AccountId: 011433970860
ContactId: 742983a2-9012-4aab-a3c4-5da461fa1b59
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1058040 ms
Total Talk Time (AGENT): 361343 ms
Total Talk Time (CUSTOMER): 346776 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/742983a2-9012-4aab-a3c4-5da461fa1b59_20250408T21:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello [PII]. My name is [PII]. Um, I'm trying to file a, uh, I believe it's because the first time I've ever done it, a wellness claim online.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEGATIVE] Completely confused on how to do this. Uh, we, we had a, uh, at my employer today, um, a representative come in and they were explaining it.
[CUSTOMER][NEUTRAL] And uh I'm kind of confused. I'm actually on the on the page right now and I'm kind of confused on I, I, I started a uh I opened up an account um.
[CUSTOMER][NEGATIVE] And I'm kind of stuck right now. I'm kind of stuck on it.
[AGENT][NEUTRAL] OK, where are you at as far as did you get your login created and all that?
[CUSTOMER][NEUTRAL] Yeah, I'm gonna file a wellness claim.
[AGENT][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] As said about the I received and I have the dates because I called.
[CUSTOMER][NEUTRAL] And got the 2 dates. I got the cleanings.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess that's what it's asking for.
[AGENT][NEUTRAL] Yeah, let me try and.
[CUSTOMER][NEUTRAL] I believe.
[AGENT][NEUTRAL] Just 1 2nd.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] OK, so you click.
[AGENT][NEUTRAL] File a claim online.
[CUSTOMER][NEUTRAL] Yeah, but I have directions here because they gave us a little packet, so I kind of put the um, yeah, I put everything in.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And uh let's see um.
[CUSTOMER][NEUTRAL] Yeah, and also they, they, um, they, they staple a well disclaim form, actually a physical one to the paper. So that's how I got the name that it was well disclaimed form because that's actually what's on this, uh, in this little packet here.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] Um, when you're clicking the, uh, you're clicking the right policy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then you're clicking next, is that where you're kind of stuck at, or?
[CUSTOMER][NEUTRAL] I think I'm stuck on OK it says uh er um.
[CUSTOMER][NEUTRAL] I guess I'm at the first, the front page of it, I guess, tell us about the service you received. What date was the service performed? And then it says tell us the name of the facility. OK, so that would be the dental office, I guess, what is the contact number?
[CUSTOMER][NEUTRAL] OK, because I guess she said there were two dates because I guess it was saying here I can file back for [PII] to [PII].
[CUSTOMER][NEUTRAL] Now with these two, do I have to do 2 separate claims for each date that I'm filing?
[CUSTOMER][NEUTRAL] That's why I'm kinda
[CUSTOMER][NEUTRAL] Contact number.
[CUSTOMER][NEUTRAL] October
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] On the wellness claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I don't so a wellness claim is when you're filing for.
[AGENT][NEUTRAL] Like, uh, a wellness exam meaning like you went to the doctor and you had your annual physical, or for women, they go and they have their annual mammogram.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah, she explained it saying it was like if I get my teeth cleaned.
[AGENT][NEUTRAL] Well, if you have a, no, if you have a dental policy and you need to go have your teeth cleaned, then your dental policy should cover any sort of preventative care at 100%.
[CUSTOMER][NEUTRAL] That that that's why I
[CUSTOMER][NEUTRAL] Right, that's why I'm completely confused with this paper is here. That's why I was like, huh.
[CUSTOMER][NEUTRAL] OK, all right, this is what it says. It says reimburse, uh, reimburse these preventative.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] dental cleaning vision exam see list on attached form.
[CUSTOMER][NEUTRAL] It says accident plan 2 per person, max 4 per family.
[CUSTOMER][NEUTRAL] Reimbursement per visit $50 low, and I have the $50 low plan or $75 high plan.
[CUSTOMER][NEUTRAL] And then she put added new 5-125 calendar year 5125 to 123125.
[CUSTOMER][NEUTRAL] And then she went down here and put.
[AGENT][NEUTRAL] What's your
[CUSTOMER][NEUTRAL] Policy year 51 to 4:30 file.
[CUSTOMER][NEUTRAL] Uh, file back to 5123/43024.
[CUSTOMER][NEUTRAL] And the rep told me that I can actually file back because I've never filed, but I've had it since [PII].
[CUSTOMER][NEUTRAL] That I could, I could, I could file back for those times that I went.
[CUSTOMER][POSITIVE] And she just told me to contact to find out the times that I, the dates that I went for the cleanings, the dental cleanings, which is listed on here, and I can actually file for those.
[AGENT][NEUTRAL] What's the policy number that you have?
[CUSTOMER][NEUTRAL] Um, my policy number.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, would that be on my um.
[CUSTOMER][NEUTRAL] My insurance card or?
[AGENT][NEUTRAL] Mhm, you should have like a member certificate number.
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Is a way I can give you my social? Would that help or?
[AGENT][NEUTRAL] Yeah, I can look by social. What's that?
[CUSTOMER][NEUTRAL] OK, uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Um, [PII], let me verify please your date of birth and then the address we should have on file.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, thank you for that and then what is a good email for you?
[CUSTOMER][NEUTRAL] Uh, all lowercase [PII]
[CUSTOMER][NEUTRAL] IS
[CUSTOMER][NEUTRAL] The number 2
[CUSTOMER][NEUTRAL] [PII], [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK. Thank you for that. All right.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] You have a short term disability policy and then you have this other group critical. So let me look at this policy and see exactly what it says here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] It does show a wellness benefit. Now I just need to figure out what that is. Let's see.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, the wellness benefits will pay for health screening mammogram, or vaccine. So under health screening it says we will pay health screening benefit amount shown for a covered person when they receive one or more of the following test on an outpatient basis a wellness test, a routine physical exam.
[AGENT][NEUTRAL] And it looks like any general medical accepted screening test as an outpatient. Let's see what the exclusions are.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Because it because on this packet here it's like highlighted. They they absolutely have have that highlighted when it reimburses.
[AGENT][NEUTRAL] For dental, like a dental cleaning?
[CUSTOMER][NEUTRAL] And it says like
[CUSTOMER][NEUTRAL] Yes, it's preventive uh preventive and dental cleanings and vision exams.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Yeah, cause the way I read it, I, I mean, a wellness test is not a dental cleaning.
[AGENT][NEUTRAL] And a physical exam, a routine physical exam, I don't know if they're gonna consider that dental.
[AGENT][NEUTRAL] There is no, nothing in the exclusions honestly about dental. There's nothing on there that says dental's not covered, LASIK is not covered, um, any sort of like, uh, you know, reconstructive surgeries, not, you know, it's under the exclusions, so.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] You can definitely go ahead [PII] and file the claims um since you know they highlighted that information worst thing that'll happen is just denying that it's not paid out um.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] The plan itself is gonna pay.
[AGENT][NEUTRAL] Um, for I believe, let's see.
[AGENT][NEUTRAL] There's usually one per year on the wellness.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Because here it says um I don't even know what this is, exit plan.
[CUSTOMER][NEUTRAL] It's 2 per person, max 4, max 4 per family.
[AGENT][NEUTRAL] Yeah, but you don't have an accident plan with us. You have
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The short-term disability and then you have the critical illness. So, the accident, whatever you got as far as information for accident, I would just dispose of cause you don't have an accident policy. I see that I see.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK, this is what it says with the critical illness, 1 per person per year max of 4 families.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Reimbursement per visit $50 and vaccine $25.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] I have no idea what what it reimburses, you know, like.
[AGENT][NEUTRAL] So there's a whole list of what wellness tests are and what would be considered.
[AGENT][NEUTRAL] Um, blood tests.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Pulls every
[AGENT][NEUTRAL] Like colonoscopy, chest X-rays.
[CUSTOMER][NEUTRAL] I get my uh
[CUSTOMER][NEUTRAL] Yeah, I had a colonoscopy. I think that was a couple of years back though.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] I mean, anything that you've had that has been done during the time that the plan was active, you can definitely go back retroly and still.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] You know, submit claims for, um, and so yes it would be 1 per year and then it's up to 4, you know, for each if you have more than one member on your, on your plan.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right, but that covered. That's what I'm, that's why I got confused and she kept kind of saying dental and I'm like, oh, dental, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Cleaning, yeah.
[AGENT][NEUTRAL] I don't see anything, yeah, on here for.
[AGENT][NEUTRAL] Dental listed.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So yeah, I mean, I don't see that it's covered. If you wanna still submit it, you can definitely do that. Like I said, they'll just deny the.
[AGENT][NEUTRAL] The claim itself.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then, if in the meantime, if you haven't already gotten it, I mean, I can send you a copy of the policy.
[AGENT][NEUTRAL] Lists everything that's covered, yeah, and it lists the um
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] Amounts and.
[AGENT][NEUTRAL] What a wellness test is, it gives you a list of all those, so.
[AGENT][POSITIVE] That might be, that might be helpful going forward.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, that should help because I have actually I'm scheduled next.
[CUSTOMER][NEUTRAL] Month for my yearly physical for this year, so.
[AGENT][POSITIVE] There you go, yeah, so you can definitely claim that.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And last year I took it so maybe I could go back and file for the last one from last year.
[CUSTOMER][NEUTRAL] I guess.
[AGENT][POSITIVE] Yeah, no, absolutely, absolutely. I mean, if you can get something for it, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Well, I am sending you the policy now, [PII]. So you'll have that for your records. Um, do you have any other questions or concerns you can think of?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah, the last question is, OK, when I'm filing, well, it's asking right here. It says it right here. What date was the service before? OK, so I have to call my primary care and I gotta get the dates of those.
[CUSTOMER][NEUTRAL] Um, those years of when last year when I did my physical, I guess [PII]. OK, I'll give him a call tomorrow and I know how to get to the to the wellness claim to the page.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, great. OK.
[CUSTOMER][NEUTRAL] So I'll go with the uh the yearly physicals.
[AGENT][POSITIVE] OK, sounds good, not a problem.
[CUSTOMER][POSITIVE] Well, thank you so much.
[AGENT][POSITIVE] Yeah, you're welcome. Hope that was helpful. I hope you have a nice day.
[CUSTOMER][NEUTRAL] You too. Are you sending that stuff to my email or uh physical mail?
[AGENT][NEUTRAL] No, no, no, I sent it to your email, your Gmail account.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, that'll work. All right, thank you.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye