AccountId: 011433970860
ContactId: 14b16a0f-ab51-4ea1-80ec-b32eb5834c01
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 838090 ms
Total Talk Time (AGENT): 330498 ms
Total Talk Time (CUSTOMER): 386187 ms
Interruptions: 10
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/14b16a0f-ab51-4ea1-80ec-b32eb5834c01_20250514T21:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I'm trying to call um I've got the policy number. I'm trying to find out if um he has been denied or not.
[AGENT][NEUTRAL] OK, and have you sent in a claim and you're trying to check the status of it?
[CUSTOMER][NEUTRAL] Yeah, that
[AGENT][POSITIVE] OK, I, I can help you with claim status. May I get your name and your callback number just in case the call gets dropped? I'll be able to call you right back.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The name is [PII].
[CUSTOMER][NEUTRAL] It's area code [PII].
[CUSTOMER][NEUTRAL] Number is [PII] I mean [PII].
[AGENT][NEUTRAL] Thank you. And can you spell your first and last name for me, please?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Thank you. And then what is the policy number, please?
[CUSTOMER][NEUTRAL] 02545395
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, um, is [PII] there for me to get a verbal consent to talk about the policy? Thank you. Hi [PII], can you hear me? Hello sir, this is [PII] with APL. Um, I'll need for you to verify some information real quick for me. Uh, what is your date of birth, sir?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am, I'm here.
[CUSTOMER][NEUTRAL] All right. Yeah, I can hear you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then what is your address, phone number, and email address?
[CUSTOMER][NEUTRAL] Um, uh, street address is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] ZIP code is [PII].
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah, email address is um.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] Thank you and then the phone number I see you guys are calling from is that your cell phone?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you, Mr. [PII]. Also, is it OK if um,
[AGENT][NEUTRAL] And I didn't catch the lady's name that was on the phone with me. Is it OK if I discuss the Miss [PII]? Can I talk about your policy with her? OK, thank you, Mr. [PII]. You have a blessed day. You can go ahead and put Miss [PII] back on for me if you would like.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah, yeah, it's OK. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Hi, it's on speaker so he's able to hear.
[AGENT][POSITIVE] Hi. Oh, OK. So you both can hear me. That's good.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so I'm seeing that a policy was sent in on [PII], is that the one that you're talking about that was sent through the online service center?
[CUSTOMER][NEUTRAL] I'm assuming it is um he had filled some paperwork out I think around the [PII] of last month.
[CUSTOMER][NEUTRAL] But um he hadn't heard nothing and then um this data I see it shows [PII] that somebody had sent something out that says explanation of benefits but it doesn't show that he has it or was denied.
[CUSTOMER][NEUTRAL] So that's what I'm trying to find out does it come with a couple of papers.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let me read to you what um the information that I can see it says that um based on your effective date of coverage it is necessary that we obtain your past medical history to determine if your claim is due to a preexisting condition. please complete the enclosed form and return to our office if you have any questions so they have sent something out to you.
[AGENT][NEUTRAL] To fill out to get your past medical history?
[AGENT][NEUTRAL] And that's what they're requesting at this time.
[CUSTOMER][NEUTRAL] Fill it out as disability claim form.
[CUSTOMER][NEUTRAL] Statement of insured and then um there's 2 or 3 that the doctor, I'm assuming have to fill out showing.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, and you'll have to.
[CUSTOMER][NEUTRAL] It says attending physician statement.
[AGENT][NEUTRAL] Yes ma'am, so on, on a disability claim you have to have the employer's information filled out, the physician's statement filled out, and the insured's portion filled out. There's 3 portions that need to be filled out.
[CUSTOMER][NEUTRAL] OK, now he's been filled out, yeah, he can fill these out more than once. This will be the 2nd time he's filled these out and sent them in.
[AGENT][NEUTRAL] For the physician or?
[CUSTOMER][NEUTRAL] The physician sent them in.
[CUSTOMER][NEUTRAL] Yes, he went to the physician, physician filled them out, sent them in.
[CUSTOMER][NEUTRAL] And then um whenever he got it, there was a payment, I mean, papers that he had to fill out, the doctor had to fill out, and I think the paper where he worked.
[CUSTOMER][NEUTRAL] And he just sent those in.
[CUSTOMER][NEUTRAL] So that's why we were confused why he's doing it again.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Right. Right. So at this time looking.
[CUSTOMER][NEUTRAL] And it wasn't over the phone. It was, it was papers filled out and that was around, like I said, around the [PII] or [PII].
[AGENT][POSITIVE] Right, right, which is correct.
[AGENT][NEUTRAL] Yes ma'am, and that's correct that's what needs to be filled out, but looking at uh the claim information at this time we have not received anything since [PII].
[AGENT][NEUTRAL] So it may be that um they have filled it out and sent it in but we just haven't got it yet.
[AGENT][NEUTRAL] That's, that's what I'm looking at now. So nothing's been reported since [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEGATIVE] OK. Well, that would be all of it. She said she ain't received none of them.
[CUSTOMER][NEUTRAL] None from the doctor.
[CUSTOMER][NEUTRAL] None from your employer.
[CUSTOMER][NEUTRAL] And none of yours.
[CUSTOMER][NEUTRAL] Who did you gave it all to the people you work for, didn't you?
[CUSTOMER][NEUTRAL] Because they want to feel like that.
[CUSTOMER][NEUTRAL] So yeah.
[CUSTOMER][NEUTRAL] So that was turned in on the um.
[CUSTOMER][NEUTRAL] Well you have to say did interrupt she wouldn't know about that.
[CUSTOMER][NEUTRAL] That's what I'm saying. He has that down here.
[CUSTOMER][NEUTRAL] So I found that that's um.
[CUSTOMER][NEUTRAL] And heart algorithm.
[CUSTOMER][NEUTRAL] And I was on the last week. Then she ain't turned it in.
[CUSTOMER][NEGATIVE] She ain't turned it in then because she ain't received this lady hasn't received any of them. Um, now the.
[AGENT][NEGATIVE] Right now if it went by mail, if, if they sent it by mail, it just may not have gotten to us yet, but as of now nothing's been sent or we haven't received anything since [PII].
[AGENT][NEUTRAL] And I'm not saying that they haven't turned it in, but if it went by mail, you know, the mail can be slow sometimes.
[CUSTOMER][NEUTRAL] Right. Well, we told them to fax it. Please turn it off. Um, the attending physician statement, there's two papers that says, um, from A, let see, J1 to J4 it's supposed to be filled out. OK, and then it said it can be faxed back.
[AGENT][NEUTRAL] Uh yes, ma'am.
[CUSTOMER][NEUTRAL] To, yeah, so I can get them to try to do that. And then um it says statement of insured. Now,
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Is this supposed to be filled out by the person that he worked for?
[AGENT][NEUTRAL] No that's gonna be filled out by him he's the insured.
[CUSTOMER][POSITIVE] So he's able to fill it out. I can put.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Date last work day job have your employment terminated right.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Acknowledgement OK. Alright, that's two forms there, OK.
[AGENT][NEUTRAL] And can we, can we verify the fax number real quick and make sure that they have the correct fax number and that's not the issue?
[CUSTOMER][NEUTRAL] OK, let's see, um, let's see where it shows the fax number.
[CUSTOMER][NEUTRAL] American, let's see where.
[CUSTOMER][NEUTRAL] I'm try I'm, I'm looking to see if I can see where it's at.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Honestly, uh, there's not a fax number. It's got the [PII] number, but I do not even see a fax number since you mentioned. Oh wait, wait, never mind, it's at the bottom. It's um [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Yes, ma'am. That's the correct fax number [PII]. I just wanted to make sure that we have that correct.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, yeah, that number is on this one, so I see those 4 and I think there's one at the bottom, so all these can be filled out by him and the doctor and I can just fax it all back to you.
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] And make sure that the employer's portion is filled out also.
[AGENT][NEUTRAL] Otherwise they're gonna send it back and tell you that that needs to be filled out.
[AGENT][NEUTRAL] And then it, it makes the process.
[CUSTOMER][NEUTRAL] So the person who works, so the person he worked for has
[CUSTOMER][NEUTRAL] The person he worked for has to fill that part out.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, that's what I was asking a while ago.
[AGENT][NEUTRAL] Yes, ma'am. He feels that
[CUSTOMER][NEUTRAL] That would be the, which part?
[AGENT][NEUTRAL] Let me look at the claim form. I'm gonna pull it up so I.
[CUSTOMER][NEUTRAL] The K1
[CUSTOMER][NEUTRAL] Yeah, that's why I was asking what he could fill out and what they filled out.
[AGENT][NEUTRAL] I'm gonna pull up the claim form with you.
[AGENT][NEUTRAL] Right, I understand. Let me look at the claim form with you so I can see exactly what you're looking at, OK?
[CUSTOMER][NEUTRAL] OK, the one I'm looking at now is the one I thought that the employer had to fill out, which is the disability claim form statement of insured about the insured section A.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Yes, the insured.
[CUSTOMER][NEUTRAL] Then it's got workers' compensation.
[AGENT][NEUTRAL] Right, that is what [PII] fills out, the top part.
[CUSTOMER][NEUTRAL] OK. That that should be where it says worker compensation details?
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That is going to be filled out.
[CUSTOMER][NEUTRAL] What part does the
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] OK, that's gonna be filled out by the employer because the employer if he was on workers' comp would fill that out. The date last work that in job needs to be filled out.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And the date you return.
[AGENT][NEUTRAL] Your expected return part time or full time that also needs to be filled out by the employer where it says employment details.
[AGENT][NEUTRAL] And then sources of income.
[CUSTOMER][NEUTRAL] Yeah, I, yeah, that's the one I was.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] They would need to fill out that portion.
[CUSTOMER][NEUTRAL] That's what I was thinking. They had to fill out.
[AGENT][POSITIVE] Yes. You're right.
[CUSTOMER][NEUTRAL] I figured they had to fill out actually all of it, even the disability details.
[CUSTOMER][NEUTRAL] Cause it says if
[CUSTOMER][NEUTRAL] It's a disability due to a sickness, accidental injury, or pregnancy?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I figured they filled out that one and the other one.
[CUSTOMER][NEUTRAL] So them two have to be filled out by who you work for.
[CUSTOMER][NEUTRAL] These two have to be filled out from your doctor. All right. The bottom one where it says um APL policy number, printed name of patient.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] That's also
[CUSTOMER][NEUTRAL] The doctor
[AGENT][NEUTRAL] Yes, because he, because it says patient, it's [PII] the patient, right, so [PII]'s the patient, so the doctor will fill out that for the patient's port portion of it.
[CUSTOMER][NEUTRAL] That's page 5, page 5 of 8.
[AGENT][NEUTRAL] That attending disability claim form which is attending physician statement all that needs to be filled out by the physician.
[CUSTOMER][NEUTRAL] 5 of
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] So 56.
[CUSTOMER][NEUTRAL] And 7 has to be filled out from the doctor.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] A drink doctors.
[CUSTOMER][NEUTRAL] This is the employer.
[CUSTOMER][NEUTRAL] But it
[CUSTOMER][NEGATIVE] You can't move papers on me. I don't know what I'm looking at.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] 2 and 3 are filled out by the employer correct?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, this is the same one. Almost as this one, that's an employer.
[CUSTOMER][NEUTRAL] Who fills out page 8? Is that also the employer?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh that.
[CUSTOMER][NEUTRAL] No. Hello, are you there?
[CUSTOMER][NEUTRAL] I don't know what she's doing.
[CUSTOMER][NEUTRAL] Pro the insured, first name, date of birth, address, home phone number, cell phone number, email.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.