AccountId: 011433970860
ContactId: 4a0dcf99-366a-4e77-87dc-d33f18b81d78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197149 ms
Total Talk Time (AGENT): 93199 ms
Total Talk Time (CUSTOMER): 54940 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/4a0dcf99-366a-4e77-87dc-d33f18b81d78_20250224T19:55_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am, this is [PII] uh, policy number is 02486685.
[CUSTOMER][NEGATIVE] I tried to make a wellness claim and they're trying to save my benefits are exhausted for the year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So there's a claim that was denied and you want to check on the denial reason, or you're filing it now?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, I filed it. They said it was exhausted for the year. My benefit was exhausted for the year, but this is the first claim I made this year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can definitely take a look at the claim for you. Um, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you for that [PII]. Hold on one second.
[AGENT][NEUTRAL] I forgot it was right here.
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That should be [PII].
[AGENT][NEUTRAL] Alrighty, and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. And Mr. [PII], do you mind if I place you on just a brief hold so I can take a look at the claim?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] Why do they keep doing this?
[AGENT][NEUTRAL] Oh, plan year. Wait a minute.
[AGENT][NEUTRAL] Oh thank God. I'm like, come on.
[AGENT][NEUTRAL] OK, hello, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. Um, so the, the reason for the denial is because it's been exhausted for the plan year. So your, your policy is on a plan year, not a calendar year. So calendar year would like start over each [PII] 1st. Plan year starts the month that you started the policy. So [PII], this
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So if I do another claim after [PII], it'll it'll go through.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, what was it, and you can resubmit that.
[CUSTOMER][NEUTRAL] All right, yeah, the way it was the way it was explained to me when I first got this was every year. They didn't say nothing about it was a planned date, they said it was every year, so.
[AGENT][POSITIVE] Well, that's totally fine. Um, anytime after [PII], you can go ahead and resubmit that and we'll we'll reprocess it for you.
[CUSTOMER][NEUTRAL] That's what
[CUSTOMER][NEUTRAL] OK, so that's the only one that I got a stop on correct?
[AGENT][NEUTRAL] Mhm. The other one was paid for last year. Yes, sir.
[CUSTOMER][NEUTRAL] That's not, that's the only claim I ever made, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Alright, was there anything else I can help you with today? Alright, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] That's all I needed.
[CUSTOMER][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.