AccountId: 011433970860
ContactId: c908b523-f931-4a95-9171-e5bb17bcdc1a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1055869 ms
Total Talk Time (AGENT): 392134 ms
Total Talk Time (CUSTOMER): 318336 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/c908b523-f931-4a95-9171-e5bb17bcdc1a_20250529T17:57_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, Ms. [PII], it's [PII]. I've got an insured on the phone. His name is [PII]. His policy number is 253-689-6.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me write this other policy down real quick before I forget it. Hold on.
[CUSTOMER][NEUTRAL] I didn't have my ducks in a row sorry about that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and he is calling about um.
[CUSTOMER][NEUTRAL] Claims 253-689-6 is his policy on his wife [PII] for part two, there's two claims there for her. He is stating that she had a policy and I did look, she has policy number 2499914.
[CUSTOMER][NEUTRAL] The claim was denied because um services were rendered previous to the effective date but her policy number 2499914, he is saying.
[CUSTOMER][NEUTRAL] So she had that policy for a month and it should be covered under it. I don't see in BQPHI where anything was paid for the policy, but I'm gonna let you talk to him because he is adamant that the policy was active for a month.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] And that the claim should be filed on that policy number.
[CUSTOMER][NEUTRAL] He said he paid it for a month himself.
[AGENT][NEUTRAL] Mm, OK, that's fine you can send him over.
[CUSTOMER][POSITIVE] All right, thanks, Ms. [PII]. Bye-bye.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, [PII], I was just uh following up on, uh,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, claim with uh an old policy and I just, uh, I have a claim number that she gave me and um I just need to see what's going on here. It said something wasn't covered because the policy wasn't in force at the time and I'm or my my my my insurance wasn't enforced at the time. I'm like, well yeah it was it was enforced all to the very end of May and then we added my wife to our family plan in June.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so I'm not sure, you know what's going on because you guys paid some of it, you know, 3000 of you got paid.
[CUSTOMER][NEGATIVE] And then like for some reason nothing else paid.
[CUSTOMER][NEUTRAL] Or it says insurance adjusted, yeah, I don't know. Anyway, I can give you uh some whatever you need here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is for your wife, [PII], is that correct?
[CUSTOMER][POSITIVE] Correct, yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty
[AGENT][NEUTRAL] And the data service that we're looking at is 520.
[AGENT][NEUTRAL] Of [PII].
[CUSTOMER][POSITIVE] 24, correct, yes ma'am, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like she was affected.
[AGENT][NEUTRAL] OK, so on the policy number 253-6896 on that policy, uh, that policy was effective on [PII].
[AGENT][NEUTRAL] And so the data service 5/20 was prior to that, so that's the reason that claim denied. So she also gave me policy number 249914 that [PII] had that was effective [PII] through [PII].
[AGENT][NEUTRAL] So we can reprocess the claim under uh the policy for [PII], but we still won't be able to make a payment because it looks like the effective date and pay two days are the same so and looks like the policy is also no longer active at this time.
[AGENT][NEUTRAL] So we
[CUSTOMER][NEUTRAL] Her old policy, no, is no longer active, right, but the old one at that time back in [PII], it was active. Yeah.
[AGENT][NEUTRAL] OK, yeah, so we're not showing that it was active, uh.
[AGENT][NEUTRAL] For the, for the month of May.
[AGENT][NEUTRAL] Because we um
[AGENT][NEUTRAL] It never we don't, I don't see that we it was ever active in the month of May.
[AGENT][NEUTRAL] So do you know if you all pay premium or she paid premium on this policy?
[CUSTOMER][NEUTRAL] Well, we, I was told that it, you know, that it was going to remain in effect because we paid for it already till the end of May, but they said, we'll add her to the whole family and that'll start in June. I'm like, OK, great, which, you know, we, we did have to start in June because I was paying for her and for my family, me and my two other daughters.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's a long story as to why she got separated. It was kind of more of an accident than anything else, but he just said, hey, you can just add her, man, and save yourself some money. I'm like, great. So, but he said, you know, that, you know, her policy is in effect till the end of the month and then in June, it'll become active with her on the other policy, on the new one. I'm like, great. So.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what we did. We just kind of left it, you know, and then in June she was, uh, part of the family one, so there's just one insurance uh card now instead of 2.
[AGENT][NEUTRAL] OK, alright, so um, what she may need to do is get with her employer um to see if you know uh if they sent over something.
[CUSTOMER][NEUTRAL] It wasn't, it wasn't through an employer. It was, it wasn't through an employer, it was just, uh, we just pay for ourselves, just kind of like a, you know.
[AGENT][NEUTRAL] You pay
[CUSTOMER][NEUTRAL] yes, individual, uh, insurance. It wasn't to an employer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the business workers of America, they don't, you know, take the premium out of her paycheck or out of your paycheck for the policy that she had.
[CUSTOMER][NEUTRAL] No, no, no, we just pay, we just pay for it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me see if I can get someone in billing to see if we ever received any premium on this policy and if it should be paid through the month of May because right now I'm not seeing that uh that we have anything.
[AGENT][NEUTRAL] Uh, and that way we can kind of see what you need to do to get uh.
[AGENT][NEUTRAL] You know if we need to pay if we need back premium or whatever we're needing to cover those dates for you, uh, can I put you on hold just one moment?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Thank you. You are on hold.
[AGENT][NEUTRAL] Hey [PII], how are you? This is [PII] over in [PII].
[AGENT][POSITIVE] Doing good, can't complain.
[AGENT][NEUTRAL] I have a a question.
[AGENT][POSITIVE] Yes, thank goodness.
[AGENT][NEUTRAL] Look, I have a, uh, on the line and um he was calling about policy number 2499914.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And this is for uh [PII].
[AGENT][NEUTRAL] OK, and so I can see they're stating that the policy should have been active for the month of May because she does have a data service well through the month of May she does have uh.
[AGENT][NEUTRAL] Days of service but within May that they're trying to get covered so she is, she had her own policy.
[AGENT][NEUTRAL] I guess that should have gone through May and then she picked up on her husband's policy like the [PII]. So do you know if we ever receive anything or should this policy have been active?
[AGENT][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] The mm that's how it was yesterday for me.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me go back and look. Let's see, yeah.
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] And it's Business workers of America?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm thinking
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And can you tell whether that's, that's being paid through a group or is he, cause he's saying he paid himself, does he?
[AGENT][NEUTRAL] Who's
[AGENT][NEUTRAL] Uh, the insured, uh, the husband.
[AGENT][NEUTRAL] And see that's what you know I asked them, I feel, you know, is it being.
[AGENT][NEUTRAL] You know, deducted from deducted from his check and he said no, we pay it ourselves, yeah.
[AGENT][NEUTRAL] that
[AGENT][NEUTRAL] and that's different from the group.
[AGENT][NEUTRAL] Right. I, I did, but I, I just kind of went along with it, yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Yeah, he needs to uh reach out to the group and see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] She's on.
[AGENT][NEUTRAL] She's on his policy, yes, under.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I do, uh, 253-689-6.
[AGENT][POSITIVE] Wow
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] That's what I thought, yeah.
[AGENT][NEUTRAL] Yeah, OK, that's what I was thinking, but I just want to verify.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK alright thank you alright.
[AGENT][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] OK, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Alright, thank you for holding.
[AGENT][NEUTRAL] OK, um, you would need to speak to someone in your HR.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, to find out about this, uh, about the.
[AGENT][NEUTRAL] That your wife's policy that she had to see if.
[AGENT][NEUTRAL] Uh, I guess if they're, they can go back and, you know, make that payment for the premium for her to be covered for the month of May.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, there, there's no HR it's just me. So, I mean, if I just need to make a payment to cover back then and then you can resubmit for coverage, I, we can do that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the the policy like the lady in billing, she said this was a group, this was a a policy that you had through a group, so the payment would have to come from that group.
[CUSTOMER][NEUTRAL] No, I, I was the group.
[AGENT][POSITIVE] You were OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, it was just that we're, we're self-employed or I'm self employed, yeah.
[AGENT][NEUTRAL] OK. OK. OK. All right, so, um.
[AGENT][NEUTRAL] Yes, that's the only way we can go back and do that is uh we the payment comes over from uh.
[AGENT][NEUTRAL] From the group, uh, I don't know, I'm sure there's not a deal, maybe.
[AGENT][NEUTRAL] So do you know if if whoever is in the billing department if they received the bill from APL for that particular policy?
[CUSTOMER][NEUTRAL] I don't know. I, yeah, I have no idea, uh, who to even call on that. I mean, I can call uh PHCS and just say, hey, uh, have you guys been in contact with APL? And, um, with the, you know, they gave me information in the beginning, you know, to send stuff over and get going with them, but that was all I had.
[AGENT][NEUTRAL] Yeah, I, I would reach out to them um.
[AGENT][NEUTRAL] Again about the about the billing and that you're trying to get a claim paid uh and that you need to know how you can get in that additional premium for that policy so it'll cover those days of service.
[CUSTOMER][NEUTRAL] Will they let me go back and and pay back then and then.
[AGENT][POSITIVE] Yes, sir, they will.
[CUSTOMER][NEUTRAL] Make it active again? Really? OK, and how much would that be? do you know?
[AGENT][NEUTRAL] I don't, I don't have that so you would have to get with, uh, I guess in the billing whoever does the billing for the uh policy to APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, yeah, I will, um, well, it's not for APL, it's for, um, PCHS.
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] That's, I mean that's the people that we pay through I guess they're kind of a.
[CUSTOMER][NEUTRAL] Not a broker but just they're kind of like uh a group.
[CUSTOMER][NEUTRAL] And then they offer insurance through that group. I, I don't, to be quite honest, it's getting more confusing by the day, um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sorry.
[CUSTOMER][NEUTRAL] But uh it's OK. I will call um them.
[CUSTOMER][NEUTRAL] And find out, you know, how to deal with that and then find out if I can go back and make a payment for May of last month last year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, OK, and so and I'll, and then I'll go ahead and work on getting this the claim that we processed under your policy over to her policy so that way if we do get the premium, uh, that we'll get notified that we need to, uh, reprocess the claim.
[CUSTOMER][NEUTRAL] Alright, alright, alright.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, alright, alright.
[CUSTOMER][NEUTRAL] And OK, we'll go from there alright let me uh make some phone calls here.
[AGENT][NEUTRAL] OK, alright, so anything else I can help you with on today, Mr. [PII]?
[CUSTOMER][POSITIVE] Alright, thank you very much.
[CUSTOMER][POSITIVE] Oh gosh, ma'am, you know, I, I think you've done as absolute best you could. I don't think there's anything else you could do for me at this point, so I gotta go and figure all this crap out right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, well thanks for thanks for calling ATL and have a great rest of your day. Bye bye.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] You too ma'am thank you bye bye now.