AccountId: 011433970860
ContactId: 385de97f-2833-40b5-bcbb-46cda9eb0b59
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 745849 ms
Total Talk Time (AGENT): 305944 ms
Total Talk Time (CUSTOMER): 285358 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/385de97f-2833-40b5-bcbb-46cda9eb0b59_20250217T15:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I have some questions about a um claim I'm getting ready to file and questions about the benefits too.
[AGENT][NEUTRAL] OK, and your name is?
[CUSTOMER][NEUTRAL] I'm [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], do you have the policy number?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm getting it, it's 02117201.
[AGENT][NEUTRAL] Uh yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Absolutely [PII].
[AGENT][NEUTRAL] OK, let me know how much I can tell you. I don't, um.
[CUSTOMER][NEUTRAL] I'm on there. They put a note because I go through this every time.
[AGENT][NEUTRAL] Oh, wait a minute.
[AGENT][NEUTRAL] I do see it.
[AGENT][NEUTRAL] Yeah, I see your authorization on file.
[CUSTOMER][NEUTRAL] So he's right here if you need to speak to him.
[AGENT][POSITIVE] No, we're good. Uh so we receive authorization, so you're good. Um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you say you're calling to verify benefits?
[CUSTOMER][NEUTRAL] Yes, and, and also to do a new claim, I just want some clarification.
[AGENT][NEUTRAL] OK, and let me see.
[AGENT][NEUTRAL] Well let's see.
[AGENT][NEUTRAL] OK, is he still on this bill or this is a new one?
[CUSTOMER][NEGATIVE] Well, he's never gone back to work and they told me that I have to do a new claim.
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][NEGATIVE] I need to know why he's still on disability. Does we have to start paying for the, because at first, you know, it was coming out of his check, but he's not working.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So that's one of my questions.
[AGENT][NEUTRAL] I think with that you may have to contact benefits in a card since, wait, no, not benefits and card, let me see. Oh no, um.
[CUSTOMER][NEUTRAL] OK, what's that number now will?
[AGENT][NEUTRAL] Um, let me check. This is not uh this is a different group. Give me one moment, Ms. [PII].
[AGENT][NEUTRAL] Um let's see.
[AGENT][NEUTRAL] See, I might have to transfer you to a representative, but give me one moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Before you do that, um, I have a question on.
[CUSTOMER][NEUTRAL] I'm doing a new claim.
[CUSTOMER][NEUTRAL] Before you transfer me please.
[AGENT][NEUTRAL] OK, yes, ma'am.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, I may have to transfer you to a representative with in the claims department and they'll be able to verify as far as um.
[AGENT][NEUTRAL] Since he's not uh working at how premium and then as far as a new claim or what information is needed.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You say your callback number [PII], Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me one moment I'm gonna transfer you to a representative, OK?
[CUSTOMER][NEUTRAL] OK, so what, what is this I'm calling because this is the normal number I normally call.
[AGENT][NEUTRAL] Well, this is APL, but um.
[CUSTOMER][NEUTRAL] Well I
[AGENT][NEUTRAL] But the examiner will be able to verify how to file a new claim, and as far as premium, I'm not sure. I might have to let them know and um hopefully they will have an answer for us, but hold one moment for me, OK?
[CUSTOMER][NEUTRAL] And what what number is that so I I know in the future.
[AGENT][NEUTRAL] Uh, there's not a specific extension for them. It's just, uh, call the [PII]. And usually our care team answers the phone and then if we need additional assistance, we can just transfer it to a representative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, I got the TT show back.
[CUSTOMER][NEUTRAL] Conferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. You're speaking with [PII]. How may I help you today?
[AGENT][NEUTRAL] Hey, [PII], it's [PII]. How are you?
[CUSTOMER][NEUTRAL] All right, [PII].
[AGENT][NEUTRAL] Um, I have an insurance wife on the phone, Ms. [PII], and she's wanting to verify how to, um,
[AGENT][NEUTRAL] Submit a new claim, but also
[AGENT][NEUTRAL] It
[AGENT][NEGATIVE] She is stating that he is no, he's still not working. [PII], I get that.
[CUSTOMER][NEUTRAL] Who is who is it on?
[CUSTOMER][NEUTRAL] What's that policy number?
[AGENT][NEUTRAL] 2117201.
[CUSTOMER][NEUTRAL] Let's see, uh, we paid him up to.
[CUSTOMER][NEUTRAL] Uh, 126 of 2025, they just need to fill out the doctor portion and his portion we still offer the same medical condition. He has not returned to work. We just need an updated physician claim form and an updated uh insured claim form. It's in and it's on the uh instructions tell them what they need to do. PI.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Physician and the employer?
[CUSTOMER][NEUTRAL] Uh-huh. The idea, no, we don't need the employer if he hasn't returned back to work and it's still the same medical condition. We just need an updated doctor claim form and an updated insured claim form because we paid him, we paid him up to what the doctor had on the claim form. His, his date of disability was [PII]. So if he's still and we paid him up to uh 6, based on what we had.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 26.
[CUSTOMER][NEUTRAL] Uh-huh, because let me see what he's out for before.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Last time he was out for something else and that was in [PII]. So yeah, and that was, you know, that, yeah, that was something else. So if he's out still for the same medical condition, tell them all they have to do is submit an updated doctor claim form and an updated insured claim form. We do not need to employ a claim form.
[AGENT][NEUTRAL] Oh, here's the thing, he, she is saying that he hadn't returned back to work.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So we still wouldn't need the employer's portion?
[CUSTOMER][NEUTRAL] If he hadn't returned back to work, we would need to employ a push. If he's still out for the same thing, did he return back to work or he didn't return back to work?
[AGENT][NEUTRAL] She said he didn't and she was inquiring about premium as well. I don't know if that's anything.
[CUSTOMER][NEUTRAL] It'll be taken out, it'll be taken out of his benefit. If premiums not paid, when it's time to pay him up to the time we can waive, premium will be deducted out of his benefit. After he's been off consecutive 90 days, then we start paying the premium. But until then, if premium is not paid, we would take premium out of his benefit. But as of right now, his premium is paid to 31 [PII]. Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK. OK. I didn't know how that works. Thank you, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, yeah, so make sure she knows that we need an updated doctor claim form and an updated insured claim for any benefits to be paid beyond 126 of 2025.
[AGENT][POSITIVE] 126 to 25. Awesome. Thank you, madam.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh, all right. Mm, bye-bye. You too. Bye.
[AGENT][POSITIVE] Have a good one. Bye.
[AGENT][NEUTRAL] Uh, Ms. [PII], thank you so much for holding. Um, I spoke with an examiner and um with this new disability, is it for the same condition that he was out on disability previously or is this a new one?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This is, it's the same one that that started in um December.
[AGENT][NEUTRAL] OK. Uh, she said that he would just need to fill out, uh, we would just need to update a physician's form and an updated um insurance form. So he would need to submit an updated form for himself and one from his physician.
[CUSTOMER][NEUTRAL] Updated form, what page updated form?
[AGENT][NEUTRAL] And she said,
[AGENT][NEUTRAL] Uh, let me look at the claim form. Give me one moment.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] But he had to uh go to another doctor, so the new doctor, I mean, his
[CUSTOMER][NEUTRAL] It's cause they had to send him to his primary doctor.
[AGENT][NEUTRAL] OK, um, his section would be from A.
[AGENT][NEUTRAL] Wait, what does it say on here? If it continuing, then it'd be from A through E and G through H, so page.
[CUSTOMER][NEUTRAL] I wouldn't have to do the.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Section B
[AGENT][NEUTRAL] Hm, no. Well, let me double check. I'll say that. Well, it says um A through E. So yeah, you will have to fill out uh D and E, but if it's a continuing, uh, then he would just after A through E then fill out G.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we would need the physicians, attendant physician's portion of the farm.
[AGENT][NEUTRAL] And that's pages 6 through 7.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can you look at the date, um, that I should put it says date last work which was in December. Do I put that date? Can you check for me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] one moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And what did she say? Do we start making the payments or?
[AGENT][NEUTRAL] Uh, don't start in December show in January, but as far as December, uh, um, as far as, uh, any premium, she said if there's any premium due, then it would just be taken out of the benefit.
[CUSTOMER][NEUTRAL] Oh, OK, that makes sense.
[AGENT][NEUTRAL] So he just needs to have that updated physician's form and his form and then it can be mailed, faxed or it looks like he is or if he is set up on the online service center, he can upload into the system.
[CUSTOMER][NEUTRAL] Well, the uh doctor always just fax it for him.
[AGENT][POSITIVE] Oh, that was great. If they can fax it, that's great. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so what date do I put in section C?
[AGENT][NEUTRAL] I can't give you that information on what date to put um.
[CUSTOMER][NEUTRAL] No, I'm saying the last one that he, he got paid for we put December. Do I put the same date? It says date last work was December, so which y'all know that he already got a check for the 1st 14 days already.
[AGENT][NEUTRAL] Well, they would check that, but I mean, if that's the date that he was unable to or his last day at work, then yes, you can put that date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, OK, thanks a lot.
[AGENT][POSITIVE] Yes, ma'am. And is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] OK, uh thank you for calling APL. Have a great day, Ms. [PII].
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.