AccountId: 011433970860
ContactId: 526f2388-9541-43e3-85a9-ff787cb65367
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 793739 ms
Total Talk Time (AGENT): 330577 ms
Total Talk Time (CUSTOMER): 228774 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/526f2388-9541-43e3-85a9-ff787cb65367_20250502T14:02_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] OK
[CUSTOMER][NEUTRAL] Um, I filed a wellness claim under
[CUSTOMER][NEUTRAL] My cancer policy, but it also created at the same time under my hospital supplemental policy. So whenever you submit one, does it automatically
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Go for both, whatever policies you have.
[AGENT][NEUTRAL] It actually will on a well, and you said this is for a wellness claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. It does search each of your policies for a potential wellness benefit.
[CUSTOMER][NEUTRAL] OK, so here is my question. Um, I talked to someone yesterday because under the cancer policy it said that my husband was not because I'm filing old claims like I didn't realize he had a wellness policy and they told me whoever I talked to like a week ago told me I could go ahead and file even though they're for previous years as long as, can you hear me?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am, I can now. Your voice faded out for a moment, but I can't.
[CUSTOMER][NEUTRAL] Uh, OK, OK, so, OK, OK, she told me I could go ahead and file for previous years even though they're older as long as you know the policy was in effect, um, so when I submitted this for my husband, um, for some reason it's not showing that his cancer was in effect in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which it should have been, but I've got to talk to my employer about that. But um the hospital it was effective. And I'm getting a claim that all back from it also saying that it was not in effect. But I can see here where it went back to [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so we just need to see when your, when your husband is showing that he has coverage. Is that correct?
[CUSTOMER][NEUTRAL] Yes, we need to find out why that wellness benefit claim was denied under the hospital supplemental.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, so, yes, ma'am. I'll have to uh pull the policy information up, verify some things with you for security purposes, and then we can go from there and I'll be happy to um take a look at this for you and help you with this.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right. You're welcome. So who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And Miss [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And your policy number? You can just give me one of them.
[AGENT][NEUTRAL] Well, I guess the hospital indemnity since that's, or the hospital one since that's the one you said that it's also getting.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] OK, 02010635.
[AGENT][NEUTRAL] OK, thank you. So one moment while I get that policy pulled up.
[AGENT][NEUTRAL] OK, and again, any information also Miss [PII] that I did provide for you would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth.
[AGENT][NEUTRAL] And then your husband's name and date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then your hus
[CUSTOMER][NEUTRAL] OK, mine is [PII].
[CUSTOMER][NEUTRAL] His name is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. Also the home mailing address for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. The phone number we show for you is the same as the one you gave me, so that is your best number. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you and lastly your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Just a couple of moments to look at a few things.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] OK, so as far as I can send this back, I see that I'm not sure why that remark code. I can send it back for reprocessing for a different remark code on this policy because I do see that he's been active.
[AGENT][NEUTRAL] On here since this policy went into effect in [PII]. Now, there are not any wellness benefits, but I'll be happy to send that back, um, to have it reprocessed with a different
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To have them review it with the correct remark.
[AGENT][NEUTRAL] Because they say the service for for [PII]. Is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, and you're saying there's no wellness benefit?
[AGENT][NEUTRAL] According to what I see.
[AGENT][NEUTRAL] No, there's not. On your hospital indemnity plan, that that has that remark code on there about services were rendered prior to the dependents effective date of coverage. Yes, ma'am, there's not any wellness on that policy.
[AGENT][NEGATIVE] It was just an incorrect remark.
[AGENT][NEUTRAL] Code was used.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] You're right, there's not it just, OK, we have some with another company that has some, so I was thinking it was included too, but OK, so it's not gonna matter either way but I just wanted to make sure that he was covered back to [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] He, he is, and I will, I'll just send it back so that they can you know, review it with the, and then mark it with the correct remark.
[CUSTOMER][NEUTRAL] OK, I mean it's not gonna be paid anyway so you don't have to do that it's OK, but I do, can you look again at the cancer policy and just.
[CUSTOMER][NEUTRAL] See if you see anything different because
[CUSTOMER][NEUTRAL] He's been on all of my policies since I got him.
[AGENT][NEUTRAL] OK, so let's let me get that information pulled up.
[AGENT][NEUTRAL] So, according to what I can see, he, yes, ma'am, he is covered under each of those, I mean, he's also been covered since [PII] on that policy as well.
[CUSTOMER][NEUTRAL] The cancer.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the lady I talked to yesterday said she could only see it back to [PII].
[CUSTOMER][NEUTRAL] And that's why it was denied, but like I said, he's been on everything that I've got since we got it in [PII], so.
[AGENT][NEUTRAL] Let me, let me look at the notes and then let me look, I mean, and see why they thought that.
[CUSTOMER][NEUTRAL] Do you know why?
[AGENT][NEUTRAL] Do you know who you spoke to? And you said that was yesterday?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] I don't know who I talked to, no.
[AGENT][NEUTRAL] OK, cause
[AGENT][NEUTRAL] The last night that I see was just when you called in regarding, um, that was back on the [PII]. That's why I was asking that.
[AGENT][NEUTRAL] And speak to someone, but that was about something related to filing a claim.
[AGENT][NEUTRAL] Now, I'm showing, um, so I don't, I'm so sorry but I can't answer that question as to why. I show this policy also went into effect [PII].
[AGENT][NEUTRAL] And then looking at all of the
[AGENT][NEUTRAL] Back history.
[AGENT][NEUTRAL] It shows that this policy has always been a couple.
[AGENT][NEUTRAL] For employee and spouse.
[CUSTOMER][NEUTRAL] Right, so, so can you find out for me why that, why that wellness claim for the cancer policy was denied?
[AGENT][NEUTRAL] So he is covered on here.
[AGENT][NEUTRAL] Let me look at that.
[AGENT][NEUTRAL] Yeah, I, I, yes, ma'am. I'll be happy to send that back because that's the same exact remark as what is on the other claims. So I will just request that both of those claims be looked at again.
[AGENT][NEUTRAL] But I, I show him.
[CUSTOMER][NEUTRAL] And the one for cancer, it's
[AGENT][NEUTRAL] Both. Yes, ma'am. I mean, it's the, but I show him covered from the time both of those policies went into effect.
[AGENT][NEUTRAL] To, to present.
[CUSTOMER][NEUTRAL] Yes ma'am, that should be correct, but the cancer policy does definitely have that wellness benefit, right?
[AGENT][NEUTRAL] Yes, ma'am. I see that there was, let me look to see what type of change. I mean, I think that it's always had it, but let me, let me look at that because I can see there was a
[AGENT][NEUTRAL] slight change in something.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] You just selected a different level option.
[AGENT][NEUTRAL] That changed over [PII]. You had been on the option one and you went to an option two benefit, but he was on both, both policies, so just let me look at the benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Cause your data service, you said that you were filing for on the wellness for him on the cancer policy was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So up until [PII] I was on level 1. 2024 I went to level two. Can you see if level one included that wellness benefit?
[AGENT][NEUTRAL] That's what I'm gonna, that's what I'm gonna look at.
[AGENT][NEUTRAL] And it did. Yes.
[AGENT][NEUTRAL] It does. Mhm. Both of the policies have that. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, yes, ma'am. I will, I'm so sorry about that, but I will send that back to have it re-reviewed. Yes, ma'am. I'll just have it sent back for reprocessing.
[CUSTOMER][NEGATIVE] OK, so it should have paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, I appreciate it.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. So is there, yes, ma'am, Miss [PII] can I help you with anything else today?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] That, that's it. Have a great day.
[AGENT][POSITIVE] OK. Well, I hope you have a great day as well and also a great weekend and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.