AccountId: 011433970860
ContactId: 80e3e221-9744-472b-861f-2c23daf719e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370640 ms
Total Talk Time (AGENT): 161933 ms
Total Talk Time (CUSTOMER): 100447 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/80e3e221-9744-472b-861f-2c23daf719e0_20250225T14:23_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] Good morning [PII]. I'm actually just calling to find out the status of my pending claim.
[AGENT][NEUTRAL] OK, so you're the insured and you're calling to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Oh yes, it is.
[AGENT][POSITIVE] Yes, ma'am, I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] She'll find [PII].
[AGENT][NEUTRAL] Hey, Ms. [PII], what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and your policy number?
[CUSTOMER][NEUTRAL] Oh, I'm driving. I don't, I don't, um.
[CUSTOMER][NEUTRAL] I don't know what it's a memory.
[AGENT][NEUTRAL] OK, what is your full social security number please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you one moment please while I get your information pulled up.
[AGENT][NEUTRAL] And Miss [PII], which policy is this on that you're calling to check claim status on?
[CUSTOMER][NEUTRAL] Um, it may, I'm not sure. I have several pending, um, probably one under each policy.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] So you have uh
[CUSTOMER][NEUTRAL] I know, I know critical illness.
[CUSTOMER][NEUTRAL] What were you saying, ma'am?
[AGENT][NEUTRAL] No, go ahead. I was listening.
[CUSTOMER][NEUTRAL] Oh, I know there's one under critical illness.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so one moment please, and let me get that information pulled up.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so Miss [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. I will have to verify several things with you first for security. So first off, if you could please verify your date of birth.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. Also your home mailing address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The phone number we have for you is also the same as the one you gave me, so that is your best contact number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And the last piece of information to verify, Ms. [PII] is gonna be your email.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. Alright, so one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim is for you. Is that correct?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do see that there was a claim that went through was processed on yesterday.
[AGENT][NEUTRAL] Um, one moment. This was for a wellness screening. Is that correct?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, yeah, I, yeah, I found some of the wellness and then I did.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Separate I uploaded different information.
[AGENT][NEUTRAL] OK, so under your critical illness policy, the most recently processed claim was the wellness and this one yesterday was
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Denied, it states on the denial remark that.
[AGENT][NEGATIVE] This benefit has been exhausted for the plan year.
[CUSTOMER][NEUTRAL] OK. Are you able to tell me when my plan year is?
[CUSTOMER][NEUTRAL] Begins and ends
[AGENT][NEUTRAL] Sure, one moment.
[AGENT][NEUTRAL] OK, so this appears that it goes from would be from 41.
[AGENT][NEUTRAL] To 41.
[CUSTOMER][NEUTRAL] So, so these claims that are being denied, I would be able to refile with the same information after [PII]?
[AGENT][NEUTRAL] Not for a data service prior to [PII].
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, ma'am. Anything, yes. It would have to be for something that falls within that time period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can see that that was also the same remark on the last several claims.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Was for the plan year.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] So I need to start scheduling my mammograms and stuff but my anniversary year is February, so that's why I typically file them. OK, alright, thank you.
[AGENT][NEUTRAL] Yes, sir. Well, you're welcome cause I can see that your wellness screening for [PII] was done in April. It shows that that was done in [PII] and we did pay a benefit for that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Well, are there any other questions on this? You said you had claims on all of your policies?
[CUSTOMER][NEUTRAL] Yeah, I know some of them are still pending, so, but I mean, yeah, that's it.
[AGENT][NEUTRAL] OK, this is the only one you wanted me to look out for you today?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][POSITIVE] OK, Ms. [PII]. Well, if that is all that I can help you with, thank you again for calling APL and I hope that you have a very nice day.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Bye bye.