AccountId: 011433970860
ContactId: 30af8b5d-10c2-4604-8ccd-739b96a9c5a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 753719 ms
Total Talk Time (AGENT): 332866 ms
Total Talk Time (CUSTOMER): 320313 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/30af8b5d-10c2-4604-8ccd-739b96a9c5a7_20250318T20:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], good afternoon. Um, I'm calling on behalf of my husband. We, uh, filled out a disability.
[CUSTOMER][POSITIVE] And uh I know you guys were in the process of getting additional medical records. I wanna know if you got them, and if not, I can give you the surgeon's information. Um, and I already spoke to the surgeon and they're willing to send you guys whatever else you guys might need.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, well, I can definitely take a look at the claim and see if the documents have been received. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, this is for my husband. His name is [PII], and my name is [PII].
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02571973.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So I'm just looking at the notes in the claim, hold on one moment.
[AGENT][NEUTRAL] No, so it doesn't look like any of the medical records have been received. Um, is Mr. [PII] available so I can verify the policy and um,
[AGENT][NEUTRAL] Get verification to speak with you.
[CUSTOMER][NEUTRAL] Yes, he's here
[CUSTOMER][NEUTRAL] Yeah, yeah, hold on, give me one sec.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hi, Mr. [PII], um, I just need you to verify your date of birth, your mailing and email address.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you, and your mailing address.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you're giving me permission to speak with um Ms. [PII] on your behalf to make changes?
[CUSTOMER][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] OK, so I'm also going to send to your email a third-party authorization form so that y'all can fill it out and send it back to us, so we don't have to ask you for verification. She, we can just speak with her on your behalf.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'll send that to your email for you, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. And then that's all I needed from you. I hope you have a good day.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, thank you. OK, [PII], so.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you for sending that form.
[AGENT][NEUTRAL] Oh, you're welcome. So I'm not showing that any of the documents have been received yet. I still see that, um, like that whole status on there. So what's the, what's the doctor saying?
[CUSTOMER][NEUTRAL] OK, so, um, so you guys are we listed the PCP or the primary, um, doctor as uh the first contact person for, for any information. However, he told me that it would be better if you guys contacted the surgeon, right? So we went to the follow up yesterday.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] With the surgeon and we explained to the surgeon the situation and they're more than happy to uh provide any type of documentation or medical records you guys might need so I can give you the surgeon's information and the person you can send the emails or the request to um so let me know if that's OK.
[AGENT][NEUTRAL] Honestly, what needs to happen, if you have the doctor's information there, when I send the email to you all with the form for the third party, I can also send the short disability claim form and you can send that to the doctor's team and they'll go ahead and fill it out for you because we, we technically cannot reach out to your doctor. We're, we're a third party. That's HIPAA violation.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that, that's fine, but we did fill out the, the original document.
[AGENT][NEUTRAL] Right, but the surgeon did not, correct?
[CUSTOMER][NEUTRAL] The surgeon, no, the surgeon. We listed her and the document, but I don't, but she didn't fill it out, it was the PCP who filled it out.
[AGENT][NEUTRAL] Yeah, so I'm gonna send you a blank short-term disability claim form so that the surgeon can fill it out because it sounds like the surgeon is who's taking him out of work, which is why primary wants the surgeon to do it. So I'll send you a blank copy and then the surgeon can just fill that out and if you all want to fax it to us or upload it, however you want to send it to us, you can and we'll go ahead and process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine. Um, I have one question, um, [PII], um, is this retroactive because he was, he, he went to surgery on [PII] and he's going to be out on to, well, she, we went yesterday to the follow up, one month follow up, and she wants her, she said she, he can go back to work starting on Thursday, so.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Thursday is going to be what the [PII], yeah, the [PII]. So is this going to be retroactive or how, how does it work?
[AGENT][NEUTRAL] So once we get the um documents and we see it, yes, it can be, um, it depends on what the documents say. So if he's been, you know, out of whatever those dates are, as long as everything is approved, that's what he'll be uh paid for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. OK. Perfect. OK.
[AGENT][NEUTRAL] Also keep in mind though, is this, is this the first um disability claim that you uh sent in with us or filed with us?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Let me take a look at his uh policy. Hold on one second because
[AGENT][NEUTRAL] Each claim or each policy, each short-term disability policy has an elimination period. Elimination period is a number of days that the policy is not paid for. So, it's usually that first claim that is taken out of, um, I'm gonna see what y'all do so you can kind of try to estimate it a little bit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, somebody kind of explained that to us once, but they did they just say it was an elimination period, they didn't say what does that entail, you know, like, uh.
[AGENT][NEUTRAL] So that this
[CUSTOMER][NEUTRAL] How much is that or?
[AGENT][NEUTRAL] So the disability benefit that you all would be paid for is up to $1000 a month.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There is um a maximum days that he can be on disability per claim, which is 180 days, but we won't have to worry about that because he's going back to work on Thursday.
[AGENT][NEUTRAL] That there is an elimination period of 7 days. So when you file the claim, there's gonna be 7 days of whatever the total days he's out, there's going to be 7 days that are not paid for.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And what is the, the
[CUSTOMER][NEUTRAL] The amount associated for 7 days. Like how much are we gonna subtract out of the $1000 for those 7 days?
[AGENT][NEUTRAL] Um, now that, let me see if there's a way, I, I believe, hold on one second, where's my calculator?
[AGENT][NEUTRAL] And this is for February, so it's not 30 days in February.
[AGENT][NEUTRAL] Usually, it's the $1000 divided into how many days of the month it is, and then
[AGENT][NEUTRAL] Whatever those 7 days are, but I'm not a claims examiner, so I don't want to give you the wrong figure. Hold on one moment.
[CUSTOMER][NEUTRAL] OK, so from [PII], it's one month.
[AGENT][NEUTRAL] So roughly, this is a rough estimate because I'm not an examiner, but around $250 I just broke the $1000 into the month of divided by the 28 days of February, and then I times it by 7, so that's about $35 a day. So $200 around $250 could be taken out for the elimination period, that's the estimate.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And those are working days or, or regular days?
[CUSTOMER][NEUTRAL] Or like the whole 7 weeks.
[AGENT][NEUTRAL] It's just 7 days.
[CUSTOMER][NEUTRAL] 7 days. OK, so 1234.
[CUSTOMER][NEUTRAL] 123456789 [PII] [PII] [PII] [PII] [PII], [PII] [PII].
[CUSTOMER][NEUTRAL] 207829.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] 31, 32, 33.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] 4 35 36 3738, so it's gonna be 38 days.
[AGENT][NEUTRAL] There's only 28 for the month of, it's monthly, so it's however many days in each month.
[CUSTOMER][NEUTRAL] Oh, but what happens for March?
[AGENT][NEUTRAL] The elimination period is only taken out of the first claim, so that's only the month of February.
[CUSTOMER][NEUTRAL] Oh, OK, so when you say claim it, the claims are considered by month, it's not like by situations.
[AGENT][NEUTRAL] I wait, explain that to me. What do you mean by that?
[CUSTOMER][NEUTRAL] Like, for example, he's, he was out [PII], not [PII], right? So from [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's the days that you're counting, but what happens when it gets to March? [PII] is a different month.
[AGENT][NEUTRAL] Oh, so March is, right, so March is not the only, the only claim that's affected is the very first claim. So how many days from [PII]? What is that? [PII], or no, I'm sorry.
[CUSTOMER][NEUTRAL] From the [PII], from the [PII], it's 123456789, 1011, 1213, 1415, 1617 days.
[AGENT][NEUTRAL] 10
[AGENT][NEUTRAL] So, hold on.
[CUSTOMER][NEUTRAL] So it will be 17 days in Feb.
[CUSTOMER][NEUTRAL] And then it will be, he's going back on [PII], so it will be 20 days on on March.
[AGENT][NEUTRAL] So February, for February, we'll do the $15,000 because it's $1000 for the monthly benefit.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] If they split the $1000 between those um 15 days, it would be around $412 that could be taken out because that's about $59 per day, but that's an estimate for the first claim only.
[AGENT][NEUTRAL] Or first month of payment only. March if March is uh how many days in March he'll be out, he'll have that up to $1000.
[CUSTOMER][NEUTRAL] 20.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Well, whatever. I don't know, it's complicated. OK, so don't worry, uh, as long as you send me the form, I'll, I'll send it to the surgeon, and then I'll, I'll scan it again for to you guys.
[AGENT][NEUTRAL] OK, so I'm sending you the authorization form as well as the short-term disability claim form.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you so much.
[AGENT][POSITIVE] And I'll send that to the email. You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Have a good day.
[AGENT][POSITIVE] All right, you also thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thanks bye bye.