AccountId: 011433970860
ContactId: 37a919b2-3543-42bd-ae14-cb9d18ff4733
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407890 ms
Total Talk Time (AGENT): 169789 ms
Total Talk Time (CUSTOMER): 161649 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/37a919b2-3543-42bd-ae14-cb9d18ff4733_20250117T19:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling Ael. It's [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm just calling to get a status of my claim.
[CUSTOMER][NEUTRAL] Um, I was, I was trying to do a continuing claim, but it looks like, um, it's like a new claim number for the second time I submitted some information, so I was just wondering if you can help me.
[AGENT][POSITIVE] OK, I can help you with that. Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Your policy number?
[CUSTOMER][NEUTRAL] It is 226-613-1.
[CUSTOMER][NEUTRAL] Oh like the crazy
[AGENT][NEUTRAL] Your name, date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Can you verify your address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And lastly your email address.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Ms. [PII], thank you for that. You said you had a question about your claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and how can I help you?
[CUSTOMER][NEUTRAL] Um, so I submitted a short term disability claim, um, when I was first pregnant, or sorry, when I was first giving birth, um, and I've been out of work for 6 months, so I talked to my union to see how I can extend that claim because they were saying they would only pay out the 1st 6 weeks of that, even though in my policy at the time it was um eligible for longer than that.
[CUSTOMER][NEUTRAL] And so since I've been out for 6 months, I complete, I sent in another doctor's note stating that I've been out for this long since my birth, and then um like a statement from myself that as well that was requested.
[CUSTOMER][NEUTRAL] Um, and then I was looking online and I can't view the file, but it, it was showing as a new claim number, so I'm not sure if you could help me, um, see if it's like still a continuing claim or the status of the new claim.
[AGENT][NEUTRAL] Well, anytime we process something, it's always gonna be a different claim number. We don't use the same claim number, um.
[CUSTOMER][NEUTRAL] Oh, OK, even if it was like continuing.
[AGENT][NEUTRAL] Correct, it's always, we can't, yeah, we can't process under the same claim number, um.
[CUSTOMER][NEUTRAL] For the same one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then can you tell me the status of um the second claim number? I can give it to you when you're ready.
[AGENT][NEUTRAL] What's that claim number?
[CUSTOMER][NEUTRAL] It's 354-957-3.
[AGENT][NEUTRAL] Yeah, that's the one I'm looking at. So we sent this out, we sent out this payment, um, on that claim number on [PII], so that would have been on Tuesday.
[CUSTOMER][NEUTRAL] OK, so it's probably just coming in the mail.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, can you tell me what the dates of that show, like, if it shows the 6 weeks or 8 weeks or what the payment was for?
[AGENT][NEUTRAL] So, it's a payment for, let me see, [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, it looks like it's for 6 weeks because it says August.
[AGENT][NEUTRAL] So [PII] through.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, um, thank you.
[AGENT][NEUTRAL] No promise with Cabana. Was there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Do you know is is that the end of that claim? like that's all that's going to be paid out for that or is it going to?
[CUSTOMER][NEUTRAL] Continue until [PII].
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Oh let me stop there.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, so when, um, so when we send the check out, we sent down the EOB and it explains everything. So, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Anyway, hold on.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] So it looks like originally your return to work day was supposed to been [PII], um, so they disabled you for 12 weeks. Um, so there is a waiting period when you first do it. Um, so when we received the new disability claim, um, December.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, we contacted your physician to understand the dates that he was having you out, and he confirmed he had, hadn't seen you in his office until [PII]. And so, based on his, his, um, based on that confirmation, no further benefits are due.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, if you sought medical treatment during the month of September.
[AGENT][NEUTRAL] Or let me see what this is, uh, hold on, it's taking a minute.
[AGENT][NEUTRAL] So if you saw somebody between September and October, you would have to have that position complete a disability claim form.
[AGENT][NEUTRAL] Or submit the medical records for further consideration for that other time frame. So that's the reason why we paid you for what we paid. But like I said, it's on the EUB that we sent out with the check on the [PII].
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So even though, like the doctor had me out for that long, since I didn't see them.
[AGENT][NEUTRAL] Correct. We, um, that's correct. So we verified, yes, so we verified what was on the application and so when we called to verify the doctor, he didn't see you during September, [PII], so we only paid you for the month that we.
[CUSTOMER][NEUTRAL] During that time. That's why it's not being paid out.
[CUSTOMER][NEUTRAL] Through September.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll look and see what the paperwork was that the doctor submitted because I hadn't seen that since they sent it directly to you.
[AGENT][POSITIVE] Yes, no problem, Ms. [PII]. Was there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Um, that's all. Do you happen to have an extension so if I look over stuff and I can give you a call back?
[AGENT][NEUTRAL] Uh, you would just call in and ask for this, uh, you know, cause you can't come like directly. Yes.
[CUSTOMER][POSITIVE] Anybody saying what I did this time. OK. OK, sounds good thank you very much.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] No problem. Well thanks for calling April. You have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Uh huh bye.