AccountId: 011433970860
ContactId: 1ab16cdf-7bff-42fe-a23a-645c118280fe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 884070 ms
Total Talk Time (AGENT): 214247 ms
Total Talk Time (CUSTOMER): 302365 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-2.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/1ab16cdf-7bff-42fe-a23a-645c118280fe_20250113T17:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII], and I was wondering if you could tell me, um, or just update me about, um, a claim I put in for short term disability.
[AGENT][NEUTRAL] OK, yeah, let's take a look. What is the policy number?
[CUSTOMER][NEUTRAL] Um, let me get that for you. It is.
[CUSTOMER][NEUTRAL] Um, 2500519.
[AGENT][POSITIVE] All right, thank you. Let me take a look here.
[CUSTOMER][NEUTRAL] Yeah, no,
[AGENT][NEUTRAL] Alright, and then if I could verify please your date of birth and then address we should have on file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, um, date of birth is [PII] and the address is [PII].
[AGENT][POSITIVE] Thank you. All right.
[CUSTOMER][NEUTRAL] I want to, I'm still working.
[AGENT][NEUTRAL] OK. So, I do see the claim. It looks like that was submitted uh recently. It looks like it was processed.
[AGENT][NEUTRAL] Um, it looks like claim was denied. It's stating that it was a pre-existing condition. It says please see section 4 of your policy.
[AGENT][NEUTRAL] Um, it looks like if you had received any sort of treatment for this, they were, yeah, they denied it for a pre-existing condition, it looks like.
[CUSTOMER][NEGATIVE] But I've been trying, I've been putting it, like I've been submitting it. I'm still not back to work, but I've been submitting it since I was being treated for it, like since I had the C-section, and nobody reaches out to me to tell me like why it gets denied. And like I can't go back to work yet and I was under the impression that I would be getting, like I would be owed what I was.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You know, I was supposed to be getting from having this procedure. Like that's why I signed up for this insurance.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Like when I signed up for it, they told me that when I have a C-section or if I were to have a C-section, that I would be covered under this policy. And then I keep on literally like every couple of weeks, I submit more information and nobody tells me like I have to call and ask like what's going on? Nobody ever reaches out and tells me like.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Oh this is what you're missing or you know like I was waiting for my employer to send in the paperwork they didn't then nobody from APL reached out and told me, oh we were you know waiting on your employer's paperwork like nobody ever reaches out and tells me and all of a sudden now we're in [PII] and I still haven't been paid and I can't go back to work.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] So yeah, I know it was a preexisting condition because I had a C-section and I couldn't go back to work.
[AGENT][NEUTRAL] Right, OK, so what I can do for you [PII] is have um send the claim to the examiners and then I can have a claim examiner contact you. They're the ones that actually process the claims and I can have somebody go over this with.
[AGENT][NEUTRAL] You and then let you know exactly they can look at the paperwork submit it and then let you know exactly what it is that needs to be submitted that way you can get a payment on it and they would be better suited to explain the claim processing like process itself better is that OK if I have a claims examiner call you back?
[CUSTOMER][NEGATIVE] I mean that's fine. I just can't understand why, like I've been submitting this since I had the C-section, like multiple times I submitted the same stuff over and over again. Like I just don't understand how or what is the point of having this insurance if you wouldn't be covered? Like why do I pay every week out of my paycheck?
[AGENT][NEUTRAL] Yeah, so all I.
[CUSTOMER][NEUTRAL] For it to not be covered all of a sudden. Like,
[AGENT][NEGATIVE] I know I see on the previous ones it was stating that it looked like it was missing information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] It kept on missing information, but nobody would reach out to me and tell me. But it just kept every time and I would sign into the portal like every single day, never once did it say like what it was missing. I would have to end up reaching out and I had a newborn, like, and two other toddlers. It's and at the same time trying to recover, and I would like, I had many complications, like, I've been calling since September, basically.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Yeah, I'm sorry for the frustration on it um I think the best thing to do is to have you speak with somebody because you haven't spoken with anybody that actually it sounds like is processing the claims and so I apologize that you haven't spoken with anybody. I'm happy to put in a request to have somebody in claims call you and go over this and just explain it in greater detail they're gonna be the ones better equipped to do that for you.
[CUSTOMER][NEGATIVE] So you, so somebody is going to call me to explain to me in more detail as to why they're going to deny me after 3 months, 3.5 months of having a C-section.
[CUSTOMER][NEUTRAL] waiting for the 8 weeks th[PII] I like.
[AGENT][NEUTRAL] Just if you.
[CUSTOMER][NEGATIVE] So maybe I should just put on file my attorney's number because it seems like basically you guys waited around, everybody kept on pushing me around and telling me oh you just need this submit this submit this I keep on submitting the things that they told me to submit all for them to deny me.
[AGENT][POSITIVE] Ma'am, I'm just reading the denial reason on the explanation of benefits. Again, I don't process claims and so I'm happy to have somebody reach out that actually processes claims.
[AGENT][NEUTRAL] And go over this with you and see exactly if there was something else missing like what's going on, they would be the ones best suited to answer all these questions in regards to this.
[CUSTOMER][NEGATIVE] So, so what was the reasoning? So last, every the 3 other times I got denied, they kept on saying it was because there was missing in missing paperwork, right? What was the reasoning this time that it got denied?
[AGENT][NEUTRAL] The denial reason on this explanation of benefits is that it was marked as a preexisting condition.
[CUSTOMER][NEUTRAL] Of course, it was pre-existing, because I had a C-section 3 months ago. I've been trying to submit it since then.
[CUSTOMER][NEGATIVE] But every other time that I've submitted, like, why wait, this is what I don't understand, is that I kept on, any time they would deny it, it wasn't like, oh, they were denying it and telling me that I had no chance. They just said, oh, you're just missing this piece of information, get us this, and then
[CUSTOMER][NEGATIVE] You'll get the, the payments, like, so I kept on trying because they were, every time I would call somebody, all they would say is, oh, it just got denied because you're missing this, you're missing this, like, so then I finally get everything all together, and then I get denied because it's pre-existing. Yeah, it was pre-existing. I had a child.
[AGENT][NEUTRAL] That's the, that's the denial reason that it's showing on that claim. So I'm happy to have somebody reach out to you or if you'd like me to reach out to a supervisor, I can do that. Those are kind of our options at this point.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, please. I mean, I, I'm basically this is my livelihood and I've been, I haven't even been getting paid in the past month, so I really, and my employer's answer was that, you know, you have disability insurance, like, keep up with it, make sure that like you get paid for what you signed up for.
[AGENT][NEUTRAL] So would you like me to reach out to a supervisor or have somebody call you back? What works best for you?
[CUSTOMER][NEGATIVE] Yeah, can you please reach out to a supervisor? Like I don't, I can't let this go like I don't know, I, I have way too many things going on for me to like continuously like let days go by and me thinking that, you know, I was going to get the help that I originally signed up for to get like I I can't keep on letting it go.
[AGENT][NEUTRAL] OK. Let me place you on just a brief hold, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Sorry, I had you on mute. I apologize. Hi, this is [PII] over in customer care. I have [PII], the one requesting a supervisor on the line. I just thought I would, uh.
[CUSTOMER][NEUTRAL] I have you on
[AGENT][NEUTRAL] Introduce myself before I transferred her. Do you have all of her stuff that you need?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do.
[CUSTOMER][POSITIVE] Appreciate it.
[AGENT][NEUTRAL] Yeah, here she comes. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] Ms. [PII].
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] This is the leisure.