AccountId: 011433970860
ContactId: 0873dbc5-bbae-4ff5-b781-a17f6aced70f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1039858 ms
Total Talk Time (AGENT): 471659 ms
Total Talk Time (CUSTOMER): 353582 ms
Interruptions: 6
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/0873dbc5-bbae-4ff5-b781-a17f6aced70f_20250113T14:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling because I submitted a claim for um what I call a wellness, um, benefit. I've received a check from my husband's claim, but I've never received mine, so I'm just trying to see if I can get an update because I submitted both of them at the same time.
[AGENT][NEUTRAL] OK, Miss uh [PII], so you're calling to follow up on a claim, a wellness claim that you filed for yourself because you said you have been res you've already received the benefits for your spouse, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And first off, Miss [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] That would be area code [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let's see on this here it says.
[CUSTOMER][NEUTRAL] 02448957
[AGENT][NEUTRAL] OK, thank you. So one moment please while I get your information pulled up. Once I do, I will need to verify several things with you first for security so just one moment please.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so first, I one additional the same, Miss [PII]. Any information that is provided would be a verification of benefits and not a guarantee of payment. First off, if you'll please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. And also your home mailing address.
[CUSTOMER][NEUTRAL] That would be [PII]. The zip code is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the phone number that you gave me, that is your best contact number, the [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you and then I see that we do not have an email address that states that you do not have an email is that correct?
[CUSTOMER][NEUTRAL] I have an email address I've never set anything up electronically. I got this through my job and when I decided to submit this, the claim is when I found out about the website and all of that and I still haven't had time to set up anything, but if you need one to put on file, I can give it to you or I can take time today, OK.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh, OK, but you
[AGENT][NEUTRAL] Absolutely, yes ma'am well I just need to put it on file for security so that when you set up your profile it will allow you to do that and that way then once yeah once you have that set up you'll be able to see um your information online as well and I can actually email you a user guide if you've not received one before that explains how to go about setting that up and how to use the portal.
[CUSTOMER][POSITIVE] That'd be great.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, I actually got one. The last representative I spoke to, so that way, let me see what email she sent it to, matter of fact, because yeah, she was so helpful, um.
[AGENT][POSITIVE] Oh, good. OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, she sent me the package. She sent me like, uh, she sent me two things. It was just leave it like that. Hold on one second, I, because I have several and I wanna make sure I give you the one I gave her, then I know which one I need to use when I set up.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, I understand we all have multiple everything this day and time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yes, ma'am, you got to. I have 2 that I've had for so long. I call them my personal, and I used them when I was in school. I had one and then I had to set up another one because of school and now I got like 5, and I'm like, good gracious.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, it's not up on the day. Wait a minute, care team, yep, OK, so I found the email address I need to give you. Yeah, she sent me an individual, an individual user guide, and she sent me some and she sent me something else too. So yes, let's go with this email address here that would be [PII] as in short what most people call [PII].
[AGENT][NEUTRAL] Is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Yes, ma'am. That's it. Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the letter, the letter [PII] for my um.
[CUSTOMER][NEUTRAL] Maiden name.
[AGENT][NEUTRAL] All right, so is it [PII] [PII]? Is that correct?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm go ahead.
[CUSTOMER][NEUTRAL] Yes, ma'am. Mhm. [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] OK, thank you. So [PII].
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, all right, thank you.
[AGENT][NEUTRAL] OK, so I have got that updated for you and that's um all of the information that I'll need to verify so give me just a moment to look. I do see that we did process a claim for you uh back in September but it was not approved it was denied so let me see on this.
[AGENT][NEUTRAL] OK, so now I can read you this remark, Ms. [PII], and then again you can also see you should have received though an explanation in the benefit of benefits rather in the mail.
[AGENT][NEUTRAL] With this on there, but um in the event that you didn't, again, you should be able to see this cause it's, I'm just, it's a pretty long explanation. It states the health screening test benefit rider provides benefits for one health screening test per covered person per calendar year. The health screening tests covered are specifically listed in the health screening test benefits rider.
[AGENT][NEUTRAL] According to the information received, the test submitted is not a covered test as listed in the writer. Therefore, benefits are not payable. Please refer to your health screening test benefit rider for the complete list of health screening tests covered.
[CUSTOMER][NEUTRAL] That is the first time I submitted a claim. I called and I spoke with a representative and I resubmitted a claim which would have been in the month of December. My husband claim went through. I received the check. I have that in hand, but my claim did not go through. So is it the same reject?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Correct, that's
[AGENT][NEUTRAL] Um, let's see, so, OK.
[AGENT][NEUTRAL] I'm looking at your information.
[CUSTOMER][NEUTRAL] So you only have one submitted for me basically that's what you're seeing.
[AGENT][NEUTRAL] Yes, I have one, yes ma'am. I have one claim on file for you that was initially and I do see that there were 2.
[AGENT][NEUTRAL] That were filed for Mr. [PII]. One was processed on [PII], which had the same denial on that claim as I read for you. Then I see that there was another claim received on [PII].
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed and that is the one that was paid.
[CUSTOMER][NEUTRAL] And I should have had one too. I faxed my paperwork along with his both times. So if you receive his paperwork and process his, it should be another one in that same paperwork with mine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, but I don't know what may have happened, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Ms. [PII], I'm so sorry. Um, but I just don't.
[CUSTOMER][NEUTRAL] That's OK, it's OK.
[AGENT][NEGATIVE] I just don't see that your section was received on the [PII].
[AGENT][NEUTRAL] When you submitted his information again on the [PII], I don't see that that part of your facts. Was it two separate faxes or one complete fax?
[CUSTOMER][NEUTRAL] No, it was one it was one fax, a total of 6 to 7 pages. I have my confirmation around here somewhere. If I have to look for it and call back, I would do that, but yeah, I faxed them both together.
[CUSTOMER][NEUTRAL] Went to the same fax company that I use here in [PII] every time I have to fax something mhm.
[AGENT][NEUTRAL] OK, just
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right, OK. So give me just a moment.
[CUSTOMER][NEUTRAL] Is there any way that you can retrieve the um fax paperwork, the image of it?
[AGENT][NEUTRAL] I'm going to try. Yes, ma'am. That's, I'm going to try.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] So give me just, you're welcome.
[AGENT][POSITIVE] And thank you for your patience. It, it takes a moment to load this information.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I can see that there were 2.
[AGENT][NEUTRAL] I am able to see the last fax or the yes, ma'am, the last fax that you did submit that had two wellness forms with it. So what I can do is I can send a request to have this, these documents reviewed again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and again, like I stated before, uh, any information provided would be just be a verification of benefits and not a guarantee of payment. But I will send this for them to review again.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I'll be happy to do that for you.
[CUSTOMER][NEUTRAL] OK, thank you. I just wanted to make sure that it was received and I just thought since his came it's been a couple of days, let me check up on it because I know holidays and the mail and stuff was moving slow so.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] I had a few things to do in between this morning before I get busy at work and making my phone calls now.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, ma'am. I understand we have to work it out or we can do such things. I, I totally understand. So, um, yes, ma'am, I'll be happy to do that, to send that back for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. I appreciate it. You have a great day today.
[AGENT][POSITIVE] You are, yes ma'am, you're very welcome. And just one additional thing, Ms. [PII], when you start looking at that user guide to set up your portal, when you upload documents into the portal, you instantly get a confirmation number as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and I'm sure the other representative probably explained this to you, but, and it does take this in that user guide that you do have to upload things and into the portal from a computer. It doesn't currently support mobile functionality, but also you can add in direct deposit information.
[AGENT][NEUTRAL] So that if we review a claim and we are able to pay benefits to you, they can be electronically deposited versus us having to mail a paper check. Now that's not required, that's just an option.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am, she had explained it to me and I told her this was really this is [PII], so last year these uh claims that I'm filing was my first year with the company.
[AGENT][NEUTRAL] Do I?
[AGENT][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] And I had forgot, I totally forgot all about it and I went to look and I said, OK, they do offer a wellness check because I know about the um benefit and when I call my um company who I work for,
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] The HR person um didn't know anything.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] And I, I run into a lot of that with this person, so, um, I didn't get frustrated but I was able to find out what I needed and she provided me what I needed and I was finally able to file the claim. That's why they were filed so late in the year, first of all, and she told me, um, well, you know, we have it where you can do it electronically and I said, well, since this is the first year.
[CUSTOMER][NEUTRAL] I'll wait till I get this done and I'll set everything up else up. I used to have a policy with another company and I did everything online with them and and I know the convenience of it, the upload part.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh great. Mhm.
[CUSTOMER][NEUTRAL] I don't do anything. I might snap it on my mobile in order for me to get it, but I send everything through computer. I'm, I'm, I'm OK with electronics, but I still am more old fashioned than anything, so yeah, I would that way because I know it's bigger where you can see it. Mobile, I'm just mm mm mm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I am too.
[AGENT][NEUTRAL] Yes, I
[AGENT][NEUTRAL] I tell my family all the time. I'm somewhat of an analog woman living in a digital world, but, you know, it is what it is. You have to.
[CUSTOMER][NEUTRAL] I, I, I never looked at it like that. I'm gonna have to steal that from you. I like that.
[AGENT][NEUTRAL] Well, you can. You're welcome to steal it. I tell my grown children, thank goodness y'all are more techy than me because I, I work with computers every day, but to be honest, you know, like in the evenings, once I'm done with the work that
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] This is all the last thing I think about.
[CUSTOMER][POSITIVE] That's it. That is, I, I still sit down with a good book and turn the page, fill that page, turning that corner. Yes, ma'am.
[AGENT][POSITIVE] I promise.
[AGENT][NEUTRAL] Isn't that the truth? Isn't that the truth? Me too, me too, Ms. [PII].
[CUSTOMER][NEGATIVE] That solitude from this electronic mess.
[AGENT][POSITIVE] That's exactly right. I like to unplug when my work day is over, but um anyway. But yes, ma'am, I'll be happy to send this uh for you. And then when you go to set up your profile, if you need any help, just give us a call back and we would be more than happy to assist you with that.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] I'll be glad to. Thank you so much and you've been very pleasant this Monday morning.
[AGENT][POSITIVE] Oh, well, thank you. Well, I hope you have a wonderful day today and a nice week and thank you so much again for calling uh APL today, Ms. [PII].
[CUSTOMER][POSITIVE] Thank you and you do the same bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you as well. Bye-bye.