AccountId: 011433970860
ContactId: 31d45b3d-7ac5-4cdd-b708-2dffb88f4e39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 476760 ms
Total Talk Time (AGENT): 261034 ms
Total Talk Time (CUSTOMER): 171733 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/31d45b3d-7ac5-4cdd-b708-2dffb88f4e39_20250131T13:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm a new member of uh American Public Life. How are you?
[AGENT][POSITIVE] I'm doing well thank you Mr. [PII] how are you?
[CUSTOMER][NEUTRAL] Good and I submitted a claim and then it was uh resolved and I received a text.
[CUSTOMER][NEUTRAL] And then when I go on to the website I see that the claim.
[CUSTOMER][NEUTRAL] Uh, it's not clear what is.
[CUSTOMER][NEUTRAL] But the
[CUSTOMER][NEUTRAL] Response was to the claim what your it says date completed yesterday, which is [PII] and then amount paid $0.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] So that means it was rejected and not paid to me.
[AGENT][NEUTRAL] Um, yeah, let me take a look at it for you if you don't mind, Mr. [PII]. Can
[CUSTOMER][NEUTRAL] I'm, I'm confused.
[CUSTOMER][NEUTRAL] No, I don't
[AGENT][NEUTRAL] Go ahead and provide me your callback number just in case we get disconnected and I can call you back.
[CUSTOMER][NEUTRAL] Yeah, uh, my cell phone is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And do you have your policy number handy or a claim number?
[CUSTOMER][NEUTRAL] Yeah, there's this group, uh, accident number, um, there's like 4 or 5 different numbers. I mean one says group accident another says hospital indemnity.
[AGENT][NEUTRAL] Yeah, so any one of those, um, or where, yeah, go ahead.
[CUSTOMER][NEUTRAL] And then OK so so it's one of those two it's probably it's 258.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2670.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. Just let me.
[CUSTOMER][NEUTRAL] 258 2 yep.
[AGENT][NEUTRAL] And I'll have you verify some information if you don't mind please go ahead and verify your date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And go ahead and verify um your email address.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for verifying that and then the last piece, your uh your mailing address please.
[CUSTOMER][NEUTRAL] Uh, my primary.
[CUSTOMER][NEUTRAL] Address is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Great thank you so much for verifying that information for me.
[AGENT][NEUTRAL] OK, so let's take a look and was the claim for uh yourself or?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No, for my wife and maybe.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not part of the policy and I have to submit the claim to somebody else that's what you're probably gonna help me understand is that maybe I submitted a claim to the wrong policy and and.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me take a look.
[CUSTOMER][NEUTRAL] But yes it's for my wife [PII] and it's related to a uh influenza shot that she got.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Influenza uh vaccine.
[AGENT][NEUTRAL] OK, all right.
[CUSTOMER][NEUTRAL] Flu vaccine
[AGENT][NEUTRAL] So it looks like it was a wellness claim and let me just take a look at it real quick now um it looks like.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] I'm gonna pull the uh documents that were submitted.
[CUSTOMER][NEUTRAL] Maybe wellness is not included, yeah, yeah, yeah, maybe wellness is not included.
[AGENT][NEUTRAL] Yeah and and I can check that under your policy, yeah, just give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] So under that group accident policy, um, there is not a wellness benefit uh built in for that, uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For that particular policy so um it looks like that uh was that claim form and that's what I'm looking at now, I'm pulling up the actual documents just to uh.
[AGENT][NEUTRAL] Take a peek at.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I think you're right, so I, I did this all wrong and submitting the claim to.
[CUSTOMER][NEUTRAL] And even under the uh the other policy which is the hospital indemnity that sounds like.
[CUSTOMER][NEUTRAL] It's used when you go to the hospital or.
[AGENT][NEUTRAL] Yes, now sometimes those policies do have that wellness benefit built in, um, but it does need to be certain services that um would be.
[CUSTOMER][NEUTRAL] Right, so
[AGENT][NEUTRAL] Uh, covered and, uh, vaccines and vaccine administration generally aren't considered, um, but it also depends on how we receive the claim so and if that benefit is under that hospital indemnity and um I'll go over that with you as well. I'm just kind of looking right now just to make sure that uh.
[AGENT][NEUTRAL] What was submitted, you know, we that we made the correct decision and unfortunately it does look like, like I said, under that accident policy there is no wellness benefit. So now I'm gonna take a look at the hospital indemnity. Bear with me for just a moment. I do have to look at them separately, so my apologies.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, no, no, no apology required thank you for your time.
[AGENT][NEUTRAL] Certainly.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] Because it looks like the claims submitted were, you know, one the same claim was submitted one to the indemnity and one to the accident, I guess.
[AGENT][NEUTRAL] Well, um, how we actually have it set up in in the system is when you submit that wellness, uh, claim form we kind of try to streamline the process and what happens is once you um file that wellness claim within the um portal in that an online portal um we send it to all policies that could possibly be.
[CUSTOMER][NEUTRAL] It's what I did.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, reviewed for benefits, so meaning that even though that uh accident policy doesn't have that wellness benefit, you may have an additional policy that does um cover certain, uh, wellness services. So we look at it under each policy just to make sure that um if there's a payable benefit, of course we'll go ahead and, and pay that benefit, um.
[AGENT][NEUTRAL] Now that looks like what happened here is that it was processed under the um accident policy and then it was also processed under the hospital indemnity. Now again, that um.
[AGENT][NEUTRAL] Well the wellness under your hospital indemnity.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] It's actually a combined benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, but that wellness will pay for a wellness, uh, exam or test. So if you go in for your physical or, um, say for instance, your wife has to go to, uh, her annual exam, um, and that includes like mammograms, pap smear, that sort of thing. So those, um, and if you go to see your doctor and, and the service is done in the physician's office or if it's an eligible test, like I said, such as a mammogram.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You could submit that on that claim form under your hospital indemnity.
[AGENT][NEUTRAL] So there is wellness under the hospital indemnity, however, it does not cover unfortunately immunizations, vaccine administration.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, all right, I understand much better now.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I guess that's it, right?
[AGENT][NEUTRAL] Alright, did you have any other questions? That's correct?
[CUSTOMER][POSITIVE] No, you were very helpful thank you very much for your time.
[AGENT][POSITIVE] You're so welcome, thank you.
[CUSTOMER][POSITIVE] And you have a you have a wonderful weekend.
[AGENT][POSITIVE] You too, thank you so much for calling APL. I hope you have a great rest of your day and a great weekend.
[CUSTOMER][POSITIVE] Alright thank you bye now.
[AGENT][POSITIVE] Take care bye bye.