AccountId: 011433970860
ContactId: d95ab72b-6706-4a63-b790-8ae89b434687
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 823960 ms
Total Talk Time (AGENT): 371070 ms
Total Talk Time (CUSTOMER): 377793 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/d95ab72b-6706-4a63-b790-8ae89b434687_20250224T22:24_UTC.wav
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[AGENT][NEUTRAL] Thank thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. How are you today?
[AGENT][POSITIVE] I'm doing well. How are you doing?
[CUSTOMER][NEUTRAL] I'm doing well thank you very much. um I'm actually calling this is [PII] and I'm with the broker's office, um, and I'm calling to get some more information on a really an employee that's deceased now, um, but the employer is asking me to reach out and just see, obviously no HIPAA information but just get some additional information based on the email I received back.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, Miss [PII], first, can you give me the um.
[AGENT][NEUTRAL] Insured's name and policy number?
[CUSTOMER][NEUTRAL] Yes, just one second. I was just in there and I don't know what happened. It went bye bye.
[AGENT][NEUTRAL] Oh OK and do you know the group number also?
[CUSTOMER][NEUTRAL] Don't you love technology?
[AGENT][NEUTRAL] Yeah, that happens to me a lot and always when I'm on the phone.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, let me get you the, let me see if I have this group number handy.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] OK, group number is.
[CUSTOMER][NEUTRAL] Um, 18296.
[AGENT][NEUTRAL] OK, let me pull that up first.
[CUSTOMER][POSITIVE] Perfect. Well I'm searching for my email.
[CUSTOMER][POSITIVE] Oh there it is care team ah found it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yay!
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yes, yeah, OK, so the, um, the, oh, go ahead. Did you need someone?
[AGENT][NEUTRAL] Yes, I was gonna ask you which um what's the broker's office that you work for?
[CUSTOMER][NEUTRAL] Higginbotham Insurance Agency.
[AGENT][POSITIVE] OK. Thank you so much. And can you just give me the physical address of the group?
[CUSTOMER][NEUTRAL] Uh, uh, [PII] Worth ID? Sure, it's uh [PII].
[AGENT][POSITIVE] OK, thank you. I appreciate you giving that to me. All right, and, and you said you did find the um insured's name and policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh well, I don't have a policy number because we don't have that in our system. I don't get bills or anything, but his name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have a birthday or social.
[AGENT][NEUTRAL] Yes, what's his birthday and his social? I can look him up by his social.
[CUSTOMER][NEUTRAL] His birth
[CUSTOMER][NEUTRAL] birthday is [PII].
[CUSTOMER][NEUTRAL] His social is [PII].
[AGENT][NEUTRAL] OK, let me pull him in.
[CUSTOMER][POSITIVE] Perfect thanks.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And once you get that pulled up I'll give you just a hair more information.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, please. I've got him pulled up now.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] OK, so he has been deceased since [PII], which you can probably see that in your system. Um, the question, so Fort [PII] ISD is calling because [PII] is his sister.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And, and she's telling them that you, you guys were telling her that he can't file a claim back before he died for cancer because he had no benefits in August and so uh but then when we reached out to APL via email, I got something back from your uh care team.
[CUSTOMER][NEUTRAL] That just basically says, um, you know, upon review there's no claims at all filed but that someone did speak with [PII] just last Thursday and then y'all have documents on file which are power of attorney and a death certificate which the district was like, why would they have that, you know, did [PII] send it to him and, and why, you know, they're just trying to get additional information to try to help this person, [PII], his sister.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Because I think she honestly between you and me, I think she's confused. I think she doesn't know if APL's life insurance, cancer insurance, because for her to have possibly sent you guys a power of attorney and a death certificate, that's probably not something that I'm assuming you guys would require for any cancer benefit payments.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, OK, so.
[CUSTOMER][NEUTRAL] I mean you may because it may need to be paid to her.
[AGENT][NEUTRAL] So the power of attorney is only valid when the insured is still living, so she may have sent the power of attorney so that she could help make judgment calls on the policy itself, the cancer policy. I'm gonna look and see if there's any information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Because all the power of attorneys have to go through our in-house attorney to be approved before a power of attorney can be put on.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A policy
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Of course there's only so many notes that I can see, but I do see that [PII] called and spoke to somebody in our claims department and um.
[AGENT][NEUTRAL] The claims department told her that we needed all the primary EOBs for all chemo and radiation.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I immune as well so when she called last week she was calling because she wanted to file the claim and they help helped her by telling her what she needed to send in to file the claim.
[CUSTOMER][NEUTRAL] OK, um, so prior to last week y'all don't have any or you can't see anything that shows that she's called because again she's telling [PII] I see that you guys are um saying that he doesn't have benefits that he, you know, payments weren't received, he didn't have insurance in August and so it's just strange to me and [PII] is trying to get down to the bottom of it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Right. Um.
[AGENT][NEUTRAL] The policy effective date is from [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So anything after [PII], the policy was no longer active, so it would not.
[AGENT][NEUTRAL] Be able to send claims in for after [PII] or.
[AGENT][NEUTRAL] After his death, basically, anything prior to his death.
[CUSTOMER][NEUTRAL] OK, that's the initial.
[AGENT][NEUTRAL] Should be able to send in.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yeah, I don't know if that was a different policy because the policy I'm looking at, he elected an open enrollment and he elected it um in [PII] for the effective date of [PII] and it's the Cancer high plan.
[CUSTOMER][NEUTRAL] So this may be where part of the issue is if y'all are showing there's not a second policy and it turned on.
[CUSTOMER][NEGATIVE] 91 of 23, that is not there should have been premiums sent and received by APL for the whole year after.
[AGENT][NEUTRAL] Right, and I do see that there is another policy um for the cancer option too that the effective date is [PII], which would make sense if he passed away in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So, so if you, yeah, I
[AGENT][NEUTRAL] Let me look on the notes for this one.
[CUSTOMER][NEGATIVE] Yeah, I guess I'm concerned because I think this is part of the problem is probably she's calling just like I'm calling and y'all are only seeing the first one and told her there's no benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Because basically that's what you just said to me, which is not accurate.
[AGENT][NEUTRAL] Right, there
[AGENT][NEUTRAL] I benefits up to the point of death.
[AGENT][NEUTRAL] So on policy 242-6917,
[CUSTOMER][NEUTRAL] But, but I, I.
[AGENT][NEUTRAL] The effective date is [PII] and the lapse date is [PII].
[CUSTOMER][NEUTRAL] Well, he didn't die until [PII].
[CUSTOMER][NEUTRAL] Of [PII], so why would it lapse prior to his date of death?
[AGENT][POSITIVE] OK, that's a good customer service question. Um, what I can do is.
[AGENT][NEUTRAL] I'm, I'm sorry, but I'm gonna have to transfer you to customer service so that they can they can answer the power of attorney questions they can answer why the policy was lapsed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Not unless the only other thing I could think is if it was paid to 81 that passed away before the the August premium came in. I don't know but customer service should be able to answer that.
[CUSTOMER][NEUTRAL] OK, and yeah, and I don't know if there's a way because it sounds like that's probably what happened is she called and you all told her what you told me and she doesn't have enough information to know that there's a second, you know, he, he has not had a lapse in coverage, so I, I'm assuming that's what happened is that.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean, is there a way to avoid that if she calls back because again, Fort Worth IC is a 10,000 life group for you guys and they're they're getting very upset and so I'm just trying to be the mediator in between and, and, and so what just happened, it happened to me as well so I'm concerned [PII] is gonna call back again and she's gonna get misinformation and go back to the district. So I'm just trying to see what we can do to avoid this issue.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, OK, what I'm going to do is I'm gonna go ahead because I can't, there's, I can't make the decision to change the um laps date but customer service can customer service can so I'm gonna make sure I get somebody on the phone that can help you um and I'm gonna kind of briefly explain to them uh what is going on so that.
[CUSTOMER][POSITIVE] Yeah, no problem.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You don't have to repeat everything again, but I'm sure they're gonna have questions for you also. So, OK. All right. OK, Ms. [PII], it's gonna be a brief hold while I transfer you on over to them.
[CUSTOMER][POSITIVE] Yes, OK, no problem.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank, thank you so much. You have a good afternoon and thanks for calling APL.
[CUSTOMER][NEUTRAL] S.
[CUSTOMER][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] in the customer service department. How may I help you?
[AGENT][POSITIVE] Hey [PII], this is [PII]. I'm so glad I've got you.
[AGENT][NEUTRAL] I've got, um, I've got Ms [PII] on the phone and she is the broker for group number 18296.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] She is calling about policy number 242-6917 [PII].
[CUSTOMER][NEUTRAL] Give me the number again.
[AGENT][NEUTRAL] It's 242-691-7.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII] passed away.
[AGENT][NEUTRAL] [PII]'s sister has been calling because she wants to file a claim.
[AGENT][NEUTRAL] It's showing that the policy lapse date is [PII], so she's being told she can't file claims.
[AGENT][NEUTRAL] After [PII], but he actually passed away on [PII] and [PII] on the other line with the broker's office is wondering if we can change that lapse date because it's causing a lot of confusion with um the insured sister who is on the policy as a power of attorney, and she's gone back to the school district and has complained to them.
[AGENT][NEUTRAL] And [PII]'s trying to be the in between person so that.
[AGENT][NEGATIVE] We don't get the school district up to that.
[CUSTOMER][NEGATIVE] It's not paid because it's not paid current. It looks like it was supposed to term. We can't do, we can't change that, but I'll tell her we can't change none of that. They gotta pay premiums. Premium's not here, so I don't know what to tell her that.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] OK. All right. Thank you, [PII].
[CUSTOMER][NEUTRAL] All right. What's her name again?
[AGENT][NEUTRAL] Her name is [PII] and she's with the broker's office.
[CUSTOMER][NEUTRAL] [PII], what's your call back number?
[AGENT][NEUTRAL] Her callback number is [PII].
[CUSTOMER][POSITIVE] OK, got you. Thank you.
[AGENT][POSITIVE] All right. Thanks, [PII]. bye-bye.
[CUSTOMER][POSITIVE] You're welcome. Bye-bye.