AccountId: 011433970860
ContactId: 033cf9f6-8ab0-42cc-b039-92f1c697e840
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1044219 ms
Total Talk Time (AGENT): 321312 ms
Total Talk Time (CUSTOMER): 457066 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/033cf9f6-8ab0-42cc-b039-92f1c697e840_20250609T16:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I'm calling to check on the status of my, um, I think I have 2 claims.
[AGENT][NEUTRAL] OK, do you have your uh policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, let me, um, um, hold on, well, the one that's pending I have the claim number, you said the claim number or the policy number? I'm sorry.
[AGENT][NEUTRAL] Uh, policy number.
[CUSTOMER][NEUTRAL] OK, so the policy number for this one is 259-4580.
[AGENT][NEUTRAL] And can you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then your address and email address.
[CUSTOMER][NEUTRAL] Um, the email is [PII] and the mailing address is [PII].
[AGENT][NEUTRAL] OK and then lastly good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, well, I see online that one is saying process but it's not saying nothing else.
[CUSTOMER][NEGATIVE] But the other one is saying it's pending, so I don't know, I don't know how to do this, this um since it changes, it's like um confusing.
[AGENT][NEUTRAL] OK, so it looks like the most recent thing I have is from, we processed on [PII], it looks like we actually processed today.
[AGENT][NEUTRAL] Uh, it looks like, so your policy was effective.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And so your policy has your policy has a preexisting clause on it. So anything you're treated for in the 12 months prior to [PII] would be considered pre-existing.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And so,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And not covered. So it looks like the condition in which you were disabled was found to be a pre-existing condition, and therefore, the request for benefits have been denied.
[CUSTOMER][NEGATIVE] Oh, so I was just out of work and, and I was getting it out of my check and they didn't pay, pay me for it.
[AGENT][NEUTRAL] Well, so whatever you were off work for, um, whatever the disability was, it looks like we sent out a pre-existing questionnaire to your providers and it determined that you were treated for that in the 12 months prior to your effective date.
[CUSTOMER][NEUTRAL] Yeah, but it didn't get worse after then cause I didn't need surgery then.
[AGENT][NEUTRAL] Right, but it's, it's based on the.
[CUSTOMER][NEGATIVE] Cause I even canceled, I even had, I even canceled one of my appointment because it wasn't that bad. So I was supposed to have it on January and so I was dealing with it and then it got worse and then I had to have the surgery.
[AGENT][NEUTRAL] Right, it's not based on the type of treatment you received, it's based on the very first time you were seen for it. So even if it's just an office visit, it's considered pre-existing.
[CUSTOMER][NEGATIVE] OK, so I was just out of work and I was taking money out of my check for nothing, so that, that I couldn't use.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] That's the thing that I'm saying. They was taking money out of my check for disability. But normally, at any job that I've been on, I guess it was permanent, but I guess the temp place is different. If I'm out of work, um, I get paid for.
[CUSTOMER][NEUTRAL] If I had to have surgery or disability or anything. And like I said, that money was coming out of my check.
[AGENT][NEUTRAL] Right, well, you have to pay the.
[CUSTOMER][NEGATIVE] And like I miss, I miss work because of that.
[AGENT][NEUTRAL] Right, so I, so you have to pay the premiums regardless of whether the benefit is paid or not. Is that what you're talking about, the premiums?
[CUSTOMER][NEUTRAL] No, I'm just saying that it was coming out of my check. So therefore, normally when you're paying for it, that, that means that if you have to have like be out of work for any type of disability, that, that it should be covered.
[AGENT][NEUTRAL] Well, under
[CUSTOMER][POSITIVE] Normally, that's, that's on every job, every job I've never had an issue.
[CUSTOMER][NEGATIVE] But all of a sudden, this one is an issue.
[AGENT][NEUTRAL] Yeah, it's it, and again, it's just, it's, that's the way this pre that's the way the short-term disability policy works. There's a pre-existing clause on it. So,
[AGENT][NEUTRAL] So like I said, if you're treated,
[CUSTOMER][NEGATIVE] Well they need to tell people that. They need to tell people that before cause if I knew it was there, I would have never had that money coming out of my check. Never.
[CUSTOMER][POSITIVE] It was like I said, I ain't never had no issue with this before. I ain't never on no job that I don't went on, I don't been out and they paid me because I was paying for it. I ain't never had an issue.
[CUSTOMER][NEGATIVE] So I was just out of work for nothing and then it was coming out of my, I was paying for disability or something that I couldn't even use.
[CUSTOMER][NEUTRAL] Basically, I mean, that's, that's exactly what it was.
[CUSTOMER][NEGATIVE] That that's what it was, right? That I was just paying for something that I couldn't use.
[AGENT][NEUTRAL] Yeah, the
[AGENT][NEUTRAL] It looks like you're
[CUSTOMER][NEUTRAL] Unless I unless I got hurt or um or something new pain.
[CUSTOMER][NEUTRAL] And um therefore that was it, I ain't never heard of that.
[CUSTOMER][NEUTRAL] I ain't never heard it. Is it, is it a way that you can send me the policy? Because I ain't never heard of, of what, what they denied my stuff. I ain't never heard of that before.
[AGENT][POSITIVE] Yeah, I can, I can send you the policy. Sure.
[CUSTOMER][NEUTRAL] Never.
[AGENT][NEUTRAL] Um, to the PO box.
[CUSTOMER][NEUTRAL] Um, on, on my email you can send it to my email.
[AGENT][NEUTRAL] Um, we can't email anything. It has to be by mail.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Or you could
[CUSTOMER][NEUTRAL] Oh well, you could say it's gonna be your boss.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, we also have our online portal, um, where you can create an account, um, and access all of your documents there too if you're interested in that.
[CUSTOMER][NEGATIVE] Well the online portal when they changed it, it's not telling me nothing on there. It's just saying processed and and pending. It's not like the, the one last before because I couldn't even upload no documents.
[AGENT][NEUTRAL] Did you create a new account?
[CUSTOMER][POSITIVE] I got a new account. That's how I was able to look at my claims and stuff to see that it's processed and all that.
[AGENT][NEUTRAL] Um, you should be able to see your policy certificate on there, like your, your whole policy certificate that outlines the coverage and
[AGENT][NEUTRAL] Like a several page document um under.
[CUSTOMER][NEGATIVE] But it ain't never said nothing on there about preexisting and or that if I was out of work and I'm paying for disability, so like I said, I still was working during that time, but then if it got worse, it, it never told me that if I, if anything happened and it got worse and I had to have the surgery, that um that I would get denied.
[CUSTOMER][NEUTRAL] It's nothing on there telling me that. It's like I said at the end of the day, my surgery was supposed to be before I started work, but like I said, it wasn't that bad.
[CUSTOMER][NEGATIVE] And then later on, I had to call the doctor and tell him that I was hurting real bad. I started hurting.
[AGENT][NEUTRAL] I was trying to
[CUSTOMER][NEGATIVE] And therefore, that's why I had to go out of work.
[CUSTOMER][NEUTRAL] So that's why I'm confused.
[AGENT][NEUTRAL] Uh, I was trying to locate, I'm having trouble pulling up your document. Hold on just a second.
[CUSTOMER][NEGATIVE] Cause they're gonna have to tell me something because I ain't never been denied about something that I had to have surgery cause I was hurting cause I couldn't work. I ain't never got denied because of that.
[AGENT][NEUTRAL] Yeah, the, the preexisting, um, it looks like that is on page.
[AGENT][NEUTRAL] So it's, uh, it's like page 13 of your document online.
[CUSTOMER][NEGATIVE] And it says that I'm paying for it, but if I had to have surgery for anything that occurred before that, they don't pay me.
[AGENT][NEUTRAL] Right, it's no disabilities payable, um, resulting from pre-existing condition that begins before you have been covered under this policy for at least 12 months.
[AGENT][NEUTRAL] And then it outlines provisions justly.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEGATIVE] Oh they would have, if I had have known that, I would have never got there and like I said, you, they wouldn't have never took anything out of my check if I had have known that.
[AGENT][NEUTRAL] OK, um, like I said, I can send you the policy certificate by mail.
[CUSTOMER][NEGATIVE] Yeah, send it to me because I'm gonna get, I'm gonna get somebody else to look into that because I ain't never had no issue dealing with that right there to be out of work because I can't work and then I'm paying for it and then they don't, they don't cover it because I got to get sick or anything, something new got to happen in the 12 months and I'm paying short term. I'm paying for that. I'm not, I'm paying short term is.
[CUSTOMER][NEGATIVE] When you have to be out of work, you're paying because you have to be out of work because of something that happened. Like I said, yeah, that was pre-existing, but I didn't have to have no surgery. It didn't get worse after I started the job, and I tried to work, but it got worse and I had to end up getting out. And that was the point of me getting short term.
[AGENT][NEUTRAL] Yeah, like I said, it's.
[CUSTOMER][NEUTRAL] But I'm gonna get somebody to my computer. I'm gonna get, I'm gonna get, I'm gonna get um.
[CUSTOMER][NEGATIVE] I'm gonna get a lawyer to look into that because that ain't.
[CUSTOMER][NEUTRAL] Uh uh, I ain't never had no issue. That ain't, that ain't right, but I'm, I'm gonna get somebody to look at it as soon as I get it.
[AGENT][POSITIVE] OK, well, I'll get that mailed to you and then is there anything else I can help with today?
[CUSTOMER][NEUTRAL] So they're gonna deny the, the other claim too, right?
[AGENT][NEUTRAL] Um, did you file a different
[CUSTOMER][NEUTRAL] I have another one so I'm pretty sure they're gonna deny that one too.
[AGENT][NEUTRAL] Is it under, are, are you asking on a different policy or?
[AGENT][NEUTRAL] Or for the same one.
[CUSTOMER][NEUTRAL] Yeah, it's a different phone.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A different one.
[AGENT][NEUTRAL] You know, is it your for your hospital indemnity or your group accident or which one you filed it on?
[CUSTOMER][NEUTRAL] I don't know this one just um I can give you the number, but I don't know what is it for. Some kind of medical something.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the number?
[CUSTOMER][NEUTRAL] You need the policy number or the claim number?
[AGENT][POSITIVE] Uh, yes. Uh, policy number is good.
[CUSTOMER][NEUTRAL] It's 25954578.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you filed a claim under that policy, is that right?
[CUSTOMER][NEUTRAL] Yeah, I see that, that one is pending.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Yeah, I don't know what that means.
[AGENT][NEUTRAL] Let me see how.
[AGENT][NEUTRAL] OK, it looks like, let's see.
[AGENT][NEUTRAL] OK, did you get the payment for the 32,490?
[CUSTOMER][NEUTRAL] Uh, yes, that was for the hospital.
[AGENT][NEUTRAL] Yeah, and then let me see.
[AGENT][NEUTRAL] To make sure.
[CUSTOMER][NEUTRAL] So the hospital, that one is different from disability, so that's not pre-existing.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So if I went to the hospital for something that they say was preexisting, I wanna get paid right.
[AGENT][NEUTRAL] Right, um, but the, that other policy doesn't have a pre-existing clause on it, like the short-term disability.
[AGENT][NEUTRAL] OK, yeah, that's the, that's the most recent one I see on that other policy. I don't have anything after that date. Did you submit something else after that date?
[CUSTOMER][NEUTRAL] Oh no I was just um I just see the, I was just looking at the, the ones that they had on there they had the um.
[CUSTOMER][NEUTRAL] One was pending and one was processed.
[CUSTOMER][NEUTRAL] And I was just wondering what, what was going on.
[AGENT][NEUTRAL] OK, yeah, the one for [PII], we paid the 324.90.
[AGENT][NEUTRAL] And then it looks like there was one for
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That one
[AGENT][NEUTRAL] That one looks like we're just waiting on eligibility confirmation from your benefits and a card.
[AGENT][NEUTRAL] So they're the ones who send us eligibility that shows that your policy is still active.
[AGENT][NEUTRAL] And we haven't received that yet, um, so when we receive it, if and when we receive it, we'll be able to process the claim.
[AGENT][NEUTRAL] Are you still working for that?
[CUSTOMER][NEUTRAL] So what is, what does that mean?
[AGENT][NEUTRAL] Are you still working for the employer?
[CUSTOMER][NEUTRAL] I'm, I'm confused. Um, you said that.
[CUSTOMER][NEUTRAL] You can go, what you say, you can go ahead.
[AGENT][NEUTRAL] Um, are you still working for that employer?
[CUSTOMER][NEUTRAL] No, I left the employer.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, do you know what date you left?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Shit, I guess it was, I don't know. I guess it was Tuesday that I got Terminator. I don't, I don't know what.
[CUSTOMER][NEUTRAL] What, what are they saying?
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Cause I know I went home Monday.
[AGENT][NEUTRAL] Um, so benefits in a card is who sends us, like, if you're covered under the policy. Right now we have a pay to date of 4-27-25.
[AGENT][NEUTRAL] So [PII]. So anything after that, we haven't received eligibility showing that your coverage was extended.
[CUSTOMER][NEUTRAL] What do you mean? You might from the um you said from the benefits in the car?
[AGENT][NEUTRAL] Yeah, so we're we're just waiting on information from them to show that your coverage was still in effect.
[AGENT][NEGATIVE] And they haven't sent us anything yet for this other date of service.
[CUSTOMER][NEUTRAL] Because online you saying active, active meaning that is still.
[CUSTOMER][NEUTRAL] Um, in effect, right.
[AGENT][NEUTRAL] Yeah, I, I like I said, we're waiting on benefits in a card. That's why that date of service hasn't been processed yet.
[AGENT][NEUTRAL] So sometimes they take a few weeks, um, but we haven't received the eligibility file showing that you were effective on [PII].
[CUSTOMER][NEUTRAL] I don't know, but um, yeah, if I ever see this, this place again, I'll never, ever.
[CUSTOMER][NEUTRAL] Ever do that because they should tell people up front.
[CUSTOMER][NEUTRAL] But I tell you to read it that.
[CUSTOMER][NEGATIVE] That you, you have the money taken out of your check for short term in case you have to have something. And like I said, I was supposed to have the surgery in January, but I didn't have it. But it got worse and I had to call the doctor and they had to make me an appointment.
[CUSTOMER][NEGATIVE] And then I didn't, and I never knew that if I'm out of work that I was paying for it, so therefore I never knew that it wouldn't cover it. That I would have to get another sickness.
[CUSTOMER][NEUTRAL] In order for them to cover it.
[CUSTOMER][NEGATIVE] Oh yeah, I'm gonna get somebody to look into that because that ain't no, because I, and like I said, money shouldn't have been coming out of my check cause I, you don't stay with the template for no 12 months.
[CUSTOMER][NEGATIVE] Well, you know, there you don't stay with them, so you're just paying for nothing.
[AGENT][NEUTRAL] Yeah, I mean, I
[CUSTOMER][NEUTRAL] But yeah, I probably
[AGENT][POSITIVE] Well, I'll, I'll get your, um, policy certificate sent your way and then, um, like I said, if, if you have any questions once you receive it, just feel free to give us a call back and we'll be able to assist you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a good day.