AccountId: 011433970860
ContactId: 15b6e2bf-9b83-4cc2-a8bf-52b91f816ed7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 899179 ms
Total Talk Time (AGENT): 512211 ms
Total Talk Time (CUSTOMER): 378348 ms
Interruptions: 12
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/15b6e2bf-9b83-4cc2-a8bf-52b91f816ed7_20250121T18:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking? How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] with the care team. How are you doing today?
[AGENT][POSITIVE] I'm good, and you?
[CUSTOMER][POSITIVE] Hey, I'm doing great. I need help though.
[AGENT][NEUTRAL] OK, what, what's the, uh, what I that's OK. What's the policy number?
[CUSTOMER][NEUTRAL] I'm looking at policy number 02330383.
[AGENT][NEUTRAL] OK. Let me take a look at that, get it pulled up.
[AGENT][NEUTRAL] Is it for uh [PII]?
[CUSTOMER][NEGATIVE] Oh shit, [PII]. I'm looking at the wrong policy. Sorry, that was an old one I had pulled up. It's for 2,341,350.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK, alright, and what's your question?
[CUSTOMER][NEUTRAL] OK, um, we've got so many questions. Um, Ms. [PII] filed disability with us. I like tried to read her her claim remarks and let her know, um, all the things she wants to know like why she hasn't been paid since her one payment and I like explained that she had to send, you know, additional claim forms every month that she wanted to like make claims.
[AGENT][NEUTRAL] Mhm. You have to file a claim each month. Mhm.
[CUSTOMER][NEUTRAL] Uh-huh, and she said that she wasn't notified, so I started like looking into her things and it doesn't look like her EOB like went out saying that because usually it'll say like, hey, resubmit. um her EOB says that she's been paid until her return to work date, but her return to work date on her claim was like in December and um and so I'm not really sure if what I'm looking at is wrong.
[AGENT][NEUTRAL] OK, let me, yeah, let me look at the last claim where she got a payment and see exactly what it says. Let's see here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] So it says this this payment includes your disability benefit for this month. Please contact our office immediately if you are released from the doctor's office and if you return to work so that your claim does not become overpaid. So, it's just an ongoing payment. I don't see where we pay you. She just needs to file a claim. She last filed a claim that remark code PE111.
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And yeah, that was the last time she was paid with remark code PE111 and PE 70 for June. Let me go look at that 1. PE11.
[CUSTOMER][NEUTRAL] Yeah, that's the one that said it completed the occurrence.
[AGENT][NEUTRAL] OK, let me take a look at that one.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] This complete insurance benefits have been paid to the date you were released to return to work. OK, well, with that being said.
[AGENT][NEUTRAL] Only thing we could do is look and see if she file something what the doctor extended her because uh
[CUSTOMER][NEUTRAL] So her original claim shows her return to work dates for December um but the the the um signature line.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On that is matches that return to work date so I and there's so much in here like I'm just like trying to look through it and I don't always know exactly what I'm looking at um.
[AGENT][NEUTRAL] OK, let me just, let me try to see if I can look at um that document.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Oh, let's see here.
[AGENT][NEUTRAL] OK, so when she first filed her claim,
[AGENT][NEUTRAL] Her return to work. OK.
[AGENT][NEUTRAL] Date last what.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me see it on here.
[AGENT][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] No, yeah, there's so many pages and there's
[AGENT][NEUTRAL] Anticipated return to work date [PII]. OK, so at this point all I can do is if you want to transfer her you can, but I'm just gonna have to reach out to [PII].
[AGENT][NEUTRAL] And try to figure out what happened with that because I, I can't tell you. That's, that's a more, that's a question that's geared toward, uh, you know, I take the calls just like you for disability, but unfortunately I've never been trained to process disability so I can only go so far. Yeah, I can only go so far, you know, and, uh, in this case, that's to me that's a bitsy question as to why we didn't, but I'll reach out to her and ask her if you wanna just transfer the call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] No that's the same here.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yeah, and then she does have one more question is if she submits um that continuing claim form, she needs to submit one for right like she had May and June, so she needs the rest of June, July, August, September, October, gets her 6 months. That's what her benefit is so she needs to submit 5 more forms. Are those all gonna be paid in one payment or would they come in 5 separate payments? She wants to know the answer to that question. We don't know. OK.
[AGENT][NEUTRAL] OK, what's the call back? Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We, we can't answer that. Uh, OK, but yeah, um, yeah, yeah, I, you know.
[CUSTOMER][NEUTRAL] That's why I told her I told her I wasn't sure how it shook out, but I would.
[AGENT][NEUTRAL] I'm pretty sure she's gonna if if it if it's something that has to be processed, I'm pretty sure they may do all those on that but again that's a that that's to the processor. I don't process those claims. I don't know what their rules are. I don't know if it has to be broken out. I don't know if it can be lump. I don't know, but.
[CUSTOMER][NEUTRAL] You know,
[CUSTOMER][NEUTRAL] I don't know either. I'm
[AGENT][NEUTRAL] I can get those answered for her. I'll get them answered, but I'm trying to see what [PII] put on here. Received medical records reviewed by Doctor [PII] No medical records first sent to him for review. Medical records 50 pages sent to Doctor [PII] Benefit was paid in good faith on the first claim with no medical records on file. Her medical records during requested time period benefit.
[AGENT][NEUTRAL] was paid up to the date the insured had her claim form returned to work. She basically got a return to work date in here of [PII].
[CUSTOMER][NEUTRAL] Yeah, so I know there's gotta be something like I can't see like or I or I'm not trained to look at.
[AGENT][NEUTRAL] Yeah, I'm gonna, I'm just gonna ask her. Yeah, I'm just gonna, um, you could transfer. What's her callback number?
[CUSTOMER][NEUTRAL] Yes, callback number is going to be um the one she's calling from the [PII].
[AGENT][NEUTRAL] OK. All right. OK. And you verified everything, right?
[CUSTOMER][POSITIVE] And I did, I did verify everything and she is, I already sent out a request for claim forms to be mailed to her, so they're coming her way. Awesome thank you and you said [PII], right?
[AGENT][NEUTRAL] OK, alright, go ahead and send her over.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right. Uh-huh.
[CUSTOMER][POSITIVE] OK, perfect, thank you.
[CUSTOMER][NEUTRAL] Hi, Ms. [PII], are you still there with us?
[CUSTOMER][POSITIVE] Yes. Alrighty, I have Miss [PII] on the line and um she is going to take the call on over from here and she's gonna do her best to help you answer uh the questions you had I did explain to her a little bit about the things um you called concerned with um and she's gonna do our best to help you get some answers today, OK?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] My pleasure.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK. Uh, good afternoon, Ms. [PII]. Um, I understand your name, date of birth, email, and uh address has been verified. And you have some questions about uh your disability payment. Um, you say you were slated to return to work on [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] But I'm showing the last time you were paid was July.
[AGENT][NEUTRAL] I'm sorry, no, June. You received a payment in June.
[AGENT][NEUTRAL] And the remark code that was placed on that, give me one second, one moment.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][POSITIVE] Thank you for your patience.
[AGENT][NEUTRAL] So I'm showing you received a payment in May. I'm sorry, no, yeah, in May and then you received a payment in June and then there was no payment after that, um, but I am showing in the on the June payment.
[AGENT][NEUTRAL] It was paid with a remark code that states.
[AGENT][NEUTRAL] This payment completes your claim for this occurrence. Benefits have been paid to the date you were released to return to work. Now when I look in the notes, I see that there was a return to work, I guess originally of [PII]. Does that ring a bell?
[CUSTOMER][NEGATIVE] No, I don't know why they put that since the last time I went to work is [PII]. That's the last time I work. I've never worked, and the payment you're talking about, I think they put, they made it, they put it together and I was only paying 900.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] As she explained because I only received one time payment. I've not received any payment since one time payment, and it's 9 something. It's not even 1000 something.
[AGENT][NEUTRAL] Right, but it's still, it, it
[AGENT][NEUTRAL] You, you
[AGENT][NEUTRAL] Oh, you
[AGENT][NEUTRAL] You will pay $1,306.72. $823.33 was for May. Uh, 506 67 cents was for June. When you add both of those together, they were on the same check that was a payment of $1,306.72.
[CUSTOMER][NEUTRAL] That what you said it to.
[AGENT][NEUTRAL] Now, I'm not really sure what is going on. I, I see something that says
[CUSTOMER][NEUTRAL] No, I received 900 and something one time payment.
[CUSTOMER][NEUTRAL] I went to the bank and told them that the receipt is showing 1000 something. Yeah, you, your receipt is showing 1000 something. I show it to them at the bank. I said, look at how much they say they pay me. They say, man, APL pay them so so amount which is 900. That what I'm seeing, I'm showing them is different.
[AGENT][NEUTRAL] No, I don't see, I, it was more than 900. It was more, yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and we, we have a copy, we could send you a copy of the, we can send you a copy of the voided cash check from the bank.
[CUSTOMER][NEUTRAL] I had a copy. I have a copy. I showed them that you guys pay me 1000 something. I showed it to the bank. They say, man, the only thing we see is now. I said, go back and see if there's anything they have paid. I'll be going to the bank all the time checking on it, and they keep saying they will receive, uh, payment from you guys one time. I said, look at the receipt. You are giving me 9 something. The receipt showing 1000 something.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So here's, here's what I'm gonna do, Miss [PII] because I'm looking at the form that was filled out that was supposed to be signed by the doctor, and I think I know why you were paid just to [PII] because that's the date that the doctor signed this form. So.
[CUSTOMER][NEUTRAL] That's how, that's how it went.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So, uh, we're gonna, I'm gonna have to reach out to the processor to see if that's why you were only paid to that date, they need more documentation from the doctor. I'm gonna have that person reach out to you and give you a phone call to further explain it to you. That will be the person that processed your claim. Now, is there a good phone number to call you back at? Is it [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. All right, so that individual is away from her desk right now. So, um, I'm gonna send her an email and I'll make sure she reach out to you, reach out to you and give you a call to explain what may be needed or what is going on, OK? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, and the date of the days that you guys pay me so that when I go back to the bank and tell them, you know, to check, to check again what's going on so that I know they said they pay so that you check that date and see if they have not paid me because I don't know why you guys don't want to give me money. You, uh, you guys give me 1000, they are giving me 9 something.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, I can give you the, let me.
[CUSTOMER][NEGATIVE] I told them look at the receipt. They keep saying, oh, we receive the receipt says something else. So if I can get the days, the days and the month that you guys paid, I'll go back there and point it at them. Look at this date, check if you know if if there's nothing in my account so that I will know because I've not worked since April and right now I still got to pay my hospital bill. They put me on payment plan. I can't even come up with a payment plan because that's I was hoping on that day.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I'm showing that that payment process process it was direct deposit and it processed on [PII] and direct deposit, you just need to check with the bank and ask them if they show a direct deposit one or after [PII] for the amount of $1,306.72.
[AGENT][NEUTRAL] Because that was the amount.
[CUSTOMER][NEGATIVE] OK, so right now the, the one I'm expecting now from that June they have not paid up to this up to date. I have not received anything after June.
[AGENT][NEUTRAL] Correct. And I just explained to you, Ms. [PII], that this form was signed by the doctor, [PII]. OK? So, you're gonna have to speak to the processor. I don't know why, if that's why you were only paid up to June.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because they considered that the return to work date because that's when this doctor signed this form. If it was later than that, it may be that the doctor needs to sign another form. I'm not sure. That processor will explain that to you when she returns the call, OK? All right? OK. Anything else I can help you with?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. OK, thank you. All right, thank you.
[CUSTOMER][NEUTRAL] Uh, but, uh, I'm just saying that you said somebody's going to talk to me because uh
[CUSTOMER][NEUTRAL] We have been, uh, sending doctor's reports, doctor's reports. So this lady that called you and said, probably because we have no fee form, that's why they have no, uh, because they don't need no more doctors, they have enough doctor's report. That's what she told me that we only need to fill the form every month if you why we're not receiving anything because I, I did not see the form. So I don't know I have to refill the form like every month. That's why. So then if you said the lady have another explanation.
[AGENT][NEUTRAL] Yeah, we have, you have to file, you have to file a con.
[AGENT][NEUTRAL] Yes, you have to file a continuing disability claim every month to be paid. So every new month you have to file a claim, uh-huh, and that claim is located, mhm, yeah, I'm sorry that you didn't know, but that claim form is located on our website at [PII] up on the claim forms it's the disability claim form, OK? So let me send this email and just look to hear from uh this individual um I believe she's at lunch right now, OK?
[CUSTOMER][NEUTRAL] Oh, OK. That's what I told her that, yeah.
[CUSTOMER][NEUTRAL] I did not know.
[CUSTOMER][NEUTRAL] Mm, oh, OK.
[AGENT][NEUTRAL] But she is here today.
[CUSTOMER][NEUTRAL] OK, she's gonna call me. Yeah.
[AGENT][POSITIVE] Yeah, she'll give you a call. Yes, ma'am. OK. All right. Well, thank you, Miss [PII]. You take care and thanks for calling APO. Uh-huh. Bye-bye. Mhm. Bye-bye.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much.
[CUSTOMER][POSITIVE] Thank you. Yes, ma'am. Thank you. Yeah bye.