AccountId: 011433970860
ContactId: d20a8e9c-623e-4c55-8d4d-d00c38b61f05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 425420 ms
Total Talk Time (AGENT): 189160 ms
Total Talk Time (CUSTOMER): 104699 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/d20a8e9c-623e-4c55-8d4d-d00c38b61f05_20250304T18:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. Can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] in the claims department. I have the admin on the line with group number 25773, Miss [PII].
[CUSTOMER][NEUTRAL] Um, last initial M.
[CUSTOMER][NEUTRAL] She's calling in regards she has actually she was calling in regards to a claim that she has this pending um eligibility um premium or payment. She says that she has an invoice in front of her for March, but it shows that they're paid up until [PII].
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She's calling about her own policy?
[CUSTOMER][NEUTRAL] Well, she, she was calling to check claim status but then I told her she read the remark associated with the ELB that states that we're waiting for information from your employer, but she is also the admin of the group.
[AGENT][NEUTRAL] OK, let me look at her policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 678.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Wow, with money taken out of the policy.
[AGENT][NEUTRAL] August. OK, 8.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Come on computer.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] I appreciate it.
[CUSTOMER][NEUTRAL] I have a callback number too so.
[AGENT][NEUTRAL] Uh, yeah, we're probably gonna have to call her back, um.
[AGENT][NEUTRAL] Cause this will take a little bit of research to figure out what's going on. Um.
[CUSTOMER][NEUTRAL] OK, what can you explain it to her?
[AGENT][NEUTRAL] Why is that? Hang on, what in the world?
[AGENT][NEUTRAL] What is the I's just going into the
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] September.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] On computer.
[AGENT][NEUTRAL] When does the premium change? That's gonna be.
[AGENT][NEUTRAL] So I injured passed away, so we'll be effective 8 months so.
[AGENT][NEUTRAL] 8179.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] TX.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Alright, so now.
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] I don't understand why that didn't post, but
[AGENT][NEUTRAL] February
[AGENT][NEUTRAL] And.
[AGENT][NEUTRAL] Alright, the policy is now paid to 31, so if there's a claim that's needs to be reviewed, it can now be reviewed.
[CUSTOMER][NEUTRAL] OK, can you explain it to her though? I mean, I, I wasn't sure what to tell her. You were, I think were talking to me, but out loud but talking about it. So can you explain to her what happened then because that's what she wants to know. OK, thank you. One moment please.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Ridiculous
[AGENT][NEUTRAL] Simply tell her it's been fixed.
[AGENT][NEUTRAL] This is [PII], can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I was put through to you to explain what's going on with my account.
[AGENT][NEUTRAL] Um, well, your policy is fine now. What happened was when the coverage changed from, um,
[AGENT][NEGATIVE] Uh, family to parent coverage, the premium did not automatically post because it wasn't technically, it didn't match technically what we had in the system. Um, so it just kicked it out and nobody had, uh, nobody I guess realized it and so I have applied the premium from.
[CUSTOMER][NEUTRAL] it's
[AGENT][NEUTRAL] The invoices that have been paid, so your policy is now paid to 31.
[CUSTOMER][NEGATIVE] So in other words it only affected me.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. It was just, it was just whenever you had your, the coverage changed.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The coverage changed to over 7 months ago.
[CUSTOMER][NEUTRAL] My husband's been dead since July.
[AGENT][NEUTRAL] Yes ma'am, I understand that that's why I said the premium that was paid, um, for September kicked out and the processor, I guess, did not see it and so, um, the premium, the now the new premium didn't roll into the quote unquote roll into the policy so it was just kicking the premium out and putting it in what we call group dispense instead of applying it.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] And so, um, whenever I figured that out, I was able to apply the premium that had been sitting out there.
[CUSTOMER][NEGATIVE] OK, and you guys didn't do anything to notify us in reference to this, correct? Because I've not seen anything come through. The only reason I was aware of this was because of the explanation of benefits that I received.
[AGENT][NEGATIVE] No, you wouldn't have received notification of it.
[CUSTOMER][NEUTRAL] And how much do I have that has not been paid because I'm really confused. I've been getting plenty of explanation of benefits recently that have been paid on.
[AGENT][NEUTRAL] How much of what hasn't been paid?
[CUSTOMER][NEUTRAL] My claims.
[AGENT][NEUTRAL] Uh, that, I can't answer that. I'm not in the claims department. I'm in the group billing department.
[AGENT][NEUTRAL] Whatever claims are out there pending, um, eligibility will be um, reprocessed.
[CUSTOMER][NEUTRAL] OK, and that is as of today, correct?
[AGENT][NEUTRAL] That they'll be reprocessed.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I am.
[CUSTOMER][POSITIVE] All right thank you so very much.
[AGENT][POSITIVE] You're welcome [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] All right. Thank you for calling APL and you have a good afternoon.
[CUSTOMER][NEUTRAL] Bye bye.