AccountId: 011433970860
ContactId: 2e288544-beaf-4f31-b03d-0e83c81d272a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 635419 ms
Total Talk Time (AGENT): 243370 ms
Total Talk Time (CUSTOMER): 180026 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/2e288544-beaf-4f31-b03d-0e83c81d272a_20250123T14:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I was calling. I had a question. I put in a wellness, uh, claim and, uh, I'm wondering why he got paid for it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, well, I can take a look at the claim for you and um let you know of the status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's uh [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] I don't have it right now.
[AGENT][NEUTRAL] OK, I can also look your policy up with your social.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies here. Hold on one moment.
[AGENT][NEUTRAL] And you said it was a wellness claim. Was this for your, were you filing it under your cancer policy or your hospital indemnity or accident?
[CUSTOMER][NEUTRAL] Usually when I file it files uh.
[CUSTOMER][NEUTRAL] When you submit the claim, it just goes against all the policies you have.
[CUSTOMER][NEUTRAL] And like last year I got 50 from one policy and 50 from the other so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I did it the same exact way I did it uh last year I just did it on that uh through y'all website.
[AGENT][NEUTRAL] OK. Can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] uh [PII], and it's uh [PII].
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So I'm just going through the um policies. I do see claims here. They were received on [PII], so I'm just getting the statuses.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, so we have [PII].
[AGENT][NEUTRAL] So for your accident policy and your
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Hostile indemnity policy, those both are still in processing. So it takes about 7 to 10 business days. So we received it on the [PII] and then it looks like for the, which one is this, your
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Critical illness policy, that claim processed and it was denied. Hold on, let me get that reason and see what they need.
[CUSTOMER][NEUTRAL] Why is it not? Because I got paid last year for it.
[AGENT][NEUTRAL] Hold on one moment, let me get the reason and see what they need. Hold on one second.
[CUSTOMER][NEUTRAL] So last, let me, I'm looking at it right now last year was paid on the.
[CUSTOMER][NEGATIVE] I was paid on a critical illness and accident and not paid on a hospital amenity.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not saying you weren't, I'm just trying to get everything together, so I have it all in one place because it's not a calendar year, it's a plan year. So, just, just give me one moment, let me get all the information together.
[CUSTOMER][NEUTRAL] So what you're saying is it's too it's too early to file it hasn't been a year on the plan, is that what you tell her?
[AGENT][NEUTRAL] Well, I'm just asking to hold just a moment so that I can get your policy documents up and be able to speak.
[CUSTOMER][NEUTRAL] That's
[AGENT][POSITIVE] Correctly.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] Because if it goes by the date of the claim received.
[CUSTOMER][NEUTRAL] It's not a full calendar year.
[CUSTOMER][NEUTRAL] When I filed this.
[AGENT][NEUTRAL] Right, so April.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can work.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, is the plan year, so that's why this, this one claim was denied because it's not, it's the same year, it's not a new year yet for your plan.
[CUSTOMER][NEUTRAL] OK, alright, so the rest are gonna get the not so I'd have to wait till after that date to file my wellness.
[AGENT][NEUTRAL] Well, that's for your critical illness. Let me see if your other ones are on a plan year or a calendar year. Hold on one second.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] I'm pretty sure it is.
[CUSTOMER][NEGATIVE] Because the only other one that's gonna pay the hospital amenities is not gonna pay the accident's gonna pay $50 also.
[AGENT][NEUTRAL] Yeah, the hospital indemnity doesn't have a wellness benefit, so that one won't pay. And then the accident.
[CUSTOMER][NEUTRAL] It's probably a calendar year too uh from the last date.
[CUSTOMER][NEUTRAL] So that'll be January, February, March, April, May.
[CUSTOMER][NEUTRAL] We may
[CUSTOMER][NEUTRAL] May
[AGENT][NEUTRAL] Per person, hold on one second.
[AGENT][NEUTRAL] Family.
[AGENT][NEUTRAL] Yeah. So the, so both of them are playing here and then hospital indemnity doesn't have a wellness benefit. So it'll be April for the accident policy as well.
[CUSTOMER][NEUTRAL] So I just so when I do do like blood work or whatever.
[CUSTOMER][NEUTRAL] After that date, I just redo my wellness claim and file it again.
[AGENT][NEUTRAL] After you do your blood work and everything, yeah, you would just wait until.
[CUSTOMER][NEUTRAL] After you do your
[CUSTOMER][NEUTRAL] After April.
[AGENT][NEUTRAL] Correct, to file those claims, but let me
[AGENT][NEUTRAL] Let me see what your terms are. Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] That's fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK, hold on one
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I got to think.
[AGENT][NEUTRAL] Is it one pair?
[AGENT][NEUTRAL] OK, that's what I thought.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So the wellness benefit is one per calendar year, so yes, you will have to wait until that next calendar year to file, not for
[AGENT][NEUTRAL] The current, well, you have to wait for the next year to file the 2nd 1.
[CUSTOMER][NEUTRAL] So when, when would that be?
[CUSTOMER][NEUTRAL] April
[AGENT][NEUTRAL] Yes, your policies became effective [PII].
[AGENT][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And just resubmit the redo my uh wellness claim.
[CUSTOMER][NEUTRAL] It's all I gotta do
[CUSTOMER][NEUTRAL] I just resubmit the claim online, fill out the paperwork once I do.
[AGENT][NEUTRAL] Well
[AGENT][NEUTRAL] I understand your question. The reason I'm hesitant is because so
[AGENT][NEUTRAL] And this is for, hold on one second.
[AGENT][NEUTRAL] Because the one you're submitting now is for [PII] though, right?
[CUSTOMER][MIXED] Well I mean I was submitted under the impression that it was I didn't know that I submitted this under the impression it's [PII] if I knew that it was after April wouldn't have not submitted any claims, but it's good.
[AGENT][NEUTRAL] Wait, wait, sir, hold on, sir, because I don't want to get confused anymore. So I'm just asking the data service for the claim that's processing is for [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so yes, now in you'll have to refile it again in April and that's the new plan here. So you've already been paid once for 2024 that last claim, the one that's in process and may be denied because it's not April yet, but if you resubmit it, it should, um,
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] be reprocessed for April and the new calendar year.
[AGENT][NEUTRAL] Or a new plan here, I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] Alrighty. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL and I do hope you have a great day.
[CUSTOMER][POSITIVE] Alright, well thank you.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Bye.