AccountId: 011433970860
ContactId: dbbe7476-0695-4d91-872a-35af6ad60de4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 927539 ms
Total Talk Time (AGENT): 408595 ms
Total Talk Time (CUSTOMER): 301414 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/dbbe7476-0695-4d91-872a-35af6ad60de4_20250505T20:14_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. My name is [PII]. I'm the agency manager for Hill Insurance in [PII], and we, we are the broker for uh the Wills Point Independent School District uh benefit plan.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And one of our insured, one of our insured, uh, just came in and he had a claim, uh, denied, uh, saying that services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] And so his policy is active, uh.
[CUSTOMER][NEGATIVE] He's having, you know, money deducted from his check. We're receiving commission on this policy, and I noticed that uh the policy number is incorrect uh on this uh EOB that he received.
[CUSTOMER][NEUTRAL] And so I'm, I'm, I'm guessing that's probably the, the, the problem here. I don't know where he got the or where he came up with the number maybe it was a.
[CUSTOMER][NEUTRAL] Uh, I know some of the, some of the policies have undergone a name change or a number change and maybe his policy number did did as well. I'm not sure. Uh, is this something you can help me with?
[AGENT][NEUTRAL] OK, [PII]. So you're calling on behalf of an insured. He's got a claim denied saying that he was not active at the time of service. Is that correct? Yes, sir. I can take a look at that and try and help you with this. Um, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Right, yes, ma'am.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] Uh, sure, [PII].
[CUSTOMER][NEUTRAL] 873
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, I do, uh, do you want the one that's on the page or the correct one?
[AGENT][NEUTRAL] Well, I need the one that's referenced regarding the claim you're calling about to start with.
[CUSTOMER][NEUTRAL] OK, that, that makes sense. I just want to verify, uh, so that, uh, policy on this EOB is 0255.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 45
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 49
[AGENT][NEUTRAL] OK, thank you. So give me just a couple of moments to get the information pulled up. Then I will have to verify several things with you, [PII] first for security. So just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I also have a claim number if that will help.
[AGENT][NEUTRAL] Uh, we'll get to that in just a moment. So first off, if you could please verify, um, you gave me the name of the group, if you could please verify your the agent of record on this group.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I'm the agency manager, the agent of record, I'm guessing would be either [PII] or perhaps [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you and then what is your email?
[CUSTOMER][NEUTRAL] Those are our prin those are our principles.
[AGENT][NEUTRAL] OK, thank you, and then [PII], what is your email please? Yes.
[CUSTOMER][NEUTRAL] My email?
[CUSTOMER][NEUTRAL] My email is my first name [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] At
[CUSTOMER][NEUTRAL] Hill H I L L.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The letters INS for insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Texas spelled out.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. So [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, thank you. And then what is the member's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, his name is [PII].
[CUSTOMER][NEUTRAL] Although I'm sure his name is middle name isn't [PII], uh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you for laughing.
[CUSTOMER][NEUTRAL] Uh, let's see, and his birth date?
[AGENT][NEUTRAL] You never know. So I don't, I don't ever go there because I never know.
[CUSTOMER][NEUTRAL] You know, I guess it could be uh.
[AGENT][NEUTRAL] I don't assume anything.
[CUSTOMER][NEUTRAL] [PII]'s real name was was.
[CUSTOMER][NEUTRAL] [PII]'s real name was [PII].
[AGENT][NEUTRAL] Right. So, yeah, so I don't assume.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So date of birth is gonna be [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And what is the data service and total bill amount that you're calling about [PII]?
[CUSTOMER][NEUTRAL] Uh, you know, that is not, uh, the date of service. Well, I really, I'm thinking it's, uh, gonna be 323. Those are 322 to 323.
[CUSTOMER][NEUTRAL] Are the two dates uh listed under these, but I don't have an amount.
[AGENT][NEUTRAL] Of this year?
[CUSTOMER][NEUTRAL] All I'm looking at is the is the EOB that shows that 0 was paid.
[AGENT][NEUTRAL] OK, so it does have on our EOB it does have the date, so it's [PII] to 323.
[CUSTOMER][NEUTRAL] Uh, yes ma'am, there's there there's 4 lines that says from and to.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, and then
[CUSTOMER][NEUTRAL] And so uh I'm seeing that that's what I'm seeing is a date range.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Oh no, I'm sorry, there's one actually says 323 to 325.
[CUSTOMER][NEUTRAL] Yeah, his confinement period, hospital confinement period, uh, 323 to 325.
[AGENT][NEUTRAL] OK, and any information that I do provide for you, [PII] will be a verification of benefits and not a guarantee of payment. So yes, um, you do have the claim number there?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and what is that?
[CUSTOMER][NEUTRAL] That number is
[CUSTOMER][NEUTRAL] 359.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 563 6
[AGENT][POSITIVE] Mhm. OK, thank you.
[AGENT][NEUTRAL] Alright, so yes, sir, I do see that claim. I do see that this policy, that is, I mean I can see the same denial remark that you have there in front of you. So let me just look at.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Yes, so this policy, it's kind of like it went into effect, but it didn't. It's because it has an effective date and a term date of the same thing, but I do not have another policy, another hospital indemnity policy that is active for him.
[CUSTOMER][NEUTRAL] OK, let me give you the number that I have on my commission statement.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So for [PII], uh, I've got a policy number of 02.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 12
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 0673
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] As in a
[CUSTOMER][NEUTRAL] Effective date of [PII].
[CUSTOMER][NEUTRAL] And and shows current.
[AGENT][NEUTRAL] Let me pull up another screen and look at that policy number because that's not.
[AGENT][NEUTRAL] I don't see that on his profile at all, so just a moment.
[AGENT][NEUTRAL] And you said 02120673.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Yes ma'am, 02120673.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] He has both the hospital indemnity.
[AGENT][NEUTRAL] OK, that's because, mhm, but that's because his social.
[CUSTOMER][NEUTRAL] And also like
[AGENT][NEUTRAL] There's a discrepancy in his facial.
[AGENT][NEUTRAL] So that's why I can't see it.
[AGENT][NEUTRAL] So I can see it under the other profile in which everything is. So what I'm gonna need to do is to transfer you over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To customer service, [PII].
[AGENT][NEUTRAL] So, what is his full social?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, right now my screen is only allowing me to see the last 4. Let me see, let me, let me, let me see if I can, let me, I, I've got another screen I can pull up his profile under his, uh, enrollment page and see what I can find.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, and while you're doing that, I'm gonna look, I'm gonna try to access some additional information myself, but just a moment.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Yeah, I'm here. Can you hear me?
[CUSTOMER][NEUTRAL] OK, so here's his full social if you want it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 04
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] If that's what we have on on our file.
[AGENT][NEUTRAL] OK, so the 2nd policy number that you gave me has got a different.
[AGENT][NEUTRAL] Social. I I'm not sure if it was a typo, so again, give me just a couple of moments to look up some additional information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And thank you for your patience while I'm looking up this other information.
[CUSTOMER][POSITIVE] Oh, that's no problem.
[AGENT][NEUTRAL] OK, so actually what you're going to need to do because I can't see how this information came in, I was looking for the application because it looked like it was an application, so I was just gonna cross verify that, but there, there is a number discrepancy in his social on that policy number you said that's on your commission statement versus every other policy that we have and the other policies that we have, do you have the number that you have?
[AGENT][NEUTRAL] That you just gave me, but in order to get this corrected, we will have to have you to send us an email, [PII].
[AGENT][NEUTRAL] With the correction request.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that email can be with the correction to his social.
[CUSTOMER][NEUTRAL] With the with the what?
[AGENT][NEGATIVE] Requested because the policy number you gave me is not, it does not have the social that you just verbally gave me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] But we can't just change that over the phone. Mhm.
[CUSTOMER][NEUTRAL] But, but the other ones do.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I just need
[CUSTOMER][NEUTRAL] And so just to verify, so his cancer policy which is 02556300, that's under the correct, that's under the social that I just gave you.
[AGENT][NEUTRAL] Yes, but he does not have an active cancer policy.
[CUSTOMER][NEUTRAL] You're saying that he does not?
[AGENT][NEUTRAL] I'm saying he does not.
[CUSTOMER][NEUTRAL] OK, well, he, he does on our page. It goes back, uh, actually he took it out, uh, this last year.
[AGENT][NEUTRAL] OK so again it's OK so what I'm gonna do even though you need to send it OK so when I look at the other social.
[AGENT][NEUTRAL] The one that's incorrect?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's got, so he's got a lot of things that need to be corrected, essentially.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] That policy number for his cancer policy?
[AGENT][NEUTRAL] Also include that.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] In your email to have his social corrected and make sure, you know, obviously for the correct for the correct social there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we get that updated.
[AGENT][NEUTRAL] Um, if you'll also include in your email to have his claims reprocessed.
[AGENT][NEUTRAL] Under
[CUSTOMER][NEUTRAL] And can I, can I just reference that claim number?
[AGENT][NEUTRAL] That correct policy number.
[AGENT][NEUTRAL] Yes, and ask that it, well, you can, you can ask that that claim be reprocessed.
[AGENT][NEUTRAL] Under the policy number that you have that's active, the [PII], once his social is corrected.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Because this is gonna have to go to multiple departments, so I don't want it to get lost.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, very good.
[AGENT][NEUTRAL] So, yes, sir. Um, in that email, you would just send that to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And again include those policy numbers.
[AGENT][NEUTRAL] Ask for the social to be corrected.
[AGENT][NEUTRAL] On the, on these policy numbers too, and his correct social and then for that specific claim to be reprocessed under the correct policy once the social has been corrected.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll try to get all that in one email.
[AGENT][NEUTRAL] I know that's a lot, but I just, I can't correct it over the, the phone.
[CUSTOMER][NEUTRAL] But I understand, but I understand the process, yeah, you need to they need to only have one guy with one social in your system.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct. Correct. So it's a digit off just one.
[CUSTOMER][NEUTRAL] Should I go ahead and include uh his group name and number, Will's Point ISD and the group number just to, OK.
[AGENT][NEUTRAL] Please, yes.
[AGENT][POSITIVE] Yes, that would be excellent.
[CUSTOMER][NEUTRAL] All right. I'll, I'll put all that together.
[CUSTOMER][NEUTRAL] So and I send it to [PII].
[AGENT][POSITIVE] Yes sir, that is correct.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And I will make a note uh regarding our conversation as well.
[CUSTOMER][POSITIVE] OK, very good. Well, thank you for that.
[AGENT][NEUTRAL] Mhm. OK. Well, is there anything else that I can help you with this afternoon?
[CUSTOMER][NEGATIVE] No ma'am, that's uh my only issue today.
[AGENT][POSITIVE] OK, well then, thank you so much for calling APL and I hope you have a wonderful rest of your day.
[CUSTOMER][POSITIVE] You too ma'am thank you bye bye.
[AGENT][POSITIVE] Uh, thank you. Bye bye.