care of and we'll go from there.
[CUSTOMER][POSITIVE] I do appreciate you. What was your name again? I'm sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII], OK, I totally appreciate your help, [PII].
[AGENT][POSITIVE] Absolutely. Give me just a second, I'll get this over.
[CUSTOMER][POSITIVE] OK then. Thank you. Bye bye.
[AGENT][POSITIVE] Uh huh have a good day bye bye.