AccountId: 011433970860
ContactId: f4e91dba-8380-4d34-88a3-34d575542aab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1014719 ms
Total Talk Time (AGENT): 332643 ms
Total Talk Time (CUSTOMER): 283703 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/f4e91dba-8380-4d34-88a3-34d575542aab_20250203T18:43_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] and [PII]. How are you?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Good. So I have a group admin on the line um calling about this policy that they
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We have her on a claim. It looks like to me looking at it, um, but she said that this person's been back to work. So I just wanted to know if you could maybe look at it and see if.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Uh, what's the policy number?
[CUSTOMER][NEUTRAL] We have
[CUSTOMER][NEUTRAL] 244-383-1.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, and I'm sorry I didn't catch your name. Who am I speaking with?
[CUSTOMER][NEUTRAL] Uh, uh, this is [PII] in the billing department.
[AGENT][NEUTRAL] You said [PII]? OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and now you say that she's back at work?
[CUSTOMER][NEUTRAL] Uh, the, we have the group admin on the line. She said that she's been back to work since [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Premium.
[AGENT][POSITIVE] OK, you can send her over. I'll see if I can help her.
[CUSTOMER][NEUTRAL] OK, and her name is [PII].
[AGENT][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] Hi [PII], I have [PII] from the claims department on the line.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Hi [PII], this is [PII]. How are you today?
[CUSTOMER][POSITIVE] Good, good. How are you?
[AGENT][NEUTRAL] I'm doing well, thanks for asking. OK, and uh I think she said you were calling uh to let us know that the uh insured has been back at work since [PII], is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And she really didn't go without pay.
[CUSTOMER][NEUTRAL] Except for like from [PII].
[CUSTOMER][NEUTRAL] I mean for a short period of time, it wasn't.
[CUSTOMER][NEUTRAL] Let me see if I can figure this out.
[CUSTOMER][NEGATIVE] What the heck happened.
[AGENT][NEUTRAL] OK, so did she bring something in saying that she um.
[CUSTOMER][NEUTRAL] Can return to work?
[AGENT][NEUTRAL] Yeah, because it looks like we we're only paying her to to that return to work date that same return to work date that you that you're giving me.
[CUSTOMER][NEUTRAL] To [PII]?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then I, I mean, I'm assuming she did I think I've turned it in.
[AGENT][NEUTRAL] OK, yes, I don't think it doesn't look like we need anything else, so that's why I was asking, did she say that we needed something else?
[CUSTOMER][NEUTRAL] No, no, the reason I think she sent me over to you is because they took her off the bill and now that.
[CUSTOMER][NEUTRAL] I couldn't I'm like why till February because they said she was receiving short term disability through February.
[AGENT][NEUTRAL] Uh, no, ma'am, she's.
[CUSTOMER][NEUTRAL] Or something to the sort.
[AGENT][NEUTRAL] No, she's not.
[CUSTOMER][NEUTRAL] And I
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][MIXED] That's OK, but they took her off the bill.
[CUSTOMER][NEUTRAL] And that's the thing is like she never did not, there was never a point where she didn't receive a check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So on our system automatically deducts premiums.
[AGENT][NEUTRAL] OK, and so maybe they sent it over because um.
[AGENT][NEUTRAL] We took the premium out of her payment that she was receiving from us.
[AGENT][NEUTRAL] To pay her for January and February.
[AGENT][NEUTRAL] So that premium has already been paid for February premium has already been paid.
[CUSTOMER][NEUTRAL] And those premiums have been paid on our end also.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So what they would probably do is, we're probably
[AGENT][NEUTRAL] Refund that premium back but can I put you on hold for a brief moment while I check to be sure that that's what we will do?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Being that we've already taken, OK. Give me just one second.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] CO 244383.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Alright, OK.
[AGENT][NEUTRAL] Alright, so let's see.
[AGENT][NEUTRAL] Um, I'm trying to, I've checked with someone else, so we're gonna have to determine who the premium should be paid back to whether it's you or the employer. So I'm gonna have to, uh, check with billing, but let me check with them. I'm, and, uh, I'm just gonna come right back to you with the answer. I don't wanna keep transferring you back and forth.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, give me one more second.
[CUSTOMER][NEUTRAL] So I have a question for you on the, on the form is there a way that we could do something because there's no way for me to know if they're even approved.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] That that who approved it.
[CUSTOMER][NEUTRAL] So that you guys approved their disability that they're gonna get a payment.
[AGENT][NEUTRAL] Uh, we've already
[CUSTOMER][NEUTRAL] You see what I'm saying?
[AGENT][NEUTRAL] Yeah I do I understand, but we've already paid her, uh, that's.
[CUSTOMER][NEUTRAL] No, no, I understand, I understand that. I'm just saying in, in the future for future form.
[AGENT][NEUTRAL] Yeah. OK.
[CUSTOMER][NEUTRAL] For future people that apply.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Is there somewhere on the form because you guys don't tell us that you've approved someone.
[AGENT][NEUTRAL] I don't see that's gonna. I do, but see that's gonna be a billing question because I only deal with the claims part of it.
[CUSTOMER][NEUTRAL] Do you see what I'm saying?
[CUSTOMER][NEUTRAL] Right. So on the claims, on the claims form, is there anywhere?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That we could mark something saying like.
[CUSTOMER][NEUTRAL] Don't deduct on your end or.
[CUSTOMER][NEUTRAL] Is there a way for us to know?
[AGENT][NEUTRAL] There's really not, I do, I understand, but when we take the premium that's for the insured benefit because if she's not, if we don't have her premium for like a certain month that she's out instead of us having to pin her claim and delay her payment we just go ahead and take the premium out of her payment so that way she's able to get her benefits.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] So that's to benefit the patient, the insured, but I do understand what you're saying so that way you know she's not being double deducted and you are not deducted on your end.
[CUSTOMER][NEUTRAL] Right, right.
[AGENT][NEUTRAL] I, I do understand what you're saying.
[CUSTOMER][NEUTRAL] OK, yeah, I just wonder if there's a way to avoid this, I guess I just keep calling and getting it refunded.
[AGENT][NEUTRAL] Look, I do. I'm
[CUSTOMER][NEUTRAL] I don't know what else to do.
[AGENT][POSITIVE] I know, I'm so sorry. Uh, alright, give me one second.
[CUSTOMER][NEUTRAL] Oh that's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] Deferring.
[CUSTOMER][NEUTRAL] Thank you for calling APO. This is [PII]. Can I help you?
[AGENT][NEUTRAL] Hey [PII], how you doing today?
[CUSTOMER][NEUTRAL] I'm fine. How are you?
[AGENT][POSITIVE] I'm doing well thanks for asking. [PII], this is [PII]. I have a question.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I have a um
[AGENT][NEUTRAL] To let the group admin on the line uh for policy number 2443831.
[AGENT][NEUTRAL] And that's [PII].
[AGENT][NEUTRAL] And let me know when you're ready for my question.
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] OK, and so she had a claim with us and so we took her premiums out for February, but it looks like I guess billing is also billing for uh February as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so I don't know if you know if they've already paid it so in this instance who would get refunded the premium, the group or the insured?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh, I do believe they should go back. Oh, no, it's on cafeteria plan. um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do believe since the group is on cafeteria plan it would have to be refunded back to the group and the group would have to be the one that.
[CUSTOMER][NEUTRAL] Refund it back to the insured.
[AGENT][NEUTRAL] OK, and uh uh she also had a question, you know, is there a way, well, I don't know if how.
[AGENT][NEUTRAL] I mean, I, I know y'all don't know when we make a payment I guess and when we take premium out of someone's, uh, thing, but I guess she was trying to figure out if there's a way so that she don't have to keep calling I guess whenever something has to be refunded.
[AGENT][NEUTRAL] Because it's double paid
[CUSTOMER][NEUTRAL] What do you
[AGENT][NEUTRAL] How it
[AGENT][NEUTRAL] You know, like we took the premium out, but then you all also billed her for February, so she wanted to know is there a way.
[CUSTOMER][NEUTRAL] Yeah, because the policy is not on waiver, so yeah, it's still gonna be billed up until it ends up right now it's paid ahead of the group, so it wasn't on the January invoice and not on the February invoice um so if her.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim is still gonna be paying premium, it's just gonna keep paying the policy, um.
[CUSTOMER][NEUTRAL] A month, a month ahead or whatever, um.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I mean,
[CUSTOMER][NEUTRAL] If the insured's not on the invoice and they don't need to send in premium if the premiums being taken from the claim.
[AGENT][NEUTRAL] OK, but I guess her question was how would she know that, but I mean I know there's no way I guess with the for the group to know that.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] If I mean if the insured's not on the invoice then.
[CUSTOMER][NEUTRAL] That I mean that would be their their clue uh but there's not a way for us to put on the invoices.
[CUSTOMER][NEUTRAL] Uh, premium taken prior from claims or anything like that when they go out, no, I mean there's, yeah, there's.
[AGENT][NEUTRAL] Right, that's that's what, yeah.
[CUSTOMER][NEUTRAL] Yeah, there's not a
[CUSTOMER][NEUTRAL] There's not the only the only way that anything gets put on invoices is if the policy is on waiver.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] But if if premiums being taken from the claim to get the claim paid then yeah I mean there's nothing that.
[AGENT][NEUTRAL] That's what I told her I just.
[CUSTOMER][NEUTRAL] There's no kind of documentation that that billing does on the invoices.
[AGENT][POSITIVE] Got you. That's what I told her and so I just wanted to be sure. Alright, thank you so much for that.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] All right bye bye
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] All right. I'm so sorry for that hold. OK. So she did say that um.
[AGENT][NEUTRAL] That uh if there's an overpayment on these on this they will refund back to the group so the payment will come back to you and then I guess you can refund it back to the insured back to your the employer.
[AGENT][NEUTRAL] But she also said that there's no way um for us to, you know, determine when um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, when a payment has been made to the insured or when we've taken out the premium, uh, she says, you know.
[AGENT][NEUTRAL] I, I hate to say it, but you probably just have to keep uh a calling because if she's on the invoice he or she's on the invoice and, and you pay that premium and then I guess they come in and say that they've already it was taken out of theirs.
[AGENT][NEUTRAL] You know, then on the
[CUSTOMER][NEGATIVE] Well then they've never the employees don't tell me. I wish that they would tell me and then I could just stop.
[AGENT][NEGATIVE] There's no way for it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] The deduction, you see what I'm saying? I'm not told either way to stop the deduction. If I was told to stop the deduction, it'd be easier.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You would, yes, OK, yeah, but she said there's no way, um, for us to, uh, to, you know, let you know in advance that has been taken.
[CUSTOMER][POSITIVE] OK, OK, that sounds good thank you.
[AGENT][POSITIVE] All right, I'm so sorry.
[CUSTOMER][POSITIVE] That's OK have a good one.
[AGENT][POSITIVE] You too thanks for calling APO bye bye.
[CUSTOMER][NEUTRAL] You too, bye bye.